Integrating HIV Screening into Urban ED COVID-19 Testing

The COVID-19 pandemic has emphasized so much of what we’ve often known, but frequently neglected to give enough resources or attention to—public health, global health, equity, vulnerable populations, essential workers, and mental health are just the tip of the iceberg. While it will likely take decades for us to understand the true impact of COVID-19, there is a historical precedence of neglecting health disparities and endemic diseases during times of outbreaks.

Neglecting other diseases during public health crises isn’t new. We saw this with already neglected tropic diseases, but also disease like HIV/AIDs, malaria, and tuberculosis during the 2014/2016 Ebola outbreak. With resources focused on the most immediate infectious disease threat, there is always concern that other, more endemic infectious diseases will be ignored and thus, surge. A new article in JAMA Internal Medicine sought to address this through the lens of HIV/AIDS and emphasizing the need to incorporate screening with COVID-19 testing in emergency departments in urban areas.

In this study, the authors incorporated universal HIV screening phlebotomy into COVID-19 testing at the University of Chicago Medicine emergency department. Researchers compared the rate of acute HIV infection rates diagnosed per day for the 1461 days prior to January 1, 2020 and then the 290 days between January 1, 2020 and October 16, 2020. During this time, there was a 49% reduction in testing and a significant drop in HIV screenings.

The authors note that “The ED at UCM, however, maintained HIV screening volumes throughout the pandemic and performed 19 111 HIV screens (14 215 in the ED) between January 1 and October 16, 2020, along with 112 242 COVID-19 polymerase chain reaction (PCR) tests (18 830 in the ED). Twelve patients were diagnosed with AHI after the first COVID-19 diagnosis in Cook County on January 24, 2020. The rate of AHI diagnoses per day was significantly higher during the pandemic compared with the prior 4 years (incidence rate ratio, 2.43; 95% CI, 1.22-4.83; P = .01). Other EDs not incorporating HIV screening into COVID-19 testing saw a 25% decrease in AHI diagnoses (incidence rate ratio, 0.75; 95% CI, 0.26-2.14; P = .59) that was not statistically significant.”

The research team noted that patients with acute HIV infections comprised 26% (11 of 46) of new diagnoses and 11 presented with COVID-19 symptoms. This is another important reminder in that while we respond to a pandemic, it is critical not to lose sight regarding the existing health issues and disparities. With the increase in acute HIV infection diagnoses through this process of incorporating screening, it’s an important reminder to incorporate health education and provide screening opportunities for all.

As the authors note, there is of course the potential that this is a product of increase in screening or that those with HIV are more likely to present to the hospital due to concerns for SARS-CoV-2 infection. Overall though, the authors make an important point- “Finally, new transmissions may be increasing owing to disrupted HIV care and prevention efforts. Thus, HIV screening programs, particularly in EDs, should incorporate or even link HIV screening to COVID-19 testing.”