Cotesting for HIV, STIs Improved Screening Practices for HIV

Urgent care and emergency departments increased their HIV testing alongside their sexually transmitted infection (STI) testing for chlamydia and gonorrhea through an intervention, leading to better linkage of care and more diagnoses of HIV, according to a new study published in Clinical Infectious Diseases.¹

Testing for HIV improved when care providers were prompted to administer a test with STI testing. | Image credit: gamjai - stock.adobe.com

Urgent care and emergency departments have become places for patients to receive care immediately and conveniently, including testing for STIs.² HIV testing is recommended across US health agencies, including the CDC³ and the US Preventive Services Task Force, due to its frequent diagnosis alongside other STIs. Recruiting both urgent care providers and emergency departments in an intervention to incorporate HIV testing into STI testing could help to improve the number of diagnoses and addressing HIV in general. This study aimed to implement an intervention that would increase cotesting of HIV and STIs in urgent cares and emergency departments in the network to evaluate the effect on diagnoses.

The study took place in the Intermountain Health nonprofit health system, which includes 22 emergency departments and 26 urgent care centers in Utah. All encounters in any of the emergency departments or urgent cares that included patients aged 18 to 64 years who had testing for gonorrhea or chlamydia between April 1, 2022, and March 31, 2024, were included in the study. The intervention period was April 1, 2023, to March 31, 2024; dates before that period were considered the preintervention period.

The intervention consisted of electronic prompting for HIV tests when encountering patients seeking tests for gonorrhea or chlamydia. All data were collected from electronic health records. This included test results, the number of encounters, patient demographics, and setting. The cotesting rate of HIV and STIs was the primary outcome, defined by the proportion of encounters where both tests were ordered for the patient.

There were 18,783 encounters during the study, of which 10,633 came during the intervention and 8150 came before the intervention. The cotesting rate was 29% in the preintervention period, which improved to 39% during the intervention period in urgent cares; for emergency department, the cotesting rate improved from 12% in the preintervention period to 25% during the intervention period.

The cotesting rate was 12.7 percentage points (95% CI, 6.2-19.2) higher than at the start of the intervention in the urgent care network. Cotesting rate was estimated to be 12.3 percentage points (95% CI, 1.08-23.6) higher in the emergency department by the end of the study. These represented 41.9% and 53.4% relative increases for the urgent care and emergency department, respectively, compared with a scenario where the intervention was not implemented. Increases in testing were associated with patients who were male, non-Hispanic, and White, and those who preferred to communicate in English. Diagnoses improved from 11 in the preintervention period to 17 during the intervention (1.35 vs 1.60 per 1000 encounters).

There were some limitations to this study. Each component of the intervention could not be isolated due the phased roll-out of the intervention. The clinicians in the health system work in multiple emergency departments and urgent cares, which could have led to carry-over effects when the clinician switched locations, and patients with multiple encounters were not excluded. Also, this study only focused on cotesting between HIV and chlamydia or gonorrhea rather than all STIs, the population of people with HIV is lower in Utah compared with other areas in the US, and sexual orientation or gender identity were not included in the data.

“These results demonstrate that interventions to increase HIV cotesting can be effectively implemented within large geographically dispersed health systems,” the authors concluded.

References

1. Seibert AM, Matheu M, Buckel WR, et al. Increasing HIV testing during gonorrhea and chlamydia evaluations in urgent care and emergency departments: a large health system initiative. Clin Infect Dis. Published online September 1, 2025. doi:10.1093/cid/ciaf434

2. STD and HIV testing. CityMD. Accessed September 2, 2025. https://www.citymd.com/services/lab-tests-screenings/std-hiv-testing

3. Clinical testing guidance for HIV. CDC. February 10, 2025. Accessed September 2, 2025. https://www.cdc.gov/hivnexus/hcp/diagnosis-testing/index.html