Background
Emergency Departments (EDs) are a major source of medical care for people living with HIV (PLWH) in the United States. PLWH who are out of care (OOC) experience poorer health outcomes and contribute to more than 40% of HIV transmissions. Gilead Sciences’ FOCUS program is a public health initiative that supports healthcare institutions to implement routine blood-borne virus (HIV, HCV, HBV) screening, diagnosis, and linkage to a first appointment in accordance with CDC guidelines. We examined data collected from US FOCUS ED-based HIV screening programs to determine the proportion of PLWH who were previously diagnosed and OOC and describe the geographic and demographic distribution of these patients.
Methods
From 2021 – 2023, data from 94 ED-based HIV screening programs were reviewed for HIV testing volume, HIV test results, previous HIV test result, and linkage status.Previously diagnosed persons were identified through routine screening or alternative mechanisms, including electronic medical record (EMR) flags. Previously diagnosed persons who were OOC were defined as those with a previous positive HIV test result not reported as in care through EMR abstraction, surveillance records or patient interview. Outcomes include the proportion of persons identified with HIV infection who were previously diagnosed and OOC, distribution across U.S. regions and demographic characteristics of those identified and linked to care.
Results
ED programs conducted 1,561,517 HIV tests. Of persons identified with HIV infection, 22% were newly diagnosed, 69% were previously diagnosed, and 9% had an unknown previous HIV status. Of those who were previously diagnosed or had an unknown previous HIV status, 50% were OOC. Two-thirds (67%) of all previously diagnosed OOC persons were identified in the South. Of all previously diagnosed persons who were OOC, 71% were male, 38% were 50 years or older, 57% were Black/African American, and 76% were non-Hispanic. Overall, 71% of persons previously diagnosed and OOC were linked to care. Linkage to care rates were highest among males (72%), persons aged 20 -29 (73%) and 50 years or older (73%), White persons (74%) and Hispanic persons (77%).
Conclusions
EDs play a critical role in identifying and linking PLWH who are OOC. Given that EDs face resource constraints and must consider impact to patient throughput, more research is needed on efficient strategies for identifying and linking PLWH who are OOC while they are accessing care in the ED.