Specific Aims and Hypotheses: 
This study aimed to identify socioeconomic (SE), sexual, and other risk factors (RFs), among patients diagnosed with HIV infection through an emergency department-based opt-out HIV screening program, and to examine trends in intravenous drug use (IVDU) as a RF.   H1: Unsafe sexual practices are the most commonly reported RF. H2: Role of IVDU as a RF has increased over the time period studied. 
Poster presented at 2017 APHA conference in Atlanta Georgia.https://jdc.jefferson.edu/cwicposters/1040/thumbnail.jp

Boyce, BA, Tyler G.

Mammen, MD, MPH, Priya

English

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsCWIC Posters Jefferson College of Population Health11-7-2017Reaching high-risk patient populations throughemergency department opt-out HIV testing: Aretrospective chart reviewTyler G. Boyce, BAThomas Jefferson University, tgb003@jefferson.eduPriya Mammen, MD, MPHThomas Jefferson University Hospital, Priya.Mammen@jefferson.eduFollow this and additional works at: http://jdc.jefferson.edu/cwicpostersPart of the Public Health CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inCWIC Posters by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:JeffersonDigitalCommons@jefferson.edu.Recommended CitationBoyce, BA, Tyler G. and Mammen, MD, MPH, Priya, "Reaching high-risk patient populations through emergency department opt-outHIV testing: A retrospective chart review" (2017). CWIC Posters. 39.http://jdc.jefferson.edu/cwicposters/39LimitationsSexual Risk Factors:Prevalence: Most Common Sexual RFs Among Those With 1 or More:Socioeconomic Risk Factors:Insurance Status: Employment: Homelessness:BackgroundUrban emergency departments (EDs) serve high-risk populations that face challenges in regards to chronic diseases like Human Immunodeficiency Virus infection (HIV), including the following:- Limited access to care, and reliance on ED services for primary care.1, 2- High prevalence of HIV seropositivity (3.5% to 11.8%) and unawareness of HIV infection (4.0% of those HIV positive).1, 3- Frequent engagement in HIV risk behaviors (37.6% to 89.0%).3, 4Additionally, the current opioid crisis raises questions regarding the role of intravenous drug use as a risk factor for HIV infection.5Emergency department screening programs have the potential to provide substantial medical and financial benefits in relation to these high risk individuals.6Specific Aims and Hypotheses- Retrospective chart review - Setting: Urban academic level 1 trauma center and affiliated urban community ED- Sample: All patients newly diagnosed with HIV infection through the ED opt-out HIV screening program from October 2009 to June 2017- Data were collected from electronic medical records (EMR) and forms completed by screening program personnel for mandatory reporting to the Philadelphia Department of Pubic Health- Exclusions: Patient records indicated a prior diagnosis of HIV infection; Confirmatory testing not performed or results negative for HIV infection- Analysis was performed using chi-square and logistic regressionResults (n=134)Demographics: Illicit Drug Use: Intravenous Drug Use:-Average age: 34.5 years-82% Male-67% African American, 19% White, 7% Hispanic, 4% AsianAnalysisIVDU by year:Socioeconomic RFs vs. Phase of Infection (n=93):Conclusions- Unsafe sexual practices were the most commonly reported RF.- Patients in this study rarely presented specifically for HIV testing, the majority reported SE and multiple sexual RFs, and many reported drug use. - SE risks were associated with diagnosis in the chronic phase of HIV, reflecting a delay in identification and treatment. - Patients were predominantly male and African American, two groups that have faced challenges in health care utilization.7, 8- No significant trends in IVDU were found, however a larger sample size may provide statistical power to do so.- This study supports the notion that ED-based public health interventions are an important means for reaching at-risk patients.- EDs switched EMR software in 2017, limiting access to some older data. However, necessary data was accessible in mandatory reporting forms.- ED HIV testing prior to 2014 did not include antigen detection, preventing acute phase diagnosis. Chronic vs. acute analysis therefore excluded pre-2014 patients. - One ED’s proximity to a district historically associated with a large homosexual population may account for the high prevalence of males who have sex with males.Reaching high-risk patient populations through emergency department opt-out HIV testing: A retrospective chart reviewTyler G. Boyce, BA and Priya E. Mammen, MD, MPHSidney Kimmel Medical College at Thomas Jefferson UniversityMethodsThis study aimed to identify socioeconomic (SE), sexual, and other risk factors (RFs), among patients diagnosed with HIV infection through an emergency department-based opt-out HIV screening program, and to examine trends in intravenous drug use (IVDU) as a RF.H1: Unsafe sexual practices are the most commonly reported RF.H2: Role of IVDU as a RF has increased over the time period studied.50%32%18% Use 1 or MoreDrugNoneUnknown87%2%11%1 or More Sex RFNoneUnknown88.0%65.8%55.6%50.4%40.2% 40.2%30.8%17.1%8.5% 6.0%24%24%32%20% InsuredMedicaidUninsuredUnknown27%55%18%UnemployedEmployedUnknown10%68%22%HomelessHousedUnknown0%20%40%60%80%100%1 or more SE RF (n =72) None (n =21)Acute ChronicNo statistically significant trend was found for changes in IVDU by year, likely due in part to the low number of IVDU (p = 0.57).Having 1 or more SE RFs (77.4% of patient sample) was associated with diagnosis in chronic phase (OR, 3.41; 95% CI, 1.15 to 10.15; p = 0.02). No similar significant association was found for IVDU or sexual RFs.8%84%8%IVDUNot IVDUUnknownChief complaint of seeking HIV/STI testing: 9.0%0%13%0% 0%8%0%17%7% 7%IVDU PrevalenceReferences1. Silva A, Glick NR, Lyss SB, et al. Implementing an HIV and Sexually Transmitted Disease Screening Program in an Emergency Department. Ann of Emerg Med. 2007; 49 (5):564-572. http://dx.doi.org/10.1016/j.annemergmed.2006.09.028.2. Marco CA, Weiner M, Ream SL, et al. Access to care among emergency department patients. Emerg Med J. 2012; 29 (1):28-31. http://dx.doi.org/10.1136/emj.2010.103077.3. Alpert PL, et al. Factors associated with unrecognized HIV-1 infection in an inner-city emergency department. Ann Emerg Med. 1996; 28 (2):159-164. 10.1016/S0196-0644(96)70056-2.4. Merchant RC, et al. The relationship of reported HIV risk and history of HIV testing among emergency department patients. Postgrad Med. 2010; 122 (1):61-74. 10.3810/pgm.2010.01.2100.5. Conrad C, Bradley HM, Broz D, et al. Community Outbreak of HIV Infection Linked to Injection Drug Use of Oxymorphone — Indiana, 2015. Morbidity and Mortality Weekly Report. 2015; 64 (16):443-444.6. Paltiel AD, Weinstein MC, Kimmel AD, et al. Expanded Screening for HIV in the United States —An Analysis of Cost-Effectiveness. New England Journal of Medicine. 2005; 352:586-595. 10.1056/NEJMsa042088.7. Merzel C. Gender differences in health care access indicators in an urban, low-income community. American Journal of Public Health. 2000; 90 (6):909-916.8. Boulware, LE, Cooper LA, Ratner LE, et al. Race and trust in the health care system. Public health reports 2016; 118 (4):358-65. https://doi.org/10.1093/phr/118.4.358.

Reaching high-risk patient populations through emergency department opt-out HIV testing: A retrospective chart review

Specific Aims and Hypotheses: 
This study aimed to identify socioeconomic (SE), sexual, and other risk factors (RFs), among patients diagnosed with HIV infection through an emergency department-based opt-out HIV screening program, and to examine trends in intravenous drug use (IVDU) as a RF.   H1: Unsafe sexual practices are the most commonly reported RF. H2: Role of IVDU as a RF has increased over the time period studied. 
Poster presented at 2017 APHA conference in Atlanta Georgia.http://jdc.jefferson.edu/cwicposters/1040/thumbnail.jp

Name not available

https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1040&amp;context=cwicposters

Reaching high-risk patient populations through emergency department opt-out HIV testing: A retrospective chart review

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