Implementation of a Best Practice Advisory-Based HIV Screening Program in the Emergency Department with Integrated...

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Services Research

Background:

• National guidelines advocate for universal HIV screening, yet emergency departments (EDs) often miss testing opportunities.
• EDs serve as crucial primary care access points for vulnerable populations.
• Barriers to HIV screening in the ED setting require innovative solutions.

Purpose of the Study:

• To describe a collaborative ED-based program designed to reduce barriers to HIV screening.
• To evaluate the effectiveness of a best practice alert (BPA)-based opt-out HIV screening program.
• To assess outcomes including diagnosis, linkage to care, and treatment initiation.

Main Methods:

• Retrospective, observational study of an opt-out HIV screening program in an ED (Detroit, MI, 2019-2025).
• Collaboration between ED and Infectious Disease (ID) teams.
• Analysis of medical records for newly diagnosed HIV infections from screening, focusing on demographics, clinical features, and outcomes.

Main Results:

• Out of 75,914 patients screened, 176 (0.23%) were newly diagnosed with HIV.
• Nearly 60% of newly diagnosed patients were linked to care within 90 days (median 13 days).
• Median time to antiretroviral therapy initiation was 9 days, with 72.9% achieving viral suppression at 12 months.

Conclusions:

• A BPA system, supported by ED and ID team collaboration, can overcome structural barriers to HIV screening.
• This approach enhances equitable access to diagnosis, care linkage, and treatment for individuals with limited healthcare access.
• The program demonstrates a successful model for integrating HIV screening into emergency care settings.