A rural Level 1 Trauma Center ED serving two EHE counties will hire a peer navigator to identify Latino patients with SUD-related HIV risk and link them to care. Eligible patients will be identified in the EHR through automated alerts sent to the navigator's pager. The navigator will approach these patients during triage, assist them in completing self-screening, review the results, and offer HIV and HCV testing. Post-test counseling will be provided, along with appropriate referrals. To ensure linkage to care, eNavigation services will be offered via text messaging.
As of 2018, an estimated 18% of all HIV cases remain undiagnosed in the Inland Empire, comprised of San Bernardino and Riverside EHE priority counties. These high rates of PLWH who are unaware of their HIV serostatus are significant drivers of HIV infection in the region, with 80% of new HIV infections traced to undiagnosed or out-of-care individuals. Emergency Departments (EDs) play a crucial role in providing healthcare access for individuals at risk of or living with undiagnosed HIV, particularly in medically underserved areas. Expanding HIV screening in EDs is a key strategy recommended by local public health departments.
The Loma Linda University (LLU) ED, the sole Level 1 Trauma Center in the Inland Empire, receives 85,000 annual visits, yet it lacks an implemented HIV screening process. An internal review suggests this absence results in missed HIV diagnoses (~48 cases) and missed referrals to the LLU PrEP clinic (~132 cases) each year. The review identified barriers to HIV testing, including limited staff capacity for pre/post-test counseling, a lack of cultural competency to address the rising HIV diagnoses among the Latino population, especially Latino MSM (representing 79% of new HIV diagnoses among non-white individuals and 69% among MSM). Additionally, high rates of HIV test refusals among minority patients, the failure to address HIV risks related to substance use (contributing to one in three seroconversions in the region), and the lack of coordination between HIV and SUD services within the ED were identified as challenges.
To address these gaps, the project aims to implement an effective HIV screening process tailored to the specific needs of Latino MSM and MSM with SUD in the LLU ED. The project will use an existing computer-based self-screening intervention to identify Latino ED patients with SUD-related HIV risks. Latino ED patients often refuse HIV testing due to fears of the stigma associated with an HIV diagnosis, discussions about HIV risk, or being perceived as MSM. By using a computer-based self-screening intervention, this project aims to discreetly address barriers to HIV testing, effectively reducing refusal rates and addressing cultural competency concerns when eliciting sensitive information. The self-screening tool used in this intervention encompasses measures for both HIV and SUD risks, thus enabling the identification and coordination of services for SUD-related HIV risk within the ED. Furthermore, the implementation of this intervention will be facilitated by community health workers (CHWs) trained as HIV test counselors. These Latino CHWs will provide rapid HIV/HCV tests to at-risk patients, deliver required post-test counseling, and ensure linkage to appropriate resources and care.
This project addresses the locally defined HIV prevention needs by expanding HIV screening within EDs. The screening approach is designed to be culturally and linguistically appropriate, ensuring that it effectively reaches and engages Latino patients. Recognizing the significant role of substance use in driving HIV transmission among this population in the area, the project specifically targets and addresses this issue. Importantly, the project builds upon the resources and successes of a previously funded EHE demonstration project, optimizing the utilization of existing infrastructure and organizational expertise.