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Stanford KA, Almirol E, Meyer M, McNulty MC. An automated best practice advisory increases both routine HIV screening and HIV cotesting with sexually transmitted infections in the emergency department. Am J Infect Control 2024; 52:770-773. [PMID: 38309531 PMCID: PMC11193631 DOI: 10.1016/j.ajic.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND There is increasing interest in improving routine HIV screening in emergency departments and increasing HIV cotesting rates among patients tested for sexually transmitted infections (STIs), who are considered at elevated risk of acquiring HIV. METHODS This is a retrospective review of all ED encounters at a large, urban emergency departments with an existing HIV screening program for seven months before (November 1, 2018, to May 30, 2019) and after (June 1 to December 31, 2019) the implementation of a best practice advisory prompting universal HIV and syphilis screening. RESULTS The study included 14,767 unique encounters, with 3,982 pre-implementation encounters and 10,785 post-implementation. After implementation, HIV testing increased 242%, from 2,851 tests to 9,757, and syphilis testing increased 326%, from 2,191 tests to 9,330. The proportion of encounters for urogenital STI testing without HIV cotesting decreased by 10.3%, from 43.6% to 33.3%. DISCUSSION An automated electronic medical record (EMR) prompt can have a huge impact on both HIV and syphilis testing rates, as well as the rate of missed opportunities for cotesting among patients undergoing STI testing. CONCLUSIONS Hospitals should support screening with automated alerts to help meet quality metrics, improve screening rates, and reduce missed opportunities for screening in vulnerable patients.
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Affiliation(s)
- Kimberly A Stanford
- Department of Medicine, Section of Emergency Medicine, University of Chicago, Chicago, IL.
| | - Ellen Almirol
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL
| | - Makenna Meyer
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL
| | - Moira C McNulty
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL
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Zucker J, Castor D, Theodore D, Carnevale C, Osilama E, Archer N, Bonadonna L, Wadden E, Morley N, Huang S, Meyers K, Cohall A, Gordon P, Sobieszczyk ME. Get2PrEP2-A Provider Messaging Strategy to Improve PrEP Uptake: A Randomized Controlled Quality Improvement Project. Open Forum Infect Dis 2024; 11:ofae297. [PMID: 38911948 PMCID: PMC11191360 DOI: 10.1093/ofid/ofae297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction HIV preexposure prophylaxis (PrEP), a key strategy for preventing HIV transmission, requires awareness and access to PrEP services. Although all patients should be made aware of HIV PrEP; the diagnosis of bacterial sexually transmitted infections (STIs) is an important indicator of potential HIV PrEP need. In a previous evaluation of Get2PrEP (G2P), we found that an electronic medical record laboratory comments did not increase the frequency of PrEP discussions between patients and providers. In Get2PrEP2 (G2P2), we hypothesized that active, personalized messaging to providers about HIV PrEP would increase the documentation of PrEP discussions, referrals, and/or provision of HIV PrEP to individuals diagnosed with an STI. Methods G2P2 was a parallel 3-arm, unblinded, randomized controlled design. Participants were allocated 2:1 to intervention or control. Participants in the intervention arm were further allocated to receive provider messaging through the electronic medical record chat message or e-mail. Results The 191 randomized encounters resulted in a modest 7.8% (odds ratio, 1.078; confidence interval, 1.02-1.13) increase in documented PrEP discussions in intervention encounters versus none in the standard care group. There was no statistical difference by intervention modality. All documented discussions occurred in the outpatient or emergency department and were more frequent in women and those aged <25 years. Discussion An e-mail or electronic medical record chat message sent to providers of patients testing positive for an STI had a small but significant effect on documented patient-provider PrEP discussions. Further investigation is required to determine whether provider messaging can increase PrEP uptake among eligible patients and longer-term outcomes.
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Affiliation(s)
- Jason Zucker
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- HIV Prevention Program in the Comprehensive Health Program, Ambulatory Care Network West, NewYork-Presbyterian Hospital, New York, New York, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Delivette Castor
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
| | - Deborah Theodore
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- HIV Prevention Program in the Comprehensive Health Program, Ambulatory Care Network West, NewYork-Presbyterian Hospital, New York, New York, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Caroline Carnevale
- HIV Prevention Program in the Comprehensive Health Program, Ambulatory Care Network West, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Eshiemomoh Osilama
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Norman Archer
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- UCSF School of Medicine, San Francisco, California, USA
| | - Lily Bonadonna
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Elena Wadden
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Nicholas Morley
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Simian Huang
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Kathrine Meyers
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Alwyn Cohall
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- HIV Prevention Program in the Comprehensive Health Program, Ambulatory Care Network West, NewYork-Presbyterian Hospital, New York, New York, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Peter Gordon
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- HIV Prevention Program in the Comprehensive Health Program, Ambulatory Care Network West, NewYork-Presbyterian Hospital, New York, New York, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Magdalena E Sobieszczyk
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- HIV Prevention Program in the Comprehensive Health Program, Ambulatory Care Network West, NewYork-Presbyterian Hospital, New York, New York, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Ford JS, Mousa MA, Voong S, Matsumoto CG, Chechi T, Tran N, May L. Risk factors for HIV infection at a large urban emergency department: a cross-sectional study. Sex Transm Infect 2023; 99:404-408. [PMID: 37015802 DOI: 10.1136/sextrans-2022-055513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES In 2019, the US Preventative Services Task Force released updated guidelines recommending HIV screening in all individuals aged 15-64 years and all pregnant females. In the current study, we aimed to identify risk factors for HIV infection in an emergency department (ED) population. METHODS We performed a cross-sectional study that employed a post hoc risk factor analysis of ED patients ≥18 years who were screened for HIV between 27 November 2018 and 26 November 2019, at a single urban, quaternary referral academic hospital. Patients were screened using HIV antigen/antibody testing and diagnoses were confirmed using HIV-1/HIV-2 antibody testing. The outcome of interest was the number of positive HIV tests. Multiple logistic regression models were used to identify risk factors associated with HIV positivity. RESULTS 14 335 adult patients were screened for HIV (mean age: 43±14 years; 52% female). HIV seroprevalence was 0.7%. Independent risk factors for HIV positivity included male sex (adjusted OR (aOR) 3.1 (95% CI 1.7 to 5.6)), unhoused status (aOR 2.9 (95% CI 1.7 to 4.9)), history of illicit drug use (aOR 1.8 (95% CI 1.04 to 3.13)) and Medicare insurance status (aOR 2.2 (95% CI 1.1 to 4.4)). CONCLUSIONS The study ED services a high-risk population with regard to HIV infection. These data support universal screening of ED patients for HIV. Risk factor profiles could improve targeted screening at institutions without universal HIV testing protocols.
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Affiliation(s)
- James S Ford
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mohammad A Mousa
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Stephanie Voong
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Cynthia G Matsumoto
- Department of Population Health and Accountable Care, University of California Davis Health, Sacramento, CA, USA
| | - Tasleem Chechi
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Nam Tran
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Larissa May
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
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