Promoting Re-engagement in HIV Care after Emergency Department Visit by Leveraging Clinical Informatics at a Southern Academic Medical Center.
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2025-08
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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.
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Alavian, Naseem, Charles M Burns, Jeffrey D Jenks, Frances Hung, Richard Barfield, Daniel Popham, John Purakal, Nwora Lance Okeke, et al. (2025). Promoting Re-engagement in HIV Care after Emergency Department Visit by Leveraging Clinical Informatics at a Southern Academic Medical Center. AIDS research and human retroviruses. 10.1177/08892229251365260 Retrieved from https://hdl.handle.net/10161/33097.
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Scholars@Duke
Charles M Burns
Jeffrey Daniel Jenks
Richard Barfield
Richard received his PhD from Harvard University in 2017 and his MPH from Emory University in 2012. He is currently working with researchers within the Duke Center for Human Systems Immunology and Center for Aids Research. His past research was working with DNA methylation microarray data and methods development for summary Mendelian Randomization studies. He works closely with investigators to answer research questions related to the immune system or HIV/AIDS.
John David Purakal
John David Purakal, MD, MS, is an Associate Professor in the Department of Emergency Medicine at Duke University School of Medicine. He serves as the Department of Emergency Medicine's Director of Health Equity & Community Engagement, and holds appointments with the Duke-Margolis Institute for Health Policy and Samuel Dubois Cook Center on Social Equity. Dr. Purakal's educational roles include serving as the Emergency Medicine Clerkship Director for the Duke University School of Medicine Outpatient Integrated Longitudinal Experience (PIONEER), and Core Faculty within the Department of Emergency Medicine Residency Program. Dr. Purakal has been an invited speaker locally, nationally, and internationally on topics related to health equity, racial disparities in care, and cardiovascular disease. His medical career started as a student at the Wayne State University School of Medicine, where he created a public health education initiative to provide multidisciplinary health education to at-risk populations around the city of Detroit. This work led to his receipt of the Arthur Johnson Leadership Award, Ralph Wadley, MD Scholarship, and the Crain's Detroit Business "Twenty in their 20's" Award. Dr. Purakal completed his emergency medicine residency at The University of Illinois - Chicago, and served as chief resident in his final year. He then started his academic career at The University of Chicago as an Assistant Professor in the Section of Emergency Medicine.
Since joining Duke University School of Medicine, Dr. Purakal has worked to address unmet social needs in the emergency department patient population through development of a social needs screening program utilizing student volunteers and cross-sectoral collaborations with platforms such as NCCare360. He created the Health Equity Curriculum for the Emergency Medicine Residency Program, and serves multiple teaching roles within the School of Medicine, including Emergency Medicine clerkship director for the novel PIONEER curriculum. He is the physician champion for the Duke University Hospital Violence Recovery Program, and advises multiple Duke University student organizations that address health inequities in the Durham community. Finally, Dr. Purakal routinely addresses community members locally and regionally on public health topics such as gun violence and women's health, oftentimes advocating alongside local and regional elected officials and law enforcement.
His work has been recognized through multiple departmental awards since joining Duke Emergency Medicine, including Faculty Teacher of the Year (2020), the Kathleen J. Clem Distinguished Faculty Award (2022), and the Departmental Service & Leadership Award (2025). Dr. Purakal has additionally received prestigious recognition from Duke University for his leadership, mentorship, and service, including the university's highest individual honor, the Presidential Award (2023), and the Algernon Sydney Sullivan Award (2025). Regionally, he was recognized by the Triangle Business Journal with the "40 under 40" Leadership Award (2023), and nationally was the recipient of the American College of Emergency Physicians (ACEP) National Junior Faculty Teaching Award (2022) and the Society of Academic Emergency Medicine's ADIEM "Outstanding Academician Award" (2026). Finally, Dr. Purakal has been invited to the White House multiple times as a recognized healthcare leader in addressing social needs, health equity and health policy.
Nwora Lance Okeke
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