Implementation of Systems to Support Status-Neutral HIV Care in the Emergency Department

To assess the impact of the implementation of an electronic medical record (EMR)-based sexually transmitted infection (STI) order set on human immunodeficiency virus (HIV) testing rates and the acceptability of status-neutral HIV Care in the emergency department (ED).

We developed and implemented an STI order set integrated into the EMR to streamline HIV testing and status-neutral care. The cohort included ED encounters from April 2022 to December 2023 in which patients were tested for chlamydia or gonorrhea. We measured the adoption and acceptability of the order set among clinicians through surveys and analyzed the impact on rates of HIV testing and referral to Infectious Diseases using regression models.

Of 3922 ED encounters, 1161 (29.6%) included an HIV test. The introduction of the STI order set in February 2023 correlated with increased testing rates for all STIs, including a significant rise in HIV testing ( P < 0.001). Survey data indicated that a majority of attending ED physicians were aware of and had used the order set. Despite low overall usage (6.8%), the order set was perceived to improve efficiency. Male gender and Black/African American race were significantly associated with increased HIV testing.

The implementation of an EMR-based STI order set was associated with improved HIV testing rates in the ED and was well received by clinicians, although its low usage suggests a need for further promotion and training. The study highlights the potential of systems-based interventions to enhance status-neutral care and reduce missed opportunities for HIV diagnosis.