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. 2016 Jan-Feb;131 Suppl 1(Suppl 1):96-106.
doi: 10.1177/00333549161310S112.

Evolution and Escalation of an Emergency Department Routine, Opt-out HIV Screening and Linkage-to-Care Program

James W Galbraith  1 , James H Willig  2 , Joel B Rodgers  1 , John P Donnelly  3 , Andrew O Westfall  2 , Kelly L Ross-Davis  2 , Sonya L Heath  2
Affiliations

Evolution and Escalation of an Emergency Department Routine, Opt-out HIV Screening and Linkage-to-Care Program

James W Galbraith et al. Public Health Rep. 2016 Jan-Feb.

Abstract

Objective: The Centers for Disease Control and Prevention has recommended emergency department (ED) opt-out HIV screening since 2006. Routine screening can prove challenging due to the ED's complexity and competing priorities. This study examined the implementation and evolution of a routine, integrated, opt-out HIV screening program at an urban academic ED in Alabama since August 2011.

Methods: ED routine, opt-out HIV screening was implemented as a standard of care in September 2011. To describe the outcomes and escalation of the screening program, data analyses were performed from three separate data queries: (1) encounter-level HIV screening questionnaire and test results from September 21, 2011, through December 31, 2013; (2) test-level, fourth-generation HIV results from July 9 through December 31, 2013; and (3) daily HIV testing rates and trends from September 9, 2011, through June 30, 2014.

Results: Of the 46,385 HIV screening tests performed, 252 (0.5%) were confirmed to be positive. Acute HIV infection accounted for 11.8% of all HIV patients identified using the fourth-generation HIV screening assay. Seventy-six percent of confirmed HIV-positive patients had successful linkage to care. Implementation of fourth-generation HIV instrument-based testing resulted in a 15.0% decline in weekly HIV testing rates. Displacement of nursing provider HIV test offers from triage to the bedside resulted in a 31.6% decline in weekly HIV testing rates.

Conclusion: This program demonstrated the capacity for high-volume, routine, opt-out HIV screening. Evolving ED challenges require program monitoring and adaptation to sustain scalable HIV screening in EDs.

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Figures

Figure 1
Figure 1
Timeline of programmatic changes in HIV test offering, conversion to fourth-generation HIV instrument-based testing, adoption of Multispot for confirmatory testing, and data acquisition, University of Alabama at Birmingham Emergency Department, August 2011 through June 2014
Figure 2
Figure 2
Fourth-generation HIV screening algorithm using supplemental OraQuick HIV testing to identify potential acute HIV infection at the point of care, University of Alabama at Birmingham Emergency Department laboratory, July 2013 to June 2014
Figure 3
Figure 3
HIV screening questionnaire and testing results by encounter flowchart, University of Alabama at Birmingham Emergency Department, September 21, 2011, through December 31, 2013
Figure 4
Figure 4
Identification of acute HIV infection using fourth-generation HIV assay, University of Alabama at Birmingham Emergency Department, July 9 through December 31, 2013
Figure 5
Figure 5
Impact of HIV screening programmatic changes implementing fourth-generation instrument-based testing and displacement of HIV test offering from nursing triage on weekly volume of HIV tests performed, University of Alabama at Birmingham Emergency Department, September 9, 2011, through June 30, 2014
See this image and copyright information in PMC

References

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