The CARE Initiative New Positives Known Positives Routine HIV screening in an Emergency Department requires multidisciplinary collaboration to improve public health outcomes and enhance educational opportunities Caitlin Gardner, MSc; Jean Wiggins, BSPH; Jay Goldstein, MD; Lori Conway, MSN, MBA; Joshua Lane, RN; Bonzo Reddick, MD, MPH* Memorial Health University Medical Center - *Mercer University School of Medicine 4700 Waters Ave Savannah, Georgia 31404 Savannah, Georgia Notification Window: EMR determines patient eligibility based on above screening criteria Patient Response (triage): Patient response determines if screening algorithm continues Lab Order (ED physician): CBC or CBC w/ Diff fires pre-populated window Physician “Accepts” to order screening test Reactives: In-Basket message and call to CARE Initiative team cell phone Team calls On-Call resident to perform counseling & linkage after hours. Assessment: Assess patient chart prior to risk counseling, education and linkage. Linkage to Family Medicine Center or Ryan White Clinic Relinkage: CARE Initiative teams receives message when known HIV patient presents to hospital and Assessment of care compliance takes place BACKGROUND RESULTS/PROTOCOLS ROUTINE, OPT-OUT HIV SCREENING & LINKAGE ALGORITHM Address Problem II Screening Criteria: Patient is > 13 years old, not documented as HIV positive, no EMR-documented HIV test > 12 months of current visit FACULTY & RESIDENT DEVELOPMENT ON HIV TREATMENT Address Problem I Educational series performed by institutional, local and regional champions of HIV care IMPACT HIV SCREENING RESULTS September 2016 - April 2017 = 9879 HIV tests; .5% were new positives HIV IS A MAJOR HEALTH DISPARITY OF SOUTHEAST GEORGIA Georgia is ranked 5th nationally for HIV infection. Savannah has the highest incidence of HIV outside of Atlanta. Memorial Health is a Safety Net Level 1 Trauma Center which serves 35 counties, as circled. 25 Tested known 31 EMR- identified 56 Possible relinkages 75% in care 27 New Positives 4 acute HIV infections 100% notified 14 hours 76% linked to care New Positives Known Positives II. HIV TESTING WAS RARE & ENGAGEMENT LACKED STRATEGY HIV tests 2014 2015 Emergency Department Visits 97,176 101,052 Rapid Assays + 4th gen HIV ½ Ab, p24 Ag 943 865 New Confirmed Positives 12 8 Patients Linked to Care ? III. RYAN WHITE CLINIC WAS THE ONLY TREATMENT CENTER FOR UNDERINSURED PATIENTS Conclusions & Discussion METHODS Implementation of routine, opt out HIV screening in the emergency department (ED)- CARE Initiative program Identified project champions, core team, and created buy-in Obtained funding sources Updated institutional policies and procedures Formulated research questions and write IRB Performed cross-departmental education on policies/procedures Budgeted program with project manager and support staff Screening and Linkage Protocol Development EMR automation of real-time result notification, counseling, and linkage to care for newly diagnosed and known HIV patients. Collaborated with laboratory, linkage specialists, and resident physicians Development of champion, resident-driven department Pioneered absorption of HIV care into a primary care setting Incorporated HIV treatment into resident curriculum to develop clinical skills and create care access for underinsured patients Incorporation of medical students Facilitated medical student-led (PGY1-3) 18-month research projects as part of the Professional Growth and Development curriculum of Mercer School of Medicine Included rotating students for observation of screening and HIV care balnoca1@memorialhealth.com- 912-350-0633 CARE Initiative increased HIV screening of eligible patients from 9% to 63%, with 75% and 76% of those in care. Geographic distribution of new diagnoses suggests our hospital is at the epicenter of HIV transmission in Southeast Georgia. The CARE Initiative aims to minimize the gap between public health and primary care. Screening efforts in the ED lead to absorption of HIV patients into the Family Medicine clinic. Residents and the CARE team engage with new diagnoses in the hospital and make linkage appointments during the encounter, which may increase patient adherence to care. 90% of patients linked to Family Medicine maintained compliance, compared to 73% linked to the Ryan White clinic. More time is needed to assess comparative efforts. Developing primary care residents to treat HIV is crucial for regional rural and at-risk urban populations. We expect robust effects on enhancing current and future care capacity and minimizing health disparities by expanding access to HIV care. Medical student involvement continues with research projects to characterize local HIV infection and expand screening efforts while building an understanding of population and public health research and mechanisms for creating access to care. Recent efforts include expansion to HCV screening and treatment and partnership with FQHCs to further increase care access for marginalized populations. Georgia Department of Public Health State Diplomat and Medical Advisor on HIV Medicine and Infectious Disease Grand Rounds- comprehensive overview of treatment Provided curriculum material Pharmacist / Medical Scientist Reviewed DHHS Guidelines on HIV treatment Provided curriculum materials with updates from Community HIV Liaison History of HIV and Treatment Expanded lecture on DHHS Guidelines incorporated clinical scenarios Patient and clinic resources CARE Initiative Program Staff Explained clinical and laboratory protocols as they exist in the EMR Discussed resident and faculty role in new HIV cases vs. acute HIV cases Reviewed counseling methods from the CDC and DPH Screening program efforts made possible by Gilead Sciences, Inc. in partnership with the FOCUS program