Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026
Increasing HIV Testing During Gonorrhea and Chlamydia Evaluations in Urgent Care and Emergency Departments: A Large Health System Initiative.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Seibert Allan M, Matheu Michelle, Buckel Whitney R, Bledsoe Joseph, Willis Park, Balls Adam, Butler Allison M, Moores Todd Tamara D, Vines Caroline, Hellewell James, Smout Randall, Lopansri Bert, Stanfield Valoree, Fino Nora F, Wormser Vanessa R, Gutierrez Armeny, Gwiazdon Matt, Wallin Anthony, Patel Payal K, Hersh Adam L, Webb Brandon J, Stenehjem Eddie
Аннотация
BACKGROUND: HIV testing opportunities are often missed during urgent care (UC) and emergency department (ED) evaluations for sexually transmitted infections. We implemented a multimodal diagnostic stewardship intervention to increase HIV testing in UC and ED gonorrhea (GC)/chlamydia (CT) testing encounters ("HIV co-testing").
METHODS: We conducted a pre-/post implementation study across 26 UCs and 22 EDs in our health system (April 2022-March 2024). The intervention included system-wide simultaneous implementation of provider and patient education and a link-to-care program for newly diagnosed people with HIV (PWH) and patients needing additional testing, followed by phased activation of an electronic health record alert prompting HIV co-testing. We estimated the impact of the intervention on HIV GC/CT co-testing using interrupted time series analysis, measured alert engagement, and described the impact of the link-to-care program.
RESULTS: By the end of the intervention period, HIV GC/CT co-testing rates were 12.7% points higher in UC (95% CI 6.2-19.2), a 41.9% relative increase (P < .001) compared with preintervention trends. In the ED, co-testing rates rose 12.3% points (95% CI 1.08-23.6), a 53.4% relative increase (P = .02). A total of 4704 alerts fired, resulting in 730 alert-associated HIV co-tests. During the intervention, 17 PWH were newly diagnosed: 5 (29%) were due to alert-associated co-tests. All PWH and those requiring additional testing received prompt linkage to care.
CONCLUSIONS: HIV GC/CT co-testing increased in UC and ED during our intervention, leading to new HIV diagnoses and linkage to care. Integrating HIV co-testing into GC/CT testing encounters improved HIV screening practices in our large health system.
METHODS: We conducted a pre-/post implementation study across 26 UCs and 22 EDs in our health system (April 2022-March 2024). The intervention included system-wide simultaneous implementation of provider and patient education and a link-to-care program for newly diagnosed people with HIV (PWH) and patients needing additional testing, followed by phased activation of an electronic health record alert prompting HIV co-testing. We estimated the impact of the intervention on HIV GC/CT co-testing using interrupted time series analysis, measured alert engagement, and described the impact of the link-to-care program.
RESULTS: By the end of the intervention period, HIV GC/CT co-testing rates were 12.7% points higher in UC (95% CI 6.2-19.2), a 41.9% relative increase (P < .001) compared with preintervention trends. In the ED, co-testing rates rose 12.3% points (95% CI 1.08-23.6), a 53.4% relative increase (P = .02). A total of 4704 alerts fired, resulting in 730 alert-associated HIV co-tests. During the intervention, 17 PWH were newly diagnosed: 5 (29%) were due to alert-associated co-tests. All PWH and those requiring additional testing received prompt linkage to care.
CONCLUSIONS: HIV GC/CT co-testing increased in UC and ED during our intervention, leading to new HIV diagnoses and linkage to care. Integrating HIV co-testing into GC/CT testing encounters improved HIV screening practices in our large health system.