Study Objectives
Emergency department (ED) HIV screening programs are important sites for diagnosing HIV-infected individuals. Our EMR-assisted, triage-based, routine, opt-out program is based at an urban, safety-net ED where patient volume is approximately 148,000 annually and all patients presenting to the ED are offered HIV screening if eligible (18 years or older, not known to be HIV positive, not tested in prior 6 months). Georgia’s COVID-19 peak occurred April 20, 2020, right behind our hospital peak COVID-19 diagnoses on April 19, 2020. During this time our ED volumes dropped significantly. We sought to characterize the impact on our HIV screening program.
Methods
Data were analyzed to compare total ED visits and patients eligible for screening between January – April 2019 and 2020, and tabulated the percent who were offered testing through opt out screening language, had blood drawn for testing, and resulted in a confirmed positive test result. A simple comparison was used to analyze differences between 2019 and 2020, as well as between months in the same year.
Results
Comparisons of ED visits between January – April 2019 versus 2020 showed a modest reduction in overall patients eligible to be screened in January – March 2020, and a 43% reduction in patients eligible in April 2020 (5540) compared with April 2019 (9781). In April 2020, only 26% of those eligible were screened, compared with 80% in 2019. On average 2020, 16% of patients screened were tested compared with 19% in 2019. The largest drop off in testing acceptance occurred in March 2020, with only 13% of patients who were screened being tested. Overall percent confirmed seropositivity was similar, 1.9% (2019) vs 2.3% (2020), p=0.12, but absolute number of confirmed HIV positive patients identified (108 in 2019 vs. 74 in 2020) was reduced.
Conclusion
Our ED-based HIV screening program was impacted by the COVID-19 pandemic in Georgia. In April 2020, the month most heavily impacted by COVID-19, we had a stark reduction in eligible patients presenting to the ED, reflecting our lower ED volumes at the time likely due to fear in the general public to come to the hospital and stay-at-home orders in place. Interestingly, in March 2020 as the pandemic was ramping up and heavily featured in the media, there were fewer patients who either agreed to testing or had their blood drawn for testing than we would have expected. This may reflect fear of additional health care steps in patients presenting to the ED and/or frequently changing ED processes during that time to streamline care, impacting blood draws. As acute HIV can present as a febrile illness, it is also important to maintain an HIV screening program during a pandemic of febrile illness, and continue to work to provide linkage and access to care services for this especially vulnerable group.