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

• Published in: Public health reports (1974) 2016-01, Vol.131 (1_suppl), p.96-106
• Main Authors: Galbraith, James W., Willig, James H., Rodgers, Joel B., Donnelly, John P., Westfall, Andrew O., Ross-Davis, Kelly L., Heath, Sonya L.
• Format: Article
• Language: English
• Subjects: Adaptation; Adolescent; Adult; AIDS Serodiagnosis - methods; AIDS Serodiagnosis - statistics & numerical data; Alabama - epidemiology; Assaying; Biological evolution; Complexity; Continuity of Patient Care - organization & administration; Continuity of Patient Care - statistics & numerical data; Data processing; Diagnostic Tests, Routine; Disease control; Displacement; Emergencies; EMERGENCY DEPARTMENT SETTINGS; Emergency medical care; Emergency medical services; Emergency Service, Hospital - organization & administration; Escalation; HIV; HIV Infections - diagnosis; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Implementation; Infections; Mass Screening - methods; Mass Screening - organization & administration; Medical screening; Medical tests; Middle Aged; Nurses; Nursing; Patient Acceptance of Health Care; Patients; Prevention; Priorities; Program Development; Public health; Queries; Screening; Surveys and Questionnaires; Young Adult
• ISSN: 0033-3549; 1468-2877
• DOI: 10.1177/00333549161310S112

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. Seventysix 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.