A groundbreaking study emerging from Intermountain Health in Salt Lake City reveals a transformative initiative that dramatically enhances HIV testing rates among patients evaluated for other sexually transmitted infections (STIs) in urgent care clinics and emergency departments. This comprehensive program, underpinned by a robust educational framework and technological innovations, addresses a critical gap in public health by integrating routine HIV screening into the diagnostic process for gonorrhea and chlamydia. The initiative’s success not only increases detection of previously undiagnosed HIV cases but also ensures these patients receive immediate linkage to specialized care, embodying a model of preventive medicine with far-reaching community health implications.
Published in the esteemed journal Clinical Infectious Diseases, the study details how the introduction of targeted interventions within 26 urgent care clinics and 22 emergency departments across an expansive geographic area resulted in striking increases in HIV screening rates—by 42% in urgent care and 53% in emergency settings. These statistics underscore the potential of systemic changes in clinical workflows and provider education to overcome longstanding barriers to HIV testing in acute care environments, where opportunities for early diagnosis have historically been missed. This aligns with national public health guidelines advocating for routine HIV testing in the context of STI evaluations to curtail transmission and improve long-term outcomes.
Central to the program’s success was a multifaceted strategy emphasizing education for both clinicians and patients. Targeted training modules enhanced provider awareness of the importance and logistics of HIV co-testing, while patient education improved acceptance and understanding of HIV screening as a routine aspect of STI care. This educational foundation was bolstered by an innovative electronic health record (EHR) alert system that automatically prompted providers to offer HIV testing whenever gonorrhea or chlamydia tests were ordered for patients with unknown HIV status. By embedding reminders within existing clinical workflows, the system minimized dependence on provider memory or initiative, thereby standardizing care processes and ensuring consistency across facilities.
Crucially, the program incorporated a dedicated “link-to-care” component designed to facilitate seamless transition of newly diagnosed individuals into specialized HIV treatment. Upon positive diagnosis or confirmation testing, patients were promptly referred to infectious disease specialists, receiving counseling and medical management to optimize health outcomes and reduce transmission risks. This component addressed a pivotal aspect of HIV care continuum, as early linkage to care is essential for viral suppression and prevention of onward infection. The coordinated efforts across clinical disciplines enabled a rapid, patient-centered response that is often lacking in traditional acute care settings.
The study’s context is particularly noteworthy given Utah’s historically low HIV testing rates, ranking last nationally among states in the proportion of adults tested for HIV. This initiative thus represents a significant step forward in combating regional disparities in HIV diagnosis and care access, embodying a public health intervention tailored to local epidemiologic realities. By embedding testing within existing urgent and emergency care frameworks, the program transcends traditional barriers such as stigma, logistical hurdles, and provider time constraints, fostering equitable healthcare delivery and advancing health justice principles.
Allan Seibert, MD, principal investigator and infectious disease physician, emphasized the paradigm shift inherent in normalizing HIV tests during STI evaluations. He articulated that this approach not only aligns with clinical best practices but also serves as an equitable strategy to reduce HIV-related health disparities. The amplification of testing rates directly correlates with earlier detection, facilitating timely antiretroviral therapy initiation and diminishing the community viral load, a critical factor in epidemic control. Dr. Seibert’s insights reflect the integration of evidence-based medicine and public health imperatives in designing and implementing the program.
The technological infrastructure underpinning the initiative further exemplifies innovative healthcare informatics applications. The EHR-based alerts provided real-time clinical decision support, triggering providers at the point of care and seamlessly integrating preventive screening into high-volume environments typically oriented toward urgent symptom management rather than routine screening. These alerts were meticulously designed to balance sensitivity and specificity, minimizing alert fatigue while maximizing public health benefit. Such digital interventions highlight the potential of health information technology to catalyze system-level improvements in preventive care.
Collaborative efforts across specialties—including emergency medicine, infectious diseases, pharmacy, stewardship, and clinical informatics—were instrumental in the program’s design and deployment. The interdisciplinary collaboration ensured comprehensive stakeholder engagement, resource alignment, and iterative feedback mechanisms to refine processes and address challenges. This collective approach fostered a culture of shared responsibility, underscoring that complex healthcare challenges require integrated solutions beyond siloed clinical domains. The team’s success illustrates the power of concerted action in health systems transformation.
From a clinical standpoint, the initiative not only elevated screening rates but also demonstrated tangible outcomes in HIV case identification and linkage to care, effectively reducing the burden of undiagnosed infection. All patients testing positive through the program received prompt follow-up, underscoring the robustness of the support system in preventing loss to follow-up—a common pitfall in HIV care. This comprehensive model exemplifies the continuum of care approach, moving beyond diagnosis to ensure sustained engagement and treatment adherence, which are critical determinants of individual and public health benefits.
Family medicine and urgent care leaders within Intermountain Health echoed their pride in the program’s acceptance and impact. The initiative’s integration into everyday clinical practice reflects not merely procedural change but also a cultural evolution in patient care, where preventive screening is embedded seamlessly in acute care encounters. This attests to the feasibility of scaling similar interventions across diverse healthcare settings, paving the way for systemic enhancement of HIV prevention efforts nationwide.
Looking ahead, Intermountain Health plans to expand this effective model to additional care settings and geographic regions within the health system. The vision includes embedding routine HIV screening within all relevant clinical workflows, thereby eliminating missed opportunities for early detection across the spectrum of healthcare services. This proactive stance aligns with national and global ambitions to ending the HIV epidemic by leveraging innovation, education, and integrated care pathways.
In conclusion, this study illuminates how targeted education, strategic EHR interventions, and robust care coordination can synergistically transform HIV screening practices within urgent and emergency care environments. The initiative not only increases early HIV diagnosis and rapid linkage to specialty care but also models scalable strategies to enhance preventive health services in high-stakes clinical settings. By closing critical gaps in HIV testing, Intermountain Health exemplifies how health systems can marshal resources to elevate public health outcomes and drive toward epidemic control.
Subject of Research: People
Article Title: Increasing HIV Testing During Gonorrhea and Chlamydia Evaluations in Urgent Care and Emergency Departments: A Large Health System Initiative
News Publication Date: 1-Sep-2025
Image Credits: Intermountain Health
Keywords: HIV research, Emergency medicine
