Implementation of a Best Practice Advisory-Based HIV Screening Program in the Emergency Department with Integrated Infectious Diseases: A Descriptive Study

Abstract Background Despite national guidelines recommending universal HIV screening, opportunities for testing are frequently missed in the emergency department (ED), a setting many vulnerable populations rely on for primary care. We describe a collaborative ED-based program created to reduce barriers to HIV screening. Methods This was a retrospective, observational study describing a best practice alert (BPA)-based opt-out HIV screening program established in an ED in Detroit, Michigan in 2019. A key program efficiency feature was collaboration between ED and infectious diseases (ID) teams. Medical records for patients who had a newly diagnosed HIV infection from a screening test during an ED visit between 2019 and 2025 were analyzed. Demographic and clinicopathologic features were described. Primary outcomes included annual rates of newly diagnosed HIV infections, linkage to care, time to initial clinical visit and antiretroviral therapy, and post-treatment viral suppression. Results Of 75,914 patients screened for HIV after program implementation, 176 (0.23%) were newly diagnosed with HIV. Almost 60% of newly diagnosed patients were linked to medical care (n=104) within 90 days (median, 13 days). Median time to antiretroviral treatment initiation was 9 days, and 54 patients (72.9%) showed evidence of viral suppression at 12 months. Conclusions Through close collaboration between ED and ID teams, a BPA system for ED HIV screening can remove structural barriers and reach patients with limited access to care, advancing equitable access to diagnosis, linkage to care, and HIV treatment.