Patient Characteristics and Subsequent Health Care Use by Location of SARS-CoV-2 Testing Initiation in a Safety-Net Health System

Khazanchi, Rohan; Winkelman, Tyler N.A.; Pandita, Deepti; Jelinek, Ryan; Shearer, Riley D.; Bodurtha, Peter

doi:10.1001/jamanetworkopen.2021.12857

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…In addition, individuals with symptomatic but untreated HIV might also have been at increased risk of symptoms requiring emergency care. Indeed, during the pandemic, patients with HIV have been shown to be more likely to seek emergency care than primary care or telehealth services ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention

Vaz-Pinto,

Ortega,

Chivite

et al. 2024

Front. Public Health

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BackgroundAround 57,000 people in Spain and Portugal currently living with HIV or chronic hepatitis C are unaware of their infection. The COVID-19 pandemic severely disrupted screening efforts for these infections. We designed an intervention to increase and sustain opportunistic blood-borne virus (BBV) screening and linkage to care (SLTC) by implementing the TEST model.MethodsThe Plan Do Study Act (PDSA) method of quality improvement (QI) was implemented in 8 healthcare organizations (HCOs), including four hospitals, two clusters of community health centers, and two community-based organizations (CBOs). Baseline assessment included a review of BBV SLTC practices, testing volume, and results 12 months before the intervention. Changes in BBV testing rates over time were measured before, during, and after the COVID-19 lockdowns in 2020. A mixed ANOVA model was used to analyze the possible effect on testing volumes among HCOs over the three study periods.InterventionBBV testing was integrated into normal clinical flow in all HCOs using existing clinical infrastructure and staff. Electronic health record (EHR) systems were modified whenever possible to streamline screening processes, implement systemic institutional policy changes, and promote QI.ResultsTwo years after the launch of the intervention in screening practices, testing volumes increased by 116%, with formal healthcare settings recording larger increases than CBOs. The start of the COVID-19 lockdowns was accompanied by a global 60% decrease in testing in all HCOs. Screening emergency department patients or using EHR systems to automate screening showed the highest resilience and lowest reduction in testing. HCOs recovered 77% of their testing volume once the lockdowns were lifted, with CBOs making the fullest recovery. Globally, enhanced screening techniques enabled HCOs to diagnose a total of 1,860 individuals over the research period.ConclusionsImplementation of the TEST model enabled HCOs to increase and sustain BBV screening, even during COVID-19 lockdowns. Although improvement in screening was noted in all HCOs, additional work is needed to develop strong patient linkage to care models in challenging times, such as global pandemics.

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Section: Discussionmentioning

confidence: 99%

Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention

Vaz-Pinto,

Ortega,

Chivite

et al. 2024

Front. Public Health

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“… 18 There is additional evidence that individuals with HIV may have been more likely to initiate care in the emergency department (ED) after the start of the COVID-19 pandemic. 19 HIV testing in EDs may offer an opportunity to capture those individuals not picked up by traditional testing programs as the pandemic, and its effects continue, and as HIV testing levels continued below pre-COVID levels for the duration of our analysis. Mail-out HIV and sexually transmitted infection testing were readily used during a pilot in Washington, District of Columbia, during the COVID-19 pandemic indicating demand for HIV testing remained in high-priority demographic areas.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on HIV Testing Among AIDS Institute–Funded Providers in New York State–A Time Series Analysis

O'Grady

Yuan

Harris

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Impact of the COVID-19 pandemic on HIV testing rates across four geographically diverse urban centres in the United States: An observational study

Moitra

Tao

Olsen³

et al. 2022

The Lancet Regional Health - Americas

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Background Non-emergent clinical services were limited or suspended during the early stages of the coronavirus disease 2019 (COVID-19) pandemic in the United States (U.S.). This could adversely impact epidemics of public health importance, such as HIV, and access to testing, which is a cornerstone of prevention efforts. Methods In this observational study, we collected HIV testing and positivity rate clinical data from four geographically diverse U.S. healthcare systems in New Orleans, Louisiana; Minneapolis, Minnesota; Providence, Rhode Island; and, Seattle, Washington. Data from 2019 to 2020 were examined to assess changes in HIV testing in community-based, emergency department, and outpatient settings. Poisson regression was used to explore trends in HIV testing through phases of the COVID-19 pandemic. Findings In outpatient settings, there was a 68-97% reduction in the number of HIV tests per week during each state's stay-at-home order period, compared to during the pre-stay-at-home order period in early 2020. HIV testing remained reduced 11-54% after states transitioned to advisory phases. The HIV positivity rate increased slightly at outpatient settings, except in New Orleans where it fell. Interpretation We found a concerning trend of substantially decreased HIV testing across four geographically diverse sites. These findings suggest that new HIV infections within the U.S. may be undiagnosed and not yet linked to clinical care and services, as a consequence of the COVID-19 pandemic. Thus, augmented efforts to identify patients and link them to HIV services will be needed as healthcare settings return to full operation. Funding U.S. National Institute of Mental Health.

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Patient Characteristics and Subsequent Health Care Use by Location of SARS-CoV-2 Testing Initiation in a Safety-Net Health System

Abstract: This cross-sectional study examines patterns in entry location for SARS-CoV-2 testing in a safety-net health system by patient demographic characteristics.

Cited by 4 publications

References 7 publications

Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention

Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention

Impact of COVID-19 on HIV Testing Among AIDS Institute–Funded Providers in New York State–A Time Series Analysis

Impact of the COVID-19 pandemic on HIV testing rates across four geographically diverse urban centres in the United States: An observational study

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