Research

 
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HIV Testing in the Emergency Department

The Centers for Disease Control and Prevention (CDC) recommends HIV screening for all people, ages 13 to 64, at least once in their lifetime. However, many Americans have never been tested for HIV or are not tested at frequencies reflective of their risk profiles. Patients with undiagnosed HIV serve as a reservoir for ongoing transmission and account for 38% of new infections. Insufficient testing exacerbates the ongoing HIV epidemic and approximately 1 in 7 Americans living with HIV are unaware of their infection. The CDC acknowledges suboptimal uptake of prior recommendations. Thus, they recently launched the Ending the HIV Epidemic (EHE) initiative. Given that a majority of new diagnoses occur in a minority of US areas, this initiative provides resources, technology, and expertise to a subset of “priority” jurisdictions disproportionately impacted by HIV (left map). One of EHE’s four pillars centers on increasing HIV testing rates in priority jurisdictions. Although much of the previous conversation surrounding HIV testing has been focused on “who” and/or “how” to test, this new effort focuses on “where” (geographically) to test. Notably, current guidelines encourage routine opt-out testing in all venues - including US emergency departments (EDs). However, HIV testing occurs in only a fraction of ED visits each year. EDs remain an underutilized venue for HIV testing, despite routinely serving both vulnerable populations targeted by HIV-related efforts and individuals who lack alternative forms of health care.

Our group is interested in better:

  1. Understanding rates of HIV testing in US EDs (and how this has changed over time).

  2. Exploring why certain emergency departments test (or do not test) persons for HIV.

  3. Identifying barriers to (and facilitators of) emergency department based HIV testing.

  4. Identify which US ED might be best positioned to respond to EHE’s appeal.

The Emergency Physician Workforce

All Americans should be able to seek emergency care. Over 140 million emergency department visits occur each year - a number that has greatly increased over the last decade (128 million visits in 2010). At current, EDs provide a growing portion of all care provided in the US. Unfortunately, many portions of the country have an insufficient number of emergency departments and inadequate access to emergency physicians (e.g. right map). The American College of Emergency Physician’s Report Card on America’s Emergency Care Environment gave a D- grade for access to emergency care.

Our group is interested in better:

  1. Understanding where emergency physicians are clinically active (and how this has changed over time).

  2. Exploring supply and demand of emergency physicians.

  3. Characterizing attrition from the clinically active workforce.