Abstract：
BACKGROUND: Human immunodeficiency virus (HIV) and syphilis disproportionately impact communities with low access to primary care, who often utilize urgent care centers (UCCs) for sexual health care. UCC visits represent an opportunity for identification and treatment of syphilis and linkage to HIV testing and prevention services. We describe a universal, opt-out syphilis screening program pilot at an Atlanta UCC.
METHODS: A chart review was performed on patients 18 years and older who were offered opt-out syphilis screening and had a rapid plasma reagin (RPR) test collected from September 1, 2021 to December 31, 2021. Demographic data, syphilis stage and treatment, and HIV testing and serostatus were abstracted from the electronic health record. Patients with reactive RPRs were contacted by a study physician for syphilis staging and treatment, counseling, and referral for HIV preexposure prophylaxis (PrEP) or treatment.
RESULTS: From September 1, 2021 to December 31, 2021, 5794 patients were triaged and 1381 underwent RPR screening (23.8%). Eighty (5.8%) had reactive RPRs, and 42 (52.5%) had active syphilis. Of those with active syphilis, 39 (92.9%) received any treatment, and 35 (83.3%) completed treatment. Patients with late syphilis were less likely to complete syphilis treatment (adjusted odds ratio, 0.03; P = 0.009; 95% confidence interval, 0.002-0.42). Among 955 offered PrEP, 41 (4.3%) expressed interest in PrEP, and 7 (0.7%) completed PrEP clinic intake. Univariate analysis did not identify any factors associated with interest in PrEP.
CONCLUSIONS: In a UCC setting, routine, opt-out syphilis testing resulted in increased syphilis identification and treatment. It also provided an opportunity for PrEP counseling and referral, although few patients completed PrEP clinic intake.
METHODS: A chart review was performed on patients 18 years and older who were offered opt-out syphilis screening and had a rapid plasma reagin (RPR) test collected from September 1, 2021 to December 31, 2021. Demographic data, syphilis stage and treatment, and HIV testing and serostatus were abstracted from the electronic health record. Patients with reactive RPRs were contacted by a study physician for syphilis staging and treatment, counseling, and referral for HIV preexposure prophylaxis (PrEP) or treatment.
RESULTS: From September 1, 2021 to December 31, 2021, 5794 patients were triaged and 1381 underwent RPR screening (23.8%). Eighty (5.8%) had reactive RPRs, and 42 (52.5%) had active syphilis. Of those with active syphilis, 39 (92.9%) received any treatment, and 35 (83.3%) completed treatment. Patients with late syphilis were less likely to complete syphilis treatment (adjusted odds ratio, 0.03; P = 0.009; 95% confidence interval, 0.002-0.42). Among 955 offered PrEP, 41 (4.3%) expressed interest in PrEP, and 7 (0.7%) completed PrEP clinic intake. Univariate analysis did not identify any factors associated with interest in PrEP.
CONCLUSIONS: In a UCC setting, routine, opt-out syphilis testing resulted in increased syphilis identification and treatment. It also provided an opportunity for PrEP counseling and referral, although few patients completed PrEP clinic intake.
摘要：
背景：艾滋病毒和梅毒不成比例地影响了获得初级保健的社区，他们经常利用紧急护理中心(UCC)进行性保健。UCC访问是识别和治疗梅毒以及与艾滋病毒检测和预防服务联系的机会。我们描述了一个普遍的，在亚特兰大UCC选择退出梅毒筛查计划试点。
方法：对18岁及以上接受选择退出梅毒筛查并在9/1/21至12/31/21进行快速血浆反应素（RPR）检测的患者进行了图表回顾。人口统计数据,梅毒分期和治疗，从电子健康记录中提取艾滋病毒检测和血清状态。有反应性RPR的患者由研究医生联系梅毒分期和治疗，咨询,并转诊HIV暴露前预防（PrEP）或治疗。
结果：从9/1/21到12/31/21，5794例患者被分诊，1381例接受RPR筛查（23.8%）。80(5.8%)有反应性RPR，42例(52.5%)有活动性梅毒。在那些患有活跃梅毒的人中，39人（92.9%）接受了任何治疗，35人(83.3%)完成治疗。晚期梅毒患者完成梅毒治疗的可能性较小（aOR0.03，p=0.009，95％CI0.002-0.42）。在提供的955个PrEP中，41（4.3％）表示对PrEP感兴趣，7人(0.7%)完成了PrEP诊所的摄入。单变量分析未发现与对PrEP的兴趣相关的任何因素。
结论：在UCC设置中，常规,选择退出梅毒检测导致梅毒识别和治疗增加。它还为PrEP咨询和转介提供了机会，尽管很少有患者完成PrEP诊所的摄入。
方法：对18岁及以上接受选择退出梅毒筛查并在9/1/21至12/31/21进行快速血浆反应素（RPR）检测的患者进行了图表回顾。人口统计数据,梅毒分期和治疗，从电子健康记录中提取艾滋病毒检测和血清状态。有反应性RPR的患者由研究医生联系梅毒分期和治疗，咨询,并转诊HIV暴露前预防（PrEP）或治疗。
结果：从9/1/21到12/31/21，5794例患者被分诊，1381例接受RPR筛查（23.8%）。80(5.8%)有反应性RPR，42例(52.5%)有活动性梅毒。在那些患有活跃梅毒的人中，39人（92.9%）接受了任何治疗，35人(83.3%)完成治疗。晚期梅毒患者完成梅毒治疗的可能性较小（aOR0.03，p=0.009，95％CI0.002-0.42）。在提供的955个PrEP中，41（4.3％）表示对PrEP感兴趣，7人(0.7%)完成了PrEP诊所的摄入。单变量分析未发现与对PrEP的兴趣相关的任何因素。
结论：在UCC设置中，常规,选择退出梅毒检测导致梅毒识别和治疗增加。它还为PrEP咨询和转介提供了机会，尽管很少有患者完成PrEP诊所的摄入。
