472. Use of an EMR-based algorithm to identify patients for prevention follow-up among patients tested for HIV in the Emergency Department
Session: Poster Abstract Session: HIV and STI Prevention
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • IDWeek_PTC_final.pdf (491.2 kB)
  • Background: Many patients who test negative for HIV remain at risk for future HIV infection. Automated identification of HIV negative, high-risk patients may help providers target such patients for HIV prevention services including post-test counseling (PTC), regular HIV/STI testing and referral for PrEP.

    Methods: We performed PTC, including HIV risk assessment, via telephone for a subset of patients who tested negative for HIV in the Emergency Department (ED) between August 2015 and April 2016. Patients were classified as high risk if they reported one or more risk factors (Table 1). To develop an algorithm to identify patients at high risk for HIV infection, we identified EMR-based criteria associated with HIV risk and applied these criteria to those who completed PTC. We assessed performance of the criteria in identifying patients at high risk for HIV infection.

    Results: 267 patients completed PTC (mean age 26.7 years (SD 8.1), 69.9% Female, 95.5% Black/African-American, and 1.9% Hispanic). EMR criteria used in the algorithms included: history of STI, male patient who reported a male sexual partner (MSM), chief complaint related to STI, and ICD-codes related to STI symptoms. EMR criteria and the associated sensitivity, specificity and positive predictive value (PPV) are shown in Table 2.

    Conclusion:

    Using commonly available data from an EMR, we developed an algorithm for identifying HIV-negative patients at high risk for HIV who could benefit from HIV prevention services. The algorithm that incorporated history of STI, MSM, and chief complaint related to STI provided relatively high sensitivity and specificity. Additional validation among all patients tested in the ED is needed.

    Table 1

    Risk factor

    Time frame (months)

    # met criteria

    STI +(EMR or self-report)

    12

    64

    Sex w/ HIV + partner

    6

    2

    Sex in exchange for money, goods or other benefit

    6

    6

    ≥ 2 sexual partners

    1

    28

    Sex w/o condoms with a partner who injects drugs

    6

    0

    Sex w/o condoms if MSM or with MSM partner (female clients)

    6

    7

    Injection drug user shared needles

    6

    0

    Table 2

    EMR criteria

    #

    Sensitivity

    (95% CI)

    Specificity

    (95% CI)

    PPV

    (95% CI)

    STI + & MSM

    51

    54 (43-65)

    98 (94-99)

    92 (80-98)

    Chief complaint, STI + & MSM

    102

    69 (58-78)

    77 (70-83)

    58 (49-68)

    ICDs, STI + & MSM

    124

    71 (60-80)

    66 (58-72)

    50 (41-59)

    Chief complaint, ICDs, STI + & MSM

    143

    78 (68-86)

    58 (51-66)

    48 (39-56)

    Nicola Lancki, MPH1, Denise Holman, MPH1, Rebecca Eavou, LCSW1, David Pitrak, MD, FIDSA2, John Schneider, MD, MPH3 and Jessica P. Ridgway, MD, MS3, (1)University of Chicago Center for HIV Elimination, Chicago, IL, (2)University of Chicago, Department of Medicine, Section of Infectious Diseases and Global Health, Chicago, IL, (3)Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL

    Disclosures:

    N. Lancki, Gilead Sciences: Grant recipient , Grant recipient

    D. Holman, Gilead Sciences: Grant recipient , Grant recipient

    R. Eavou, Gilead Sciences: Grant recipient , Grant recipient

    D. Pitrak, Gilead Sciences: Grant recipient , Grant recipient

    J. Schneider, Gilead Sciences: Grant Investigator , Grant recipient

    J. P. Ridgway, Gilead Sciences: Grant Investigator , Grant recipient

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