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Sweitzer S, Sharp J, Baker D, Lynch A, Stauch MA, Wheatley M, Lora M, Cantos VD, Gruen J. Opt-Out Syphilis Screening at an Urgent Care Center in Atlanta: Evaluation of a Pilot Program. Sex Transm Dis 2024; 51:516-520. [PMID: 38647243 DOI: 10.1097/olq.0000000000001980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) and syphilis disproportionately impact communities with low access to primary care, who often utilize urgent care centers (UCCs) for sexual health care. UCC visits represent an opportunity for identification and treatment of syphilis and linkage to HIV testing and prevention services. We describe a universal, opt-out syphilis screening program pilot at an Atlanta UCC. METHODS A chart review was performed on patients 18 years and older who were offered opt-out syphilis screening and had a rapid plasma reagin (RPR) test collected from September 1, 2021 to December 31, 2021. Demographic data, syphilis stage and treatment, and HIV testing and serostatus were abstracted from the electronic health record. Patients with reactive RPRs were contacted by a study physician for syphilis staging and treatment, counseling, and referral for HIV preexposure prophylaxis (PrEP) or treatment. RESULTS From September 1, 2021 to December 31, 2021, 5794 patients were triaged and 1381 underwent RPR screening (23.8%). Eighty (5.8%) had reactive RPRs, and 42 (52.5%) had active syphilis. Of those with active syphilis, 39 (92.9%) received any treatment, and 35 (83.3%) completed treatment. Patients with late syphilis were less likely to complete syphilis treatment (adjusted odds ratio, 0.03; P = 0.009; 95% confidence interval, 0.002-0.42). Among 955 offered PrEP, 41 (4.3%) expressed interest in PrEP, and 7 (0.7%) completed PrEP clinic intake. Univariate analysis did not identify any factors associated with interest in PrEP. CONCLUSIONS In a UCC setting, routine, opt-out syphilis testing resulted in increased syphilis identification and treatment. It also provided an opportunity for PrEP counseling and referral, although few patients completed PrEP clinic intake.
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Affiliation(s)
| | | | - Dylan Baker
- From the Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | | | | | | | - Meredith Lora
- From the Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Valeria D Cantos
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
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2
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White DAE, Solnick RE. Communicable Disease Screening and Human Immunodeficiency Virus Prevention in the Emergency Department. Emerg Med Clin North Am 2024; 42:369-389. [PMID: 38641395 DOI: 10.1016/j.emc.2024.02.007] [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] [Indexed: 04/21/2024]
Abstract
Emergency departments (ED) provide care to populations with high rates of communicable diseases, like HIV, hepatitis C virus, and syphilis. For many patients, the ED is their sole entry point into the healthcare system and they do not routinely access screening and prevention services elsewhere. As such, the ED can serve an important public health role through communicable disease identification, treatment, and prevention. In this article, we examine national recommendations, peer-reviewed literature, and expert consensus to provide cutting edge strategies for implementing communicable infectious disease screening and prevention programs into routine ED care.
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Affiliation(s)
- Douglas A E White
- Department of Emergency Medicine, Alameda Health System, Wilma Chan Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA.
| | - Rachel E Solnick
- Icahn School of Medicine at Mount Sinai Hospital, 555 West 57th Street 5-25, New York, NY 10019, USA
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3
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Scott K, Faryar KA, Patil N, Gripshover B, Hammond C, Purohit M, Schmotzer C, Suleman-Civis L, Niforatos J, Avery A, Yax J. Evaluation of an emergency department opt-out provider-driven HIV and syphilis screening and linkage-to-care program. Am J Emerg Med 2024; 77:187-193. [PMID: 38163414 DOI: 10.1016/j.ajem.2023.12.029] [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: 07/28/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE While the effectiveness of emergency departments (ED) in screening for HIV and syphilis is understood, less is known about dual screening programs. We aim to evaluate the impact of an opt-out provider-initiated HIV and syphilis program on screening, diagnosis, and linkage to care outcomes. METHODS We performed a retrospective review of patients screened pre (2014-2017) and post (2017-2021) program implementation. Primary outcomes include HIV and syphilis screening, incidence of positive tests, and proportion of patients linked to care. Secondary outcomes included pre-exposure prophylaxis (PrEP) referral and successful linkage rates for HIV-negative syphilis-positive patients. RESULTS Pre-implementation, 882 HIV tests were performed, of which 22 (2.49%) were new cases and 18 (81.82%) were linked to care; 754 syphilis tests were performed, of which 33 (4.38%) were active infections and 30 (90.91%) were treated. No eligible patients received PrEP referral. Post-implementation, 12,999 HIV tests were performed, of which 73 (0.56%) were new cases and 55 (75.34%) were linked to care; 10,885 syphilis tests were performed, of which 216 (1.98%) were active infections and 188 (87.04%) were treated. 25 (9.09%) eligible patients were referred for PrEP, and four (16.0%) attended their appointment. CONCLUSIONS Post-implementation, there was a 1373.81% and 1343.63% increase in screening, and a 231.82% and 554.55% increase in positive cases of HIV and syphilis, respectively. Dual screening programs can be successfully implemented within the existing ED framework to increase screening and early detection for HIV and syphilis.
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Affiliation(s)
- Kristal Scott
- Department of Emergency Medicine, University Hospitals, Cleveland, OH, USA.
| | - Kiran A Faryar
- Department of Emergency Medicine, University Hospitals, Cleveland, OH, USA
| | - Nirav Patil
- Clinical Research Center, University Hospitals, Cleveland, OH, USA
| | - Barbara Gripshover
- Department of Infectious Disease, University Hospitals, Cleveland, OH, USA
| | | | - Maulik Purohit
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christine Schmotzer
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Joshua Niforatos
- Department of Emergency Medicine, University Hospitals, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ann Avery
- MetroHealth Medical Center, Cleveland, OH, USA
| | - Justin Yax
- Department of Emergency Medicine, University Hospitals, Cleveland, OH, USA
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Sweitzer S, Sharp J, Gruen J. A Retrospective Chart Review of Patients With Reactive Rapid Plasma Reagin Tests in the Emergency Department of an Urban Safety Net Hospital. Sex Transm Dis 2023; 50:760-763. [PMID: 37643408 DOI: 10.1097/olq.0000000000001862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
ABSTRACT Emergency departments are a critical access point to care in safety net health systems. A retrospective chart review of patients with reactive rapid plasma reagins collected in the emergency department of an Atlanta safety net hospital from May 1, 2020, to October 31, 2020, found suboptimal rates of syphilis treatment completion and linkage to human immunodeficiency virus pre-exposure prophylaxis services.
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Affiliation(s)
| | - Joseph Sharp
- From the Department of Medicine, Emory University School of Medicine, Atlanta, GA
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5
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Reynolds L, Franco R, Prados M, Rodgers JB, Hand DT, Walter LA. Hepatitis C active viremia over time in an ED-based testing programme: Impact, disparities and surveillance tool. J Viral Hepat 2022; 29:1026-1034. [PMID: 36062383 DOI: 10.1111/jvh.13744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 12/09/2022]
Abstract
Hepatitis C virus (HCV) surveillance is a critical component of a comprehensive strategy to prevent and control HCV infection and HCV-related chronic liver disease. The emergency department (ED) has been increasingly recognized as a vital partner in HCV testing and linkage. We sought to consider active RNA HCV viremia over time in patients participating in an ED-based testing programme as a measure of local HCV surveillance and as a barometer of ED-testing programme impact. We performed a retrospective analysis of individuals participating in our ED-based HCV testing programme between 2015 and 2021. Chi-square tests were used to compare the demographic characteristics of HCV antibody positive tests with active viremia to those without active viremia. Cox proportional hazard models were used to estimate the trend in active viremia risk over time in the overall study population as well as in key subpopulations of interest. Of 5456 HCV antibody positive individuals, 3102 (56.8%) had active viremia. In the overall study population, we found that the risk of active viremia decreased by 4.8% per year during the study period (RR: 0.95, 95% CI: 0.93-0.97|p < .0001). Baby boomers experienced a 9% decrease in active viremia risk per year over the study period while non-baby boomers only had a 2% decrease in risk per year (p = .0009). Compared with insured patients, uninsured patients had a smaller decrease in risk of active HCV viremia per year (p = .003). No significant differences in the risk of active viremia over time were observed for gender (p = .4694) or by primary care provider status (p = .2208). In conclusion, this ED-based testing and linkage programme demonstrates significantly decreased active HCV viremia over time. It also highlights subpopulations, specifically non-baby boomers and uninsured patients, who may benefit from focused interventions to improve access to and adoption of definitive HCV care.
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Affiliation(s)
- Lindy Reynolds
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ricardo Franco
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Myles Prados
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joel B Rodgers
- Division of Acute Care Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Delissa T Hand
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lauren A Walter
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ford JS, Hollywood E, Steuble B, Meng Z, Voong S, Chechi T, Tran N, May L. Risk factors for hepatitis C virus infection at a large urban emergency department. J Viral Hepat 2022; 29:930-937. [PMID: 35789152 DOI: 10.1111/jvh.13730] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/23/2022] [Accepted: 06/17/2022] [Indexed: 12/09/2022]
Abstract
In 2020, Centers for Disease Control and Prevention (CDC) released guidelines recommending HCV screening in all adults 18 years and older. In the current study, we aimed to identify risk factors for HCV infection in an ED population. We performed a retrospective analysis of ED patients ≥ 18 years who were screened for HCV between 28 November 2018, and 27 November 2019, at a single urban, quaternary referral academic hospital. An HCV-antibody immunoassay (HCV-Ab) was used for screening; positive results were confirmed by measuring HCV ribonucleic acid (RNA). The outcome of interest was the number of new HCV diagnoses (presence of viremia by HCV RNA testing). Multiple logistic regression models were used to identify risk factors associated with a new HCV diagnosis. 16,722 adult patients were screened for HCV (mean age: 46 ± 15 years; 51% female). HCV seroprevalence was 5%. Independent risk factors for HCV included increasing age [10-year aOR 1.26 (95% CI 1.23, 1.30)], male sex [aOR 1.25 (95% CI 1.03, 1.51)], undomiciled housing status [aOR 2.8 (95% CI 2.3, 3.5)], history of tobacco use [aOR 3.0 (95% CI 2.3, 3.9)], history of illicit drug use [aOR 3.6 (95% CI 2.9, 4.5)], Medicaid insurance status [aOR 4.0 (95% CI 2.9, 5.5)] and Medicare insurance status [aOR 1.6 (95% CI 1.1, 2.2)].The ED services a high-risk population with regards to HCV infection. These data support universal screening of ED patients for HCV. Risk factor profiles could improve targeted screening at institutions without universal testing protocols.
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Affiliation(s)
- James S Ford
- Department of Emergency Medicine, University of California, San Francisco, California, USA
| | - Erika Hollywood
- A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona, USA
| | - Bradley Steuble
- Touro University of California, College of Osteopathic Medicine, Vallejo, California, USA
| | - Zichun Meng
- Department of Statistics, Graduate Group of Biostatistics, University of California Davis Health, Sacramento, California, USA
| | - Stephanie Voong
- Department of Emergency Medicine, University of California, Davis, California, USA
| | - Tasleem Chechi
- Department of Emergency Medicine, University of California, Davis, California, USA
| | - Nam Tran
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, California, USA
| | - Larissa May
- Department of Emergency Medicine, University of California, Davis, California, USA
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7
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Seballos SS, Lopez R, Hustey FM, Schold JD, Kadkhoda K, McShane AJ, Phelan MP. Cotesting for Human Immunodeficiency Virus and Sexually Transmitted Infections in the Emergency Department. Sex Transm Dis 2022; 49:546-550. [PMID: 35587394 DOI: 10.1097/olq.0000000000001642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) and US Preventive Services Task Force (USPSTF) guidelines recommend screening for human immunodeficiency virus (HIV) in patients aged 15 to 65 years, as well as those at increased risk. Patients screened in the emergency department (ED) for gonorrhea (GC) and/or chlamydia represent an increased-risk population. Our aim was to assess compliance with CDC and USPSTF guidelines for HIV testing in a national sample of EDs. METHODS We examined data from the 2010 to 2018 Nationwide Emergency Department Sample, which can be used to create national estimates of ED care to query tests for GC, chlamydia, HIV, and syphilis testing. Weighted proportions and 95% confidence intervals (CIs) were reported, and Rao-Scott χ 2 tests were used. RESULTS We identified 13,443,831 (weighted n = 3,094,214) high-risk encounters in which GC/chlamydia testing was performed. HIV screening was performed in 3.9% (95% CI, 3.4-4.3) of such visits, and syphilis testing was performed in 2.9% (95% CI, 2.7-3.2). Only 1.5% of patients with increased risk encounters received both HIV and syphilis cotesting. CONCLUSIONS Despite CDC and USPSTF recommendations for HIV and syphilis screening in patients undergoing STI evaluation, only a small proportion of patients are being tested. Further studies exploring the barriers to HIV screening in patients undergoing STI assessment in the ED may help inform future projects aimed at increasing guidance compliance.
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Affiliation(s)
- Spencer S Seballos
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
| | - Rocio Lopez
- Center for Populations Health Research and Quantitative Health Sciences
| | | | - Jesse D Schold
- Center for Populations Health Research and Quantitative Health Sciences
| | - Kamran Kadkhoda
- Immunopathology Laboratory, Robert Tomsich Pathology and Laboratory Medicine Institute
| | - Adam J McShane
- Automated Biochemistry Laboratory, Robert Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
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8
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Risk Factors for Syphilis at a Large Urban Emergency Department. Sex Transm Dis 2022; 49:e111. [PMID: 35921637 DOI: 10.1097/olq.0000000000001684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ford JS, Chechi T, Otmar M, Baker M, Waldman S, Morgan B, Tan D, Tran NK, May L. ED syphilis and gonorrhea/chlamydia cotesting practices before and after the implementation of an electronic health record-based alert. Emerg Med J 2021; 39:emermed-2020-210331. [PMID: 34548414 DOI: 10.1136/emermed-2020-210331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/08/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The prevalence of syphilis is increasing in many countries, including the USA. The ED is often used by underserved populations, making it an important setting to test and treat patients who are not evaluated in outpatient clinical settings. We aimed to assess the utility of an ED-based syphilis and gonorrhoea/chlamydia cotesting protocol by comparing testing practices before and after its implementation. METHODS We implemented an electronic health record (EHR) alert that prompted clinicians to order syphilis testing in patients undergoing gonorrhoea/chlamydia testing. We performed a retrospective cohort analysis that compared outcomes between the preimplementation period (January-November 2018) and the postimplementation period (January-November 2019). Patients were tested for Treponema pallidum antibody (TPA) using a multiplex flow immunoassay (MFI), and positive results were confirmed by rapid plasma reagin (RPR). The primary implementation outcome was the number of syphilis tests/month, and the primary clinical outcome was the number of syphilis diagnoses/month (defined as positive TPA MFI and RPR). We performed an interrupted time-series analysis to evaluate the effect of implementing the alert over time. RESULTS Four-hundred and ninety-four and 1106 unique patients were tested for syphilis in the preimplementation and postimplementation periods, respectively. Syphilis testing increased by 55.6 tests/month (95% CI 45.9 to 65.3, p<0.001) following alert implementation. Patients tested in the postimplementation period who were tested using the alert were much younger (difference: 14 years (95% CI 12 to 15)) and were more likely to be female (difference: 15% (95% CI 8 to 21)) and African-American (difference: 11% (95% CI 5 to 17)) than patients tested by clinician-initiated testing. Presumptive syphilis diagnoses increased from 3.4 diagnoses/month to 7.9 diagnoses/month (difference, 4.5 (95% CI 2.2 to 6.9), p<0.001). CONCLUSIONS Our study demonstrates that use of a targeted EHR alert testing protocol can increase syphilis testing and diagnosis and may reduce clinician bias in testing.
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Affiliation(s)
- James S Ford
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
| | - Tasleem Chechi
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
| | - Michella Otmar
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
| | - Melissa Baker
- Georgetown University School of Medicine, Washington, DC, USA
| | - Sarah Waldman
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
| | - Brittany Morgan
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
| | - David Tan
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
| | - Nam K Tran
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, California, USA
| | - Larissa May
- Department of Emergency Medicine, University of California Davis Health, Sacramento, California, USA
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10
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Ford JS, Chechi T, Toosi K, Mahmood B, Meehleis D, Otmar M, Tran N, May L. Universal Screening for Hepatitis C Virus in the ED Using a Best Practice Advisory. West J Emerg Med 2021; 22:719-725. [PMID: 34125052 PMCID: PMC8203013 DOI: 10.5811/westjem.2021.1.49667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/23/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction In 2019 the United States Preventive Services Task Force (USPSTF) released draft guidelines recommending universal hepatitis C virus (HCV) screening for individuals aged 18–79. We aimed to assess the efficacy of an emergency department-based HCV screening program, by comparing screening practices before and after its implementation. Methods We performed a retrospective cohort analysis of two temporally matched, 11-month study periods, corresponding to before and after the implementation of a best practice advisory (BPA). Patients were screened for anti-HCV antibody (Ab), and positive results were followed by HCV viral load (VL) testing. The primary implementation outcome was ED testing volume (number of tests performed/month). The primary screening outcomes were the seroprevalence of anti-HCV Ab and HCV VL. We describe data with simple descriptive statistics. Results The median age of patients was similar between periods (pre: 50 years [interquartile range [IQR] 34–62], post: 47 years [IQR 33–59]). Patients screened were more likely to be males in the pre-BPA period (Male, pre: 60%, post: 49%). During the pre-BPA study period, a total of 69,604 patients were seen in the ED, and 218 unique patients were screened for HCV (mean 19.8 tests/month). During the post-BPA study period, a total of 68,225 patients were seen in the ED, and 14,981 unique patients were screened for HCV (mean 1361.9 tests/month). Anti-HCV Ab seroprevalence was 23% (51/218) and 9% (1340/14,981) in the pre-BPA and post-BPA periods, respectively. In the pre-BPA period, six patients with a positive anti-HCV Ab level had follow-up VL testing (detectable in three). In the post-BPA period, reflex VL testing was performed in most patients (91%, 1225/1,340), and there were 563 patients with detectable VLs, indicating active infection. Conclusion Our study shows that using a universal BPA-driven screening protocol can dramatically increase the number of patients screened for HCV and increase the number of new HCV diagnoses.
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Affiliation(s)
- James S Ford
- UC Davis Health, Department of Emergency Medicine, Sacramento, California
| | - Tasleem Chechi
- UC Davis Health, Department of Emergency Medicine, Sacramento, California
| | - Kavian Toosi
- UC Davis Health, Department of Emergency Medicine, Sacramento, California
| | - Bilawal Mahmood
- UC Davis Health, Department of Emergency Medicine, Sacramento, California
| | - Dillon Meehleis
- UC Davis Health, Department of Emergency Medicine, Sacramento, California
| | - Michella Otmar
- UC Davis Health, Department of Emergency Medicine, Sacramento, California
| | - Nam Tran
- UC Davis Health, Department of Pathology and Laboratory Medicine, Sacramento, California
| | - Larissa May
- UC Davis Health, Department of Emergency Medicine, Sacramento, California
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Yax JA, Niforatos JD, Summers DL, Bigach MH, Schmotzer C, Gripshover BM, Avery A. A Model for Syphilis Screening in the Emergency Department. Public Health Rep 2020; 136:136-142. [PMID: 33166486 DOI: 10.1177/0033354920967302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The incidence of syphilis infections is on the rise, particularly among African American men and men who have sex with men, and it is reaching epidemic levels in these communities throughout the United States. Although syphilis is relatively inexpensive to treat and cure and is a predictor for HIV incidence among men and transgender women who have sex with men, rates of co-screening for syphilis are low in the emergency department setting, with a dearth of literature on this topic since the 1990s and early 2000s. In this case study, we describe an operational model for routine syphilis screening implemented in June 2017 at the University Hospitals Cleveland Medical Center in Cleveland, Ohio. We describe the advantages of screening using a reverse testing algorithm rather than the traditional method and the necessity of partnering with the Cleveland Department of Public Health for both diagnostic and follow-up logistics.
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Affiliation(s)
- Justin A Yax
- 24575 Division of Population Health, Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western University School of Medicine, Cleveland, OH, USA
| | - Joshua D Niforatos
- 24575 Division of Population Health, Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,161821 Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel L Summers
- 24575 Division of Population Health, Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Margaret H Bigach
- 24575 Division of Population Health, Department of Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christine Schmotzer
- Case Western University School of Medicine, Cleveland, OH, USA.,24575 Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Barbara M Gripshover
- Case Western University School of Medicine, Cleveland, OH, USA.,365856 John T. Carey Special Immunology Unit, Department of Medicine, Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ann Avery
- Case Western University School of Medicine, Cleveland, OH, USA.,2559 Division of Infectious Diseases, MetroHealth Medical Center, Cleveland Medical Center, Cleveland, OH, USA
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