Increasing HIV Testing During Gonorrhea and Chlamydia Evaluations in Urgent Care and Emergency Departments: A Large Health System Initiative

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BACKGROUND: HIV testing opportunities are often missed during urgent care (UC) and emergency department (ED) evaluations for sexually transmitted infections. We implemented a multimodal diagnostic stewardship intervention to increase HIV testing in UC and ED gonorrhea (GC)/chlamydia (CT) testing encounters ("HIV co-testing"). METHODS: We conducted a pre-/post implementation study across 26 UCs and 22 EDs in our health system (April 2022-March 2024). The intervention included system-wide simultaneous implementation of provider and patient education and a link-to-care program for newly diagnosed people with HIV (PWH) and patients needing additional testing, followed by phased activation of an electronic health record alert prompting HIV co-testing. We estimated the impact of the intervention on HIV GC/CT co-testing using interrupted time series analysis, measured alert engagement, and described the impact of the link-to-care program. RESULTS: By the end of the intervention period, HIV GC/CT co-testing rates were 12.7% points higher in UC (95% CI 6.2-19.2), a 41.9% relative increase (P < .001) compared with preintervention trends. In the ED, co-testing rates rose 12.3% points (95% CI 1.08-23.6), a 53.4% relative increase (P = .02). A total of 4704 alerts fired, resulting in 730 alert-associated HIV co-tests. During the intervention, 17 PWH were newly diagnosed: 5 (29%) were due to alert-associated co-tests. All PWH and those requiring additional testing received prompt linkage to care. CONCLUSIONS: HIV GC/CT co-testing increased in UC and ED during our intervention, leading to new HIV diagnoses and linkage to care. Integrating HIV co-testing into GC/CT testing encounters improved HIV screening practices in our large health system.

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