Benefits of a Routine Opt-Out HIV Testing and Linkage to Care Program for Previously Diagnosed Patients in Publicly Funded Emergency Departments in Houston, TX

Abstract

Background The Routine Universal Screening for HIV (RUSH) program provides opt-out HIV testing and linkage to care for emergency department (ED) patients in Harris Health System, Houston, TX. Seventy-five percent of patients testing positive in this program have been previously diagnosed. Whether linkage to care is increased among these patients is unknown. Methods We conducted a retrospective cohort study of persons tested for HIV in the ED between 2008–2012 but had a previously documented positive HIV test ≥1 year prior. Outcomes were engagement in care (≥1 HIV outpatient visits in 6 months), retention in care (≥2 HIV outpatient visits in 12 months, at least 3 months apart) and virologic suppression (<200 c/ml in 12 months) compared before and after the ED visit. Analysis was conducted using McNemar’s test and multivariate conditional logistic regression. Results A total of 202,767 HIV tests identified 2068 previously diagnosed patients. The mean age was 43 years with 65% male and 87% racial and ethnic minorities. Engagement in care increased from 41.3% pre-visit to 58.8% post-visit (P<0.001). Retention in care increased from 32.6% pre-visit to 47.1% post-visit (P<0.001). Virologic suppression increased from 22.8% pre-visit to 34.0% post-visit (P<0.001). Analyses revealed that engagement in care after visit improved most among younger participants (ages 16 to 24), retention improved across all groups, and virologic suppression improved most among participants 25 to 34 years old. Conclusions Routine opt-out HIV testing in an ED paired with standardized service linkage improves engagement, retention, and virologic suppression in previously diagnosed patients.

Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review

“…Reengagement studies reported on 8 different outcomes; three of the four studies reported viral load or viral suppression as one of their outcomes. Three of these four studies found significant improvements in engagement in care following the intervention, though these significant impacts included a range of effect sizes (such as a 5% increase in re-linkage [24], 11.2% increase in viral suppression [25], and 3.9–5.4% reduction in no care in the past 6 months [26]).…”

The Perilous Road from HIV Diagnosis in the Hospital to Viral Suppression in the Outpatient Clinic

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Feasibility of identifying out of care HIV-positive patients in a hospital setting and enrolling them in a retention intervention

“…Another source of identifying patients was the BTGH emergency center’s routine HIV testing program. Routine screening helped identify persons with HIV infection, including many diagnosed elsewhere but not known positive in our system 19 . These latter recruitment methods were most fruitful when persons were newly diagnosed with HIV infection during the course of their hospital stay, since the census review focused on what was known at the time of admission.…”