Impact of three different interventions designed to improve the implementation of an opt-in targeted strategy of HIV testing in emergency departments.

Objectives: Undiagnosed HIV infection remains the main driver of new HIV cases in Western countries. Emergency Departments (EDs) offer a key opportunity for detection. In 2020, Spanish emergency and infectious diseases societies recommended an opt-in strategy for targeted conditions for HIV testing in EDs. This study evaluates the efficacy of three strategies for targeted HIV testing.

Methods: Twelve Spanish EDs, selected based on predefined structural criteria, assessed HIV testing from April to June 2024. Hospitals applied: no strategy (control, three EDs), an educational programme (strategy A, three EDs), strategy A plus preconfigured electronic orders (strategy B, three EDs) or strategy B plus electronic alerts in medical records (strategy C, three EDs). The impact on HIV testing was measured overall and by targeted condition, using absolute differences with 95% confidence intervals (CIs).

Results: Of the 612 909 ED visits, 210 039 occurred in control hospitals (1232 patients [0.59%] had targeted conditions), 172 806 in hospitals applying strategy A (1497 [0.87%]), 132 835 in strategy B hospitals (1761 [1.33%]) and 97 229 in hospitals applying strategy C (1269 [1.31%]). Testing rates were 0.16%, 0.38%, 1.17% and 2.16% in the control, and strategy A, B and C EDs., respectively. Among patients with targeted conditions, testing reached 13.1%, 22.9%, 30.7% and 78.1%. Compared to no strategy, testing increased by 0.22% (95% CI = 0.18-0.25) with strategy A, 0.79% (95% CI = 0.73-0.86) with B, and 0.98% (95% CI = 0.88-1.09) with C. In targeted conditions, testing rose by 9.8%, 7.8% and 47.5% for strategies A, B and C, respectively. All strategies improved testing in sexually transmitted infections (STI), meningitis/neurological syndromes and community-acquired pneumonia (CAP); strategy C also increased testing in herpes zoster (HZ) and post-exposure prophylaxis.

Conclusion: All the strategies evaluated enhanced targeted HIV testing, especially strategy C (electronic alerts), which was associated with the highest testing rates observed, particularly in STI, CAP and HZ.