Increased HIV testing among hospitalized patients who declined testing in the emergency department

ABSTRACT

Health-care systems have serial encounters with many of the same patients across care settings; however, few studies have examined the role of reoffering HIV testing after a patient declines. We assessed whether an intervention to increase HIV testing among hospitalized patients was associated with increased testing among those who declined a test while in the Emergency Department (ED). We studied 8-week periods pre- and post-implementation of an electronic medical record (EMR)-based intervention to increase HIV testing among hospitalized patients. We included all patients 21–64 years old who had no prior HIV test, declined HIV testing in the ED, and were subsequently hospitalized. We used logistic regression to test for an association between time of hospital admission (pre- vs. post-intervention) and whether an HIV test was performed prior to discharge. Pre- and post-implementation, 220 and 218 patients who declined HIV testing in the ED were hospitalized, respectively. There were no significant demographic or clinical differences among patients pre- and post-implementation. Pre- and post-implementation, the median proportion of patients tested weekly was 6.7% (IQR 6.5%, 10.0%) and 41.4% (IQR 33.3%, 41.9%), respectively (aOR 6.2: 95%CI: 3.6, 10.6). HIV testing increased among hospitalized patients who declined a test in the ED after implementation of an EMR-based intervention. Almost half of the patients who declined testing in the ED ultimately underwent testing after it was reoffered during hospitalization, suggesting that the decision to undergo HIV testing is a dynamic process. Leveraging EMR resources may be an effective tool for expanding HIV testing, and testing should be reoffered to patients who previously declined.

KEYWORDS:

• Routine HIV testing
• emergency department
• hospital admission
• reoffer
• electronic medical record

Acknowledgements

The authors gratefully acknowledge Montefiore Medical Center's AIDS Center HIV Counseling and Testing team and collaborators at Montefiore Information Technology whose efforts made this work possible.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported in part by the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center (NIH AI-51519; NIH R25DA023021; and NIH K24DA036955) and by the New York City Department of Health and Mental Hygiene HIV through a contract with Public Health solutions (13-SLC-165). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the funders. B.S. Zingman has received prior research grants from Siemens to evaluate HIV diagnostic assays, as well as from Gilead, ViiV, and Pfizer to study antiretroviral agents. However, none of this funding is related to the work presented in this manuscript. No other authors have relevant conflicts of interest to report.