title: Evolution and Escalation of an Emergency Department Routine, Opt-out HIV Screening and Linkage-to-Care Program.
abstract: OBJECTIVE
  The Centers for Disease Control and Prevention has recommended emergency department (ED) opt-out HIV screening since 2006. Routine screening can prove challenging due to the ED's complexity and competing priorities. This study examined the implementation and evolution of a routine, integrated, opt-out HIV screening program at an urban academic ED in Alabama since August 2011.
  
  
  METHODS
  ED routine, opt-out HIV screening was implemented as a standard of care in September 2011. To describe the outcomes and escalation of the screening program, data analyses were performed from three separate data queries: (1) encounter-level HIV screening questionnaire and test results from September 21, 2011, through December 31, 2013; (2) test-level, fourth-generation HIV results from July 9 through December 31, 2013; and (3) daily HIV testing rates and trends from September 9, 2011, through June 30, 2014.
  
  
  RESULTS
  Of the 46,385 HIV screening tests performed, 252 (0.5%) were confirmed to be positive. Acute HIV infection accounted for 11.8% of all HIV patients identified using the fourth-generation HIV screening assay. Seventy-six percent of confirmed HIV-positive patients had successful linkage to care. Implementation of fourth-generation HIV instrument-based testing resulted in a 15.0% decline in weekly HIV testing rates. Displacement of nursing provider HIV test offers from triage to the bedside resulted in a 31.6% decline in weekly HIV testing rates.
  
  
  CONCLUSIONS
  This program demonstrated the capacity for high-volume, routine, opt-out HIV screening. Evolving ED challenges require program monitoring and adaptation to sustain scalable HIV screening in EDs.
authors: University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, AL.
authors: James W
authors: JW
authors: Galbraith
authors: University of Alabama at Birmingham, Division of Infectious Diseases, Department of Medicine, Birmingham, AL.
authors: James H
authors: JH
authors: Willig
authors: University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, AL.
authors: Joel B
authors: JB
authors: Rodgers
authors: University of Alabama at Birmingham, Department of Emergency Medicine, Birmingham, AL; University of Alabama at Birmingham, Division of Preventive Medicine, Department of Medicine, Birmingham, AL; University of Alabama at Birmingham, Department of Epidemiology, Birmingham, AL.
authors: John P
authors: JP
authors: Donnelly
authors: University of Alabama at Birmingham, Division of Infectious Diseases, Department of Medicine, Birmingham, AL.
authors: Andrew O
authors: AO
authors: Westfall
authors: University of Alabama at Birmingham, Division of Infectious Diseases, Department of Medicine, Birmingham, AL.
authors: Kelly L
authors: KL
authors: Ross-Davis
authors: University of Alabama at Birmingham, Division of Infectious Diseases, Department of Medicine, Birmingham, AL.
authors: Sonya L
authors: SL
authors: Heath
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000407:Alabama / Q000453:epidemiology; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D003955:Diagnostic Tests, Routine; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000458:organization & administration; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D016730:Program Development; D011795:Surveys and Questionnaires; D055815:Young Adult