Presentation Title

Emergency Department HIV Screening and Care Linkage in the Carolinas

Abstract

Access to care, specifically primary care and preventative care, is a challenge especially in the rural South. Regarding HIV, this is one factor that translates into more new AIDS diagnoses than any other region and more people living with HIV who unaware of their status. By implementing a routine opt-out HIV screening program in the Emergency Department, patients with limited access to healthcare are successfully diagnosed and linked to care.

Proposal Summary

According to 2016 data from the Centers for Disease Control and Prevention, over half of new HIV diagnoses occurred in the South, which includes the Carolinas. Yet access to care continues to be a problem especially in the South where many states did not expand Medicaid. Patients have few opportunities for primary or preventative care and utilize the Emergency Department when care is needed. A mounting body of evidence shows that screening patients in the Emergency Department for HIV can be effective as this screening may not take place elsewhere. Through the help of a partnership with Frontlines of Communities in the US (FOCUS), routine opt-out HIV testing was implemented at the East Carolina University (ECU)/Vidant Medical Center and Medical University of South Carolina (MUSC) Emergency Departments (EDs). The aim was to implement the CDC’s guidelines for HIV screening and therefore diagnose people living with HIV who were unaware of their HIV status or identify people living with HIV who were out of care. The secondary aim was to link these patients either into care or re-link to care. Our programs were developed to integrate testing into normal ED workflow, utilizing the existing EMR to streamline testing during the nurse assessment, and provide a linkage coordinator to initiate posttest counseling and linkage-to-care. By integrating opt-out screening into normal emergency department workflow, specifically with the ease of ordering the testing through the EMR, we were successful at screening many patients through these two sites. From March through December 2017, ECU/Vidant Medical Center screened 5,978 patients. Of those, 34 were positive for HIV (12, 35% of those were new diagnoses and 22, 64% were previously diagnosed). All 12 patients with a new diagnosis were linked to care. Seventeen patients (77%) with a known diagnosis were already in care and 2 patients (1%) with a known diagnosis were re-linked to care. During all of 2017 at MUSC, 11,038 patients were screened in the Emergency Department. Of those, 73 were positive for HIV (17, 23% of those were new diagnoses and 56 (77%) were already known. Fourteen of those patients with a new diagnosis have been linked to care. 42 patients with a known diagnosis were already in care and 11 patients with a known diagnosis were re-linked to care. Screening in the Emergency Department can be highly effective in diagnosing those with HIV, identifying those were previously diagnosed and not in care, and linking and reengaging patients into care that they would not have otherwise had. ECU had a 100% linkage rate for new patients which is above the 2010 National HIV/AIDS Strategy goal of 85%. Although MUSC had an 82% linkage rate which fell just short of the goal, it was better than many ED based HIV screening programs nationally. Of note, even though the two academic medical centers in this study were located in urban areas, a significant number of their emergency department patients came from outside the city. In the case of MUSC, one-third of the emergency department census is from outside Charleston County. This model has the potential for not only providing opportunity care for those individuals living with HIV disease but also preventing HIV infection, especially in the South, by reducing the overall community viral load. Of course, our data also point out another issue with the rural South. Some patients, even with the knowledge that they have HIV, are resistant to follow-up and engage in care. This was seen at both ECU where three patients declined to get re-linked to care and at MUSC where six patients declined to be linked or re-linked to care. Of the patients who were not linked or re-linked, one patient was deceased, one was incarcerated, and the other seven did not want to pursue treatment. There is an opportunity to continue engaging communities, especially in the rural South, in the benefit of care as well as determining the barriers patients perceive that keep them from the care.

Relevance And Significance

Access, retention, and care in rural communities Innovative strategies and tools for prevention and intervention in rural communities

Session Format

Poster Session

Keywords

Access to care, test-link-treat, routine opt-out testing, ED-based screening

Publication Type and Release Option

Presentation (Open Access)

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Sep 21st, 5:30 PM Sep 21st, 7:30 PM

Emergency Department HIV Screening and Care Linkage in the Carolinas

Access to care, specifically primary care and preventative care, is a challenge especially in the rural South. Regarding HIV, this is one factor that translates into more new AIDS diagnoses than any other region and more people living with HIV who unaware of their status. By implementing a routine opt-out HIV screening program in the Emergency Department, patients with limited access to healthcare are successfully diagnosed and linked to care.