Promoting Re-engagement in HIV Care after Emergency Department Visit by Leveraging Clinical Informatics at a Southern Academic Medical Center.

Abstract

Retaining persons with HIV (PWH) in HIV care and ensuring access to antiretroviral therapy are crucial for reducing HIV transmission and enhancing health outcomes. HIV care engagement rates in the United States have plateaued over the last decade, indicating the need for innovative re-engagement strategies. We developed an automated electronic health record-based alert system to identify out-of-care (OOC) PWH presenting to any emergency department (ED) within the Duke University Health System. OOC was defined as no HIV care clinical visit in over 12 months. Automated alerts were processed by the HIV Rapid Response Re-engagement Team (H3RT), which connected with disengaged PWH by phone after an alert was triggered by an ED visit. Re-engagement was defined as a completed HIV clinic visit after H3RT outreach. The alert system identified 217 PWH, of whom 117 (54%) had transferred care to another health system. Among the 71 truly OOC PWH, 63% were male, 82% Black, and 34% uninsured. Median ED utilization while OOC was 1.30 ED visits/year [interquartile range (IQR): 0.66-2.37], compared with 1.05 ED visits/year [IQR: 0.33-1.85] when engaged in care. H3RT successfully re-engaged 46 (64.8%) of the 71 OOC PWH. The H3RT cohort had a higher proportion of persons assigned female sex at birth, uninsured, and Black compared with the overall engaged HIV clinic population. This low-cost, informatics-driven approach successfully re-engaged OOC PWH from priority populations within a large, multi-facility health system. Higher ED utilization rates among PWH while OOC support the integration of HIV care re-engagement efforts into these points of health care access. H3RT represents a scalable approach to HIV care re-engagement in Southern health care systems.