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By using an educational and EHR intervention, Intermountain Health significantly increased HIV co-testing for patient encounters involving testing for gonorrhea and/or chlamydia (GC/CT) in urgent care (UC) and emergency departments (ED). Urgent care HIV co-testing increased from 29% in the preintervention period to 39% during the 24-month intervention—from April 2023 through March 2024. Also, ED co-testing rates increased from 12% to 25% during the intervention as well. The analysis of 18,783 encounters published in Clinical Infectious Diseases showed a 12.7-percentage-point co-testing gain in urgent care (95% confidence interval [CI], 6.2–19.2; P < .001), representing a 41.9% relative increase, and a 12.3-point rise in the ED setting (95% CI, 1.08–23.6; P = .02), a 53.4% relative increase compared with expected trends. A total of 4,704 EMR alerts were triggered, leading to 730 HIV co-tests, with higher engagement in EDs (23.2%) than UCs (8.9%). Overall, 17 new HIV cases were diagnosed during the intervention—including 6 that were tested in UC—all of which were referred directly to infectious disease care. In this experimental study, the authors used 3 intervention components: provider and patient HIV testing education; HIV surveillance with an on-call infectious disease physician; and an EMR-based co-test “alert” nudging clinicians to consider HIV co-testing when GC/CT testing was ordered.
Who orders HIV testing: During the study intervention in the urgent care setting, physicians ordered 163 HIV co-tests (out of 1,927 alerts for an engagement rate of 8.5%), and nurse practitioners and physician assistants ordered 62 tests (out of 602 alerts for an engagement rate of 10.3%) with a total engagement across both UC provider types of 8.9%.
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