Improvements in the continuum of HIV care in an inner-city emergency department

Research output: Contribution to journalArticle

Abstract

Objective: The Johns Hopkins Hospital Emergency Department has served as a window on the HIV epidemic for 25 years, and as a pioneer in emergency department-based screening/linkage-to-care (LTC) programs. We document changes in the burden of HIV and HIV care metrics to the evolving HIV epidemic in inner-city Baltimore. Design/methods: We analyzed seven serosurveys conducted on 18 144 adult Johns Hopkins Hospital Emergency Department patients between 1987 and 2013 as well as our HIV-screening/LTC program (2007, 2013) for trends in HIV prevalence, cross-sectional annual incidence estimates, undiagnosed HIV, LTC, antiretrovirals treatment, and viral suppression. Results: HIV prevalence in 1987 was 5.2%, peaked at more than 11% from 1992 to 2003 and declined to 5.6% in 2013. Seroprevalence was highest for black men (initial 8.0%, peak 20.0%, last 9.9%) and lowest for white women. Among HIV-positive individuals, proportion of undiagnosed infection was 77% in 1987, 28% in 1992, and 12% by 2013 (P <0.001). Cross-sectional annual HIV incidence estimates declined from 2.28% in 2001 to 0.16% in 2013. Thirty-day LTC improved from 32% (2007) to 72% (2013). In 2013, 80% of HIV-positive individuals had antiretrovirals ARVs detected in sera, markedly increased from 2007 (27%) (P <0.001). Proportion of HIV-positive individuals with viral suppression (

Original languageEnglish (US)
Pages (from-to)113-120
Number of pages8
JournalAIDS
Volume30
Issue number1
DOIs
StatePublished - Jan 2 2016

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Continuity of Patient Care
Hospital Emergency Service
HIV
Hospital Departments
Baltimore
Incidence
Seroepidemiologic Studies

Keywords

  • cascade of care
  • emergency department
  • HIV
  • HIV testing program
  • seroprevalence studies

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Improvements in the continuum of HIV care in an inner-city emergency department. / Kelen, Gabor D; Hsieh, Yu-Hsiang; Rothman, Richard; Patel, Eshan U.; Laeyendecker, Oliver B.; Marzinke, Mark A; Clarke, William; Parsons, Teresa; Manucci, Jordyn L.; Quinn, Thomas C.

In: AIDS, Vol. 30, No. 1, 02.01.2016, p. 113-120.

Research output: Contribution to journalArticle

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abstract = "Objective: The Johns Hopkins Hospital Emergency Department has served as a window on the HIV epidemic for 25 years, and as a pioneer in emergency department-based screening/linkage-to-care (LTC) programs. We document changes in the burden of HIV and HIV care metrics to the evolving HIV epidemic in inner-city Baltimore. Design/methods: We analyzed seven serosurveys conducted on 18 144 adult Johns Hopkins Hospital Emergency Department patients between 1987 and 2013 as well as our HIV-screening/LTC program (2007, 2013) for trends in HIV prevalence, cross-sectional annual incidence estimates, undiagnosed HIV, LTC, antiretrovirals treatment, and viral suppression. Results: HIV prevalence in 1987 was 5.2{\%}, peaked at more than 11{\%} from 1992 to 2003 and declined to 5.6{\%} in 2013. Seroprevalence was highest for black men (initial 8.0{\%}, peak 20.0{\%}, last 9.9{\%}) and lowest for white women. Among HIV-positive individuals, proportion of undiagnosed infection was 77{\%} in 1987, 28{\%} in 1992, and 12{\%} by 2013 (P <0.001). Cross-sectional annual HIV incidence estimates declined from 2.28{\%} in 2001 to 0.16{\%} in 2013. Thirty-day LTC improved from 32{\%} (2007) to 72{\%} (2013). In 2013, 80{\%} of HIV-positive individuals had antiretrovirals ARVs detected in sera, markedly increased from 2007 (27{\%}) (P <0.001). Proportion of HIV-positive individuals with viral suppression (",
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AU - Marzinke, Mark A

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