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. 2015 May 1;69 Suppl 1(0 1):S8-15.
doi: 10.1097/QAI.0000000000000578.

Benefits of a routine opt-out HIV testing and linkage to care program for previously diagnosed patients in publicly funded emergency departments in Houston, TX

Charlene A Flash  1 , Siavash Pasalar, Vagish Hemmige, Jessica A Davila, Camden J Hallmark, Marlene McNeese, Nancy Miertschin, Michael C Ruggerio, Thomas P Giordano
Affiliations

Benefits of a routine opt-out HIV testing and linkage to care program for previously diagnosed patients in publicly funded emergency departments in Houston, TX

Charlene A Flash et al. J Acquir Immune Defic Syndr. .

Abstract

Background: The Routine Universal Screening for HIV program provides opt-out HIV testing and linkage to care for emergency department (ED) patients in Harris Health System, Houston, TX. Seventy-five percent of patients testing positive in this program have been previously diagnosed. Whether linkage to care is increased among these patients is unknown.

Methods: We conducted a retrospective cohort study of persons tested for HIV in the ED between 2008 and 2012 but had a previously documented positive HIV test ≥1 year prior. Outcomes were engagement in care (≥1 HIV outpatient visits in 6 months), retention in care (≥2 HIV outpatient visits in 12 months, at least 3 months apart), and virologic suppression (<200 copies/mL in 12 months) compared before and after the ED visit. Analysis was conducted using McNemar test and multivariate conditional logistic regression.

Results: A total of 202,767 HIV tests identified 2068 previously diagnosed patients. The mean age was 43 years with 65% male and 87% racial and ethnic minorities. Engagement in care increased from 41.3% previsit to 58.8% postvisit (P < 0.001). Retention in care increased from 32.6% previsit to 47.1% postvisit (P < 0.001). Virologic suppression increased from 22.8% previsit to 34.0% postvisit (P < 0.001). Analyses revealed that engagement in care after visit improved most among younger participants (ages 16-24 years), retention improved across all groups, and virologic suppression improved most among participants aged 25-34 years.

Conclusions: Routine opt-out HIV testing in an ED paired with standardized service linkage improves engagement, retention, and virologic suppression in previously diagnosed patients.

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Conflict of interest statement

Conflicts of Interest: No relevant conflicts of interest were declared by any of the authors.

Figures

Figure 1
Figure 1
Outcomes among a cohort of patients previously diagnosed with HIV infection, before and after a RUSH-era ED visit (2009–2012; N= 2068), and before and after a pre-RUSH era ED visit (2004–2007; N= 672)
See this image and copyright information in PMC

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