A Different Form of Injury Prevention: Successful Screening and Referral for HIV and Hepatitis C in a Trauma Population.

BACKGROUND: In the United States, millions of patients are living with HIV and Hepatitis C (0.44% and 1.5%) and many are currently undiagnosed. Since highly effective treatments are now available, early identification of these patients is extremely important to achieve improved clinical outcomes. Prior data and trauma-associated risk factors suggest a higher prevalence of both diseases in the trauma population. We hypothesized that a screening program could be successfully initiated amongst trauma activation patients and that a referral and linkage-to-care program could be developed.

METHODS: Hepatitis C and HIV screening tests were added to standard trauma activation lab orders at an academic Level 1 Trauma Center. Confirmatory viral load was sent when indicated. Patients with positive results were educated about their disease and referred to disease-specific follow-up. Data was collected prospectively from January 1, 2016 until June 30, 2017. Total and new diagnosis, referral rates, and linkage-to-care rates were analyzed.

RESULTS: 1898 patients arrived as trauma activations. 1217 patients (64.1%) were screened (Level A = 75.6%, Level B = 60.2%). 7% of screened patients were initially positive and 5.5% were confirmed positive. Rates of both HIV (1.1%) and Hepatitis C (4.4%) were almost triple the national average. Overall, 3.3% screened positive for a new diagnosis. For Hepatitis C, the rate of new diagnosis was twice the national average (3%). Over 85% of all cases were referred for follow-up and the combined linkage-to-care rate was 43.3%.

CONCLUSIONS: The majority of patients were screened and referred for follow-up indicating successful implementation of our trauma screening program. Routine screening of trauma patients should be considered to increase diagnosis rate, increase linkage-to-care rates, and decrease disease transmission. These screening efforts would help bridge the health care gap that exists in the trauma population due to lower insurance rates and limited access to primary care.

LEVEL OF EVIDENCE: Level III STUDY TYPE: Prospective Intervention.