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. 2025 Jul 3;6(4):100203.
doi: 10.1016/j.acepjo.2025.100203. eCollection 2025 Aug.

Development of a Quality Measure to Improve HIV and Syphilis Screening in the Emergency Department: A Modified Delphi Approach

Tehreem Rehman  1 , Christopher Bennett  2 , Herbert C Duber  3 , Michael S Lyons  4 , Michael P Phelan  5 , Rachel E Solnick  6 , Kimberly A Stanford  7 , Erena Weathers  6   8 , Arjun K Venkatesh  9 , Michelle P Lin  2
Affiliations

Development of a Quality Measure to Improve HIV and Syphilis Screening in the Emergency Department: A Modified Delphi Approach

Tehreem Rehman et al. J Am Coll Emerg Physicians Open. .

Abstract

Emergency department (ED) screening is an important strategy to address the persistent human immunodefiency virus (HIV) epidemic; however, ED screening rates remain low. This study describes the development of a quality measure to improve screening rates for HIV among ED patients. A panel of 10 emergency physicians with expertise in ED-based preventive health and quality measurement employed a 3-round modified Delphi process. The panel reviewed peer-reviewed literature and national guidelines to identify high-risk patient populations; participated in anonymous surveys to rank ED screening approaches based on the impact and feasibility of measurement and practice; and discussed survey rankings in consensus discussions. The highest impact and most feasible group to target for quality measurement were ED patients already undergoing testing for other sexually transmitted infections (ie, "co-screening"). This study successfully designed a quality measure to improve coscreening for HIV in the ED. Implementing this measure could enhance detection and subsequent linkage to care, ultimately contributing to the control of these epidemics. The focus on combining screening for HIV with diagnostic testing for patients with signs and symptoms of sexually transmitted infection aligns with an emerging approach in health care settings that balances expected health impact with feasibility challenges.

Keywords: infectious disease; quality screening; reproductive health; social emergency medicine.

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Conflict of interest statement

CB: Prior honorarium from Gilead Sciences for serving on an advisory board. Other authors have affirmed they have no conflicts of interest to declare. MSL: Investigator-initiated project support paid to institution by Gilead Sciences, Inc., Columbus Public Health, and SAMHSA. KAS: Investigator-initiated project support paid to institution by Gilead FOCUS and HRSA.

Figures

Figure 1
Figure 1
Types of quality measures. ED, emergency department.
See this image and copyright information in PMC

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