Incorporating HIV Screening With COVID-19 Testing in an Urban Emergency Department During the Pandemic

Stanford, Kimberly; McNulty, Moira; Schmitt, Jessica; Eller, Dylan; Ridgway, Jessica P; Beavis, Kathleen V.; Pitrak, David

doi:10.1001/jamainternmed.2021.0839

Cited by 23 publications

(18 citation statements)

References 5 publications

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“…Importantly, for HIV and hepatitis B a similar trajectory with a significant decrease in testing and linkage to care during the first months of the COVID-19 pandemic in 2020, with only testing mostly rebounding later in 2020, had also been described [ 10 , 20–25 ]. Particularly for HIV, relinkage to care of known HIV positives out of care was impacted by COVID-19, also in part due to conflicting priorities of county healthcare departments that came with the COVID-19 pandemic [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Sustained Impact of the Coronavirus Disease 2019 Pandemic on Hepatitis C Virus Treatment Initiations in the United States

Hoenigl

Abramovitz

Ortega

et al. 2022

Clinical Infectious Diseases

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Background Recent reports indicated declines in HCV testing during the first half of 2020 in the United States due to COVID-19, but the longer-term impact on HCV testing and treatment is unclear. Methods We obtained monthly state-level volumes of HCV antibody, RNA and genotype testing and HCV treatment initiation, stratified by age and gender, spanning January 2019 until December 2020 from two large national labs (Quest and LabCorp). We performed segmented regression analysis for each state from a mixed effects Poisson regression model with Month as the main fixed predictor, and State as a random intercept. Results During the pre-COVID period (January 2019-March 2020), monthly HCV antibody and genotype tests decreased slightly while RNA tests and treatment initiations remained stable. Between March and April 2020, there were declines in the number of HCV antibody tests (37% reduction, p<0.001), RNA tests (37.5% reduction, p<0.001), genotype tests (24% reduction, p=0.023) and HCV treatment initiations (31%, p<0.001). Starting April 2020 through the end of 2020 there were significant increases in month-to-month HCV antibody (p<0.001), RNA (p=0.035), and genotype tests (p=0.047), but only antibody testing rebounded to pre-COVID levels. HCV treatment initiations remained low after April 2020 throughout the remainder of the year. Conclusion HCV testing and treatment dropped by over 30% during April 2020 at the start of the COVID pandemic, but while HCV testing increased again later in 2020, HCV treatment rates did not recover. Efforts should be made to link HCV positive patients to treatment and revitalize HCV treatment engagement by health care providers.

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Section: Discussionmentioning

confidence: 99%

Sustained Impact of the Coronavirus Disease 2019 Pandemic on Hepatitis C Virus Treatment Initiations in the United States

Hoenigl

Abramovitz

Ortega

et al. 2022

Clinical Infectious Diseases

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“…We also found that approximately 10% of ED patients had an active and/or uncontrolled infection and 4% were coinfected with at least 2 viruses, translating to approximately 750 and 30 unique viremic ED patients over the 4.5-month study period, respectively. These findings create a “call for action” for urban EDs to develop and implement systematic and integrated testing/screening strategies that improve the identification and care of patients harboring infections who come through our doors, including those with previously undiagnosed and previously diagnosed HCV, HIV, and SARS-CoV-2 (given potential long-term sequalae and/or complications of each infection) [ 36 ]. Finding appropriate methods and resources to implement these strategies will require thoughtful collaboration between engaged clinicians, hospitals, and government agencies.…”

Section: Discussionmentioning

confidence: 99%

A Tale of 3 Pandemics: Severe Acute Respiratory Syndrome Coronavirus 2, Hepatitis C Virus, and Human Immunodeficiency Virus in an Urban Emergency Department in Baltimore, Maryland

Hsieh

Rothman

Solomon

et al. 2022

Open Forum Infectious Diseases

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Background Emergency Departments (EDs) serve as a window for detecting and tracking emerging infectious disease epidemics. We sought to determine the prevalence, socio-demographic and clinical correlates of acute and convalescent SARS-CoV-2, HCV, and HIV infections among ED patients in Baltimore. Methods Remnant blood samples from 7450 unique ED patients were collected over four months in 2020 for SARS-CoV-2 antibody (Ab), HCV Ab, and HIV-1/2 antigen (Ag) and Ab. 5012 patients were tested by PCR for SARS-CoV-2 based on clinical suspicion. Socio-demographics, ED clinical presentations and outcomes associated with co-infections were assessed. Results Overall, 729 (9.8%) had SARS-CoV-2 (acute or convalescent), 934 (12.5%) HCV, and 372 (5.0%) HIV infection. There were 211 patients (2.8%, 95% CI: 2.5%, 3.2%) with evidence of any co-infection (HCV/HIV: 1.5%, SARS-CoV-2/HCV: 0.7%, SARS-CoV-2/HIV: 0.3%, SARS-CoV-2/HCV/HIV: 0.3%). The prevalence of SARS-CoV-2 (acute or convalescent) was significantly higher in those with HCV or HIV versus those without (13.6% vs. 9.1%, p<0.001). Key socio-demographic disparities (race, ethnicity, and poverty), and specific ED chief complaints, diagnoses, and disposition were significantly correlated with having any co-infections versus no infection or individual mono-infection. Among those with HCV or HIV, age 18-34 years, Black, Hispanic, and having a cardiovascular-related chief complaint had a significantly higher odds of having SARS-CoV-2 (prevalence ratio: 2.02, 2.37, 5.81, and 2.07, respectively). Conclusions The burden of SARS-CoV-2, HCV, and HIV co-pandemics and their associations with specific socio-demographic disparities, clinical presentations and outcomes suggest that urban EDs should consider implementing integrated screening and linkage-to-care programs for these three infections.

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“…Moreover, individuals who seek care for COVID-19 should incorporate or even link HIV screening to COVID-19 testing as the previous report has demonstrated a considerable increase in HIV diagnoses with incorporating HIV screening into COVID-19 testing in the ED. 26 …”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on an emergency department-based opt-out HIV screening program in a South Florida hospital: An interrupted time series analysis, July 2018-March 2021

Niu¹,

Sareli²,

Eckardt³

2022

American Journal of Infection Control

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Incorporating HIV Screening With COVID-19 Testing in an Urban Emergency Department During the Pandemic

Cited by 23 publications

References 5 publications

Sustained Impact of the Coronavirus Disease 2019 Pandemic on Hepatitis C Virus Treatment Initiations in the United States

Sustained Impact of the Coronavirus Disease 2019 Pandemic on Hepatitis C Virus Treatment Initiations in the United States

A Tale of 3 Pandemics: Severe Acute Respiratory Syndrome Coronavirus 2, Hepatitis C Virus, and Human Immunodeficiency Virus in an Urban Emergency Department in Baltimore, Maryland

Impact of the COVID-19 pandemic on an emergency department-based opt-out HIV screening program in a South Florida hospital: An interrupted time series analysis, July 2018-March 2021

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