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Stanford KA, Mason J, Friedman E, Hazra A, Augustine E, Schneider J. An Opt-Out Emergency Department Screening Intervention Leads to Major Increases in Diagnosis of Syphilis. Open Forum Infect Dis 2024; 11:ofae490. [PMID: 39282633 PMCID: PMC11393470 DOI: 10.1093/ofid/ofae490] [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: 06/11/2024] [Accepted: 08/22/2024] [Indexed: 09/19/2024] Open
Abstract
Background With rising rates of syphilis in the United States, novel strategies are needed to improve early diagnosis, particularly among priority populations such as pregnant people. As the primary source of healthcare for many communities with limited access to care, the emergency department (ED) visit represents a crucial opportunity for syphilis detection and congenital syphilis prevention. Methods This pre-post design study examined all ED encounters for 2-year periods before and after implementation of an opt-out ED syphilis screening intervention in May 2019 at a large, urban, academic ED. Data on laboratory testing, syphilis status, and demographics were extracted from the medical record. Descriptive statistics and logistic regression were used to examine trends in syphilis screening and diagnosis. Results Syphilis screening increased from 5209 (3.6%) to 37 289 (24.4%) encounters. Presumed active syphilis infection (PAI) increased 288%, from 161 patients (3.1% of those screened) to 624 (1.7%). The proportion of female PAI increased from 25.6% to 42.5%, despite no change in proportion of females screened. Post-intervention, 23.6% of PAI were tested for a urogenital sexually transmitted infection (STI) in the ED and 9.0% presented with symptoms of an STI by diagnosis code. Among pregnant people, screening increased from 5.9% to 49.9% of encounters, and syphilis diagnosis increased 750%, from 2 cases to 15. Conclusions Opt-out ED syphilis screening led to a dramatic increase in screening and diagnosis, especially among pregnant individuals, a priority population for congenital syphilis prevention. Most individuals with syphilis did not have STI symptoms. Opt-out screening will be an important strategy in the effort to address the syphilis epidemic.
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Affiliation(s)
- Kimberly A Stanford
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois, USA
| | - Joseph Mason
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
| | - Eleanor Friedman
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
| | - Erin Augustine
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
| | - John Schneider
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
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Symum H, Van Handel M, Sandul A, Hutchinson A, Tsang CA, Pearson WS, Delaney KP, Cooley LA, Gift TL, Hoover KW, Thompson WW. Testing trends and co-testing patterns for HIV, hepatitis C and sexually transmitted infections (STIs) in Emergency departments. Prev Med Rep 2024; 44:102777. [PMID: 39099772 PMCID: PMC11295952 DOI: 10.1016/j.pmedr.2024.102777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/19/2024] [Accepted: 05/28/2024] [Indexed: 08/06/2024] Open
Abstract
Background Many underserved populations use Emergency Department (EDs) as primary sources of care, representing an important opportunity to provide infectious disease testing and linkage to care. We explored national ED testing trends and co-testing patterns for HIV, hepatitis C, and sexually transmitted infections (STIs). Methods We used 2010-2019 Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample data to estimate ED visit testing rates for HIV, hepatitis C, chlamydia, gonorrhea, and syphilis infections, identified by Current Procedural Terminology codes. Trends and co-testing (visit with tests for > 1 infection) patterns were analyzed by sociodemographic, hospital, and visit characteristics. Trends were evaluated as the average annual percentage change (AAPC) using the Joinpoint Regression. Results During 2010-2019, testing events per 1000 visits (AAPCs) increased for HIV from 1.3 to 4.2 (16.3 %), hepatitis C from 0.4 to 2.2 (25.1 %), chlamydia from 9.1 to 16.0 (6.6 %), gonorrhea from 8.4 to 15.7 (7.4 %), and syphilis from 0.7 to 2.0 (12.9 %). Rate increases varied by several characteristics across infections. The largest AAPC increases were among visits by groups with lower base rate testing in 2010, including persons aged ≥ 65 years (HIV: 36.4 %), with Medicaid (HIV: 43.8 %), in the lowest income quintile (hepatitis C: 36.9 %), living in the West (syphilis: 49.4 %) and with non-emergency diagnoses (hepatitis C: 44.1 %). Co-testing increased significantly for all infections except hepatitis C. Conclusions HIV, hepatitis C, and STI testing increased in EDs during 2010-2019; however, co-testing patterns were inconsistent. Co-testing may improve diagnosis and linkage to care, especially in areas experiencing higher rates of infection.
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Affiliation(s)
- Hasan Symum
- Program and Performance Improvement Office, Office of the Director, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), United States
| | - Michelle Van Handel
- Program and Performance Improvement Office, Office of the Director, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), United States
| | - Amy Sandul
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), United States
| | - Angela Hutchinson
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), United States
| | - Clarisse A. Tsang
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), United States
| | - William S. Pearson
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), United States
| | - Kevin P. Delaney
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), United States
| | - Laura A. Cooley
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), United States
| | - Thomas L. Gift
- Division of STD Prevention, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), United States
| | - Karen W. Hoover
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), United States
| | - William W. Thompson
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD, and Tuberculosis Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), United States
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Abu YF, Huang B, Thomas E, Lang DM, Ferreira T, Estes K, Bahamon M, Pagan P, Villamizar K, Scheppke KA, Battles M, Jayaweera D. Decreasing HIV Transmission and Improving Linkage to Care with Opt-out Screening for Adults in the UHealth Tower Emergency Department in Miami, Florida. AIDS Patient Care STDS 2024; 38:344-347. [PMID: 39158978 DOI: 10.1089/apc.2024.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Affiliation(s)
- Yaa F Abu
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - Barbara Huang
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - Emmanuel Thomas
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - David M Lang
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - Tanira Ferreira
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - Kimar Estes
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - Monica Bahamon
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - Paula Pagan
- Department of Medicine, University of Miami, Miami, Florida, USA
| | - Kira Villamizar
- Department of Health, Miami-Dade County, Miami, Florida, USA
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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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Miró Ò, Miró E, González Del Castillo J, Carbó M, Rebollo A, de Paz R, Guardiola JM, Smithson A, Iturriza D, Ramió Lluch C, Leey C, Ferro JI, Saura M, Llaneras J, Ros N, Robert N, Picart Puertas E, Sotomayor M, Rodríguez Masià F, Salazar P, Domínguez-Fandos D, Buxo S, Oliazola C, Villamor A, Gené E. Analysis of the reasons for requesting HIV serology in the emergency department other than those defined in the targeted screening strategy of the "Urgències VIHgila" program and its potential inclusion in a future consensus document. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024:S2529-993X(24)00063-7. [PMID: 38519281 DOI: 10.1016/j.eimce.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/29/2023] [Indexed: 03/24/2024]
Abstract
OBJECTIVE To describe other reasons for requesting HIV serology in emergency departments (ED) other than the 6 defined in the SEMES-GESIDA consensus document (DC-SEMES-GESIDA) and to analyze whether it would be efficient to include any of them in the future. METHODS Review of all HIV serologies performed during 2 years in 20 Catalan EDs. Serologies requested for reasons not defined by the DC-SEMES-GESIDA were grouped by common conditions, the prevalence (IC95%) of seropositivity for each condition was calculated, and those whose 95% confidence lower limit was >0.1% were considered efficient. Sensitivity analysis considered that serology would have been performed on 20% of cases attended and the remaining 80% would have been seronegative. RESULTS There were 8044 serologies performed for 248 conditions not recommended by DC-SEMES-GESIDA, in 17 there were seropositive, and in 12 the performance of HIV serology would be efficient. The highest prevalence of detection corresponded to patients from endemic countries (7.41%, 0.91-24.3), lymphopenia (4.76%, 0.12-23.8), plateletopenia (4.37%, 1.20-10.9), adenopathy (3.45%, 0.42-11.9), meningoencephalitis (3.12%, 0.38-10.8) and drug use (2.50%, 0.68-6.28). Sensitivity analysis confirmed efficiency in 6 of them: endemic country origin, plateletopenia, drug abuse, toxic syndrome, behavioral-confusional disorder-agitation and fever of unknown origin. CONCLUSION The DC-SEMES-GESIDA targeted HIV screening strategy in the ED could efficiently include other circumstances not previously considered; the most cost-effective would be origin from an endemic country, plateletopenia, drug abuse, toxic syndrome, behavioral-confusional-agitation disorder and fever of unknown origin.
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Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
| | - Emília Miró
- Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, Spain; Societat Catalana de Medicina d'Urgències i Emergències (SoCMUE), Acadèmia de Ciències Mèdiques i de la Salut de Catalunya i de Balears, Barcelona, Spain; Hospital Universitari Vall d'Hebron, Facultat d'Infermeria de la Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Míriam Carbó
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Alexis Rebollo
- Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Rocío de Paz
- Servicio de Urgencias, Hospital del Mar, Barcelona, Spain
| | | | - Alejandro Smithson
- Servicio de Urgencias, Hospital Esperit Sant, Santa Coloma de Gramenet, Barcelona, Spain
| | - Daniel Iturriza
- Servicio de Urgencias, Hospital de Sant Pau i Santa Tecla, Tarragona, Spain
| | | | - Connie Leey
- Servicio de Urgencias, Althaia Xarxa Assitencial Universitària de Manresa, Institut de Recerca i Innovació CIències de la Vida i de la Salut a Catalunya Central, Manresa, Barcelona, Spain
| | | | - Mireia Saura
- Servicio de Urgencias, Hospital Arnau de Vilanova, Lérida, Spain
| | - Jordi Llaneras
- Servicio de Urgencias, Hospital Unversitari Vall d'Hebron, Barcelona, Spain
| | - Núria Ros
- Servicio de Urgencias, Hospital Creu Roja Dos de Maig, Barcelona, Spain
| | - Neus Robert
- Servicio de Urgencias, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Margarita Sotomayor
- Servicio de Urgencias, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, Spain
| | | | - Paul Salazar
- Servicio de Urgencias, Hospital Joan XXIII, Tarragona, Spain
| | | | - Silvia Buxo
- Servicio de Urgencias, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - Cristina Oliazola
- Servicio de Urgencias, Consorci Sanitari del Maresme, Mataró, Barcelona, Spain
| | - Alberto Villamor
- Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, Spain; Societat Catalana de Medicina d'Urgències i Emergències (SoCMUE), Acadèmia de Ciències Mèdiques i de la Salut de Catalunya i de Balears, Barcelona, Spain; Enfermería, Hospital Clínic, IDIBAPS, Facultat d'Infermeria, Universitat de Barcelona, Barcelona, Spain
| | - Emili Gené
- Societat Catalana de Medicina d'Urgències i Emergències (SoCMUE), Acadèmia de Ciències Mèdiques i de la Salut de Catalunya i de Balears, Barcelona, Spain; Servicio de Urgencias, Hospital Parc Taulí, Sabadell, Barcelona, Spain
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Ahadinezhad B, Maleki A, Akhondi A, Kazemi M, Yousefy S, Rezaei F, Khosravizadeh O. Are behavioral economics interventions effective in increasing colorectal cancer screening uptake: A systematic review of evidence and meta-analysis? PLoS One 2024; 19:e0290424. [PMID: 38315699 PMCID: PMC10843112 DOI: 10.1371/journal.pone.0290424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/08/2023] [Indexed: 02/07/2024] Open
Abstract
Various interventions have been investigated to improve the uptake of colorectal cancer screening. In this paper, the authors have attempted to provide a pooled estimate of the effect size of the BE interventions running a systematic review based meta-analysis. In this study, all the published literatures between 2000 and 2022 have been reviewed. Searches were performed in PubMed, Scopus and Cochrane databases. The main outcome was the demanding the one of the colorectal cancer screening tests. The quality assessment was done by two people so that each person evaluated the studies separately and independently based on the individual participant data the modified Jadad scale. Pooled effect size (odds ratio) was estimated using random effects model at 95% confidence interval. Galbraith, Forrest and Funnel plots were used in data analysis. Publication bias was also investigated through Egger's test. All the analysis was done in STATA 15. From the initial 1966 records, 38 were included in the final analysis in which 72612 cases and 71493 controls have been studied. About 72% have been conducted in the USA. The heterogeneity of the studies was high based on the variation in OR (I2 = 94.6%, heterogeneity X2 = 670.01 (d.f. = 36), p < 0.01). The random effect pooled odds ratio (POR) of behavioral economics (BE) interventions was calculated as 1.26 (95% CI: 1.26 to 1.43). The bias coefficient is noteworthy (3.15) and statistically significant (p< 0.01). According to the results of this meta-analysis, health policy and decision makers can improve the efficiency and cost effectiveness of policies to control this type of cancer by using various behavioral economics interventions. It's noteworthy that due to the impossibility of categorizing behavioral economics interventions; we could not perform by group analysis.
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Affiliation(s)
- Bahman Ahadinezhad
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Aisa Maleki
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Amirali Akhondi
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Sama Yousefy
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fatemeh Rezaei
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Omid Khosravizadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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González Del Castillo J, Mirò E, Miguens I, Trenc P, Espinosa B, Piedrafita L, Pérez Elías MJ, Moreno S, García F, Villamor A, Carbó M, Gené E, Mirò Ò. Feasibility of a selective targeted strategy of HIV testing in emergency departments: a before-after study. Eur J Emerg Med 2024; 31:29-38. [PMID: 37729041 DOI: 10.1097/mej.0000000000001078] [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: 09/22/2023]
Abstract
BACKGROUND AND IMPORTANCE The rates of hidden infection and late diagnosis of HIV still remain high in Western countries. Missed diagnostic opportunities represent the key point in changing the course of the epidemic. OBJECTIVE To evaluate the feasibility and results of implementation of a selective strategy to test for HIV in the emergency department (ED) in patients with six pre-defined medical situations: sexually transmitted infections, herpes zoster, community-acquired pneumonia, mononucleosis syndrome, practice of chemsex (CS) or request of post-exposure prophylaxis. DESIGN This quasi-experimental longitudinal study evaluated the pre- and post-implementation results of HIV testing in the six aforementioned clinical scenarios. SETTINGS AND PARTICIPANTS Patients attended 34 Spanish EDs. INTERVENTION OR EXPOSURE The intervention was an intensive educational program and pathways to facilitate and track orders and results were designed. We collected and compared pre- and post-implementation ED census and diagnoses, and HIV tests requested and results. OUTCOME MEASURES AND ANALYSIS The main outcome was adherence to the recommendations. Secondary outcomes were to evaluate the effectiveness of the program by the rate of positive test and the new HIV diagnoses. Differences between first and second periods were assessed. The magnitude of changes (absolute and relative) was expressed with the 95% confidence interval (CI). MAIN RESULTS HIV tests increasing from 7080 (0.42% of ED visits) to 13 436 (relative increase of 75%, 95% CI from 70 to 80%). The six conditions were diagnosed in 15 879 and 16 618 patients, and HIV testing was ordered in 3393 (21%) and 7002 (42%) patients (increase: 97%; 95% CI: 90-104%). HIV testing significantly increased for all conditions except for CS. The positive HIV test rates increased from 0.92 to 1.67%. Detection of persons with undiagnosed HIV increased from 65 to 224, which implied a 220% (95% CI: 143-322%) increase of HIV diagnosis among all ED comers and a 71% (95% CI: 30-125%) increase of positive HIV tests. CONCLUSION Implementation of a strategy to test for HIV in selective clinical situations in the ED is feasible and may lead to a substantial increase in HIV testing and diagnoses.
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Affiliation(s)
- Juan González Del Castillo
- Emergency Department, Instituto de Investigación Sanitaria (IdISSC), Hospital Clínico San Carlos, Madrid
| | | | - Iria Miguens
- Emergency Department, Hospital Universitario Gregorio Marañon, Madrid
| | - Patricia Trenc
- Emergency Department, Hospital Universitario Miguel Servet, Zaragoza
| | - Begoña Espinosa
- Emergency Department, Hospital General Universitario de Alicante Dr. Blamis. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante
| | | | - María Jesús Pérez Elías
- Servicio de Enfermedades Infecciosas. Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERINFECC, Madrid
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas. Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERINFECC, Madrid
| | - Federico García
- Servicio de Microbiología Clínica. Hospital Universitario Clínico San Cecilio, Granada
| | | | - Míriam Carbó
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona
| | - Emili Gené
- Servicio de Urgencias, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Òscar Mirò
- Emergency Department, Hospital Clínic, IDIBAPS, Universitat de Barcelona
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8
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Ibitoye M, Bennett AS, Jarlais DCD, Bugaighis M, Chernick LS, Aronson ID. "I Didn't Know What They're Gonna Do to Me: So That's Why I Said No": Why Youth Decline HIV Testing in Emergency Departments. Behav Med 2024; 50:47-54. [PMID: 35904104 PMCID: PMC9884312 DOI: 10.1080/08964289.2022.2100864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/06/2022] [Indexed: 01/31/2023]
Abstract
Youth between the ages of 13 and 24 account for over 20% of new HIV diagnoses in the United States but are the least likely age group to be HIV tested in healthcare settings including the emergency department. This is in part due to the fact that almost 50% of youth decline testing when offered. We elucidated youth patients' perspectives on barriers to and facilitators of routine HIV testing of youth in an urban emergency department setting. Thirty-seven patients aged 13-24 years were recruited from the pediatric and adult emergency departments at a high-volume hospital in New York City from August 2019 to March 2020. Semi-structured in-depth interviews were conducted with all participants. Interviews were audio-recorded and transcribed verbatim, and transcripts were coded using an inductive thematic analysis approach. Youths' main reasons for declining HIV testing when offered included low risk perception, privacy concerns, HIV-related stigma, and low levels of HIV-related knowledge. Participants' responses suggested that HIV educational materials provided when testing is offered may be insufficient. Participants recommended providing additional HIV education and better incorporating HIV testing into the emergency department routine to increase testing among youth. Efforts are needed to help youth recognize their own HIV risk and increase their HIV-related knowledge. This may be accomplished by providing youth with additional educational materials on HIV, possibly via tablet-based interventions or other methods that may enhance privacy, combined with discussions with healthcare providers. Such efforts may help increase HIV testing acceptance among youth seen in the emergency department.
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Affiliation(s)
- Mobolaji Ibitoye
- Digital Health Empowerment, Brooklyn, NY, USA
- Institute for Population Research, The Ohio State University, Columbus, OH, USA
| | - Alex S. Bennett
- Digital Health Empowerment, Brooklyn, NY, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Don C. Des Jarlais
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | - Mona Bugaighis
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Lauren S. Chernick
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ian D. Aronson
- Digital Health Empowerment, Brooklyn, NY, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
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9
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Gutman CK, Newton N, Duda E, Alevy R, Palmer K, Wetzel M, Figueroa J, Griffiths M, Koyama A, Middlebrooks L, Camacho-Gonzalez A, Morris CR. Comparison of Targeted and Routine Adolescent HIV Screening in a Pediatric Emergency Department. Pediatr Emerg Care 2022; 38:e1613-e1619. [PMID: 35686965 DOI: 10.1097/pec.0000000000002772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were (1) to compare targeted and routine HIV screening in a pediatric emergency department (PED) and (2) to compare provider documented HIV risk assessment with adolescent perception of HIV risk assessment conducted during the PED visit. METHODS This prospective study ran concurrent to a PED routine HIV screening pilot. Adolescents could be tested for HIV by the PED provider per usual care (targeted testing); if not tested, they were approached for the routine screening pilot. A subset of adolescents completed a questionnaire on HIV risk. χ 2 analysis compared adolescents with targeted testing and routine screening. HIV-tested patients were asked if HIV risk was assessed; κ analysis compared this with documentation in the provider note. RESULTS Over 4 months, 107 adolescents received targeted testing and 344 received routine screening. One 14-year-old patient tested positive by routine screening; this adolescent had 2 PED visits without targeted testing within 60 days. Compared with routine screening, adolescents with targeted testing were more likely female (82% vs 57%, P < 0.001), 16 years or older (71% vs 44%, P < 0.001), or had genitourinary/gynecologic concerns (48% vs 6%, P < 0.001). Adolescents with HIV risk factors were missed by targeted testing but received routine screening. Adolescents with documented HIV risk assessment were more likely to receive targeted testing. There was moderate agreement (κ = 0.61) between provider documentation and adolescent perception of HIV risk assessment. CONCLUSIONS There are gaps in PED HIV risk assessment and testing, which may miss opportunities to diagnose adolescent HIV. Routine HIV screening addresses these gaps and expands adolescent HIV testing in the PED.
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Affiliation(s)
| | | | | | | | | | - Martha Wetzel
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Janet Figueroa
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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10
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HIV Testing Uptake According to Opt-In, Opt-Out or Risk-Based Testing Approaches: a Systematic Review and Meta-Analysis. Curr HIV/AIDS Rep 2022; 19:375-383. [PMID: 35829949 PMCID: PMC9508204 DOI: 10.1007/s11904-022-00614-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 11/18/2022]
Abstract
Purpose of Review Improving HIV testing uptake is essential to ending the HIV pandemic. HIV testing approaches can be opt-in, opt-out or risk-based. This systematic review examines and compares the uptake of HIV testing in opt-in, opt-out and risk-based testing approaches. Recent Findings There remain missed opportunities for HIV testing in a variety of settings using different approaches: opt-in (a person actively accepts to be tested for HIV), opt-out (a person is informed that HIV testing is routine/standard of care, and they actively decline if they do not wish to be tested for HIV) or risk-based (using risk-based screening tools to focus testing on certain individuals or sub-populations at greater risk of HIV). It is not clear how the approach could impact HIV test uptake when adjusted for other factors (e.g. rapid testing, country-income level, test setting and population tested). Summary We searched four databases for studies reporting on HIV test uptake. In total, 18,238 records were screened, and 150 studies were included in the review. Most studies described an opt-in approach (87 estimates), followed by opt-out (76) and risk-based (19). Opt-out testing was associated with 64.3% test uptake (I2 = 99.9%), opt-in testing with 59.8% (I2 = 99.9%) and risk-based testing with 54.4% (I2 = 99.9%). When adjusted for settings that offered rapid testing, country income level, setting and population tested, opt-out testing had a significantly higher uptake (+ 12% (95% confidence intervals: 3–21), p = 0.007) than opt-in testing. We also found that emergency department patients and hospital outpatients had significantly lower HIV test uptake than other populations. Supplementary Information The online version contains supplementary material available at 10.1007/s11904-022-00614-0.
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11
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Salmerón-Béliz OJ, Pérez-Fernández E, Miró O, Salido-Mota M, Diez-Diez V, Gil-Mosquera M, Robert-Boter N, Arranz-Betegón M, Navarro-Bustos C, Guardiola-Tey JM, González-Del-Castillo J. Evaluation of emergency department visits prior to an HIV diagnosis: Missed opportunities. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022:S2529-993X(22)00128-9. [PMID: 35659772 DOI: 10.1016/j.eimce.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/09/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE There is a high rate of occult infection and late diagnosis in HIV. Hospital emergency departments (ED) are an important point of health care. The present work aims to know the number of missed opportunities for HIV diagnosis occurring in the ED. METHOD Retrospective multicenter cohort study that included all patients diagnosed with HIV infection in 2019 in 27 Spanish hospitals in 7 different autonomous communities. All ED consultation episodes in the 5 years prior to diagnosis were reviewed to find out the reason for consultation and whether this represented a missed opportunity for HIV diagnosis. RESULT Seven hundred twenty-three patients were included, and 352 (48.7%, 95%CI: 45.1%-52.3%) had at least one ED visit during the 5 years prior to diagnosis (median 2, p25-p75: 1-4). One hundred and eighteen patients (16.3%, 95%CI: 13.8%-19.2%) had a missed diagnostic opportunity. The main consultations were drug use [145 (15%)], sexually transmitted infections [91 (9.4%)] and request for post-exposure HIV prophylaxis [39 (4%)]. One hundred and fifty-five (42.9%) of the 352 had less than 350 CD4/mm3 when the HIV diagnosis was established. In patients with previous ED visits, the mean time to diagnosis from this visit was 580 (SD 647) days. CONCLUSIONS Sixteen percent of patients diagnosed with HIV missed the opportunity to be diagnosed in the 5 years prior to diagnosis, highlighting the need to implement ED screening measures different from current ones to improve these outcomes.
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Affiliation(s)
| | - Elia Pérez-Fernández
- Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Oscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, Spain
| | | | - Verónica Diez-Diez
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Neus Robert-Boter
- Servicio de Urgencias, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
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12
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Sundararajan R, Ponticiello M, Nansera D, Jeremiah K, Muyindike W. Interventions to Increase HIV Testing Uptake in Global Settings. Curr HIV/AIDS Rep 2022; 19:184-193. [PMID: 35441985 PMCID: PMC9110462 DOI: 10.1007/s11904-022-00602-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 12/16/2022]
Abstract
Purpose of Review HIV testing is the critical first step to direct people living with HIV (PLWH) to treatment. However, progress is still being made towards the UNAIDS benchmark of 95% of PLWH knowing their status by 2030. Here, we discuss recent interventions to improve HIV testing uptake in global settings. Recent Findings Successful facility-based HIV testing interventions involve couples and index testing, partner notification, and offering of incentives. Community-based interventions such as home-based self-testing, mobile outreach, and hybrid approaches have improved HIV testing in low-resource settings and among priority populations. Partnerships with trusted community leaders have also increased testing among populations disproportionally impacted by HIV. Summary Recent HIV testing interventions span a breadth of facility- and community-based approaches. Continued research is needed to engage men in sub-Saharan Africa, people who inject drugs, and people who avoid biomedical care. Interventions should consider supporting linkage to care for newly diagnosed PLWH.
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Affiliation(s)
- Radhika Sundararajan
- Department of Emergency Medicine, Weill Cornell Medicine, 525 East 68th Street, M-130, New York, NY, 10065, USA. .,Weill Cornell Center for Global Health, New York, NY, USA.
| | - Matthew Ponticiello
- Department of Emergency Medicine, Weill Cornell Medicine, 525 East 68th Street, M-130, New York, NY, 10065, USA
| | - Denis Nansera
- Mbarara Regional Referral Hospital, Mbarara, Uganda.,Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Winnie Muyindike
- Mbarara Regional Referral Hospital, Mbarara, Uganda.,Mbarara University of Science and Technology, Mbarara, Uganda
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13
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Evaluación de las visitas a urgencias previas a un diagnóstico de VIH: oportunidades perdidas. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Martel-Laferriere V, Baril JG, Alarie I, Leblanc J, Côté J, Jourdenais E, Horth D, Lambert G, Tremblay C. Opt-out universal HCV and HIV screening in a Canadian emergency room: a cross-sectional study. BMJ Open 2022; 12:e048748. [PMID: 35042704 PMCID: PMC8768931 DOI: 10.1136/bmjopen-2021-048748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the prevalence of undiagnosed hepatitis C virus (HCV) and HIV cases in a population sample tested in the emergency room (ER) and to evaluate linkage-to-care. SETTING Canadian university hospital. PARTICIPANTS Adults born after 1945 who consulted at ER for any condition and on any shift were included. Patients unable to opt-out were excluded. INTERVENTIONS ER nurse confirmed patients' eligibility and provided them with the option to opt-out. A physician met patients with a new diagnosis. Linkage-to-care was assessed 3 months postdiagnosis. Patients newly diagnosed with HCV were considered linked if they had an HCV RNA test, genotype, liver fibrosis evaluation, and if indicated, treatment prescription. Patients newly diagnosed with HIV were considered linked to care if they had an HIV serology confirmation test, viral load, CD4 cell count and started antiretroviral therapy. PRIMARY AND SECONDARY OUTCOME MEASURES Primary objective: to determine the prevalence (overall and undiagnosed cases) of HIV and HCV among the patients who consult the ER. Secondary objectives: to determine the proportion of patients who opt-out, assess the adherence of emergency staff to the offer of testing, determine the proportion of patients linked to care at 3 months. RESULTS Among 6350 eligible patients informed of the screening programme, 62.1% of patients were tested for at least one virus (HIV: 3905; HCV: 3910). 25% patients opted-out, 12% were not tested for organisational reasons, 0.3% (18) patients were HCV-HIV coinfected. Overall prevalence of HCV and HIV cases were 1.9% and 1.2%, respectively. Prevalence of new cases was 0.23% (95% CI 0.12% 0.45%) for HCV and 0.05% (95% CI 0.01% to 0.20%) for HIV. Among the new cases, only two HCV-infected and one HIV-infected patients were linked-to-care 3 months postdiagnosis. CONCLUSIONS Identification of new cases of HCV and HIV through universal screening at the ER and linkage-to-care were both low. TRIAL REGISTRATION NUMBER NCT03595527; Results.
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Affiliation(s)
- Valerie Martel-Laferriere
- CRCHUM, Montreal, Québec, Canada
- CHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Guy Baril
- CHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Clinique médicale urbaine du Quartier-Latin, Montreal, Québec, Canada
| | - Isabelle Alarie
- Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Department of Medicine, CHUS, Sherbrooke, Québec, Canada
| | - Judith Leblanc
- AP-HP Greater Paris University Hospital, AP-HP.Sorbonne Université, Clinical Research Platform of East of Paris, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, SUMO, Paris, France
| | - José Côté
- CRCHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Emmanuelle Jourdenais
- CHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Damy Horth
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Gilles Lambert
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
- Direction régionale de santé publique de Montréal, Montréal, Quebec, Canada
| | - Cécile Tremblay
- CRCHUM, Montreal, Québec, Canada
- CHUM, Montreal, Québec, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
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15
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Leistikow PT, Patel V, Nouryan C, Cervia JS. Acceptability of HIV testing for adolescents and young adults by delivery model: a systematic review. J Investig Med 2021; 70:829-836. [PMID: 34880049 DOI: 10.1136/jim-2021-002056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/04/2022]
Abstract
HIV infections are prevalent among adolescents and young adults, of whom 44% remain unaware of their diagnosis. HIV screening presents numerous challenges including stigma, fear, and concerns about confidentiality, which may influence young people's acceptance of HIV screening and linkage to care differently from individuals in other age groups. It is imperative to understand which care delivery models are most effective in facilitating these services for youth. This systematic review analyzes the rates of HIV test acceptance and linkage to care by care delivery model for adolescents and young adults. Studies were classified into emergency department (ED), primary care/inpatient setting, community-based program, or sexually transmitted infection clinic models of care. From 6395 studies initially identified, 59 met criteria for inclusion in the final analyses. Rate of test acceptance and linkage to care were stratified by model of care delivery, gender, race, age ranges (13-17, 18-24 years) as well as site (North America vs rest of the world). A significant difference in acceptance of HIV testing was found between care models, with high rates of test acceptance in the ED setting in North America and primary care/hospital setting in the rest of the world. Similarly, linkage to care differed by model of care, with EDs having high rates of linkages to HIV care in North America. Future studies are needed to test mechanisms for optimizing outcomes for each care delivery model in addressing the unique challenges faced by adolescents and young adults.
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Affiliation(s)
- Peter Thomas Leistikow
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Vidhi Patel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Institute of Health Innovations and Outcomes Research, Northwell Health, New Hyde Park, New York, USA
| | - Christian Nouryan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Institute of Health Innovations and Outcomes Research, Northwell Health, New Hyde Park, New York, USA
| | - Joseph Steven Cervia
- Medicine and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA.,Senior Medical Director, HealthCare Partners IPA & MSO, Garden City, New York, USA
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16
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Eckardt P, Niu J, Montalvo S. Emergency Room "Opt-Out" HIV Testing Pre- and During COVID-19 Pandemic in a Large Community Health System. J Int Assoc Provid AIDS Care 2021; 20:23259582211041260. [PMID: 34488480 PMCID: PMC8427921 DOI: 10.1177/23259582211041260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: South Florida has the highest HIV rates across the country. Emergency Rooms (ERs) are optimal clinical sites for the identification of people living with HIV. We aimed to evaluate the feasibility and yield of opt-out HIV testing among ER patients in a large community healthcare system in South Florida, and determine the impact of the COVID-19 pandemic on HIV testing. Methods: This was a retrospective study conducted in the Memorial Healthcare System, Hollywood, Florida. HIV test was offered on an “opt-out” basis to patients aged 16 years or older presenting to the ER of the Memorial Regional Hospital between July 2018 and August 2020. Number of ER visits, HIV testing offered, acceptance of HIV testing, tested positive for HIV infection and linkage to care were reviewed and analyzed. Results: A total of 105,264 (53.7%) patients of 196,110 ER visits were eligible for HIV testing and 39,261 (37.3%) completed HIV testing. Of those tested, 206 (0.5%) patients tested positive, with 54 (26.2%) new infected patients and 152 (73.8%) known infected patients who had not disclosed their status. 45 (60%) of 75 patients with known HIV infections who were not engaged in HIV care were successfully relinked into care after testing, and engagement in care increased from 50.7% pre-testing to 80.3% post-testing (p = 0.001). 45 (83.3%) of 54 newly diagnosed patients were successfully linked into care. During the COVID-19 pandemic, there was a significant reduction in both the ER visits and HIV tests as compared with the pre-pandemic period (p = 0.007 and p < 0.001, respectively). Conclusion: An “Opt-out” HIV testing program was successfully implemented in a community hospital ERs. The use of this strategy successfully identified patients with undiagnosed HIV infection and improved their engagement in HIV care. Given the impact of COVID-19 pandemic on the testing program, new strategies should develop to reduce service disruption and maintain the progress of “Opt-out” HIV testing.
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Affiliation(s)
- Paula Eckardt
- Chief Division of Infectious Disease, Memorial Healthcare System, Hollywood, FL, USA
| | - Jianli Niu
- Clinical Research, Office of Human Research, Memorial Cardiac and Vascular Institute, Memorial Healthcare System, Hollywood, FL, USA
| | - Sheila Montalvo
- Clinical Pharmacist Division of Infectious Disease, Memorial Healthcare System, Hollywood, FL, USA
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17
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Affiliation(s)
- Michael S Saag
- From the University of Alabama at Birmingham, Birmingham
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18
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Palfreeman A, Sullivan A, Rayment M, Waters L, Buckley A, Burns F, Clutterbuck D, Cormack I, Croxford S, Dean G, Delpech V, Josh J, Kifetew C, Larbalestier N, Mackie N, Matthews P, Murchie M, Nardone A, Randell P, Skene H, Smithson K, Trevelion R, Trewinnard K, White A, Young E, Peto T. British HIV Association/British Association for Sexual Health and HIV/British Infection Association adult HIV testing guidelines 2020. HIV Med 2020; 21 Suppl 6:1-26. [PMID: 33333625 DOI: 10.1111/hiv.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Adrian Palfreeman
- Honorary Associate Professor, Consultant in Genitourinary Medicine, University Hospitals of Leicester NHS Trust
| | - Ann Sullivan
- Consultant in HIV and Sexual Health, Chelsea and Westminster Healthcare NHS Foundation Trust and Imperial College, London
| | - Michael Rayment
- Consultant in Genitourinary Medicine and HIV, Chelsea and Westminster Hospital NHS Foundation Trust, London
| | - Laura Waters
- Chair British HIV Association, Consultant in HIV & Sexual Health, Mortimer Market Centre, CNWL NHS Trust, London
| | - Anna Buckley
- Consultant in Emergency Medicine, University College Hospital NHS Trust, London
| | - Fiona Burns
- Associate Professor in HIV and Sexual Health, Institute for Global Health, University College London
| | - Daniel Clutterbuck
- Clinical Lead for Sexual and Reproductive Health and HIV, Lothian Sexual and Reproductive Health Service, Edinburgh
| | - Ian Cormack
- Clinical Lead HIV Medicine, Croydon University Hospital
| | - Sara Croxford
- Senior HIV/STI Prevention Scientist, Public Health England, London
| | - Gillian Dean
- Consultant in Genitourinary/HIV Medicine, Brighton & Sussex University Hospitals NHS Trust
| | | | | | - Chamut Kifetew
- Project Manager, National HIV Prevention Programme, Terrence Higgins Trust and HIV, Prevention England
| | - Nick Larbalestier
- Consultant in HIV Medicine, Guy's & St. Thomas' NHS Foundation Trust, London
| | - Nicola Mackie
- Consultant in HIV/Sexual Health, Imperial College Healthcare NHS Trust, London
| | - Philippa Matthews
- General Practitioner, Medical Director, Islington GP Federation, Islington Clinical Lead for Sexual Health, London
| | - Martin Murchie
- Lecturer in Adult Nursing/Sexual Health Adviser, Glasgow Caledonian University/Sandyford Sexual Health NHS GGC
| | - Anthony Nardone
- Consultant Scientist (Sexual Health Promotion), HIV/STI Department, Public Health England (September 2016 to June 2018) and Senior Epidemiologist, Epiconcept, Paris (June 2018 to November 2019)
| | - Paul Randell
- Consultant Virologist, Imperial College Healthcare NHS Trust
| | - Hannah Skene
- Clinical Lead for Acute Medicine, Chelsea and Westminster Hospital, London
| | | | | | - Karen Trewinnard
- Sexual and Reproductive Health Clinician and Trainer, Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians & Gynaecologists
| | | | - Emma Young
- Consultant Emergency Medicine, Barts Health NHS Trust, London
| | - Tim Peto
- Consultant in Infectious Diseases, John Radcliffe Hospital, Oxford
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19
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Shull JA, Attys JM, Amutah‐Onukagha NN, Hill MJ. Utilizing emergency departments for pre-exposure prophylaxis (PrEP). J Am Coll Emerg Physicians Open 2020; 1:1427-1435. [PMID: 33392547 PMCID: PMC7771789 DOI: 10.1002/emp2.12295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 12/23/2022] Open
Abstract
HIV incidence and prevalence rates in emergency departments (EDs) around the nation warrant strategies to protect and sustain the HIV negative status of persons who are at risk for HIV. The ED provides a rare opportunity to serve as a vehicle for connecting pre-exposure prophylaxis (PrEP)-eligible patients with clinical settings such as an ED that are knowledgeable and well informed about PrEP. PrEP has established efficacy at preventing HIV acquisition. The greatest challenge is access to PrEP and uptake thereof among vulnerable populations. We propose recommendations to improve the functionality of EDs as access points for PrEP referrals as an HIV prevention strategy to increase PrEP availability and uptake.
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Affiliation(s)
- Jordan A. Shull
- The University of Texas Health Science Center at Houston McGovern Medical SchoolHoustonTexasUSA
| | - Julie M. Attys
- Tufts University School of MedicineBostonMassachusettsUSA
| | | | - Mandy J. Hill
- The University of Texas Health Science Center at Houston McGovern Medical SchoolHoustonTexasUSA
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20
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Gutman CK, Duda E, Newton N, Alevy R, Palmer K, Wetzel M, Figueroa J, Griffiths M, Koyama A, Middlebrooks L, Simon HK, Camacho‐Gonzalez A, Morris CR. Unique Needs for the Implementation of Emergency Department Human Immunodeficiency Virus Screening in Adolescents. Acad Emerg Med 2020; 27:984-994. [PMID: 32717124 DOI: 10.1111/acem.14095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) recommend universal human immunodeficiency virus (HIV) screening starting at 13 years, which has been implemented in many general U.S. emergency departments (EDs) but infrequently in pediatric EDs. We aimed to 1) implement a pilot of routine adolescent HIV screening in a pediatric ED and 2) determine the unique barriers to CDC-recommended screening in this region of high HIV prevalence. METHODS This was a prospective 4-month implementation of a routine HIV screening pilot in a convenience sample of adolescents 13 to 18 years at a single pediatric ED, based on study personnel availability. Serum-based fourth-generation HIV testing was run through a central laboratory. Parents were allowed to remain in the room for HIV counseling and testing. Data were collected regarding patient characteristics and HIV testing quality metrics. Comparisons were made using chi-square and Fisher's exact tests. Regression analysis was performed to assess for an association between parent presence at the time of enrollment and adolescent decision to participate in HIV screening. RESULTS Over 4 months, 344 of 806 adolescents approached consented to HIV screening (57% female, mean ± SD = 15.1 ± 1.6 years). Adolescents with HIV screening were more likely to be older than those who declined (p = 0.025). Other blood tests were collected with the HIV sample for 21% of adolescents; mean time to result was 105 minutes (interquartile range = 69 to 123) and 79% were discharged before the result was available. Having a parent present for enrollment was not associated with adolescent participation (adjusted odds ratio = 1.07, 95% CI = 0.67 to 1.70). Barriers to testing included: fear of needlestick, time to results, cost, and staff availability. One of 344 tests was positive in a young adolescent with Stage 1 HIV. CONCLUSIONS Routine HIV screening in adolescents was able to be implemented in this pediatric ED and led to the identification of early infection in a young adolescent who would have otherwise been undetected at this stage of disease. Addressing the unique barriers to adolescent HIV screening is critical in high-prevalence regions and may lead to earlier diagnosis and treatment in this vulnerable population.
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Affiliation(s)
- Colleen K. Gutman
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
| | - Elizabeth Duda
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Naomi Newton
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Ryan Alevy
- Morehouse School of Medicine Atlanta GAUSA
| | - Katherine Palmer
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Martha Wetzel
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Janet Figueroa
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Mark Griffiths
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
| | - Atsuko Koyama
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
| | - Lauren Middlebrooks
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
| | - Harold K. Simon
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
| | - Andres Camacho‐Gonzalez
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Grady Infectious Disease Program Ponce Family and Youth ClinicGrady Health Systems Atlanta GAUSA
| | - Claudia R. Morris
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
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21
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Success of Supplementing National HIV Testing Recommendations With a Local Initiative in a Large Health Care System in the U.S. South. J Acquir Immune Defic Syndr 2020; 83:e6-e9. [PMID: 31929408 DOI: 10.1097/qai.0000000000002222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Mendlowitz AB, Naimark D, Wong WWL, Capraru C, Feld JJ, Isaranuwatchai W, Krahn M. The emergency department as a setting-specific opportunity for population-based hepatitis C screening: An economic evaluation. Liver Int 2020; 40:1282-1291. [PMID: 32267604 DOI: 10.1111/liv.14458] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/06/2020] [Accepted: 03/28/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS The World Health Organization's hepatitis C virus (HCV) elimination strategy recognizes the need for interventions that identify populations most affected by infection. The emergency department (ED) has been suggested as a setting for HCV screening. The study objective was to explore the health and economic impact of HCV screening in the ED setting. METHODS We used a microsimulation model to conduct a cost-utility analysis evaluating two ED setting-specific strategies: no screening, and screening and subsequent treatment. Strategies were examined for two populations: (a) the general ED patient population; and (b) ED patients born between 1945 and 1975. The analysis was conducted from a healthcare payer perspective over a lifetime time horizon. A reference and high ED HCV seroprevalence measure were examined in the Canadian healthcare setting.US costs of chronic infection were used for a scenario analysis of screening in the US healthcare setting. RESULTS For birth cohort screening, in comparison to no screening, one liver-related death was averted for every 760 and 123 persons screened for the reference and high seroprevalence measures. For general population screening, one liver-related death was averted for every 831 and 147 persons screened for the reference and high seroprevalence measures. In comparison to no screening, birth cohort screening was cost-effective at CAN$25,584/quality-adjusted life year (QALY) and US$42,615/QALY. General population screening was cost-effective at CAN$19,733/QALY and US$32,187/QALY. CONCLUSIONS ED screening may represent a cost-effective component of population-based strategies to eliminate HCV. Further studies are warranted to explore the feasibility and acceptability of this approach.
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Affiliation(s)
- Andrew B Mendlowitz
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - David Naimark
- Department of Medicine, Sunnybrook Hospital, Toronto, ON, Canada
| | - William W L Wong
- School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Camelia Capraru
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, ON, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, ON, Canada
| | - Wanrudee Isaranuwatchai
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.,University Health Network - Toronto General Hospital, Toronto, ON, Canada
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Grant C, O'Connell S, Lillis D, Moriarty A, Fitzgerald I, Dalby L, Bannan C, Tuite H, Crowley B, Plunkett P, Kennedy U, McMahon G, McKiernan S, Norris S, Hughes G, Shields D, Bergin C. Opt-out screening for HIV, hepatitis B and hepatitis C: observational study of screening acceptance, yield and treatment outcomes. Emerg Med J 2019; 37:102-105. [PMID: 31806726 DOI: 10.1136/emermed-2019-208637] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 11/16/2019] [Accepted: 11/23/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND We initiated an emergency department (ED) opt-out screening programme for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) at our hospital in Dublin, Ireland. The objective of this study was to determine screening acceptance, yield and the impact on follow-up care. METHODS From July 2015 through June 2018, ED patients who underwent phlebotomy and could consent to testing were tested for HIV, HBV and HCV using an opt-out approach. We examined acceptance of screening, linkage to care, treatment and viral suppression using screening programme data and electronic health records. The duration of follow-up ranged from 1 to 36 months. RESULTS Over the 36-month study period, there were 140 550 ED patient visits, of whom 88 854 (63.2%, 95% CI 63.0% to 63.5%) underwent phlebotomy and 54 817 (61.7%, 95% CI 61.4% to 62.0%) accepted screening for HIV, HBV and HCV, representing 41 535 individual patients. 2202 of these patients had a positive test result. Of these, 267 (12.1%, 95% CI 10.8% to 13.6%) were newly diagnosed with an infection and 1762 (80.0%, 95% CI 78.3% to 81.7%) had known diagnoses. There were 38 new HIV, 47 new HBV and 182 new HCV diagnoses. 81.5% (95% CI 74.9% to 87.0%) of known patients who were not linked were relinked to care after screening. Of the new diagnoses, 86.2% (95% CI 80.4 to 90.8%) were linked to care. CONCLUSION Although high proportions of patients had known diagnoses, our programme was able to identify many new infected patients and link them to care, as well as relink patients with known diagnoses who had been lost to follow-up.
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Affiliation(s)
- Conor Grant
- Department of Genito-Urinary Medicine and Infectious Diseases, St. James's Hospital, Dublin, Ireland
| | - Sarah O'Connell
- Department of Genito-Urinary Medicine and Infectious Diseases, St. James's Hospital, Dublin, Ireland
| | - Darren Lillis
- Department of Emergency Medicine, St. James's Hospital, Dublin, Ireland
| | - Anne Moriarty
- Department of Genito-Urinary Medicine and Infectious Diseases, St. James's Hospital, Dublin, Ireland
| | - Ian Fitzgerald
- Department of Clinical Microbiology and Virology, St. James's Hospital, Dublin, Ireland
| | - Linda Dalby
- Department of Clinical Microbiology and Virology, St. James's Hospital, Dublin, Ireland
| | - Ciaran Bannan
- Department of Genito-Urinary Medicine and Infectious Diseases, St. James's Hospital, Dublin, Ireland
| | - Helen Tuite
- Department of Genito-Urinary Medicine and Infectious Diseases, St. James's Hospital, Dublin, Ireland
| | - Brendan Crowley
- Department of Clinical Microbiology and Virology, St. James's Hospital, Dublin, Ireland
| | - Patrick Plunkett
- Department of Emergency Medicine, St. James's Hospital, Dublin, Ireland
| | - Una Kennedy
- Department of Emergency Medicine, St. James's Hospital, Dublin, Ireland
| | - Geraldine McMahon
- Department of Emergency Medicine, St. James's Hospital, Dublin, Ireland
| | - Susan McKiernan
- Department of Hepatology, St. James's Hospital, Dublin, Ireland
| | - Suzanne Norris
- Department of Hepatology, St. James's Hospital, Dublin, Ireland
| | - Gerard Hughes
- Department of Finance, St. James's Hospital, Dublin, Ireland
| | - Darragh Shields
- Department of Emergency Medicine, St. James's Hospital, Dublin, Ireland
| | - Colm Bergin
- Department of Genito-Urinary Medicine and Infectious Diseases, St. James's Hospital, Dublin, Ireland
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Gebrezgi MT, Mauck DE, Sheehan DM, Fennie KP, Cyrus E, Degarege A, Trepka MJ. Acceptance of Opt-Out HIV Screening in Outpatient Settings in the United States: A Systematic Review and Meta-Analysis. Public Health Rep 2019; 134:484-492. [PMID: 31365316 DOI: 10.1177/0033354919860510] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES In the United States, about 15% of persons living with HIV infection do not know they are infected. Opt-out HIV screening aims to normalize HIV testing by performing an HIV test during routine medical care unless the patient declines. The primary objective of this systematic review and meta-analysis was to assess the acceptance of opt-out HIV screening in outpatient settings in the United States. METHODS We searched in PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature) for studies published from January 1, 2006, through December 31, 2018, of opt-out HIV screening in outpatient settings. We collected data from selected studies and calculated for each study (1) the percentage of persons who were offered HIV testing, (2) the percentage of persons who accepted the test, and (3) the percentage of new HIV diagnoses among persons tested. We also collected information on the reasons given by patients for opting out. The meta-analysis used a random-effects model to estimate the average percentages of HIV testing offered, HIV testing accepted, and new HIV diagnoses. RESULTS We initially identified 6986 studies; the final analysis comprised 14 studies. Among the 8 studies that reported the size of the study population eligible for HIV screening, 71.4% (95% confidence interval [CI], 53.9%-89.0%) of the population was offered an HIV test on an opt-out basis. The test was accepted by 58.7% (95% CI, 47.2%-70.2%) of persons offered the test. Among 9 studies that reported data on new HIV diagnoses, 0.18% (95% CI, 0.08%-0.26%) of the persons tested had a new HIV diagnosis. Patients' most frequently cited reasons for refusal of HIV screening were that they perceived a low risk of having HIV or had previously been tested. CONCLUSIONS The rates of offering and accepting an HIV test on an opt-out basis could be improved by addressing health system and patient-related factors. Setting a working target for these rates would be useful for measuring the success of opt-out HIV screening programs.
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Affiliation(s)
- Merhawi T Gebrezgi
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Daniel E Mauck
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,2 Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, USA.,3 Research Centers in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Elena Cyrus
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Abraham Degarege
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Mary Jo Trepka
- 1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.,3 Research Centers in Minority Institutions (RCMI), Florida International University, Miami, FL, USA
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25
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Matulionytė R, Žagminas K, Balčiūnaitė E, Matulytė E, Paulauskienė R, Bajoriūnienė A, Ambrozaitis A. Routine HIV testing program in the University Infectious Diseases Centre in Lithuania: a four-year analysis. BMC Infect Dis 2019; 19:21. [PMID: 30616558 PMCID: PMC6322331 DOI: 10.1186/s12879-018-3661-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/26/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND HIV transmission remains a major concern in Eastern Europe, and too many people are diagnosed late. Expanded testing strategies and early and appropriate access to care are required. Infectious disease departments might be targets for expanded HIV testing owing to the intense passage of key patient populations that carry indicators of HIV disease. Our objective was to evaluate the feasibility and clinical effectiveness of a fully integrated, opt-out routine, rapid HIV testing program. METHODS A retrospective four-year study of a screening program was conducted from 2010 through 2014. The program was divided into two periods: from 2010 to 2012 (pilot study) and from 2013 to 2014. The pilot study consisted of routine HIV testing of patients aged 18-55 that were hospitalized in one department. In the second period, all inpatients aged 18-65 were eligible. Targeted testing was conducted in the other inpatient department during the pilot study and the outpatient department during both periods. RESULTS During the pilot study, 2203 patients were hospitalized, 1314 (59.6%) were eligible, 954 (72.6%) were tested, and 3 (0.31%) were newly diagnosed HIV-positive. In the second period, 4911 patients were hospitalized, 3727 (75.9%) were eligible, 3303 (88.6%) were tested, and 7 (0.21%) were HIV-positive. In total, 2800 targeted tests were performed, and 4 (0.14%) patients tested positive with newly discovered HIV. All 14 newly diagnosed patients were provided with care. Comparing cumulative groups of routine and targeted testing, the HIV prevalence was 0.23% vs. 0.14% (p = 0.40) and was above the reported cost-effectiveness threshold of 0.1% (p = 0.012). A lower proportion of advanced disease and a higher proportion of heterosexually transmitted infection were found in the routine testing group. CONCLUSION Routine HIV testing in admissions of infectious diseases is acceptable, feasible, sustainable and clinically effective. Compared to targeted testing, routine testing helped to discover more patients in earlier stages and those with heterosexually transmitted HIV infection.
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Affiliation(s)
- Raimonda Matulionytė
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kęstutis Žagminas
- Institute of Health Sciences, Vilnius University, Vilnius, Lithuania
| | - Eglė Balčiūnaitė
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Elžbieta Matulytė
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Rasutė Paulauskienė
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Almina Bajoriūnienė
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Arvydas Ambrozaitis
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Tan R, Hugli O, Cavassini M, Darling K. Non-targeted HIV testing in the emergency department: not just how but where. Expert Rev Anti Infect Ther 2018; 16:893-905. [PMID: 30406726 DOI: 10.1080/14787210.2018.1545575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The emergency department (ED) has the potential to enhance early HIV diagnosis through HIV testing programs. How these are implemented is a subject of debate. Areas covered: We describe the main HIV testing approaches: diagnostic testing, targeted screening, and non-targeted screening, and review ED-based non-targeted HIV screening studies conducted after 2006 among ≥5000 patients. As well as examining how testing is offered, we focus on where it is offered, through the patient's journey from registration, via triage and the waiting room, to the bedside. Barriers to the testing offer, acceptance and performance were examined at each location. While testing offer rates were higher at registration and triage, compared to the waiting room and bedside, this was sometimes at the expense of testing acceptance and performance. Variables affecting testing rates included type of consent, employment of external staff and type of testing: fourth generation serological testing versus rapid testing. Expert commentary: These large studies shed light on the importance of where as well as how HIV testing is performed, and the ways in which the 'where' can influence non-targeted screening yields. This perspective enables testing approaches to be tailored to specific ED settings in order to maximize testing rates.
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Affiliation(s)
- Rainer Tan
- a Infectious Diseases Service , Lausanne University Hospital , Lausanne , Switzerland
| | - Olivier Hugli
- b Emergency Department , Lausanne University Hospital , Lausanne , Switzerland
| | - Matthias Cavassini
- a Infectious Diseases Service , Lausanne University Hospital , Lausanne , Switzerland
| | - Katharine Darling
- a Infectious Diseases Service , Lausanne University Hospital , Lausanne , Switzerland
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27
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HIV Testing in the Emergency Department. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40138-018-0161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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28
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Henriquez Camacho C, Losa JE, Pérez Molina J, Villafuerte P. Cribado de virus de inmunodeficiencia humana. Enferm Infecc Microbiol Clin 2018; 36:256. [DOI: 10.1016/j.eimc.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/14/2017] [Indexed: 11/25/2022]
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29
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Escudero-Sánchez R, Meier-de-Taboada CJK, Bartolome-García E, Rodríguez-de-Bethencourt-Sanjuan PM, Losa-García JE. [Post-exposure prophylaxis against HIV, the view from the emergency department - authos´s response]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2018; 31:167-169. [PMID: 29644824 PMCID: PMC8024029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rosa Escudero-Sánchez
- Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Madrid, España
| | | | - Emma Bartolome-García
- Servicio de Farmacia Hospitalaria, Hospital Universitario Fundación Alcorcón, Madrid, España
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30
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Valère MK, Nelly K, Mefo N, Pascal F. Mother to Child Transmission of HIV after Option B+ in Low Income Environment. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojog.2018.812118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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