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Characteristics of California Emergency Departments in Centers for Disease Control and Prevention designated HIV Priority Counties

Published:November 05, 2022DOI:https://doi.org/10.1016/j.jemermed.2022.10.020

      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))
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      References

        • Branson BM
        • Handsfield HH
        • Lampe MA
        • et al.
        Centers for Disease Control and Prevention (CDC). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings.
        MMWR Recomm Rep. 2006; 55: 1-17
        • Alexovitz KA
        • Merchant RC
        • Clark MA
        • et al.
        Discordance of voluntary HIV testing with HIV sexual risk-taking and self-perceived HIV infection risk among social media-using black, Hispanic, and white young-men-who-have-sex-with-men (YMSM).
        AIDS Care. 2018; 30: 81-85
        • Bennett CL
        • Marks SJ
        • Liu T
        • et al.
        Factors Associated with Lack of HIV Testing among Latino Immigrant and Black Patients at 4 Geographically and Demographically Diverse Emergency Departments.
        J Int Assoc Provid AIDS Care. 2020; 19 (Jan-Dec)2325958220970827
      1. HIV Testing: Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/testing/index.html Accessed September 12, 2022.

        • Crepaz N
        • Song R
        • Lyss SB
        • Hall HI.
        Estimated time from HIV infection to diagnosis and diagnosis to first viral suppression during 2014-2018.
        AIDS. 2021; 35: 2181-2190
        • Fauci AS
        • Redfield RR
        • Sigounas G
        • Weahkee MD
        • Giroir BP.
        Ending the HIV Epidemic: A Plan for the United States.
        JAMA. 2019; 321: 844-845
      2. Ending the HIV Epidemic: Jurisdictions. Centers for Disease Control and Prevention. https://www.cdc.gov/endhiv/jurisdictions.html Accessed September 12, 2022.

        • Hoover KW
        • Huang YA
        • Tanner ML
        • et al.
        HIV Testing Trends at Visits to Physician Offices, Community Health Centers, and Emergency Departments - United States, 2009-2017.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 776-780
      3. National Emergency Department Inventories: Emergency Medicine Network. https://www.emnet-usa.org/research/studies/nedi/ Accessed September 12, 2022.

        • Olatosi B
        • Siddiqi KA
        • Conserve DF.
        Towards ending the human immunodeficiency virus epidemic in the US: State of human immunodeficiency virus screening during physician and emergency department visits, 2009 to 2014.
        Medicine (Baltimore). 2020; 99: e18525
        • Berg LJ
        • Delgado MK
        • Ginde AA
        • Montoy JC
        • Bendavid E
        • Camargo Jr., CA
        Characteristics of U.S. emergency departments that offer routine human immunodeficiency virus screening.
        Acad Emerg Med. 2012; 19: 894-900
        • Clay CE
        • Ling A
        • Bennett CL.
        HIV Testing at Visits to United States Emergency Departments, 2018.
        J Acquir Immune Defic Syndr. 2022; 90 (Jul 1): 256-262
      4. HIV Basics, Impact on Racial and Ethnic Minorities: Jurisdictions. US Department of Health and Human Services https://www.hiv.gov/hiv-basics/overview/data-and-trends/impact-on-racial-and-ethnic-minorities Accessed September 12, 2022.

        • Wainwright JJ
        • Beer L
        • Tie Y
        • Fagan JL
        • Dean HD
        Medical Monitoring Project. Socioeconomic, Behavioral, and Clinical Characteristics of Persons Living with HIV Who Experience Homelessness in the United States, 2015-2016.
        AIDS Behav. 2020; 24 (Jun): 1701-1708
      5. California Department of Public Health: Ending the Epidemics. https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/CDPH_StratPlan2021_FINAL_ADA.pdf Accessed September 12, 2022.

        • Taylor Jr, DH
        • Whellan DJ
        • Sloan FA.
        Effects of admission to a teaching hospital on the cost and quality of care for Medicare beneficiaries.
        N Engl J Med. 1999; 340: 293-299
        • Burke L
        • Khullar D
        • Orav EJ
        • Zheng J
        • Frakt A
        • Jha AK.
        Do Academic Medical Centers Disproportionately Benefit The Sickest Patients?.
        Health Aff (Millwood). 2018; 37: 864-872
        • Haukoos JS
        • Hopkins E
        • Hull A
        • et al.
        HIV testing in emergency departments in the United States: a national survey.
        Ann Emerg Med. 2011; 58 (e1-8): S10-S16
      6. California Health and Human Services: Hospital Emergency Department - Characteristics by Facility. https://data.chhs.ca.gov/dataset/hospital-emergency-department-characteristics-by-facility-pivot-profile Accessed September 12, 2022.

      7. Health Resources & Services Administration: Area Health Resource Files. https://data.hrsa.gov/topics/health-workforce/ahrf Accessed September 12, 2022.

      8. Centers for Disease Control and Prevention: Atlas Plus. https://www.cdc.gov/nchhstp/atlas/index.htm Accessed September 12, 2022.

      9. United States Census Bureau: Small Area Income and Poverty Estimates. https://www.census.gov/programs-surveys/saipe.html Accessed September 12, 2022.

        • von Elm E
        • Altman DG
        • Egger M
        • et al.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Lancet. 2007; 370: 1453-1457
        • Chou SC
        • Venkatesh AK
        • Trueger NS
        • Pitts SR.
        Primary Care Office Visits For Acute Care Dropped Sharply In 2002-15, While ED Visits Increased Modestly.
        Health Aff. 2019; 38: 268-275
        • Haukoos JS
        • Lyons MS
        • Rothman RE
        • White DAE
        • Hopkins E
        • Bucossi M
        • Ruffner AH
        • Ancona RM
        • Hsieh YH
        • Peterson SC
        • Signer D
        • Toerper MF
        • Saheed M
        • Pfeil SK
        • Todorovic T
        • Al-Tayyib AA
        • Bradley-Springer L
        • Campbell JD
        • Gardner EM
        • Rowan SE
        • Sabel AL
        Thrun MW; HIV TESTED Trial Investigators. Comparison of HIV Screening Strategies in the Emergency Department: A Randomized Clinical Trial.
        JAMA Netw Open. 2021 Jul 1; 4e2117763
        • Chu C
        • Selwyn PA.
        Complications of HIV infection: a systems-based approach.
        Am Fam Physician. 2011 Feb 15; 83: 395-406
        • Mayer KH
        • Allan-Blitz LT
        Enhancing HIV Prevention With New Modalities and Routine Sexual History Discussions.
        JAMA. 2022 Apr 19; 327: 1447-1448
        • Shull JA
        • Attys JM
        • Amutah-Onukagha NN
        • Hill MJ.
        Utilizing emergency departments for pre-exposure prophylaxis (PrEP).
        J Am Coll Emerg Physicians Open. 2020 Oct 22; 1: 1427-1435
        • Kazi DS
        • Katz IT
        • Jha AK.
        PrEParing to End the HIV Epidemic - California's Route as a Road Map for the United States.
        N Engl J Med. 2019 Dec 26; 381: 2489-2491
      10. Statement by President Joe Biden Recognizing the 40th Year of the HIV/AIDS Epidemic.
        The White House, 2022 (Accessed September 12)
        • Flanagin A
        • Frey T
        • Christiansen SL
        • AMA Manual of Style Committee
        Updated Guidance on the Reporting of Race and Ethnicity in Medical and Science Journals.
        JAMA. 2021; 326: 621-627