HIV Screening and Early Referral in the Trauma Population

The Experience of a Large Safety Net Hospital

Maryanne L. Pickett, Luis R. Taveras, Traneika Turner-Wentt, Samuel W. Ross, Holly B. Weis, Tarik D. Madni, Jonathan B. Imran, Michael Zhou, So Youn Park, Michael W Cripps, Herbert Phelan

Research output: Contribution to journalArticle

Abstract

Background: While the prevalence of HIV infection in the population is 0.5%, it is higher among trauma patients as are rates of unknown seropositivity. Routine HIV screening for all trauma evaluations was implemented at our urban level I center in 2009. We aimed to evaluate use and results of the program in our trauma population. Methods: This was a retrospective analysis of all trauma evaluations between July 2015 and February 2018. After passage of legislation rescinding the requirement for consent to perform HIV testing, our trauma service instituted an order set which automatically tested for HIV unless the ordering physician opted out. Patients found to be infected with HIV were to be counseled and referred to specialty care. Results: Of 6175 consecutive trauma evaluations during the study period, 449 (7.3%) patients had been screened within the prior year and were excluded. Of the remaining cohort, 2024 (35.3%) patients were screened with 27 (1.3%) testing positive. Among those testing positive for infection, 100% were male, 77% white, 63% non-Hispanic, and 70% lacked insurance. Twenty-five (92.6%) patients received counseling and 19 were referred to specialty care. Age, gender, race, ethnicity, Injury Severity Score, trauma activation level, and payor type were not significant predictors for positive HIV screen on logistic regression analysis. Conclusions: Despite a significantly higher rate of HIV in the trauma population, only a third of patients are screened. Such high infection rates justify the existence of this screening program but steps must be taken to increase screening rate. Level of Evidence: Level 3.

Original languageEnglish (US)
Pages (from-to)360-366
Number of pages7
JournalJournal of Surgical Research
Volume245
DOIs
StatePublished - Jan 1 2020

Fingerprint

Safety-net Providers
Referral and Consultation
HIV
Wounds and Injuries
Population
Injury Severity Score
Infection
Insurance
Legislation
HIV Infections
Counseling
Logistic Models
Regression Analysis
Physicians

Keywords

  • HIV screening
  • Human immunodeficiency virus
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

HIV Screening and Early Referral in the Trauma Population : The Experience of a Large Safety Net Hospital. / Pickett, Maryanne L.; Taveras, Luis R.; Turner-Wentt, Traneika; Ross, Samuel W.; Weis, Holly B.; Madni, Tarik D.; Imran, Jonathan B.; Zhou, Michael; Park, So Youn; Cripps, Michael W; Phelan, Herbert.

In: Journal of Surgical Research, Vol. 245, 01.01.2020, p. 360-366.

Research output: Contribution to journalArticle

Pickett, ML, Taveras, LR, Turner-Wentt, T, Ross, SW, Weis, HB, Madni, TD, Imran, JB, Zhou, M, Park, SY, Cripps, MW & Phelan, H 2020, 'HIV Screening and Early Referral in the Trauma Population: The Experience of a Large Safety Net Hospital', Journal of Surgical Research, vol. 245, pp. 360-366. https://doi.org/10.1016/j.jss.2019.07.071
Pickett, Maryanne L. ; Taveras, Luis R. ; Turner-Wentt, Traneika ; Ross, Samuel W. ; Weis, Holly B. ; Madni, Tarik D. ; Imran, Jonathan B. ; Zhou, Michael ; Park, So Youn ; Cripps, Michael W ; Phelan, Herbert. / HIV Screening and Early Referral in the Trauma Population : The Experience of a Large Safety Net Hospital. In: Journal of Surgical Research. 2020 ; Vol. 245. pp. 360-366.
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abstract = "Background: While the prevalence of HIV infection in the population is 0.5{\%}, it is higher among trauma patients as are rates of unknown seropositivity. Routine HIV screening for all trauma evaluations was implemented at our urban level I center in 2009. We aimed to evaluate use and results of the program in our trauma population. Methods: This was a retrospective analysis of all trauma evaluations between July 2015 and February 2018. After passage of legislation rescinding the requirement for consent to perform HIV testing, our trauma service instituted an order set which automatically tested for HIV unless the ordering physician opted out. Patients found to be infected with HIV were to be counseled and referred to specialty care. Results: Of 6175 consecutive trauma evaluations during the study period, 449 (7.3{\%}) patients had been screened within the prior year and were excluded. Of the remaining cohort, 2024 (35.3{\%}) patients were screened with 27 (1.3{\%}) testing positive. Among those testing positive for infection, 100{\%} were male, 77{\%} white, 63{\%} non-Hispanic, and 70{\%} lacked insurance. Twenty-five (92.6{\%}) patients received counseling and 19 were referred to specialty care. Age, gender, race, ethnicity, Injury Severity Score, trauma activation level, and payor type were not significant predictors for positive HIV screen on logistic regression analysis. Conclusions: Despite a significantly higher rate of HIV in the trauma population, only a third of patients are screened. Such high infection rates justify the existence of this screening program but steps must be taken to increase screening rate. Level of Evidence: Level 3.",
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AU - Taveras, Luis R.

AU - Turner-Wentt, Traneika

AU - Ross, Samuel W.

AU - Weis, Holly B.

AU - Madni, Tarik D.

AU - Imran, Jonathan B.

AU - Zhou, Michael

AU - Park, So Youn

AU - Cripps, Michael W

AU - Phelan, Herbert

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AB - Background: While the prevalence of HIV infection in the population is 0.5%, it is higher among trauma patients as are rates of unknown seropositivity. Routine HIV screening for all trauma evaluations was implemented at our urban level I center in 2009. We aimed to evaluate use and results of the program in our trauma population. Methods: This was a retrospective analysis of all trauma evaluations between July 2015 and February 2018. After passage of legislation rescinding the requirement for consent to perform HIV testing, our trauma service instituted an order set which automatically tested for HIV unless the ordering physician opted out. Patients found to be infected with HIV were to be counseled and referred to specialty care. Results: Of 6175 consecutive trauma evaluations during the study period, 449 (7.3%) patients had been screened within the prior year and were excluded. Of the remaining cohort, 2024 (35.3%) patients were screened with 27 (1.3%) testing positive. Among those testing positive for infection, 100% were male, 77% white, 63% non-Hispanic, and 70% lacked insurance. Twenty-five (92.6%) patients received counseling and 19 were referred to specialty care. Age, gender, race, ethnicity, Injury Severity Score, trauma activation level, and payor type were not significant predictors for positive HIV screen on logistic regression analysis. Conclusions: Despite a significantly higher rate of HIV in the trauma population, only a third of patients are screened. Such high infection rates justify the existence of this screening program but steps must be taken to increase screening rate. Level of Evidence: Level 3.

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