Benefits of a Routine Opt-Out HIV Testing and Linkage to Care Program for Previously Diagnosed Patients in Publicly Funded Emergency Departments in Houston, TX

Background: The Routine Universal Screening for HIV program provides opt-out HIV testing and linkage to care for emergency department (ED) patients in Harris Health System, Houston, TX. Seventy-five percent of patients testing positive in this program have been previously diagnosed. Whether linkage to care is increased among these patients is unknown. Methods: We conducted a retrospective cohort study of persons tested for HIV in the ED between 2008 and 2012 but had a previously documented positive HIV test >= 1 year prior. Outcomes were engagement in care (>= 1 HIV outpatient visits in 6 months), retention in care (>= 2 HIV outpatient visits in 12 months, at least 3 months apart), and virologic suppression (<200 copies/mL in 12 months) compared before and after the ED visit. Analysis was conducted using McNemar test and multivariate conditional logistic regression. Results: A total of 202,767 HIV tests identified 2068 previously diagnosed patients. The mean age was 43 years with 65% male and 87% racial and ethnic minorities. Engagement in care increased from 41.3% previsit to 58.8% postvisit (P < 0.001). Retention in care increased from 32.6% previsit to 47.1% postvisit (P < 0.001). Virologic suppression increased from 22.8% previsit to 34.0% postvisit (P < 0.001). Analyses revealed that engagement in care after visit improved most among younger participants (ages 16-24 years), retention improved across all groups, and virologic suppression improved most among participants aged 25-34 years. Conclusions: Routine opt-out HIV testing in an ED paired with standardized service linkage improves engagement, retention, and virologic suppression in previously diagnosed patients.