Trends and outcomes in emergency department-based HIV screening in a community healthcare system in South Florida, 2018 - 2024.

BACKGROUND

This study evaluated trends and outcomes in emergency department (ED)-based HIV screening across pre-, during, and post-pandemic periods in a community healthcare system.

METHODS

ED-based HIV screening across three distinct periods: pre-pandemic (June 2018-February 2020), pandemic (March 2020-June 2022), and post-pandemic (July 2022-February 2024) was analyzed using Joinpoint regression models. Monthly percent change (MPC) was calculated to describe trends in HIV test acceptance and positivity rates. The projected HIV test acceptance and positivity rates, estimated from the pre-pandemic trends, were compared with observed rates during the pandemic to evaluate the impact of the COVID-19 pandemic on ED-based HIV screening.

RESULTS

During the pandemic, monthly HIV test acceptance rates decreased, followed by a partial recovery in the post-pandemic period, but they remained below the pre-pandemic levels. HIV positivity rate was significantly higher during the pandemic than in the pre- and post-pandemic periods (p = 0.004 and p = 0.015, respectively). Trends in monthly HIV test acceptance rates were stable pre-pandemic (MPC = -0.05, 95 % CI: -0.95, 0.83; p = 0.925), increased during the pandemic (MPC = 1.91, 95 % CI: 0.33, 3.53; p = 0.018), and declined post-pandemic (MPC = -1.08, 95 % CI: -1.78, -0.39; p = 0.002). Monthly HIV test positivity rates remained stable pre- and post-pandemic but increased during the pandemic (MPC = 3.03, 95 % CI: 1.67, 4.41; p < 0.001). Observed HIV test acceptance rate was comparable to model-projected rate (p = 0.973), whereas observed HIV positivity rate was significantly higher than model-projected rate (p = 0.002).

CONCLUSIONS

Our findings indicate reduced HIV test acceptance but increased positivity rates during the pandemic, highlighting the need to optimize testing strategies to mitigate missed tests. Insights into the disruptions caused by COVID-19 could help strengthen health systems in preparation for future public health crises.