Assessing the impact of an STI nurse on the delivery of STI/HIV services in an inner-city emergency department using a HIV/syphilis point-of-care test during a syphilis outbreak in Alberta, Canada.

BACKGROUND: A sexually transmitted infection (STI) nurse was embedded in an emergency department (ED) to support implementation of HIV and syphilis point-of-care testing (POCT). METHODS: Outcomes were compared between two time periods: 1) routine care and 2) the introduction of HIV/syphilis treponemal POCT and an STI nurse. POCT and standard serology were offered to eligible people with HIV or syphilis as a differential diagnosis, who were at risk of loss to follow-up, or who were pregnant without prenatal screening. Testing volumes, rates of new diagnoses, and treatment initiation between the time periods were compared using Chi-square or Fisher exact tests for categorical variables and Mann-Whitney U test for continuous variables. RESULTS: 2,689 visits included HIV or syphilis testing, with serology more common in the post-intervention period than in the pre-intervention period (HIV: 91.0% vs. 81.4%, p<0.001; syphilis: 86.4% vs. 77.8%, p<0.001). Rates of newly diagnosed syphilis increased slightly in the post-intervention period (0.12% vs. 0.09%; p=0.07), with more same-visit syphilis treatment initiated in the post-intervention period (54.1% vs. 17.6%, p<0.001). The number of newly diagnosed syphilis cases was 46.7% higher in STI RN visits (n=44) than ED Staff-only (n=30), all new cases of HIV were found during STI RN visits, and POCT was ordered in 78.4% (n=472) of the STI RN visits as compared to 15.6% (n=178) of visits with ED staff-only (p<0.001). CONCLUSIONS: An STI nurse in an urban ED contributed to the increased HIV and syphilis testing rates, and same-visit syphilis treatment initiation.