CROI 2025 Abstract eBook

Abstract eBook

Poster Abstracts

1182 Evaluating the Effectiveness and Population Impact of Status-Neutral HIV Screening in AZ Lazaro Ruiz, Sheila Soto University of Arizona, Tucson, AZ, USA Background: In Arizona, the Hispanic population faces significant barriers to accessing HIV testing services due to stigma, cultural insensitivity, and limited healthcare access. These challenges have led to low testing rates in Hispanic communities. To address this, we implemented a status-neutral HIV screening service integrated into routine health screenings offered by Mobile Health Units (MHUs) operating across Arizona. This study aims to evaluate the effectiveness and population impact of this intervention on HIV testing uptake and to model its potential for scalability and long-term sustainability. Methods: We designed a status-neutral health screening service that includes cardiovascular, diabetes, and HIV testing. The model we applied helps to reduce stigma and improve HIV testing rates for Hispanic and other hard-to-reach populations in Arizona. We analyzed the data collected from our intake forms through October 2022 to March 2022 using both MHUs. The intake forms captured demographic information, HIV risk factors, and testing results. Additionally, population impact was modeled using data on first-time testers, uptake among high-risk populations, and improvement in linkage to Comprehensive Preventive Services (CPS). Results: During the study period, 2,050 HIV tests were administered, with 84% of participants being first-time testers and 78% identifying as Hispanic. After adopting a status-neutral testing service, HIV testing rates increased from 16% to 77% for the Phoenix team and from 17% to 73% in the Tucson team. With the ability to be mobile and applying a status-neutral screening service it allows us to provide services to 13 different counties across Arizona, improving HIV testing rate, HIV awareness, and access/knowledge of CPS. Conclusions: Our findings suggest that integrating HIV testing into routine health screenings via MHUs is an effective strategy for increasing testing rates and reducing HIV transmission in underserved populations. The status-neutral approach not only reduces stigma but also proves to be effective and scalable. These results support the expansion of similar programs in other regions with high HIV prevalence and low testing rates, particularly among marginalized populations. 1183 Effectiveness of Clinical Decision Support in Improving HIV Screening in Pediatric Primary Care Sarah Wood 1 , Gabrielle Difiore 2 , Mary Kate Kelly 2 , Stephanie Mayne 2 , Gregory Lawton 2 , Anthony Luberti 2 , Angela Raposseli 2 , Haley Richardson 2 , Robert Gross 3 , Alexander Fiks 2 , Brian Jenssen 2 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA, 2 The Children's Hospital of Philadelphia, Philadelphia, PA, USA, 3 Hospital of the University of Pennsylvania, Philadelphia, PA, USA Background: Clinical decision support (CDS) systems are a promising strategy to improve HIV screening in pediatric settings. We assessed effectiveness of a CDS system to improve HIV screening at well-adolescent visits. Methods: In this quasi-experimental pragmatic study, we developed and launched an electronic health record (EHR)-based CDS system across a 31-clinic, northeastern U.S, pediatric primary care network. The system included three components at annual well visits: 1) order sets with non-defaulted HIV test orders and universal HIV screening recommendations for patients 13+ years, 2) the Adolescent Health Questionnaire (AHQ), an electronic screener assessing sexual activity completed by patients on arrival, and 3) an automated EHR alert in the visit note for sexually active youth reminding clinicians to screen for HIV. Interrupted time series (ITS) analyses assessed differences in HIV screening rates pre- and post-CDS (12/2022-6/2023 vs 6/2023-12/2023) at well visits. Logistic regression included binary indicators for HIV test completion (primary outcome) and intervention period (pre vs post CDS), a fixed effect accounting for non independence of intra-clinic observations, time in months, and a time x period interaction term. To a priori explore subgroup differences in effectiveness, separate ITS models included interaction terms for patient race (Black vs. non Black), ethnicity, sex assigned at birth, gender identity, sexual orientation, and insurance. Results: Of 60,592 adolescents aged 13-19 years-old (n=26,267 pre- and n=34,325 post-CDS), 24.7% were Black, 8.7% Latine, 49.5% female sex, 9.0% identified as LGBTQ, median age was 15 (IQR 14-16) and 15.1% reported sexual activity. Among all patients and sexually active patients, 2.2% and 11.1% received HIV screening, respectively. In ITS analyses, there were no differences in HIV screening rates between the pre- and post-CDS periods for all

adolescents (OR 1.03, 95% CI: 0.87, 1.09). Similarly, there were no differences in HIV screening rates for sexually active youth (OR 1.11, 95% CI: 0.79, 1.03; Figure 1). In our subgroup analyses, there were no significant differences in HIV test completion within any patient subgroups. Conclusions: In a large regional pediatric healthcare system, we found no significant effect of a CDS system on HIV screening. Our findings suggest that CDS primarily targeting knowledge and situational awareness may be insufficient to improve screening. Future CDS interventions should target additional systemic barriers.

1184 Impact of a New Opt-In Targeted Strategy for HIV Testing in Emergency Departments Jose Guardiola 1 , Miriam Carbo 2 , Emilia Miro 3 , Juan Carlos Hurtado 2 , Agustin Avila 2 , Neus Robert 4 , Gemma Fernandez Ribas 4 , Jordi Llaneras 3 , Ariadna Rando 3 , Elisenda Miro 1 , Laia Sentis 2 , Juan González del Castillo MD, PhD 5 , Oscar Miro 2 , for the Urgencias VIHgila Project 1 Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, 2 Hospital Clinic of Barcelona, Barcelona, Spain, 3 Hospital Universitario de la Vall d'Hebron, Barcelona, Spain, 4 Hospital Germans Trias i Pujol, Barcelona, Spain, 5 Hospital Clinico San Carlos, Madrid, Spain Background: To analyze the time trends of HIV testing in Barcelona (Spain) and investigate if emergency departments (EDs) have changed HIV screening patterns and if the implementation of an opt-in targeted strategy for HIV testing in these EDs impacted these trends. Methods: Between 2017-2023 (7 years), monthly HIV tests performed in 4 hospitals covering a population of 1.6-million inhabitants in Barcelona were recorded. Tests were classified as ordered by ED, other hospital departments (HD) or community healthcare centers (CHCC). Monthly ED attendances were also compiled, along with new HIV diagnosed performed in ED. Temporal trends were assessed by linear models. Between 2021 and 2022, the 4 EDs implemented an opt-in strategy to test every patient with targeted conditions Results: 769,134 HIV tests were performed in 7 years (2,296/month-center): 430,582 (56.0%) by HD, 324,469 (42.2%) by CHCC and 14,083 (1.8%) by EDs. HIV tests steadily increased by 29 per month (R 2 =0.13, p<0.001), with HD-, CHCC and ED-ordered tests increasing by 11 (R 2 =0.14, p<0.001), 17 (R 2 =0.09; p<0.001) and 1 (R 2 =0.50, p<0.001), respectively. The rhythm of increment in ED testing was higher than in HD (p<0.001) and CHCC (p=0.04). There were 4.3 million ED visits (12,849/month-ED) and 0.33% were screened for HIV, with a significant 0.05% monthly increase of tested patients over time (p<0.001). There were 302 new HIV diagnoses performed in EDs (0.9/month-ED), resulting in a 2.1% of positive tests among the 14,083 screened patients, which decreased by -0.36% per year; R 2 =0.06, p<0.001. The opt-in targeted strategy was associated with higher increases in monthly HIV testing in EDs (p<0.001) and percentage of HIV tests ordered coming from EDs (from 1.62% to 2.08%, p<0.001); however, the percentage of ED comers screened, HIV new diagnoses and HIV tests resulting in new diagnoses did not vary (p=0.68, p=0.48 and p=0.78, respectively). Conclusions: HIV screening in Barcelona increased from 2017 to 2023, and EDs incremented HIV screening more than HDs and CHCCs. Implementation of an opt-in targeted strategy for HIV screening in EDs increased the number of tests and the role of EDs in HIV testing, but not the proportion of patients tested or new HIV diagnoses made in EDs, probably due to the progressive decline of undiagnosed HIV people during the studied period. on top of other classical reasons for HIV testing. Post-implementation HIV screening and new diagnoses in EDs were compared with the pre implementation period.

Poster Abstracts

CROI 2025 388