Evaluation of an emergency department opt-out provider-driven HIV and syphilis screening and linkage-to-care program.

OBJECTIVE: While the effectiveness of emergency departments (ED) in screening for HIV and syphilis is understood, less is known about dual screening programs. We aim to evaluate the impact of an opt-out provider-initiated HIV and syphilis program on screening, diagnosis, and linkage to care outcomes. METHODS: We performed a retrospective review of patients screened pre (2014-2017) and post (2017-2021) program implementation. Primary outcomes include HIV and syphilis screening, incidence of positive tests, and proportion of patients linked to care. Secondary outcomes included pre-exposure prophylaxis (PrEP) referral and successful linkage rates for HIV-negative syphilis-positive patients. RESULTS: Pre-implementation, 882 HIV tests were performed, of which 22 (2.49%) were new cases and 18 (81.82%) were linked to care; 754 syphilis tests were performed, of which 33 (4.38%) were active infections and 30 (90.91%) were treated. No eligible patients received PrEP referral. Post-implementation, 12,999 HIV tests were performed, of which 73 (0.56%) were new cases and 55 (75.34%) were linked to care; 10,885 syphilis tests were performed, of which 216 (1.98%) were active infections and 188 (87.04%) were treated. 25 (9.09%) eligible patients were referred for PrEP, and four (16.0%) attended their appointment. CONCLUSIONS: Post-implementation, there was a 1373.81% and 1343.63% increase in screening, and a 231.82% and 554.55% increase in positive cases of HIV and syphilis, respectively. Dual screening programs can be successfully implemented within the existing ED framework to increase screening and early detection for HIV and syphilis.

A Model for Syphilis Screening in the Emergency Department.

The incidence of syphilis infections is on the rise, particularly among African American men and men who have sex with men, and it is reaching epidemic levels in these communities throughout the United States. Although syphilis is relatively inexpensive to treat and cure and is a predictor for HIV incidence among men and transgender women who have sex with men, rates of co-screening for syphilis are low in the emergency department setting, with a dearth of literature on this topic since the 1990s and early 2000s. In this case study, we describe an operational model for routine syphilis screening implemented in June 2017 at the University Hospitals Cleveland Medical Center in Cleveland, Ohio. We describe the advantages of screening using a reverse testing algorithm rather than the traditional method and the necessity of partnering with the Cleveland Department of Public Health for both diagnostic and follow-up logistics.

Geographic monitoring for early disease detection (GeoMEDD).

Identifying emergent patterns of coronavirus disease 2019 (COVID-19) at the local level presents a geographic challenge. The need is not only to integrate multiple data streams from different sources, scales, and cadences, but to also identify meaningful spatial patterns in these data, especially in vulnerable settings where even small numbers and low rates are important to pinpoint for early intervention. This paper identifies a gap in current analytical approaches and presents a near-real time assessment of emergent disease that can be used to guide a local intervention strategy: Geographic Monitoring for Early Disease Detection (GeoMEDD). Through integration of a spatial database and two types of clustering algorithms, GeoMEDD uses incoming test data to provide multiple spatial and temporal perspectives on an ever changing disease landscape by connecting cases using different spatial and temporal thresholds. GeoMEDD has proven effective in revealing these different types of clusters, as well as the influencers and accelerators that give insight as to why a cluster exists where it does, and why it evolves, leading to the saving of lives through more timely and geographically targeted intervention.

Prevalence of Human Immunodeficiency Virus and Opportunistic Infections Among Transgender Patients in the Clinical Setting: An All-Payer Electronic Health Record Database Study.

We performed a cross-sectional analysis of the prevalence of HIV and opportunistic infections among transgender patients in clinical care. Of 10,160 transgender patients identified, 3.9% had a diagnosis of HIV, compared to 0.32% in the non-transgender cohort (p<0.0001). Transgender patients experience the burden of all opportunistic infection compared to non-transgender patients in this analysis, although prevalence of pneumocystis pneumonia was not significant. This cohort-based, all-payer electronic health record study of HIV patients connected to care revealed that transgender patients have a higher prevalence of HIV infection and opportunistic infections compared to the non-transgender cohort.

Body lice and bed bug co-infestation in an emergency department patient, Ohio, USA.

Body lice and bed bugs are hematophagous insects that parasitize humans. Body lice are established vectors of several bacterial pathogens (e.g. Bartonella quintana, Borrelia recurrentis). Bed bugs are biologically competent vectors of some of the same agents, but their vectorial capacity for these in nature is unclear. In particular, a lack of exposure to louse-borne pathogens in bed bugs in the field could be a factor that limits their contribution to transmission. Here, we describe a case of a patient seen in an urban emergency department who was suffering from infestation with both body lice and bed bugs. Insects were collected from the patient and tested for the presence of louse-borne bacterial pathogens using 16S rRNA gene amplicon sequencing. Although no Bartonella, Borrelia, or Rickettsia were detected, this case provides evidence of ecological overlap between body lice and bed bugs and highlights several potential risk factors for co-infestation. The ecological relationships between bed bugs, body lice, and louse-borne bacteria should be further investigated in the field to determine the frequency of co-infestations and identify possible instances of pathogen infection in bed bugs.

Disaster Training Needs and Expectations Among Turkish Emergency Medicine Physicians - A National Survey.

OBJECTIVES: Earthquakes, landslides, and floods are the most frequent natural disasters in Turkey. The country has also recently experienced an increased number of terrorist attacks. The purpose of this study is to understand the expectations and training of Turkish emergency medicine attending physicians in disaster medicine. METHODS: An online questionnaire was administered to the 937 members of the Emergency Medicine Association of Turkey, of which 191 completed the survey (20%). RESULTS: Most participants (68%) worked at a Training and Research Hospital (TRH) or a University Hospital (UH), and 69% had practiced as an attending for 5 years or less. Mass immigration, refugee problems, and war/terror attacks were considered to be the highest perceived risk topics. Most (95%) agreed that disaster medicine trainings should occur during residency training. Regular disaster drills and exercises and weekly or monthly trainings were the most preferred educational modalities. Most respondents (85%) were interested in advanced training in disaster medicine, and this was highest for those working less than 5 years as an attending. UH and TRH residency training programs were not considered in themselves to be sufficient for learning disaster medicine. CONCLUSIONS: Turkish emergency medicine residency training should include more disaster medicine education and training.

Assessing the National Prevalence of HIV Screening in the United States using Electronic Health Record Data.

The Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend population-based screening for human immunodeficiency virus (HIV) at least once in each patient's life. National surveys estimate that 42.5% of the population has been screened; however, these studies have relatively low sample sizes and inherent survey biases. Using a national, de-identified cloud-based electronic health record (EHR) information from over 48 million patients, we found that only 6.4% of Americans over the age of 18 had laboratory evidence of a prior HIV test. Further investigation is necessary to determine if single-item questions on national surveys correlate with objective evidence of HIV testing, as well as addressing the numerous limitations related to the use of EHR data that likely grossly underestimates the prevalence of HIV screening nationally.

Osteomyelitis pubis: a rare and elusive diagnosis.

Osteomyelitis pubis is an infectious inflammation of the symphysis pubis and accounts for 2% of hematogenous osteomyelitis. This differs from osteitis pubis, a non-infectious inflammation of the pubic symphysis, generally caused by shear forces in young athletes. Both conditions present with similar symptoms and are usually differentiated on the basis of biopsy and/or culture. A case of osteomyelitis pubis is presented with a discussion of symphisis pubis anatomy, clinical and laboratory presentation, etiology and risk factors, and optimal imaging studies.

Successful immunization of an allogeneic bone marrow transplant recipient with live, attenuated yellow Fever vaccine.

Vaccination against yellow fever is effective, but available live virus vaccines are not recommended for use in immunocompromised or elderly patients. We report the successful and uneventful immunization of a 62-year-old man with a history of allogeneic bone marrow transplant and discuss evidence for this recommendation.