Low sensitivity of CDC guidelines and limited AUC of HIRI-MSM and Gilead screening tools are of concern for PrEP implementation among most at risk populations such as YBMSM. Consideration of demographics, local epidemiology, and network factors may better guide identification of clients who could benefit most from PrEP.

Emergency Departments (EDs) have the potential to play a crucial role in HIV prevention by identifying and linking high-risk HIV-negative clients to preexposure prophylaxis (PrEP) care, but it is difficult to perform HIV risk assessment for all ED patients. We aimed to develop and implement an electronic risk score to identify ED patients who are potential candidates for PrEP. Using electronic medical record (EMR) data, we used logistic regression to model the outcome of PrEP eligibility. We converted the model into an electronic risk score and incorporated it into the EMR. The risk score is automatically calculated at triage. For patients whose risk score is above a given threshold, an automated electronic alert is sent to an HIV prevention counselor who performs real time HIV prevention counseling, risk assessment, and PrEP linkage as appropriate. The electronic risk score includes the following EMR variables: age, gender, gender of sexual partner, chief complaint, and positive test for sexually transmitted infection in the prior 6 months. A risk score ≥21 has specificity of 80.6% and sensitivity of 50%. In the first 5.5 months of implementation, the alert fired for 180 patients, 34.4% (62/180) of whom were women. Of the 51 patients who completed risk assessment, 68.6% (35/51) were interested in PrEP, 17.6% (9/51) scheduled a PrEP appointment, and 7.8% (4/51) successfully initiated PrEP. The measured number of successful PrEP initiations is likely an underestimate, as it does include patients who initiated PrEP with outside providers or referred acquaintances for PrEP care.

Background: The COVID-19 pandemic has worsened the opioid overdose crisis in the US. Rural communities have been disproportionately affected by opioid use and people who use drugs in these settings may be acutely vulnerable to pandemic-related disruptions due to high rates of poverty, social isolation, and pervasive resource limitations. Methods: We performed a mixed-methods study to assess the impact of the pandemic in a convenience sample of people who use drugs in rural Illinois. We conducted 50 surveys capturing demographics, drug availability, drug use, sharing practices, and mental health symptoms. In total, 19 qualitative interviews were performed to further explore COVID-19 knowledge, impact on personal and community life, drug acquisition and use, overdose, and protective substance use adaptations. Results: Drug use increased during the pandemic, including the use of fentanyl products such as gel encapsulated “beans” and “buttons”. Disruptions in supply, including the decreased availability of heroin, increased methamphetamine costs and a concomitant rise in local methamphetamine production, and possible fentanyl contamination of methamphetamine was reported. Participants reported increased drug use alone, experience and/or witness of overdose, depression, anxiety, and loneliness. Consistent access to harm reduction services, including naloxone and fentanyl test strips, was highlighted as a source of hope and community resiliency. Conclusions: The COVID-19 pandemic period was characterized by changing drug availability, increased overdose risk, and other drug-related harms faced by people who use drugs in rural areas. Our findings emphasize the importance of ensuring access to harm reduction services, including overdose prevention and drug checking for this vulnerable population.

The impact of the COVID-19 pandemic on syphilis rates is unknown. A retrospective chart review was performed of all patients screened for syphilis through universal screening in a large, urban emergency department from June 2019 to June 2020. During the early pandemic (April through June 2020), screening rates remained similar, but the rate of presumed active infection increased from 1.2% to 1.8% (prevalence ratio, 1.54; 95% confidence interval, 1.17-2.00; P < 0.01), with significant increases among adolescents and women. Only 19.2% of patients with presumed active infection presented for STI-related complaints. Universal screening represents a valuable tool for achieving syphilis control within high-prevalence communities.R ates of primary and secondary (P&S) and congenital syphilis in the United States are at their highest in decades. 1 This resurgence has been driven by changes in sexual behavioral trends, HIV risk compensation, and lack of widespread testing. 2 In early 2020, major public health measures were implemented in an effort to mitigate the novel coronavirus disease 2019 (COVID-19) pandemic. In addition to regional lockdowns, access to outpatient medical care in many areas was either significantly reduced or completely halted. 3 Some have speculated lockdowns offer an opportunity for sexually transmitted infection (STI) control in endemic communities; however, others are concerned about increasing STI rates during this time, citing widening inequities in accessing sexual health services. 4,5 This brief report aims to describe changes in presumed syphilis rates at a large, urban emergency department (ED) during the COVID-19 pandemic. METHODSA routine, opt-out syphilis screening program was initiated at a large, tertiary care hospital ED in Chicago in mid-May 2019, 6 which remained largely unaffected during the pandemic. 7 The screening model uses existing electronic health record (EHR) infrastructure for HIV screening based on Centers for Disease Control and Prevention guidelines: patients are flagged for HIV and syphilis screening if they are between ages 18 and 64 years, have no documented diagnosis of HIV, and have not been screened for HIV within the past 12 months. Test ordering is ultimately dependent on nurse or clinician input, and tests can be ordered on any patient at their discretion.A retrospective chart review was performed of all patients screened for syphilis in the ED between June 1, 2019, and June 30, 2020. The first local COVID-19 case was identified in early March 2020, and the first stay-at-home orders were enforced by the middle of that month. For this analysis, data from the period of June 1, 2019, through March 30, 2020, were used as a prepandemic baseline, whereas April 1 through June 30, 2020, was considered the pandemic period.