(P109) Missed Opportunities for Concurrent HIV and Syphilis Testing Among Patients At-Risk for STIs in a Large, Urban, Safety Net Hospital

Background: Infection with any STI increases the risk for HIV and other STIs, and national guidelines recommend concurrent testing for HIV/STI testing. Despite this, many patients may still not receive comprehensive STI screening. This study, which took place at a large, urban, tertiary care center, examines missed opportunities for HIV and syphilis (SP) screening in patients undergoing testing for gonorrhea (GC) and chlamydia (CL) and reports the number of comprehensive STI testing by patient demographics and testing location.

Methods: This is a retrospective review of all patient encounters in the hospital system with HIV, SP, GC, or CL testing ordered between 11/1/2018 and 7/31/2021. Demographic information and ordering departments for the STI tests were extracted from the EMR. The primary outcome for this study was defined as a comprehensive screening panel, consisting of all four STIs, ordered in a single visit. Descriptive statistics are reported by different variations of concurrent HIV/STI testing.

Results: Over the 3 years, there were a total of 43,480 encounters for GC/CT testing, of which 39.6% had a comprehensive screen, 6.1% had concurrent HIV only, 1.6% had concurrent SP only, and 52.7% were tested for GC/CT only. Overall, patients tested for STIs were aged 31.2 (SD 10.4) years, female (76.7%), Black (58.4%), and had private insurance (59.4%), which was consistent through variations of concurrent HIV/STI testing. Emergency department (ED) had the largest percentage of ordering a comprehensive STI panel compared to other departments. The outpatient primary care clinics had the highest percentage of concurrent HIV testing only, while ED had the highest percentage of concurrent SP testing only. For GC/CL only, outpatient OBGYN was substantially more prevalent than any other departments.

Conclusion: This study suggests that many patients who should undergo comprehensive HIV and STI testing miss opportunities. In this sample, comprehensive screens were most common in the ED, which may be a reflection of the extensive efforts the ED has made to implement universal HIV and syphilis screening programs. A similar intervention across all departments could reduce this gap and avoid missed opportunities for HIV and syphilis testing among patients at high risk for STIs.