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Disclosure:
Pitrak reports that he has received grants from Gilead Sciences as part of the FOCUS program. In the study you will find all relevant financial information from all other authors.
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The pandemic has disrupted HIV supplies, including routine testing. By making the phlebotomy part of the COVID-19 testing process, an ED at the University of Chicago Medicine was able to maintain its HIV screening volume during the pandemic, data shows.
“Patients seen in ED have a high prevalence of undiagnosed HIV, including those with acute HIV – public health priority populations.” David Pitrak, MD, Professor of Medicine and Head of Infectious Diseases at the University of Chicago Medicine (UCM), Healio Primary Care said. “Although there are models that suggest linking HIV screening to COVID-19 testing may be beneficial, there is no real data. ”
UCM’s ED team has set up a COVID-19 testing area that integrates phlebotomy for HIV screening “seamlessly” with no new staff. Staff reviewed the tests, informed patients of their HIV status, and linked them to care.
The researchers compared the number of daily diagnoses of acute HIV infection made before and during the pandemic at UCM ED, where they combined HIV screening with COVID-19 testing, and a dozen other health centers in Chicago that did however, HIV and COVID-19 tests implemented in opt-out HIV screening were kept separate.
David Pitrak
Most sites saw significant reductions in HIV screenings during the pandemic, Pitrak and colleagues said. Overall, the program saw a 49% reduction in test events from January 1 to April 30, 2020. However, UCM maintained its HIV screening volume, conducting 19,111 HIV screenings (14,215 of which in ED) between January 1 and October 1, through 16, 2020 and 112,242 COVID-19 PCR tests (18,830 of which in the ED) during this time.
According to the researchers, a dozen patients were diagnosed with acute HIV infection in Cook County after the initial COVID-19 diagnosis on January 24, 2020. The rate of diagnoses of acute HIV infection per day was significantly higher during the pandemic compared to the previous 4 years (incidence rate = 2.43; 95% CI, 1.22-4.83). For EDs for which HIV screening was not included in the COVID-19 tests, the diagnoses of acute HIV infection decreased by 25% (incidence rate = 0.75; 95% CI, 0.26-2.14) which was not statistically significant.
In addition, patients with acute HIV infection included 12 out of 46 new diagnoses at UCM, which the researchers said was “the highest percentage recorded”. The mean viral load was 6 million (115,000 to> 6 million) copies / ml. Eleven out of 12 patients had symptoms consistent with COVID-19, and one patient had HIV and COVID-19. All patients were assigned to care and started antiretroviral therapy a median of 1 day (0-38 days) from the time they received their PCR test result, but 3 days (1-41 days) after specimen collection, as confirmatory testing was delayed. According to the researchers, this gap was due to “high demands on laboratory staff and insufficient supplies (e.g. reinforcement and test trays) due to COVID-19 test volumes”.
UCM is working to improve the testing program, according to Pitrak.
“Although we added phlebotomy and HIV screening to the workflow for COVID-19 tests, we have not officially linked the orders for these two tests,” he said. “We are currently initiating efforts to link orders for HIV screening with orders for COVID-19 tests.”
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Rajesh Gandhi, MD
COVID-19 has had a massive impact on HIV care and testing. In many centers, HIV test rates fell significantly in the first few months of the COVID-19 pandemic, partly because routine care of all kinds was disrupted by the public health emergency.
In this study by Stanford and colleagues, HIV testing was performed in conjunction with COVID-19 testing at the University of Chicago Medicine ED. Not only was the HIV test volume maintained during the pandemic, but a greater number of patients were diagnosed with acute HIV than in previous years.
The conjunction and co-localization of HIV and COVID-19 testing services in a single location is a model of how we can maintain the ability to diagnose HIV-infected people during the pandemic for treatment and transmission to prevent HIV. In the midst of the COVID-19 storm, this study sheds light on how we can continue to help our HIV patients by developing innovative testing and treatment strategies.
Rajesh Gandhi, MD
Infectious Disease Physician, Massachusetts General Hospital and Harvard Medical School
Chairman of the HIV Medicine Association
Disclosure: Gandhi does not report any relevant financial information.
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