Aligning an emergency department hepatitis C and human immunodeficiency virus testing quality improvement initiative with universal screening recommendations.

Objective: The interactions among hepatitis C virus (HCV), human immunodeficiency virus (HIV), and the ongoing injection drug epidemic have created a syndemic that significantly affects the Appalachian region of the United States. The purpose of this work is to describe a successful Kentucky program that aimed to increase HCV and HIV testing for people visiting an urban emergency department (ED) who were screened, diagnosed, and linked to care after diagnosis with special consideration for substance use disorder. Methods: The Plan-Do-Study-Act model for quality improvement was used to create a streamlined process for testing, reporting results, and linking people to care. The program was refined and expanded across 3 phases. Results: Across all phases, a total of 25,685 patients were eligible for testing and did not opt out. Of those, 17,090 had HCV antibody (Ab) testing; 3460 (20.2%) had HCV Ab; 1750 (50.8%) had HCV RNA, and an average of 31% of patients were linked to care within 30 days. The program found 54 new cases of HIV infection. Conclusions: Universal HCV and HIV testing and linkage to care is possible within an ED. In areas affected by the syndemic, EDs may serve as a public health safety net to identify affected individuals and ensure they receive follow-up care. Testing in this center uncovered an exceptionally high prevalence of HCV infection and new HIV case identification.

Conducted-Energy Device (Taser) Usage in Subjects With Mental Illness.

Use of a conducted-energy device (CED), or Taser, by law enforcement officers (LEOs) is recommended over more lethal forms of force. LEOs interact with a wide variety of people including individuals with mental illness and those with substance use disorders. The literature is devoid of data regarding the effect of CEDs on this special population. We used data collected by LEOs from 2008 to 2009. There were 233 cases over the two-year period. Of the 233 individuals on whom the Taser was used, 38 had a mental illness and 91 were under the influence of substances (not mutually exclusive). The average number of shocks necessary to achieve compliance was 1.92 for persons with a mental illness (t(231) = 2.565; p = .011, versus nonintoxicated control subjects without mental illness and 2.55 for persons under the influence of stimulants (t(143) = 3.027; p = .003, versus nonintoxicated control subjects without mental illness). The results of this study serve to inform LEOs and administrators of the patterns of use of CEDs in communities.