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Lin J, Baghikar S, Mauntel-Medici C, Heinert S, Patel D. Patient and System Factors Related to Missed Opportunities for Screening in an Electronic Medical Record-driven, Opt-out HIV Screening Program in the Emergency Department. Acad Emerg Med 2017; 24:1358-1368. [PMID: 28833779 DOI: 10.1111/acem.13277] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/09/2017] [Accepted: 08/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Emergency departments (EDs) have implemented HIV screening using a variety of strategies. This study investigates how specific patient and health system factors in the ED impact who is and is not screened in a combined targeted and nontargeted, electronic medical record (EMR)-driven, opt-out, HIV screening program. METHODS This was a retrospective, cross-sectional study of ED visits where patients were determined eligible for HIV screening by an EMR algorithm between November 18, 2014, and July 15, 2015. The HIV screening workflow included three sequential events, all of which were required to get screened for HIV at the ED visit. The events were having a blood draw, being informed of the HIV screening policy by an ED nurse at the point of blood draw, and the patient consenting to the HIV test. Each event represented a dichotomous outcome and its association with six patient factors (age, sex, race/ethnicity, marital status, preferred language, and Emergency Severity Index [ESI]) and two health system factors (ED crowding and program phase) was investigated using multivariable modeling. RESULTS A total of 15,918 ED visits were analyzed. Blood was drawn in 8,388 of 15,918 visits (53%). Of 8,388 visits where blood was drawn, there were 5,947 (71%) visits where ED nurses documented informing patients of the HIV screening policy. Of those visits, patient consent to the HIV test was documented at 3,815 (64%) visits. Patients between 13 and 19 years of age were significantly less likely to have blood drawn, to be informed of the screening policy, and to consent to the HIV test compared to other age groups. Both ED crowding and a patient's ESI were associated with decreased odds of having a blood draw and being informed of HIV screening by an ED nurse, but showed no association with patients consenting to the HIV test. CONCLUSION Many patients, particularly adolescents and young adults, are missed in ED HIV screening programs that require blood draw and depend on providers to obtain consent for testing. To ensure that these patients are reached, future ED screening programs should strive to develop innovative workflows that allow for blood draws for HIV screening only and streamline the processes of obtaining informed consent and ordering tests for all eligible patients.
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Affiliation(s)
- Janet Lin
- Department of Emergency Medicine; University of Illinois Hospital and Health Science Systems; Chicago IL
| | - Sara Baghikar
- Department of Emergency Medicine; University of Illinois Hospital and Health Science Systems; Chicago IL
| | - Cammeo Mauntel-Medici
- Department of Emergency Medicine; University of Illinois Hospital and Health Science Systems; Chicago IL
| | - Sara Heinert
- Department of Emergency Medicine; University of Illinois Hospital and Health Science Systems; Chicago IL
| | - Daven Patel
- Department of Emergency Medicine; University of Illinois Hospital and Health Science Systems; Chicago IL
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Routine Inpatient Human Immunodeficiency Virus Screening: Missed Prevention Opportunities. CLIN NURSE SPEC 2017; 31:45-51. [PMID: 27906733 DOI: 10.1097/nur.0000000000000265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/OBJECTIVES This article reviews the current guidelines for human immunodeficiency virus (HIV) screening among inpatients and explores adherence to the guidelines and barriers to their implementation. BACKGROUND In 2006, the Centers for Disease Control and Prevention released updated recommendations suggesting HIV screening for all patients in all healthcare settings. DESCRIPTION A nonsystematic review of current HIV screening guidelines, as well as research and nonresearch literature, addressing rates of inpatient screening was performed. RESULTS Between 2000 and 2010, there was a significant increase in testing in healthcare settings. Despite these advances, 10 years after the updated Centers for Disease Control and Prevention guidelines were released, many hospitals still have not fully implemented the recommendations. Barriers to implementation of the guidelines include provider misconceptions and lack of time and reimbursement. CONCLUSIONS Screening for HIV identifies new infections, reduces transmission, prevents complications, and encourages a discussion about prevention. Increasing adherence to screening recommendations can help prevent new cases and disease progression. The nursing focus on prevention makes clinical nurse specialists and other advanced practice registered nurses uniquely positioned to increase screening. Clinical nurse specialists should implement research projects to understand adherence in their facilities and identify and address site-specific barriers. Quality improvement programs can then be implemented to improve screening rates.
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Liggett A, Futterman D, Umanski GI, Selwyn PA. Missing the mark: ongoing missed opportunities for HIV diagnosis at an urban medical center despite universal screening recommendations. Fam Pract 2016; 33:644-648. [PMID: 27507566 DOI: 10.1093/fampra/cmw075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite established recommendations from the Centers for Disease Control (CDC) to scale up testing efforts in the USA, this study shows full scale implementation of these recommendations may still be lacking. We hypothesize that patients experience ongoing missed opportunities for earlier diagnosis of HIV, despite frequent encounters to Montefiore Medical Center (MMC), an integrated hospital system in the Bronx, NY. METHODS Retrospective chart review via electronic medical records of patients newly diagnosed with HIV in 2012 and 2013 at varied MMC clinical sites. Missed opportunities were defined as > 1 prior health care encounter at MMC within three calendar years of diagnosis, in which HIV testing was not offered for those who had a prior negative test or no prior test. RESULTS There were 218 patients newly diagnosed with HIV at MMC during the study period; 31% presented with a CD4 <200 cells/mm3; 22% were asymptomatic at diagnosis. Patients (56%) without a prior HIV test had an average 4.72 clinical encounters at MMC within the 3 years prior to their HIV diagnosis. Over 95% of visits prior to diagnosis occurred in emergency departments (EDs) or primary care outpatient department (OPDs) and accounted for the vast majority of missed opportunities. CONCLUSIONS HIV infected patients continue to present late to care, with low CD4 and commonly utilize OPDs and EDs, where missed opportunities for earlier diagnosis are common. Practices that address augmentation of current HIV testing strategies are needed, especially in outpatient and first-contact acute care settings.
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Affiliation(s)
- Alisha Liggett
- Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA,
- Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Donna Futterman
- Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Galina I Umanski
- Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Peter A Selwyn
- Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Williams MV, Derose KP, Aunon F, Kanouse DE, Bogart LM, Griffin BA, Haas AC, Collins DO. Church-Based HIV Screening in Racial/Ethnic Minority Communities of California, 2011-2012. Public Health Rep 2016; 131:676-684. [PMID: 28123208 DOI: 10.1177/0033354916662641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Community-based human immunodeficiency virus (HIV) testing at religious congregations has been proposed as a potentially effective way to increase screening among disproportionately affected populations, such as those self-identifying as African American and Latino. Although congregations may provide reach into these communities, the extent to which church-based HIV testing alleviates access barriers, identifies new cases, and reaches people at increased risk for HIV is not well documented. We examined the results of an HIV testing program that was conducted as part of a larger intervention aimed at reducing HIV stigma at five churches in Los Angeles County, California, in 2011-2012. HIV screening identified one positive result in 323 tests but reached a substantial proportion of people who had not been tested before, including many who lacked health insurance. Although this approach may not be an efficient way to identify cases of previously unknown HIV infection, it could help achieve universal testing goals.
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Affiliation(s)
| | | | | | | | - Laura M Bogart
- Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
| | | | | | - Deborah Owens Collins
- Department of Health and Human Services, City of Long Beach, Physician Services Bureau, Long Beach, CA, USA
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5
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Liu N, Stone PW, Schnall R. Impact of Mandatory HIV Screening in the Emergency Department: A Queuing Study. Res Nurs Health 2016; 39:121-7. [PMID: 26829415 DOI: 10.1002/nur.21710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2016] [Indexed: 11/06/2022]
Abstract
To improve HIV screening rates, New York State in 2010 mandated that all persons 13-64 years receiving health care services, including care in emergency departments (EDs), be offered HIV testing. Little attention has been paid to the effect of screening on patient flow. Time-stamped ED visit data from patients eligible for HIV screening, 7,844 of whom were seen by providers and 767 who left before being seen by providers, were retrieved from electronic health records in one adult ED. During day shifts, 10% of patients left without being seen, and during evening shifts, 5% left without being seen. All patients seen by providers were offered testing, and 6% were tested for HIV. Queuing models were developed to evaluate the effect of HIV screening on ED length of stay, patient waiting time, and rate of leaving without being seen. Base case analysis was conducted using actual testing rates, and sensitivity analyses were conducted to evaluate the impact of increasing the testing rate. Length of ED stay of patients who received HIV tests was 24 minutes longer on day shifts and 104 minutes longer on evening shifts than for patients not tested for HIV. Increases in HIV testing rate were estimated to increase waiting time for all patients, including those who left without being seen. Our simulation suggested that incorporating HIV testing into ED patient visits not only adds to practitioner workload but also increases patient waiting time significantly during busy shifts, which may increase the rate of leaving without being seen.
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Affiliation(s)
- Nan Liu
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY
| | | | - Rebecca Schnall
- School of Nursing, Columbia University, 617 West 168th Street, New York, NY, 10032
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Merchant RC, DeLong AK, Liu T, Baird JR. Factors Influencing Uptake of Rapid HIV and Hepatitis C Screening Among Drug Misusing Adult Emergency Department Patients: Implications for Future HIV/HCV Screening Interventions. AIDS Behav 2015; 19:2025-35. [PMID: 26036465 DOI: 10.1007/s10461-015-1103-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this randomized, controlled trial among 957 English- or Spanish-speaking drug misusing adult emergency department (ED) patients, we determined if a tailored brief intervention (BI) increased uptake of rapid HIV/HCV screening, and identified factors associated with greater screening uptake. Rapid HIV/HCV screening uptake was greater in the control than the BI arm (45 vs. 38 %; p < 0.04). Screening uptake depended on elapsed study time and which research staff member offered testing. In the control arm, uptake was lowest for those spending <30 or ≥90 min in the study. In the BI arm, screening uptake generally increased over time. Tailored BI content specifically addressing participant HIV/HCV knowledge, HIV/HCV risk behaviors, or need for HIV/HCV screening was not associated with greater screening uptake. These study findings suggested factors that should be considered when designing future ED-based screening initiatives, such as elapsed study time, who offers testing, and the content of interventions.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Claverick Building, Providence, RI, 02903, USA.
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
| | - Allison K DeLong
- Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Janette R Baird
- Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Claverick Building, Providence, RI, 02903, USA
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Amesty S, Crawford ND, Nandi V, Perez-Figueroa R, Rivera A, Sutton M, Weidle PJ, Willis L, Smith DK, Hernandez C, Harripersaud K, Lewis CF. Evaluation of Pharmacy-Based HIV Testing in a High-Risk New York City Community. AIDS Patient Care STDS 2015. [PMID: 26217930 DOI: 10.1089/apc.2015.0017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Blacks/Hispanics face limited access to HIV testing. We examined in-pharmacy HIV testing among customers in pharmacies participating in a nonprescription syringe program in New York City. Participants were recruited in two pharmacies to complete a survey and receive an optional HIV test. Bivariate and multivariable analyses were performed to examine associations of demographics and risk behaviors with receiving in-pharmacy HIV testing. Most participants were male (55%), black (80%), had used hard drugs (88%), and 39.5% received in-pharmacy HIV testing. Being female (AOR=2.24; 95%CI 1.24-4.05), having multiple sex partners (AOR=1.20; 95% CI 1.06-1.35), having an HIV test more than 12 months ago (AOS=4.06; CI 1.85-8.91), injecting drugs in last 3 months (AOR=2.73; 95% CI 1.31-5.69) and having continuous care (AOR=0.32; 95% CI 0.17-0.58) were associated with receiving in-pharmacy HIV test. These data provide evidence of in-pharmacy HIV testing reaching persons at risk of HIV. HIV testing in pharmacies may complement existing strategies.
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Affiliation(s)
- Silvia Amesty
- Columbia University College of Physicians and Surgeons, Center for Family and Community Medicine, New York, New York
- Columbia University Mailman School of Public Health, Heilbrunn Department of Population and Family Health, New York, New York
| | | | - Vijay Nandi
- The Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York
| | - Rafael Perez-Figueroa
- Columbia University Mailman School of Public Health, Heilbrunn Department of Population and Family Health, New York, New York
- Columbia University College of Physicians and Surgeons, Department of Pediatrics, New York, New York
| | - Alexis Rivera
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, New York
| | - Madeline Sutton
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul J. Weidle
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leigh Willis
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dawn K. Smith
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolyn Hernandez
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, New York
| | - Katherine Harripersaud
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, New York
| | - Crystal Fuller Lewis
- Columbia University Mailman School of Public Health, Department of Epidemiology, New York, New York
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Haukoos JS, Hopkins E, Bucossi MM, Lyons MS, Rothman RE, White DA, Al-Tayyib AA, Bradley-Springer L, Campbell JD, Sabel AL, Thrun MW. Brief report: Validation of a quantitative HIV risk prediction tool using a national HIV testing cohort. J Acquir Immune Defic Syndr 2015; 68:599-603. [PMID: 25585300 PMCID: PMC4357562 DOI: 10.1097/qai.0000000000000518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Routine screening is recommended for HIV detection. HIV risk estimation remains important. Our goal was to validate the Denver HIV Risk Score using a national cohort from the Centers for Disease Control and Prevention. Patients of 13 years and older were included, 4,830,941 HIV tests were performed, and 0.6% newly diagnosed infections were identified. Of all visits, 9% were very low risk (HIV prevalence = 0.20%), 27% low risk (HIV prevalence = 0.17%), 41% moderate risk (HIV prevalence = 0.39%), 17% high risk (HIV prevalence = 1.19%), and 6% very high risk (HIV prevalence = 3.57%). The Denver HIV Risk Score accurately categorized patients into different HIV risk groups.
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Affiliation(s)
- Jason S. Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Emily Hopkins
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Meggan M. Bucossi
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Richard E. Rothman
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Douglas A.E. White
- Department of Emergency Medicine, Alameda County Medical Center, Oakland, CA
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA
| | - Alia A. Al-Tayyib
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
- Denver Public Health, Denver, Colorado
| | | | - Jonathon D. Campbell
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
| | - Allison L. Sabel
- Department of Patient Safety and Quality, Denver Health Medical Center, Denver, CO
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Mark W. Thrun
- Denver Public Health, Denver, Colorado
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
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Merchant RC, Baird JR, Liu T, Taylor LE, Montague BT, Nirenberg TD. Brief intervention to increase emergency department uptake of combined rapid human immunodeficiency virus and hepatitis C screening among a drug misusing population. Acad Emerg Med 2014; 21:752-67. [PMID: 25125271 PMCID: PMC4135533 DOI: 10.1111/acem.12419] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/22/2014] [Accepted: 03/04/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In this study, Increasing Viral Testing in the Emergency Department (InVITED), the authors investigated if a brief intervention about human immunodeficiency virus (HIV) and hepatitis C virus (HCV) risk-taking behaviors and drug use and misuse in addition to a self-administered risk assessment, compared to a self-administered risk assessment alone, increased uptake of combined screening for HIV and HCV, self-perception of HIV/HCV risk, and impacted beliefs and opinions on HIV/HCV screening. METHODS InVITED was a randomized, controlled trial conducted at two urban emergency departments (EDs) from February 2011 to March 2012. ED patients who self-reported drug use within the past 3 months were invited to enroll. Drug misuse severity and need for a brief or more intensive intervention was assessed using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants were randomly assigned to one of two study arms: a self-administered HIV/HCV risk assessment alone (control arm) or the assessment plus a brief intervention about their drug misuse and screening for HIV/HCV (intervention arm). Beliefs on the value of combined HIV/HCV screening, self-perception of HIV/HCV risk, and opinions on HIV/HCV screening in the ED were measured in both study arms before the HIV/HCV risk assessment (pre), after the assessment in the control arm, and after the brief intervention in the intervention arm (post). Participants in both study arms were offered free combined rapid HIV/HCV screening. Uptake of screening was compared by study arm. Multivariable logistic regression models were used to evaluate factors related to uptake of screening. RESULTS Of the 395 participants in the study, the median age was 28 years (interquartile range [IQR] = 23 to 38 years), 44.8% were female, 82.3% had ever been tested for HIV, and 67.3% had ever been tested for HCV. Uptake of combined rapid HIV/HCV screening was nearly identical by study arm (64.5% vs. 65.2%; Δ = -0.7%; 95% confidence interval [CI] = -10.1% to 8.7%). Of the 256 screened, none had reactive HIV antibody tests, but seven (2.7%) had reactive HCV antibody tests. Multivariable logistic regression analysis results indicated that uptake of screening was not related to study arm assignment, total ASSIST drug scores, need for an intervention for drug misuse, or HIV/HCV sexual risk assessment scores. However, uptake of screening was greater among participants who indicated placing a higher value on combined rapid HIV/HCV screening for themselves and all ED patients and those with higher levels of perceived HIV/HCV risk. Uptake of combined rapid HIV/HCV screening was not related to changes in beliefs regarding the value of combined HIV/HCV screening or self-perceived HIV/HCV risk (post- vs. pre-risk assessment with or without a brief intervention). Opinions regarding the ED as a venue for combined rapid HIV/HCV screening were not related to uptake of screening. CONCLUSIONS Uptake of combined rapid HIV/HCV screening is high and considered valuable among drug using and misusing ED patients with little concern about the ED as a screening venue. The brief intervention investigated in this study does not appear to change beliefs regarding screening, self-perceived risk, or uptake of screening for HIV/HCV in this population. Initial beliefs regarding the value of screening and self-perceived risk for these infections predict uptake of screening.
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Affiliation(s)
- Roland C Merchant
- The Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI; The Department of Epidemiology, School of Public Health, Brown University, Providence, RI
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10
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Kintziger KW, Duffus WA. How useful is universal screening for HIV infection? A review of the evidence. Future Virol 2014. [DOI: 10.2217/fvl.13.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT: Our objective is to describe the current evidence for universal HIV screening in terms of the cost–effectiveness, acceptance rates and number of new positives identified. The available data demonstrate that universal HIV screening is cost-effective, in terms of quality-adjusted life years gained, increase in life expectancy of infected individuals and in reduced HIV transmission rates; and acceptable in healthcare settings based on acceptance (7–99%) and seropositivity (0–2%) rates. Specific studies are needed that address many of the other intended outcomes of universal screening programs, such as reducing number of missed opportunities, increased linkage to care and earlier disease stage detection. Also, additional studies with direct comparisons between universal and targeted testing are necessary to provide greater evidence for where either testing approach may be best implemented.
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Affiliation(s)
- Kristina W Kintziger
- Department of Biostatistics & Epidemiology, Medical College of Georgia, Georgia Regents University – Augusta, 1120 15th Street, Augusta, GA 30912, USA
| | - Wayne A Duffus
- Division of Infectious Diseases, University of South Carolina School of Medicine, 2 Medical Park, Columbia, SC 29203, USA
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Sison N, Yolken A, Poceta J, Mena L, Chan PA, Barnes A, Smith E, Nunn A. Healthcare provider attitudes, practices, and recommendations for enhancing routine HIV testing and linkage to care in the Mississippi Delta region. AIDS Patient Care STDS 2013; 27:511-7. [PMID: 23991689 PMCID: PMC3760055 DOI: 10.1089/apc.2013.0169] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Mississippi Delta region is one of the communities most heavily impacted by HIV/AIDS in the United States. To understand local provider attitudes and practices regarding HIV testing and care, we conducted 25 in-depth qualitative interviews with local primary care providers and infectious disease specialists. Interviews explored attitudes and practices regarding HIV testing and linkage to care. Most providers did not routinely offer HIV testing, noting financial barriers, financial disincentives to offer routine screening, misperceptions about local informed consent laws, perceived stigma among patients, and belief that HIV testing was the responsibility of the health department. Barriers to enhancing treatment and care included stigma, long distances, lack of transportation, and paucity of local infectious disease specialists. Opportunities for enhancing HIV testing and care included provider education programs regarding billing, local HIV testing guidelines, and informed consent, as well as telemedicine services for underserved counties. Although most health care providers in our study did not currently offer routine HIV testing, all were willing to provide more testing and care services if they were able to bill for routine testing. Increasing financial reimbursement and access to care, including through the Affordable Care Act, may provide an opportunity to enhance HIV/AIDS services in the Mississippi Delta.
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Affiliation(s)
- Nathan Sison
- Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Annajane Yolken
- Department of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Joanna Poceta
- Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Leandro Mena
- Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
- Department of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Philip A. Chan
- Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
| | - Arti Barnes
- Department of Infectious Diseases, University of Mississippi Medical Center, Jackson, Mississippi
| | - Erin Smith
- Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Amy Nunn
- Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island
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Mutter R, Clancy C. Investing in emergency medicine to improve health care for all Americans: the role of the Agency for Healthcare Research and Quality. Ann Emerg Med 2013; 63:580-3. [PMID: 23870860 DOI: 10.1016/j.annemergmed.2013.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 05/24/2013] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Ryan Mutter
- Agency for Healthcare Research and Quality, Rockville, MD.
| | - Carolyn Clancy
- Agency for Healthcare Research and Quality, Rockville, MD
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13
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Trillo AD, Merchant RC, Baird JR, Ladd GT, Liu T, Nirenberg TD. Interrelationship of alcohol misuse, HIV sexual risk and HIV screening uptake among emergency department patients. BMC Emerg Med 2013; 13:9. [PMID: 23721108 PMCID: PMC3686630 DOI: 10.1186/1471-227x-13-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 04/03/2013] [Indexed: 01/29/2023] Open
Abstract
Background Emergency department (ED) patients comprise a high-risk population for alcohol misuse and sexual risk for HIV. In order to design future interventions to increase HIV screening uptake, we examined the interrelationship among alcohol misuse, sexual risk for HIV and HIV screening uptake among these patients. Methods A random sample of 18-64-year-old English- or Spanish-speaking patients at two EDs during July-August 2009 completed a self-administered questionnaire about their alcohol use using the Alcohol Use Questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), and the HIV Sexual Risk Questionnaire. Study participants were offered a rapid HIV test after completing the questionnaires. Binging (≥ five drinks/occasion for men, ≥ four drinks for women) was assessed and sex-specific alcohol misuse severity levels (low-risk, harmful, hazardous, dependence) were calculated using AUDIT scores. Analyses were limited to participants who had sexual intercourse in the past 12 months. Multivariable logistic regression was used to assess the associations between HIV screening uptake and (1) alcohol misuse, (2) sexual risk for HIV, and (3) the intersection of HIV sexual risk and alcohol misuse. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. All models were adjusted for patient demographic characteristics and separate models for men and women were constructed. Results Of 524 participants (55.0% female), 58.4% identified as white, non-Hispanic, and 72% reported previous HIV testing. Approximately 75% of participants reported drinking alcohol within the past 30 days and 74.5% of men and 59.6% of women reported binge drinking. A relationship was found between reported sexual risk for HIV and alcohol use among men (AOR 3.31 [CI 1.51-7.24]) and women (AOR 2.78 [CI 1.48-5.23]). Women who reported binge drinking were more likely to have higher reported sexual risk for HIV (AOR 2.55 [CI 1.40-4.64]) compared to women who do not report binge drinking. HIV screening uptake was not higher among those with greater alcohol misuse and sexual risk among men or women. Conclusions The apparent disconnection between HIV screening uptake and alcohol misuse and sexual risk for HIV among ED patients in this study is concerning. Brief interventions emphasizing these associations should be evaluated to reduce alcohol misuse and sexual risk and increase the uptake of ED HIV screening.
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