Connecting Patients Diagnosed With HIV in the Emergency Department to Care During the COVID-19 Pandemic

ABSTRACT

Study Objective: HIV screening in the ED is an effective means of identifying new cases of HIV. The COVID-19 pandemic caused significant disruptions to both ED operations and outpatient care, yet little is known about the impact of the COVID-19 pandemic on ED-based HIV screening programs. We hypothesized that our electronic medical record (EMR) triggered HIV screening program would continue to identify new HIV positive patients and link them to care during the COVID-19 pandemic. Methods: We conducted a retrospective chart review of ED patients screened for HIV and compared the average monthly tests performed, number of confirmed HIV positive cases, and rates of linkage to care before and after the onset of the COVID-19 pandemic. We used 3/13/2020 as the start date for the pandemic and compared data in a 5-month period prior to the pandemic (limited to initiation of EMR triggered HIV screening) and a 9-month period during the pandemic. Two tailed t-tests were used for comparison of means. Results: A total of 20,825 patients were screened for HIV from 11/18/2019 to 12/12/2020 (8,417 pre-pandemic and 12,408 during the pandemic). On average, more HIV screening tests were performed in the pre-pandemic period compared to the pandemic period (1,683/month pre-pandemic versus 1,379/month during pandemic). However, when accounting for ED volume changes, a similar rate of patients in the pre-pandemic period (35.8% of all patients seen in the ED) were screened compared to during the pandemic (34.7% of all patients seen). In the pre-pandemic period 11/18/2020 – 3/12/2020, a total of 25 patients were diagnosed with HIV and all patients were linked to care. In the pandemic period 3/13/2020 – 12/12/2020, 27 patients were diagnosed with HIV. Of the 27 patients diagnosed, 22 (81%) were linked to care. Two patients died prior to attending specialist appointments during the pandemic (88% linkage to care accounting for deaths). The average time to the first attended specialist appointments for non-admitted patients was not significantly greater during the pandemic period (6.0 days pre-pandemic vs. 6.9 days during pandemic, p=0.55). Conclusion: EMR-generated HIV screening allows for continued efforts to diagnose and link patients to care despite the global disruptions caused by the COVID-19 pandemic. The lack of disruption to screening rates may be partly due to the minimal disruption of the screening and the linkage to blood tests being performed for clinical care. These efforts are critical to the mission to end the HIV epidemic by 2030. [Formula presented]