Assessing the Impact of an Sexually Transmitted Infections Nurse on the Delivery of Sexually Transmitted Infections/Human Immunodeficiency Virus Services in an Inner-City Emergency Department Using a Human Immunodeficiency Virus/Syphilis Point-of-Care Test During a Syphilis Outbreak in Alberta, Canada.

BACKGROUND: A sexually transmitted infection (STI) nurse was embedded in an emergency department (ED) to support implementation of human immunodeficiency virus (HIV) and syphilis point-of-care testing (POCT).

METHODS: Outcomes were compared between two time periods: (1) routine care and (2) the introduction of HIV/syphilis treponemal POCT and an STI nurse. POCT and standard serology were offered to eligible people with HIV or syphilis as a differential diagnosis, who were at risk of loss to follow-up, or who were pregnant without prenatal screening. Testing volumes, rates of new diagnoses, and treatment initiation between the time periods were compared using Chi-square or Fisher exact tests for categorical variables and Mann-Whitney U test for continuous variables.

RESULTS: A total of 2689 visits included HIV or syphilis testing, with serology more common in the postintervention period than in the preintervention period (HIV: 91.0% vs 81.4%, P < 0.001; syphilis: 86.4% vs 77.8%, P < 0.001). Rates of newly diagnosed syphilis increased slightly in the postintervention period (0.12% vs 0.09%; P = 0.07), with more same-visit syphilis treatment initiated in the postintervention period (54.1% vs 17.6%, P < 0.001). The number of newly diagnosed syphilis cases was 46.7% higher in STI registered nurse (RN) visits (n = 44) than ED Staff-only (n = 30), all new cases of HIV were found during STI RN visits, and POCT was ordered in 78.4% (n = 472) of the STI RN visits as compared with 15.6% (n = 178) of visits with ED staff-only ( P < 0.001).

CONCLUSIONS: An STI nurse in an urban ED contributed to the increased HIV and syphilis testing rates, and same-visit syphilis treatment initiation.