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

National guidelines regarding sexually transmitted infections recommend Human Immunodeficiency Virus (HIV) screening for all patients evaluated for sexually transmitted infections (STI). At our institution, compliance with HIV screening in the Emergency Department (ED) for these patients was noted to be suboptimal. Human Immunodeficiency Virus screening was limited because of HIV screening and confirmatory antigen/antibody assay being transported to another location, which caused result delays and led ED providers to defer testing to Primary Care Managers (PCMs). Rapid HIV testing was implemented in our ED as a quality improvement initiative in an effort to improve compliance with guideline recommended HIV screening for these encounters.

Rapid HIV testing for patients undergoing Neisseria gonorrhea and Chlamydia trachomatis (GC/CT) testing was implemented in the ED beginning in December 2021. Three months of pre-intervention data (August-October 2021) and 3 months of post-intervention data (December 2021-February 2022) were collected. Before the post-intervention period, ED providers received education regarding the initiative and were encouraged to include rapid HIV testing for patients presenting with STI complaints. Chart review was performed for all patients tested for GC/CT during the study period; date collected included demographic, clinical, and laboratory data to assess HIV screening practices.

A total of 571 patients underwent GC/CT testing across the study period (303 pre-intervention and 268 post-intervention). Rates of bacterial STIs were similar between the 2 periods (13.5% vs. 10.8%, pre- vs. post-intervention, respectively, P = .324). Additionally, empiric treatment for GC/CT was similar in the pre-intervention period (38.3% vs. 34.3%, P = .327) compared to the post-intervention period. Screening for HIV significantly increased following the introduction of rapid HIV testing (4.3% vs. 19.8%, P = .001). Human Immunodeficiency Virus screening rates were also assessed at primary care follow-up for those not screened in the ED. Human Immunodeficiency Virus screening at primary care follow-up remained low in the pre- and post-intervention periods (6.2% vs. 8.4%, P = .35).

Sexually transmitted infections are considered biologic markers of HIV risk, including acquisition and forward transmission. Implementation of rapid HIV testing in the ED resulted in a nearly 5-fold increase in HIV screening in patients evaluated for GC/CT. Despite this increase, the overall rate of HIV screening in the ED remained low. HIV screening during PCM follow-up remained expectedly low across the study period, given that our intervention did not target PCM follow-up. This study demonstrates the success of a relatively easy-to-implement intervention for increasing HIV screening for STI encounters in our ED. Further studies are needed to explore barriers to HIV screening at primary care follow-up and methods to improve compliance with guideline recommended screening.