Benefits of a routine opt-out HIV testing and linkage to care program for previously diagnosed patients in publicly funded emergency departments in Houston, TX.

BACKGROUND: The Routine Universal Screening for HIV program provides opt-out HIV testing and linkage to care for emergency department (ED) patients in Harris Health System, Houston, TX. Seventy-five percent of patients testing positive in this program have been previously diagnosed. Whether linkage to care is increased among these patients is unknown. METHODS: We conducted a retrospective cohort study of persons tested for HIV in the ED between 2008 and 2012 but had a previously documented positive HIV test ≥1 year prior. Outcomes were engagement in care (≥1 HIV outpatient visits in 6 months), retention in care (≥2 HIV outpatient visits in 12 months, at least 3 months apart), and virologic suppression (<200 copies/mL in 12 months) compared before and after the ED visit. Analysis was conducted using McNemar test and multivariate conditional logistic regression. RESULTS: A total of 202,767 HIV tests identified 2068 previously diagnosed patients. The mean age was 43 years with 65% male and 87% racial and ethnic minorities. Engagement in care increased from 41.3% previsit to 58.8% postvisit (P < 0.001). Retention in care increased from 32.6% previsit to 47.1% postvisit (P < 0.001). Virologic suppression increased from 22.8% previsit to 34.0% postvisit (P < 0.001). Analyses revealed that engagement in care after visit improved most among younger participants (ages 16-24 years), retention improved across all groups, and virologic suppression improved most among participants aged 25-34 years. CONCLUSIONS: Routine opt-out HIV testing in an ED paired with standardized service linkage improves engagement, retention, and virologic suppression in previously diagnosed patients.

Using nonrapid HIV technology for routine, opt-out HIV screening in a high-volume urban emergency department.

OBJECTIVE: We implement an opt-out routine screening program in a high-volume, urban emergency department (ED), using conventional (nonrapid) technology as an alternative to rapid HIV tests. METHODS: We performed a retrospective cohort study. Since October 2008, all patients who visited Ben Taub General Hospital ED and had blood drawn were considered eligible for routine opt-out HIV screening. The hospital is a large, publicly funded, urban, academic hospital in Houston, TX. The ED treats approximately 8,000 patients monthly. Screening was performed with standard chemiluminescence technology, batched hourly. Patients with positive screening test results were informed of their likely status, counseled by a service linkage worker, and offered follow-up care at an HIV primary care clinic. Confirmatory Western blot assays were automatically performed on all new HIV-positive samples. RESULTS: Between October 1, 2008, and April 30, 2009, 14,093 HIV tests were performed and 39 patients (0.3%) opted out. Two hundred sixty-two (1.9%) HIV test results were positive and 80 new diagnoses were made, for an incidence of new diagnoses of 0.6%. There were 22 false-positive chemiluminescence results and 7 indeterminate Western blot results. Nearly half the patients who received a new diagnosis were not successfully linked to HIV care in our system. CONCLUSION: Opt-out screening using standard nonrapid technology, rather than rapid testing, is feasible in a busy urban ED. This method of HIV screening has cost benefits and a low false-positivity rate, but aggressive follow-up and referral of patients with new diagnoses for linkage to care is required.