Missed Opportunities for Concurrent HIV-STD Testing in an Academic Emergency Department

Abstract

Concurrent HIV-STD testing in an academic ED remains low. Systematic interventions that remove the decision-making burden of ordering an HIV test from providers may increase HIV testing in this high-risk population of suspected STD patients.

A rapid review of equity considerations in large-scale testing campaigns during infectious disease epidemics

“…The main type of study setting among the included articles were hospitals (n=16) and clinic-based (n=10). Nine of the 16 hospital-based studies were in emergency departments (31,35,49,50,53,55,56,59,71), 6 were hospital inpatient or outpatient-based (43,45,60,61,69,70), and 1 was directed at hospital healthcare workers (44). Of the 10 clinic-based studies, 7 occurred in HIV/STI testing centers, public health clinics, or community health centers (36,39,42,62– 64,72), 2 were in general practitioner offices (35,47), and 1 was in an urgent care clinic (67).…”

Clinical knowledge of human immunodeficiency virus and sexually transmitted infections among emergency medicine providers

“…27,28 In another study situated in an ED setting, only 28.3% of patients who were tested for syphilis and 3.8% who were tested for gonorrhea and chlamydia were concurrently tested for HIV during an ED visit. 15 In a nationwide pediatric population, less than 25% of patients were concurrently tested for HIV despite presenting with pelvic inflammatory disease. 13 Taken together, these observations suggest that continuing education related specifically to both STIs and HIV may provide an avenue by which to increase concurrent screening of HIV among high-risk ED patients.…”

“…[9][10][11][12] Other studies have shown abysmal screening rates for testing for HIV co-infection even for patients who present with STIs. [13][14][15] Of the one study that directly evaluated emergency provider knowledge of HIV testing guidelines, which occurred among a Switzerland cohort of ED physicians, the results revealed that knowledge of guidelines was not correlated with likelihood of screening persons at high risk for HIV infection in a simulated study. 16 The purpose of this study is to thus characterize a potential reason for missed opportunities for HIV screening in EDs in the United States by assessing emergency provider clinical knowledge of the signs and symptoms associated with different STIs and symptomatic HIV, as well as risk factors associated with transmitting these aforementioned diseases.…”

“…9–12 Other studies have shown abysmal screening rates for testing for HIV co-infection even for patients who present with STIs. 13–15 Of the one study that directly evaluated emergency provider knowledge of HIV testing guidelines, which occurred among a Switzerland cohort of ED physicians, the results revealed that knowledge of guidelines was not correlated with likelihood of screening persons at high risk for HIV infection in a simulated study. 16…”

Program Collaboration and Service Integration in the Prevention and Control of HIV Infection, Viral Hepatitis, STDs, and Tuberculosis in the U.S.: Lessons Learned from the Field

“…Cocoros et al discuss the Massachusetts-based Screening for Hepatitis C as Prevention Enhancement (SHAPE) program for HIV, which provides integrated hepatitis C and HIV testing to inmates in a correctional facility. 14 15 They found that despite the presence of CDC recommendations for routine HIV screening and a targeted HIV testing program, concurrent HIV-STD testing in the ED remains inadequately low. To improve HIV testing of people with an STD, they will remove provider barriers to concurrent HIV-STD testing by focusing on systematic changes that lessen the decision-making burden on ED providers.…”