Emergency Department Strategies to Identify Out-of-Care People Living With HIV: A Critical Step Toward Ending the HIV Epidemic.

Abstract

People with a previous HIV diagnosis (PWHDx) who are out of care (OOC) (PWHDx OOC) represent a significant but often overlooked population in the United States, accounting for nearly half of new HIV transmissions annually. Emergency departments (EDs), frequently accessed by PWHDx OOC for unscheduled care, are uniquely positioned to identify and re-engage these individuals in HIV care. While ED-based HIV efforts have traditionally focused on diagnosing new infections, this paper reviews and evaluates 3 models EDs can implement to identify PWHDx OOC: routine HIV screening, health information exchange, and electronic health record alerts. We describe each model using examples from the literature, assessing their feasibility, scalability, and effectiveness in identifying patients and determining care status. By synthesizing current approaches, this paper highlights practical and policy-relevant pathways for expanding ED-based HIV services beyond diagnosis, offering concrete guidance for healthcare systems aiming to meet the national "Ending the HIV Epidemic" goals.