12.11 HIV Screening And Early Referral In The Trauma Population. The Experience Of A Large County Hospital

Posted on January 31, 2019

L. R. Taveras1, T. Turner-Wentt2, S. W. Ross1, H. B. Cunningham1, T. D. Madni1, J. B. Imran1, M. L. Pickett1, M. Zhou1, S. Park1, H. A. Phelan1, M. W. Cripps1  1University Of Texas Southwestern Medical Center,Department Of Surgery, Division Of General And Acute Care Surgery,Dallas, TX, USA 2Parkland Health and Hospital System,HIV Department,Dallas, TEXAS, USA

Introduction:
A significant proportion of HIV-infected individuals are unaware of their serologic status. The trauma population has a higher HIV prevalence. An HIV screening program was implemented in partnership with the state health department. Our objective is to evaluate the use and results of the program in our trauma population.

Methods:
Patients evaluated in the emergency services department are screened for HIV. This is a retrospective analysis of prospectively collected data from July 2015 to February 2018. Counseling is given to all positive screens and referral to specialty care is offered. Patients were divided based on screening status. Significance was set at α = 0.05 on two-tailed testing. Student's t test, and a chi-squared test were performed where appropriate.

Results:

6175 patients were evaluated in the trauma department. Of those, 449 (7.3%) patients were previously screened the prior year and were excluded. The remaining 2024 (35.3%) patients were screened and 27 (1.3%) screened positive (table 1). The majority of the patients that screened positive were male (100%), white (77.8%), not-hispanic (63.0%) and had no insurance (70%). 25 (92.6%) patients were counseled regarding their results; median days to counseling was 0 [IQR 0 – 1.5 days]. Six (22.2%) patients were lost to follow-up, the remaining 19 patients were offered referral to specialty care but 14.3% declined.  Age, gender, race, ethnicity, injury severity score, trauma activation level, and payor type were not significant predictors for a positive screen on logistic regression analysis. 

Conclusion:
Despite a significantly higher rate of HIV in the trauma population, barely a third of patients are screened. Majority of patients that screened positive were offered referral to specialty care. Such high diagnosis rate justifies the existence of this screening program; however, steps must be taken to increase screening rate.