Online Program

336787
Identifying Out-of-Care, Known HIV+ Patients with a 4th Generation HIV Testing Platform


Sunday, November 1, 2015

Chun Nok Lam, MPH, Department of Preventive Medicine, University of Southern California, Los Angeles, CA
Michael Menchine, MD, MPH, Department of Emergency Medicine, University of Southern California, Los Angeles, CA
Kathleen Jacobson, MD, Department of Family Medicine, Keck School of Medicine at USC, Los Angeles, CA
Ira Shulman, MD, Department of Pathology, University of Southern California, Los Angeles, CA
Sanjay Arora, MD, Department of Emergency Medicine, University of Southern California, Los Angeles, CA
Routine, lab-based 4th generation testing platforms enhance emergency department (ED) HIV testing capacity by resulting tests in 1 hour. Additionally, 4th generation testing can identify known HIV+ patients and their care management status. This study evaluates the impact of a 4th generation ED screening program on the identification of out-of-care, known HIV+ patients.

We conducted a retrospective review of the HIV testing program 15 months before and after converting from a weekday-only, 8am-11pm point-of-care testing procedure to a 7/24 lab-based 4th generation program (4/2012-9/2014). Patients who did not self-report a history of HIV were tested. Patients with positive tests were categorized as previously undiagnosed or known HIV+. An HIV specialist offered linkage to care to any out-of-care, known HIV+ patients.

The number of known HIV+ individuals identified in the ED increased from 341 before the 4th generation testing to 551 in the 15 months after. The expanded test hours (from 11pm-8am) was the main contributor to the increased numbers. Out-of-care, known HIV+ patients were more likely to be identified through the testing mechanism than the self-disclosure route (50% vs. 22%, p<0.001) and 40% of these patients attended at least one HIV-specific outpatient clinic visit. Among the tested individuals, the mean age was 43.5 years, 87% male, 32% were African-American and 48% Latino.

4th Generation testing increased the likelihood of identifying out-of-care, known HIV+ patients in an ED setting. Although re-establishing care among this cohort remains challenging, the testing algorithm allows the re-identification of these patients and possibly linkage to care.

Learning Areas:

Chronic disease management and prevention
Public health or related research
Social and behavioral sciences

Learning Objectives:
Evaluate the impact of a 4th generation emergency department HIV screening program on the identification of out-of-care, known HIV+ patients.

Keyword(s): HIV/AIDS, Accessibility

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the research project manager and data analyst on this HIV program for the past three years. I received my master of public health training focusing on epidemiology and biostatistics. I am currently in a PhD program emphasizing on human behavior research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.