Outcomes of an Emergency Department Program to Identify and Link Patients at Increased Risk for Acquiring HIV Infection to Outpatient HIV Prevention Services: The HIV PreventED Program

Supplemental Digital Content is Available in the Text. Background: Emergency departments (EDs) provide care to patients at increased risk for acquiring HIV, and for many of them, the ED serves as their sole point of entry into the healthcare system. We implemented the HIV PreventED Program to increase access to HIV prevention services for ED patients. Setting: ED in Oakland, CA with an annual census of 57,000 visits. Methods: This cross-sectional study evaluated the first 9 months of the HIV PreventED Program. In this program, a navigator surveyed adult ED patients who tested HIV negative to determine their risk for acquiring HIV infection, incorporating HIV prevention counseling into their assessments. Patients at higher risk for acquiring HIV were referred to outpatient prevention services, if interested. The primary outcome measure was the number and proportion of ED patients at higher risk for acquiring HIV who followed up for outpatient prevention services. Results: In this study, 1233 patients who tested HIV negative were assessed by the navigator and received ED-based HIV prevention counseling. Of these, 193 (15.7%) were identified at higher risk and offered an outpatient referral for prevention services, of which 104 accepted (53.9%), 23 (11.9%) attended the referral, and 13 (6.7%) were prescribed preexposure prophylaxis (PrEP). The median time to linkage was 28 days (interquartile range 15–41 days). Conclusion: A navigator focused on providing ED-based HIV prevention counseling and linkage to outpatient services is feasible. Strategies to more efficiently identify ED patients at higher risk for HIV acquisition, such as automated identification of risk data from the electronic health record, and policies to improve follow-up and the receipt of PrEP, such as same-day PrEP initiation, should be prospectively evaluated.

文中有补充数字内容。背景：急诊科（ED）为感染艾滋病毒风险增加的患者提供医疗服务，对其中许多人来说，急诊科是他们进入医疗保健系统的唯一入口。我们实施了艾滋病毒预防急诊项目（HIV PreventED Program），以增加急诊科患者获得艾滋病毒预防服务的机会。地点：加利福尼亚州奥克兰市的急诊科，年就诊人数为57000人次。方法：这项横断面研究评估了艾滋病毒预防急诊项目实施的前9个月情况。在该项目中，一名引导员对艾滋病毒检测呈阴性的成年急诊科患者进行调查，以确定他们感染艾滋病毒的风险，并将艾滋病毒预防咨询纳入评估内容。如果感兴趣，感染艾滋病毒风险较高的患者会被转介到门诊预防服务机构。主要结局指标是感染艾滋病毒风险较高且后续接受门诊预防服务的急诊科患者的数量和比例。结果：在这项研究中，引导员对1233名艾滋病毒检测呈阴性的患者进行了评估，并在急诊科为他们提供了艾滋病毒预防咨询。其中，193人（15.7%）被确定为高风险并获得门诊预防服务转诊，其中104人接受（53.9%），23人（11.9%）前往转诊机构就诊，13人（6.7%）被开具暴露前预防用药（PrEP）。转诊衔接的中位时间为28天（四分位间距为15 - 41天）。结论：安排一名引导员专注于在急诊科提供艾滋病毒预防咨询并与门诊服务衔接是可行的。应前瞻性地评估更有效地识别感染艾滋病毒风险较高的急诊科患者的策略，例如从电子健康记录中自动识别风险数据，以及改善后续跟进和获取暴露前预防用药的政策，例如当日启动暴露前预防用药。