title: Benefits of a routine opt-out HIV testing and linkage to care program for previously diagnosed patients in publicly funded emergency departments in Houston, TX.
abstract: BACKGROUND
  The Routine Universal Screening for HIV program provides opt-out HIV testing and linkage to care for emergency department (ED) patients in Harris Health System, Houston, TX. Seventy-five percent of patients testing positive in this program have been previously diagnosed. Whether linkage to care is increased among these patients is unknown.
  
  
  METHODS
  We conducted a retrospective cohort study of persons tested for HIV in the ED between 2008 and 2012 but had a previously documented positive HIV test ≥1 year prior. Outcomes were engagement in care (≥1 HIV outpatient visits in 6 months), retention in care (≥2 HIV outpatient visits in 12 months, at least 3 months apart), and virologic suppression (<200 copies/mL in 12 months) compared before and after the ED visit. Analysis was conducted using McNemar test and multivariate conditional logistic regression.
  
  
  RESULTS
  A total of 202,767 HIV tests identified 2068 previously diagnosed patients. The mean age was 43 years with 65% male and 87% racial and ethnic minorities. Engagement in care increased from 41.3% previsit to 58.8% postvisit (P < 0.001). Retention in care increased from 32.6% previsit to 47.1% postvisit (P < 0.001). Virologic suppression increased from 22.8% previsit to 34.0% postvisit (P < 0.001). Analyses revealed that engagement in care after visit improved most among younger participants (ages 16-24 years), retention improved across all groups, and virologic suppression improved most among participants aged 25-34 years.
  
  
  CONCLUSIONS
  Routine opt-out HIV testing in an ED paired with standardized service linkage improves engagement, retention, and virologic suppression in previously diagnosed patients.
authors: *Department of Medicine, Baylor College of Medicine, Houston, TX; †Harris Health System, Houston, TX; ‡Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX; and §Houston Department of Health and Human Services, Houston, TX.
authors: Charlene A
authors: CA
authors: Flash
authors: Siavash
authors: S
authors: Pasalar
authors: Vagish
authors: V
authors: Hemmige
authors: Jessica A
authors: JA
authors: Davila
authors: Camden J
authors: CJ
authors: Hallmark
authors: Marlene
authors: M
authors: McNeese
authors: Nancy
authors: N
authors: Miertschin
authors: Michael C
authors: MC
authors: Ruggerio
authors: Thomas P
authors: TP
authors: Giordano
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult