141st APHA Annual Meeting and Exposition

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290803
Efficacy of non-targeted HIV testing in detecting HIV positive patients in the emergency department


Wednesday, November 6, 2013

Rebecca Schnall, RN, MPH, PhD, School of Nursing, Columbia University, New York, NY
Nan Liu, PhD, Mailman School of Public Health, Columbia University, New York, NY
Jeremy Sperling, MD, Emergency Medicine, Weill Cornell Medical College, New York, NY
Robert Green, MD, College of Physicians and Surgeons Columbia University, Department of Emergency Medicine, New York, NY
Sunday Clark, ScD, Emergency Medicine, Weill Cornell Medical College, New York, NY
David Vawdrey, PhD, Department of Biomedical Informatics, Columbia UniversityCollege of Physicians and Surgeons, new york, NY
Objective: In 2010, New York State (NYS) enacted legislation requiring health care providers in acute, emergency, and primary care settings to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13–64. Non-targeted testing can be challenging in busy emergency departments (EDs), which are frequently overcrowded and under-resourced. The purpose of this study was to assess the impact of the legislation on HIV testing rates and the diagnosis of HIV-positive individuals in the emergency care setting.

Methods: In three urban adult emergency departments using an electronic health record, an HIV Testing order set was created to allow clinicians to document whether an HIV test was offered. After 10-19.5 weeks, depending on site, an electronic alert was implemented that required the order set to be completed before ED discharge. We analyzed data from 79,786 treat-and-release visits, measuring HIV testing and detection rates before and after the implementation of the electronic alert.

Results: The percentage of visits where HIV tests were performed increased from 5.4% to 8.7% after the electronic alert. The rate of detection of HIV decreased from 0.55 cases per patient tested to 0.48 cases per patient tested after the implementation of the alert.

Conclusions: An electronic alert which encouraged non-targeted screening was effective at increasing HIV testing rates. In spite of the considerable increase in testing, we observed only a modest increase in the rate of identifying HIV-positive individuals. Findings from our study suggest that targeted screening may enable better identification of HIV-positive patients, while expending fewer resources.

Learning Areas:

Implementation of health education strategies, interventions and programs
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Describe current HIV testing guidelines and legislation Compare targeted vs. non-targeted HIV screening and how these have been implemented and studied in different settings Assess the effectiveness of non-targeted HIV screening in the ED

Keyword(s): HIV/AIDS, Emergency Department/Room

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: My employment and academic training for the past 10 years has been focused on undeserved populations, namely persons living with HIV. My most recent work has been focused on HIV prevention and testing. Currently, I have a NIH funded study entitled “Using Queuing Theory to Improve HIV testing in the Emergency Department.” The goal of this work is to understand the implementation of the New York State HIV testing law in the ED.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5009.0: HIV prevention among specific populations