title: Missed opportunities for concurrent HIV-STD testing in an academic emergency department.
abstract: OBJECTIVE
  We evaluated emergency department (ED) provider adherence to guidelines for concurrent HIV-sexually transmitted disease (STD) testing within an expanded HIV testing program and assessed demographic and clinical factors associated with concurrent HIV-STD testing.
  
  
  METHODS
  We examined concurrent HIV-STD testing in a suburban academic ED with a targeted, expanded HIV testing program. Patients aged 18-64 years who were tested for syphilis, gonorrhea, or chlamydia in 2009 were evaluated for concurrent HIV testing. We analyzed demographic and clinical factors associated with concurrent HIV-STD testing using multivariate logistic regression with a robust variance estimator or, where applicable, exact logistic regression.
  
  
  RESULTS
  Only 28.3% of patients tested for syphilis, 3.8% tested for gonorrhea, and 3.8% tested for chlamydia were concurrently tested for HIV during an ED visit. Concurrent HIV-syphilis testing was more likely among younger patients aged 25-34 years (adjusted odds ratio [AOR] = 0.36, 95% confidence interval [CI] 0.78, 2.10) and patients with STD-related chief complaints at triage (AOR=11.47, 95% CI 5.49, 25.06). Concurrent HIV-gonorrhea/chlamydia testing was more likely among men (gonorrhea: AOR=3.98, 95% CI 2.25, 7.02; chlamydia: AOR=3.25, 95% CI 1.80, 5.86) and less likely among patients with STD-related chief complaints at triage (gonorrhea: AOR=0.31, 95% CI 0.13, 0.82; chlamydia: AOR=0.21, 95% CI 0.09, 0.50).
  
  
  CONCLUSIONS
  Concurrent HIV-STD testing in an academic ED remains low. Systematic interventions that remove the decision-making burden of ordering an HIV test from providers may increase HIV testing in this high-risk population of suspected STD patients.
authors.affiliation: The University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC ; Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Milwaukee, WI.
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Klein
authors.affiliation: The University of North Carolina at Chapel Hill, School of Medicine, Departments of Emergency Medicine and Internal Medicine, Chapel Hill, NC.
authors.forename: Ian B K
authors.initials: IB
authors.lastname: Martin
authors.affiliation: The University of North Carolina at Chapel Hill, School of Medicine, Center for Infectious Diseases, Chapel Hill, NC.
authors.forename: Evelyn B
authors.initials: EB
authors.lastname: Quinlivan
authors.affiliation: The University of North Carolina at Chapel Hill, School of Medicine, Departments of Emergency Medicine and Internal Medicine, Chapel Hill, NC.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Gay
authors.affiliation: The University of North Carolina at Chapel Hill, School of Medicine, Departments of Emergency Medicine and Internal Medicine, Chapel Hill, NC.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Leone
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data; D000046:Academic Medical Centers / Q000592:standards / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002690:Chlamydia Infections / Q000175:diagnosis; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis; D019983:Guideline Adherence; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D012737:Sex Factors; D012749:Sexually Transmitted Diseases / Q000175:diagnosis*; D013587:Syphilis / Q000175:diagnosis; D055815:Young Adult