Development of a 2-step algorithm to identify emergency department patients for HIV pre-exposure prophylaxis

Haukoos, Jason S.; White, Douglas A.E.; Rowan, Sarah; Lyle, Carolynn; Gravitz, Stephanie; Basham, Kellie; Godoy, Ashley; Kamis, Kevin; Hopkins, Emily; Anderson, Eric G.

doi:10.1016/j.ajem.2021.09.084

Cited by 8 publications

(21 citation statements)

References 28 publications

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“…Novel methods to identify ED patients who might benefit from HIV prevention services may be more efficient and less stigmatizing than our model. 22,26,27 These include automating the EHR to identify patients who may be at increased risk for acquiring HIV infection. 22,27 Ridgeway et al 22 demonstrated the utility of an automated EHR risk identification tool that could be used by ED navigators in selecting high-risk cohorts of patients who would likely benefit from HIV prevention counseling and PrEP.…”

Section: Discussionmentioning

confidence: 99%

“…22,26,27 These include automating the EHR to identify patients who may be at increased risk for acquiring HIV infection. 22,27 Ridgeway et al 22 demonstrated the utility of an automated EHR risk identification tool that could be used by ED navigators in selecting high-risk cohorts of patients who would likely benefit from HIV prevention counseling and PrEP. Haukoos et al 27 report a 2-step algorithm, the Denver HIV risk score-PrEP, which accurately identifies a subpopulation of PrEP-eligible ED patients and can be completed easily during triage, integrated into the EHR, and automated.…”

Section: Discussionmentioning

confidence: 99%

“…22,27 Ridgeway et al 22 demonstrated the utility of an automated EHR risk identification tool that could be used by ED navigators in selecting high-risk cohorts of patients who would likely benefit from HIV prevention counseling and PrEP. Haukoos et al 27 report a 2-step algorithm, the Denver HIV risk score-PrEP, which accurately identifies a subpopulation of PrEP-eligible ED patients and can be completed easily during triage, integrated into the EHR, and automated. Carlisle et al 26 demonstrated that an STI test and drug screen laboratory query among nearly 27,000 ED patients screening HIV negative identified 5% of them to be potentially at risk for acquiring HIV infection and could be used to target subpopulations of ED patients for PrEP counseling and referral.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of an Emergency Department Program to Identify and Link Patients at Increased Risk for Acquiring HIV Infection to Outpatient HIV Prevention Services: The HIV PreventED Program

White,

Godoy,

Jewett

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Emergency departments (ED) provide care to patients at increased risk for acquiring HIV and for many of them, the ED serves as their sole point of entry into the healthcare system. We implemented the HIV PreventED Program to increase access to HIV prevention services for ED patients. Setting: Emergency department in Oakland, CA with an annual census of 57,000 visits. Methods: This cross-sectional study evaluated the first 9 months of the HIV PreventED Program. In this program, a navigator surveyed adult HIV negative ED patients to determine their risk for acquiring HIV infection, incorporating HIV prevention counseling into their assessments. Patients at higher risk for acquiring HIV were referred to outpatient prevention services, if interested. The primary outcome measure was the number and proportion of ED patients at higher risk for acquiring HIV that followed up for outpatient prevention services. Results: There were 1,233 HIV negative patients assessed by the navigator and who received ED-based HIV prevention counseling. Of these, 193 (15.7%) were identified at higher risk and offered an outpatient referral for prevention services, of which 104 accepted (53.9%), 23 (11.9%) attended the referral, and 13 (6.7%) were prescribed pre-exposure prophylaxis (PrEP). The median time to linkage was 28 days (interquartile range 15 to 41 days). Conclusion: A navigator focused on providing ED-based HIV prevention counseling and linkage to outpatient services is feasible. Strategies to more efficiently identify ED patients at higher risk for HIV acquisition, such as automated identification of risk data from the electronic health record, and policies to improve follow up and the receipt of PrEP, such as same-day PrEP initiation, should be prospectively evaluated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Outcomes of an Emergency Department Program to Identify and Link Patients at Increased Risk for Acquiring HIV Infection to Outpatient HIV Prevention Services: The HIV PreventED Program

White,

Godoy,

Jewett

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…O conhecimento das PVHIV é importante, pois a identificação e prescrição aos indivíduos expostos ao vírus ainda são grandes desafios nos centros de saúde. (21) Muitos estudos também relatam a baixa adesão dos indivíduos (principalmente mulheres) à profilaxia, e este é um ponto importante de discussão e aconselhamento nas primeiras orientações após diagnóstico. (22) Além disso, a educação das pessoas com HIV e da comunidade sobre profilaxia é essencial para otimizar o serviço e acessibilidade, contribuindo aos profissionais de saúde para identificar a possibilidade de contágio.…”

Section: Discussionunclassified

Validação do conteúdo de um recurso audiovisual para pessoas vivendo com HIV

Duarte,

Araújo,

Silva

et al. 2023

Acta Paulista De Enfermagem

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Conflitos de interesse: nada a declarar. ResumoObjetivo: Validar o conteúdo do roteiro de um recurso audiovisual para pessoas vivendo com HIV.Métodos: Estudo metodológico com abordagem quantitativa, norteado pelo referencial teórico metodológico da psicometria. A validação de conteúdo foi realizada por juízes especialistas na área temática usando a técnica Delphi. A amostra foi composta por 22 juízes na primeira análise de validação e sete juízes na segunda análise.Resultados: Todos domínios analisados apresentaram coeficiente de validade de conteúdo (CVC) >0,80, com CVC total (CVCt) de 0,96, consistência interna quase perfeita, Alfa de Cronbach de 0,988, ICC de 0,982 [IC 95% 0,969-0,991] e p<0,005 significativo na primeira rodada de avaliação dos especialistas. Na segunda análise, os critérios usados para validação de conteúdo apresentaram CVCt de 0,97, com os critérios de objetividade, simplicidade, clareza, relevância, precisão, variedade, credibilidade e equilíbrio, atingindo 100% de aprovação.Conclusão: O roteiro foi validado quanto ao conteúdo, mostrando ser um instrumento representativo e pertinente para construção do recurso audiovisual. Ele contribui para o avanço do conhecimento científico pois apresenta resultados com rigor metodológico, com inovações no campo da educação em saúde para pessoas vivendo com HIV.

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“…The emergency department (ED) is an apt setting for leveraging the electronic medical record (EMR) system to utilize algorithms for identifying candidates for PrEP. Patients who access the ED often have co-occurring social and health risk factors for potential exposure to HIV [2][3][4][5][6][7][8][9]. Targeted screening demonstrates that many ED patients are considered at risk for HIV and prime candidates for PrEP based on their self-reported behaviors [10].…”

Section: Introductionmentioning

confidence: 99%

“There hasn’t been a push to identify patients in the emergency department”—Staff perspectives on automated identification of candidates for pre-exposure prophylaxis (PrEP): A qualitative study

Devlin,

Johnson,

Stanford

et al. 2024

PLoS ONE

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Automated algorithms for identifying potential pre-exposure prophylaxis (PrEP) candidates are effective among men, yet often fail to detect cisgender women (hereafter referred to as “women”) who would most benefit from PrEP. The emergency department (ED) is an opportune setting for implementing automated identification of PrEP candidates, but there are logistical and practical challenges at the individual, provider, and system level. In this study, we aimed to understand existing processes for identifying PrEP candidates and to explore determinants for incorporating automated identification of PrEP candidates within the ED, with specific considerations for ciswomen, through a focus group and individual interviews with ED staff. From May to July 2021, we conducted semi-structured qualitative interviews with 4 physicians and a focus group with 4 patient advocates working in a high-volume ED in Chicago. Transcripts were coded using Dedoose software and analyzed for common themes. In our exploratory study, we found three major themes: 1) Limited PrEP knowledge among ED staff, particularly regarding its use in women; 2) The ED does not have a standardized process for assessing HIV risk; and 3) Perspectives on and barriers/facilitators to utilizing an automated algorithm for identifying ideal PrEP candidates. Overall, ED staff had minimal understanding of the need for PrEP among women. However, participants recognized the utility of an electronic medical record (EMR)-based automated algorithm to identify PrEP candidates in the ED. Facilitators to an automated algorithm included organizational support/staff buy-in, patient trust, and dedicated support staff for follow-up/referral to PrEP care. Barriers reported by participants included time constraints, hesitancy among providers to prescribe PrEP due to follow-up concerns, and potential biases or oversight resulting from missing or inaccurate information within the EMR. Further research is needed to determine the feasibility and acceptability of an EMR-based predictive HIV risk algorithm within the ED setting.

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Development of a 2-step algorithm to identify emergency department patients for HIV pre-exposure prophylaxis

Cited by 8 publications

References 28 publications

Outcomes of an Emergency Department Program to Identify and Link Patients at Increased Risk for Acquiring HIV Infection to Outpatient HIV Prevention Services: The HIV PreventED Program

Outcomes of an Emergency Department Program to Identify and Link Patients at Increased Risk for Acquiring HIV Infection to Outpatient HIV Prevention Services: The HIV PreventED Program

Validação do conteúdo de um recurso audiovisual para pessoas vivendo com HIV

“There hasn’t been a push to identify patients in the emergency department”—Staff perspectives on automated identification of candidates for pre-exposure prophylaxis (PrEP): A qualitative study

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