Streamlining HIV Testing in the Emergency Department—Leveraging Kiosks to Provide True Universal Screening: A Usability Study

Rothman, Richard E.; Gauvey-Kern, Megan; Woodfield, Alonzo; Peterson, Stephen; Tizenberg, Boris; Kennedy, Joseph F.; Bush, Devon; Locke, William; Gaydos, Charlotte A.; Deruggiero, Katherine; Hsieh, Yu Hsiang

doi:10.1089/tmj.2013.0045

Cited by 12 publications

(16 citation statements)

References 16 publications

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“…The calibration curve from our analysis actually demonstrates this, i.e. 24 the expected HIV seropositivity was slightly lower than the observed one in patients, especially in those with lower risk score (Figure 2A). Novel risk assessment via touch-screen kiosk or tablet could significantly reduce this type of information bias.…”

Section: Discussionsupporting

confidence: 57%

“…Novel risk assessment via touch-screen kiosk or tablet could significantly reduce this type of information bias. 24 Third, the HIV screening programmatic data come from two geographically close EDs under the same hospital and health system. These two urban EDs are located in a high HIV/AIDS prevalence city where several large-scale HIV intervention programs have been implemented.…”

Section: Discussionmentioning

confidence: 99%

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Validation of an abbreviated version of the Denver HIV Risk Score for prediction of HIV infection in an urban ED

Hsieh¹,

Haukoos²,

Rothman³

2014

The American Journal of Emergency Medicine

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Objective We sought to evaluate the performance of an abbreviated version of the Denver HIV Risk Score (DHRS) in two urban emergency departments (ED) with known high undiagnosed HIV prevalence. Methods We performed a secondary analysis of data collected prospectively between November 2005 and December 2009 as part of an ED-based non-targeted rapid HIV testing program from two sites. Demographics, past HIV testing history, IDU, and select high-risk sexual behaviors, including men who have sex with men, were collected by standardized interview. Information regarding receptive anal intercourse and vaginal intercourse were either not collected or collected inconsistently and where thus omitted from the model to create its abbreviated version. Results The study cohort included 15,184 patients with 114 (0.75%) newly diagnosed with HIV infection. HIV prevalence was 0.41% (95% CI: 0.21% – 0.71%) for those with a score <20, 0.29% (95% CI: 0.14% – 0.52%) with a score of 20–29, 0.65% (95% CI: 0.48% – 0.87%) with a score of 30–39, 2.38% (95% CI: 1.68% – 3.28%) with a score of 40–49, and 4.57% (95% CI: 2.09% – 8.67%) with a score ≥50. External validation resulted in good discrimination (area under the receiver operating characteristics curve = 0.75, 95% CI: 0.71–0.79). The calibration regression slope was 0.92 and its R2 was 0.78. Conclusions An abbreviated version of the DHRS had comparable performance to that reported previously, offering a promising alternative strategy for HIV screening in the ED where limited sexual risk behavior information may be obtainable.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Validation of an abbreviated version of the Denver HIV Risk Score for prediction of HIV infection in an urban ED

Hsieh¹,

Haukoos²,

Rothman³

2014

The American Journal of Emergency Medicine

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“…16 Of the patients infected with HIV, approximately 27% had not received a diagnosis (Figure) compared with 14% nationally, 4 confirming the importance of ongoing HIV screening in EDs. Although different approaches of identifying patients for ED-based testing continue to be evaluated and the optimal screening approach remains uncertain, 17–20 testing for HIV infection, irrespective of the screening approach, remains the critical first step in a series of important interventions aimed at reducing the burden of HIV disease. Identifying such individuals with HIV infection provides a critical opportunity to link them to care in which treatment slows disease progression and reduces infectivity.…”

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confidence: 99%

At the Crossroads of the HIV Care Continuum: Emergency Departments and the HIV Epidemic

Gardner

Haukoos

2015

Annals of Emergency Medicine

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“…We implemented a kiosk-facilitated screening program at registration to engage and offer patients HIV testing, following the success of our prototype system as a means of offering HIV testing to ED patients (Orlando et al, 2014; Rothman et al, 2014). Our results demonstrated that a kiosk-driven program increased numbers of engagement of higher-risk patients for testing (Hsieh et al, 2014).…”

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confidence: 99%

Novel emergency department registration kiosk for HIV screening is cost-effective

et al. 2015

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High operating costs challenge sustainability of successful U.S. Emergency Department (ED) HIV screening programs. Free-standing registration kiosks could potentially reduce the marginal costs of ED HIV screening. We investigated incremental cost-effectiveness ratio (CER) per new HIV diagnosis for a kiosk-based approach for offering screening at ED registration, versus a testing staff-based approach to offer testing at the bedside. A rapid oral-fluid HIV screening program, instituted in a U.S. ED since 2005, had a rate of new HIV diagnosis 0.16% in 2012. A two-phase quasi experimental design, including a testing staff-based approach to offer testing at the bedside (Phase I, August and September 2011) and a kiosk-based approach to offer testing at ED registration (Phase II, December 2011 and January 2012), was performed. CER per new HIV diagnosis was defined as total cost of the screening program divided by number of newly diagnosed cases. Costs included screening program personnel (study coordinator, testing staff, and kiosk helpers), diagnostic assays (rapid and confirmatory tests), and kiosks (2 kiosks, software, and IT consulting fees). Sensitivity analyses were performed. Data from our dedicated testing staff program (Phase I) resulted in an estimated 5,434 patients tested in one year and 9 newly diagnosed HIV-infected patients (95% CI: 3, 18). Data from the kiosk program (Phase II), resulted in a projected 4,571 ED patients tested in one year and 21 newly diagnosed HIV-infected patients (95% CI: 4, 70). The overall cost was $ 201,433 for the dedicated testing staff program, versus $292,008 for the kiosk program. Incremental CER per new HIV diagnosis for kiosk-based approach was $7,523 (range: $1,780 to $90,025 by sensitivity analysis). Our pilot data demonstrated that the use of kiosks for HIV screening was potentially more cost-effective than a testing staff-based bedside approach.

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Streamlining HIV Testing in the Emergency Department—Leveraging Kiosks to Provide True Universal Screening: A Usability Study

Abstract: ED patient response to the kiosk system was favorable. Subjects easily and quickly navigated the program, with the exception of a login screen, which could be eliminated via automated login using ID bracelet scanners.

Cited by 12 publications

References 16 publications

Validation of an abbreviated version of the Denver HIV Risk Score for prediction of HIV infection in an urban ED

Validation of an abbreviated version of the Denver HIV Risk Score for prediction of HIV infection in an urban ED

At the Crossroads of the HIV Care Continuum: Emergency Departments and the HIV Epidemic

Novel emergency department registration kiosk for HIV screening is cost-effective

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