Impact of Mandatory HIV Screening in the Emergency Department: A Queuing Study

Liu, Nan; Schnall, Rebecca

doi:10.1002/nur.21710

Cited by 6 publications

(4 citation statements)

References 46 publications

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“…However, these approaches only decrease the burden of the initial time for consent; the time for completing the test, interpreting results and providing referral services still remains. Additionally, a study from the United States examined the effect of mandatory HIV screening in ED patients and found an increase in patient wait times, with the potential for an increase in patients absconding [28]. It is likely that hybrid models will need to be developed that combine both self-testing and provider-initiated testing approaches, with 24-hour access to counsellors and ART initiation teams.…”

Section: Discussionmentioning

confidence: 99%

Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments

et al. 2019

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BackgroundThe Eastern Cape province of South Africa has one of the highest burdens of HIV in the world. Emergency Departments (EDs) can serve as optimal clinical sites for the identification of new HIV infections and entry into care. We sought to determine the current burden of HIV disease among ED patients in the Eastern Cape.MethodsWe conducted a prospective cross-sectional observational study in the EDs of three Hospitals in the Eastern Cape province of South Africa from June 2017 to July 2018. All adult, non-critical patients presenting to the ED were systematically approached and offered a Point-Of-Care (POC) HIV test in accordance with South African guidelines. All HIV-positive individuals had their blood tested for the presence of antiretroviral therapy (ART) and the presence of viral suppression (≤ 1000 copies/ml). HIV incidence was estimated using a multi-assay algorithm, validated for a subtype C epidemic.FindingsOf the 2901 patients for whom HIV status was determined (either known HIV-positive or underwent POC HIV testing), 811 (28.0%) were HIV positive, of which 234 (28.9%) were newly diagnosed. HIV prevalence was higher in Mthatha [34% (388/1134) at Mthatha Regional Hospital and 28% (142/512) at Nelson Mandela Academic Hospital], compared to Port Elizabeth [22% (281/1255) at Livingstone Hospital]. HIV incidence was estimated at 4.5/100 person-years (95% CI: 2.4, 6.50) for women and 1.5 (CI 0.5, 2.5) for men. Of all HIV positive individuals tested for ART (585), 54% (316/585) tested positive for the presence of ARTs, and for all HIV positive participants with viral load data (609), 49% (299/609) were found to be virally suppressed.InterpretationOur study not only observed a high prevalence and incidence of HIV among ED patients but also highlights significant attrition along the HIV care cascade for HIV positive individuals. Furthermore, despite developing an optimal testing environment, we were only able to enrol a small sub-set of the ED population. Given the high HIV prevalence and high attrition in the ED population, HIV services in the ED should also develop strategies that can accommodate large testing volumes and ART initiation.

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Section: Discussionmentioning

confidence: 99%

Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments

et al. 2019

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“…In a recent survey, the vast majority of ED providers at our institution cited higher priority issues and time constraints as key barriers to HIV screening, underscoring the importance of prescreening questionnaires or nurse-driven screenings [ 15 ]. Considering the disproportionate burden of HIV among racial and ethnic minorities, many of whom are underinsured and utilize the ED as their primary source of medical care, expanding HIV screening is especially important in the ED [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of missed HIV screening opportunities among newly diagnosed individuals at an urban medical center in New York City, 2018–2022

Paer,

Ratcliffe,

Chang

et al. 2023

PLoS ONE

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Objective To identify demographic and clinical factors predictive of having a missed opportunity (MO) for HIV screening. Design Retrospective cohort study. Methods Electronic medical records were queried for individuals newly diagnosed with HIV in different sites within a large urban academic medical center in New York City between 2018 and 2022. The primary outcome was having one or more MO for HIV screening within the institution, defined as any encounter at which screening was not performed in the 365 days preceding the HIV diagnosis. Results Over one third of new diagnoses had at least one MO in the preceding year. Older individuals, cisgender women and those assigned female sex at birth, and heterosexual individuals were more likely to have at least one MO. An initial CD4 < 200 cells/ul was more likely among men who have sex with women specifically. Most MOs occurred in the emergency department and outpatient settings, with minimal HIV prevention discussions documented during each MO. Conclusions These findings suggest that populations perceived to be at lower risk for HIV are more likely to have MOs and possibly late diagnoses, and that universal HIV screening must be implemented into the workflows of emergency department and outpatient settings to facilitate early diagnosis and reduce the incidence of HIV.

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“…For example, as serologic tests are developed and virologic testing capacity expands, there are questions of where to situate central laboratories within hub-and-spoke models or how to arrange distribution of rapid point-of-care tests from a centralized point. For example, queuing modeling has been used to prospectively plan for resource allocation for other diseases, such as HIV ( 21 , 44 ). As an effective vaccine becomes available, advanced use of these models can accelerate efficient distribution by prioritizing certain values—such as maximizing equity, or minimizing costs—and can compare a range of scenarios for decision-makers.…”

Section: Moving Forward: Integrating New Evidence Into Decision-makinmentioning

confidence: 99%

Implementation Science to Respond to the COVID-19 Pandemic

Means

Wagner

Kern

et al. 2020

Front. Public Health

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The COVID-19 pandemic continues to expand globally, requiring massive public health responses from national and local governments. These bodies have taken heterogeneous approaches to their responses, including when and how to introduce and enforce evidence-based interventions—such as social distancing, hand-washing, personal protective equipment (PPE), and testing. In this commentary, we reflect on opportunities for implementation science to contribute meaningfully to the COVID-19 pandemic response. We reflect backwards on missed opportunities in emergency preparedness planning, using the example of PPE stockpiling and supply management; this planning could have been strengthened through process mapping with consensus-building, microplanning with simulation, and stakeholder engagement. We propose current opportunities for action, focusing on enhancing the adoption, fidelity, and sustainment of hand washing and social distancing; we can combine qualitative data, policy analysis, and dissemination science to inform agile and rapid adjustment to social marketing strategies to enhance their penetration. We look to future opportunities to enhance the integration of new evidence in decision-making, focusing on serologic and virologic testing systems; we can leverage simulation and other systems engineering modeling to identify ideal system structures. Finally, we discuss the ways in which the COVID-19 pandemic challenges implementation science to become more rapid, rigorous, and nimble in its approach, and integrate with public health practice. In summary, we articulate the ways in which implementation science can inform, and be informed by, the COVID-19 pandemic, looking backwards, proposing actions for the moment, and approaches for the future.

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Impact of Mandatory HIV Screening in the Emergency Department: A Queuing Study

Cited by 6 publications

References 46 publications

Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments

Targeting the HIV Epidemic in South Africa: The Need for Testing and Linkage to Care in Emergency Departments

Predictors of missed HIV screening opportunities among newly diagnosed individuals at an urban medical center in New York City, 2018–2022

Implementation Science to Respond to the COVID-19 Pandemic

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