A Comparative Effectiveness Study of Two Nontargeted HIV and Hepatitis C Virus Screening Algorithms in an Urban Emergency Department

Study objective: We compare the effectiveness of 2 nontargeted HIV and hepatitis C virus screening protocols integrated consecutively into care in an urban emergency department: a nurse-order HIV/hepatitis C virus screening algorithm followed by an automated-laboratory-order HIV/hepatitis C virus screening algorithm programmed into the electronic health record.

Methods: This was a before-after comparative effectiveness cohort study. All patients aged 18 to 75 years who received treatment during 5-month periods were eligible for participation. The main outcome measures were the number of patients screened and the number with newly diagnosed HIV and hepatitis C virus infection.

Results: Of the eligible patients, 6,736 (33.9%) completed HIV screening during the automated-laboratory-order HIV/hepatitis C virus screening algorithm, whereas 4,121 (19.6%) completed HIV screening during the nurse-order HIV/hepatitis C virus screening algorithm (difference 14.3%; 95% confidence interval 13.4% to 15.1%); and 6,972 (35.1%) completed hepatitis C virus screening during the automated-laboratory-order HIV/hepatitis C virus screening algorithm, whereas 2,968 (14.2%) completed hepatitis C virus screening during the nurse-order HIV/hepatitis C virus screening algorithm (difference 20.9%; 95% confidence interval 20.1% to 21.7%). More patients had newly diagnosed HIV (23 versus 17) and hepatitis C virus infection (101 versus 29) during the automated-laboratory-order HIV/hepatitis C virus screening algorithm than the nurse-order HIV/hepatitis C virus screening algorithm. Results were more often available before discharge (HIV 87.2% versus 65.1%; hepatitis C virus 90.0% versus 65.4%) and fewer patients underwent repeated screening (HIV 1.6% versus 5.8%; hepatitis C virus 1.3% versus 4.5%) during the automated-laboratory-order HIV/hepatitis C virus screening algorithm than the nurse-order HIV/hepatitis C virus screening algorithm.

Conclusion: An electronic health record algorithm that automatically links HIV/hepatitis C virus screening to laboratory ordering for adult patients is more effective than a nurse-driven protocol. With widespread use of electronic health record systems, this model can be easily replicated and should be considered the standard for future programs.