Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, United States of America.
Department of Epidemiology, Stanford University School of Medicine, Stanford, CA, United States of America.
PLoS One. 2023 Oct 18;18(10):e0292869. doi: 10.1371/journal.pone.0292869. eCollection 2023.
The Ending the HIV Epidemic (EHE) Initiative targets a subset of United States (US) priority jurisdictions hardest hit by HIV. It remains unclear which emergency departments (EDs) are the most appropriate targets for EHE-related efforts. To explore this, we used the 2001-2019 National Emergency Department Inventories (NEDI)-USA as a framework to characterize all US EDs, focusing on those in priority jurisdictions and those affiliated with a teaching hospital. We then incorporate multivariable regression to explore the association between ED characteristics and location in an HIV priority jurisdiction. Further, to provide context on the communities these EDs serve, demographic and socioeconomic information and sexually transmitted infection case rate data were included. This reflected 2019 US Census Bureau data on age, race, ethnicity, and proportion uninsured and living in poverty along with 2001-2019 Centers for Disease Control and Prevention case rate data on chlamydia, gonorrhea, and syphilis. We found that EDs in priority jurisdictions (compared to EDs not in priority jurisdictions) more often served populations emphasized in HIV-related efforts (i.e., Black or African American or Hispanic or Latino populations), communities with higher proportions uninsured and living in poverty, and counties with higher rates of chlamydia, gonorrhea, and syphilis. Further, of the groups studied, EDs with teaching hospital affiliations had the highest visit volumes and had steady visit volume growth. In regression, ED annual visit volume was associated with an increased odds of an ED being located in a priority jurisdiction. Our results suggest that geographically targeted screening for HIV in a subset of US priority jurisdiction EDs with a teaching hospital affiliation could be an efficient means to reach vulnerable populations and reduce the burden of undiagnosed HIV in the US.
终结艾滋病毒流行倡议（EHE）的目标是美国受艾滋病毒影响最严重的部分优先管辖地区。目前尚不清楚哪些急诊部门（EDs）是 EHE 相关工作的最合适目标。为了探讨这一点，我们使用了 2001-2019 年国家急诊部清单（NEDI-USA）作为框架来描述所有美国 EDs，重点关注优先管辖地区的 EDs 和与教学医院有关联的 EDs。然后，我们采用多元回归来探讨 ED 特征与艾滋病毒优先管辖地区位置之间的关联。此外，为了提供这些 ED 服务的社区背景信息，还包括人口统计学和社会经济信息以及性传播感染病例率数据。这反映了 2019 年美国人口普查局关于年龄、种族、族裔以及未参保和贫困人口比例的数据，以及 2001-2019 年疾病控制与预防中心关于衣原体、淋病和梅毒病例率的数据。我们发现，优先管辖地区的 EDs（与非优先管辖地区的 EDs 相比）更常为与艾滋病毒相关工作强调的人群（即黑人或非裔美国人或西班牙裔或拉丁裔人群）、未参保和贫困人口比例较高的社区以及衣原体、淋病和梅毒病例率较高的县提供服务。此外，在所研究的群体中，有教学医院附属关系的 EDs 的就诊量最高，且就诊量呈稳步增长。在回归中，ED 年就诊量与 ED 位于优先管辖地区的可能性增加有关。我们的研究结果表明，在具有教学医院附属关系的美国部分优先管辖地区 EDs 中，针对艾滋病毒进行有针对性的地理筛查可能是一种有效的方法，可以接触到弱势群体，并减少美国未确诊的艾滋病毒负担。
