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Haukoos JS, White DAE, Rowan SE, Lyle C, Gravitz S, Basham K, Godoy A, Kamis K, Hopkins E, Anderson E. Development of a 2-step algorithm to identify emergency department patients for HIV pre-exposure prophylaxis. Am J Emerg Med 2021; 51:6-12. [PMID: 34649008 DOI: 10.1016/j.ajem.2021.09.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Expanded access to HIV PrEP is a central pillar of the "Ending the HIV Epidemic" initiative. Identification of PrEP eligible individuals in EDs remains understudied. Our goal was to estimate the accuracy of the Denver HIV Risk Score (DHRS), a quantitative HIV risk tool, for determining PrEP eligibility, and to incorporate it into a novel screening algorithm to optimize sensitivity and specificity. METHODS We performed a prospective cross-sectional study in two urban EDs. Patients were eligible if ≥18 years of age and without HIV. Research staff collected individual HIV risk, components of the DHRS, and PrEP eligibility per 2017 CDC guidelines. Accuracy estimates were calculated for the DHRS alone and the DHRS plus additional PrEP-specific questions. RESULTS 1002 patients were enrolled with a median age of 39 years; 54.8% were male, 29.5% Black/non-Hispanic, and 22.5% Hispanic. Overall, 119 (11.9%, 95% CI: 9.9%-14.0%) were PrEP eligible; 5% endorsed history of sex with a partner at higher risk for HIV or condomless sex with multiple partners, 4% an STI, and 2% sharing IDU equipment. A DHRS ≥25 had a sensitivity of 92.4% (95% CI: 86.1%-96.5%) and a specificity of 17.2% (95% CI: 14.8%-19.9%) for PrEP eligibility. A 2-step algorithm, "DHRS-PrEP", beginning with a DHRS ≥25, followed by a step with questions specific to IDU, STI, and sexual partners improved the specificity to 100% (95% CI: 99.6%-100%). CONCLUSIONS Among a heterogeneous ED sample, a substantial proportion was identified as PrEP eligible, and a 2-step algorithm had high sensitivity and specificity for identifying PrEP-eligible patients.
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Affiliation(s)
- Jason S Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America; Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States of America.
| | - Douglas A E White
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA, United States of America
| | - Sarah E Rowan
- Division of Infectious Diseases, Denver Health Medical Center and University of Colorado School of Medicine, Aurora, CO, United States of America; Public Health Institute at Denver Health, Denver, CO, United States of America
| | - Carolynn Lyle
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, United States of America
| | - Stephanie Gravitz
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, United States of America
| | - Kellie Basham
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA, United States of America
| | - Ashley Godoy
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA, United States of America
| | - Kevin Kamis
- Public Health Institute at Denver Health, Denver, CO, United States of America
| | - Emily Hopkins
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, United States of America; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Erik Anderson
- Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA, United States of America
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