HIV detection by an emergency department HIV screening program during a regional outbreak among people who inject drugs

Abstract

Objective Multiple HIV outbreaks among persons who inject drugs (PWID) have occurred in the US since 2015. Emergency departments (EDs), recognized as essential venues for HIV screening, may play a unique role in identifying undiagnosed HIV among PWID, who frequently present for complications of injection drug use (IDU). Our objective was to describe changes in HIV diagnoses among PWID detected by an ED HIV screening program and estimate the program’s contribution to HIV diagnoses among PWID county-wide during the emergence of a regional HIV outbreak. Methods This was a retrospective study of electronically queried clinical records from an urban, safety-net ED’s HIV screening program and publicly available HIV surveillance data for its surrounding county, Hamilton County, Ohio. Outcomes included the change in number of HIV diagnoses and the ED’s contribution to case identification county-wide, overall and for PWID during 2014–2018. Results During 2014–2018, the annual number of HIV diagnoses made by the ED program increased from 20 to 42 overall, and from 1 to 18 for PWID. We estimated that the ED contributed 18% of HIV diagnoses in the county and 22% of diagnoses among PWID. Conclusions The ED program contributed 1 in 5 new HIV diagnoses among PWID county-wide, further illustrating the importance of ED HIV screening programs in identifying undiagnosed HIV infections. In areas experiencing increasing IDU, HIV screening in EDs can provide an early indication of increasing HIV diagnoses among PWID and can substantially contribute to case-finding during an HIV outbreak.

Missed Opportunities for HIV and Hepatitis C Screening Among Emergency Department Patients With Untreated Opioid Use Disorder

“…The importance of ED screening and linkage to care for HIV and HCV is well established 1–5,9,11–14 . Emergency departments also contribute to surveillance and can assist in HIV/HCV outbreak detection 5 . We found that only a few of ED patients with untreated OUD, including those with recent injection drug use, were screened for HIV or HCV at the study sites.…”

“…The importance of ED screening and linkage to care for HIV and HCV is well established 1–5,9,11–14 . Emergency departments also contribute to surveillance and can assist in HIV/HCV outbreak detection 5 .…”

“…[1][2][3][4] Patients with opioid use disorder (OUD) are at especially high-risk and are often encountered in EDs. [4][5][6][7] Despite ongoing controversy and barriers, implementation of ED HIV and HCV screening has increased significantly. 8,9 However, full implementation of nontargeted screening remains elusive.…”

Increasing HIV early diagnosis by implementing an automated screening strategy in emergency departments

“…Electronic health record‐based opportunistic HIV screenings in EDs allow for the identification of new HIV cases among people who may underestimate their exposure risk or lack access to traditional HIV testing services [ 19 , 20 , 21 ]. They are also useful for detecting and controlling possible local disease outbreaks [ 22 ]. The US Centers for Disease Control and Prevention has recommended opportunistic HIV screenings in EDs since 2006 [ 12 ].…”

COVID‐19 and beyond: Lessons learned from emergency department HIV screening for population‐based screening in healthcare settings

“…In addition to contributing data to existing systems for population surveillance, EDs may have an expanding role in sentinel surveillance. As HIV outbreaks increasingly occur [44][45][46][47][48]50 , EDs could play a role in either early identification of those outbreaks or guiding response as they evolve.…”