Affiliation:
1. Prisma Health Department of Emergency Medicine Greenville South Carolina USA
2. University of South Carolina School of Medicine Greenville Greenville South Carolina USA
3. Clemson University School of Health Research Clemson University Clemson South Carolina USA
4. Prisma Health Department of Internal Medicine Greenville South Carolina USA
5. Prisma Health Addiction Medicine Center Greenville South Carolina USA
Abstract
AbstractObjectivesThe objective of this study was to identify the number of missed opportunities (MO) for human immunodeficiency virus (HIV) diagnoses within our emergency departments (EDs) and assess any significant associated patient characteristics. Following current Centers for Disease Control guidelines, an opt‐out HIV screening program was implemented in 2 of 7 EDs within a large Southern healthcare system. This study sought to differentiate the risk of MO in opt‐out compared to clinician‐initiated, risk‐based ED screening protocols.MethodsA retrospective analysis was conducted from August 2019 to March 2022 of adult patients (≥18 years old) screened for HIV, comparing the ED screening method and characterization of all MOs. MO was defined as any ED visit, before HIV seropositivity, that included sexually transmitted infection screening and/or treatment with no HIV screening. Two EDs implemented generalized opt‐out screening for all adult patients (>18 years old); whereas, the remaining 5 sites relied on clinician‐initiated screening. Patient characteristics associated with an MO were evaluated by χ2, t tests, and multivariable logistic regression.ResultsIn total, 19,423 patients were screened for HIV, 142 of who tested positive. Of the 142 HIV‐positive individuals, 12 (8.5%) had 1 MO and 3 of 12 (25%) had 2. The proportion of patients with a MO was significantly higher at clinician‐initiated EDs as compared opt‐out EDs (41.7% vs 13.9%, P = 0.01). After adjusting for demographics, individuals seen at clinician‐initiated EDs were more likely to have a MO compared opt‐out EDs (adjusted odds ratio, 4.64; 95% confidence interval, 1.18–18.27; P = 0.02).ConclusionThis novel study highlights the success and overall high positivity (0.7%) of an ED‐based opt‐out screening program. Taken together, the implementation of generalized opt‐out screening within a large Southern healthcare system can rapidly increase overall screening, uncover a surprisingly high positivity rate, and decrease MOs for HIV diagnosis.