Article Summary
- •Why is this topic important? There is a need to increase HIV testing in US EDs. Recent state and national initiatives aimed at ending the HIV epidemic in California include a geographic component and target “priority” counties hardest hit by HIV.
- •What does this study attempt to show? There are a subset of EDs in California that might be the most efficient, high-yield, targets toward which to direct future HIV testing efforts.
- •What are the key findings? A subset of EDs in California priority counties with teaching hospital affiliations are major sources of healthcare in the state. Compared to other EDs groups, these may be more capable of supporting HIV testing services.
- •How is patient care impacted? Increasing rates of HIV testing in EDs could be the most efficient way to reduce the burden of undiagnosed infections in California. Increasing the rate at which persons living with HIV are diagnosed in California could more quickly link patients to care, improve HIV/AIDS-related outcomes, and help end the ongoing epidemic.
Abstract
Background
Refocused national HIV testing initiatives include a geographic focus.
Objectives
Using a geographic focus, we sought to identify which emergency departments (EDs)
might be the most efficient targets for future HIV testing efforts using California
as an example.
Methods
Retrospective analysis of California EDs, emergency physicians, and patients served,
along with county-level estimates of HIV prevalence and proportion of the population
living in poverty. Emphasis is placed on characterizing EDs affiliated with teaching
hospitals and those located in Centers for Disease Control and Prevention HIV priority
counties.
Results
Of the 320 EDs studied, 178 were in priority counties, 29 were affiliated with teaching
hospitals, and 24 had both characteristics. Of the 12,869,889 ED visits included,
61.8% occurred in priority counties, 14.7% in EDs affiliated with teaching hospitals,
and 12.0% in EDs with both characteristics. The subset of EDs in priority counties
with teaching hospital affiliations (compared to priority and non priority county
ED groups without a teaching hospital affiliation) had higher overall median visit
volumes and higher proportions of visits by at-risk and CDC-targeted populations (e.g.,
individuals who were homeless, those who identified as Black or African American race,
and those who identified as Hispanic or Latino ethnicity, all p<0.01).
Conclusions
EDs in priority counties affiliated with teaching hospitals are major sources of healthcare
in California. These EDs more often serve populations disproportionately impacted
by HIV. These departments are efficient targets to direct testing efforts. Increasing
testing in these EDs could reduce the burden of undiagnosed HIV in California.
Keywords
Abbreviations:
CDC (Centers for Disease Control and Prevention), ED (emergency department), EP (emergency physicians), HIV (human immunodeficiency virus), STROBE (Strengthening the Reporting of Observational studies in Epidemiology), US (United States))To read this article in full you will need to make a payment
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Article Info
Publication History
Accepted:
October 21,
2022
Received in revised form:
September 21,
2022
Received:
June 15,
2022
Publication stage
In Press Accepted ManuscriptIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
