Implementation of Rapid Human Immunodeficiency Virus Screening Program in an Emergency Department

Area of Science:

• Public Health
• Infectious Diseases
• Emergency Medicine

Background:

• National guidelines recommend Human Immunodeficiency Virus (HIV) screening for all patients evaluated for sexually transmitted infections (STIs).
• Compliance with HIV screening in the Emergency Department (ED) was suboptimal due to logistical challenges and delayed test results.
• Rapid HIV testing was introduced as a quality improvement initiative to address these issues.

Purpose of the Study:

• To evaluate the impact of implementing rapid HIV testing in the ED on HIV screening rates among patients presenting with STIs.
• To assess the change in HIV screening compliance following the introduction of rapid testing.

Main Methods:

• A pre- and post-intervention study design was used, collecting data over 3 months before and 3 months after implementation.
• Rapid HIV testing was introduced for patients undergoing Neisseria gonorrhea and Chlamydia trachomatis (GC/CT) testing in the ED.
• Demographic, clinical, and laboratory data were collected via chart review to assess HIV screening practices.

Main Results:

• HIV screening increased significantly from 4.3% pre-intervention to 19.8% post-intervention (P=.001).
• Rates of bacterial STIs and empiric treatment for GC/CT remained similar between the two periods.
• HIV screening rates at primary care follow-up remained low in both periods (6.2% vs. 8.4%).

Conclusions:

• Rapid HIV testing in the ED led to a nearly 5-fold increase in HIV screening for patients with STIs.
• Despite the intervention's success, overall ED HIV screening rates remain low.
• Further research is needed to address barriers to HIV screening during primary care follow-up.