ED maintains HIV screening by combining it with COVID-19 tests
The pandemic has disrupted HIV care, including routine testing. By making phlebotomy part of the COVID-19 testing process, an ED at the University of Chicago Medicine kept up its HIV screening volumes during the pandemic, data show.
“Patients seen in the ED have a high prevalence of undiagnosed HIV, including patients with acute HIV — priority populations for public health,” David Pitrak, MD, professor of medicine and section chief of infectious diseases at the University of Chicago Medicine (UCM), told Healio Primary Care. “Although there has been modeling that suggests linking HIV screening to COVID-19 testing could be beneficial, there is no real-world data.”
The ED team at UCM created a COVID-19 testing area that “seamlessly“ incorporated phlebotomy for HIV screening without any new staff, they said. Employees reviewed tests, notified patients about their HIV status and linked them to care.
The researchers compared the number of daily acute HIV infection diagnoses made before and during the pandemic at the UCM ED, where they incorporated HIV screening with COVID-19 testing, and a dozen other health care centers in Chicago that implemented opt-out HIV screening but kept HIV and COVID-19 testing separate.
According to Pitrak and colleagues, most of the sites experienced significant reductions in HIV screens during the pandemic; overall, the program experienced a 49% reduction in testing events from Jan. 1 to April 30, 2020. However, UCM kept up its HIV screening volumes, conducting 19,111 HIV screens (14,215 of them in the ED) between Jan. 1 and Oct. 16, 2020, and 112,242 COVID-19 PCR tests (18,830 of them in the ED) during that time.
According to the researchers, a dozen patients were diagnosed with acute HIV infection after the first COVID-19 diagnosis in Cook County on Jan. 24, 2020. The rate of acute HIV infection diagnoses per day was significantly higher during the pandemic compared with the previous 4 years (incidence rate ratio = 2.43; 95% CI, 1.22-4.83). EDs that did not incorporate HIV screening into COVID-19 testing saw a 25% drop in acute HIV infection diagnoses (incidence rate ratio = 0.75; 95% CI, 0.26-2.14), which was not statistically significant.
Also, patients with acute HIV infection comprised 12 of 46 new diagnoses at UCM, which was “the highest proportion on record,” according to the researchers. The median viral load was 6 million (115,000 to > 6 million) copies/mL. Eleven of 12 patients presented with symptoms consistent with COVID-19, and one patient had HIV and COVID-19. All patients were linked to care and started antiretroviral therapy by a median of 1 day (0-38 days) from the time they received their PCR test result but 3 days (1-41 days) from sample collection due to delays in confirmatory testing. According to the researchers, this gap stemmed from “high demands on laboratory personnel and scarcity of supplies (eg, amplification and testing trays) owing to COVID-19 testing volumes.”
Pitrak said UCM is working to improve the testing program.
“Although we incorporated phlebotomy and HIV screening into the workflow for COVID-19 testing, we did not formally link orders for these two tests,” he said. “We are currently initiating efforts to link the orders for HIV screening to COVID-19 testing orders.”