Automated EHR HIV Screening Shifts Case Demographics

Automated screening changes who gets diagnosed

An automated HIV screening protocol embedded in electronic health records increased detection among women and Black patients in emergency department settings, according to research presented at the United States Conference on HIV/AIDS 2026 in Anaheim, California.

The study compared 12-month periods before and after implementation of an automated opt-out screening system at an urban medical center. The pre-automation period analyzed 93,983 emergency department encounters, while the post-automation period examined 90,376 encounters.

How the system works

In March 2025, the medical center deployed a Best Practice Advisory integrated into its EHR that automatically triggered HIV testing for adults undergoing routine blood draws. The opt-out design meant patients received testing by default unless they declined.

Screening rates increased modestly from 10.6% to 11.2% following automation. The system identified 70 HIV-positive cases compared to 74 cases under clinician-initiated testing, with screening yields of 0.69% and 0.78% respectively—a difference that was not statistically significant.

Demographic shifts in diagnosed cases

The most significant changes appeared in who was diagnosed. Under clinician-initiated screening, 70.3% of identified cases were men and 64.9% were White patients. After automation, women represented 40.0% of identified cases, up from 29.7%—a statistically significant shift.

Racial distribution also changed substantially. Black or African American patients comprised 32.9% of identified cases following automation, compared to 20.3% before implementation. The median age of patients with newly identified HIV infections rose to 50.5 years, though baseline age data was incomplete.

The researchers used chi-square analyses to compare demographic characteristics between periods, finding significant differences in both sex distribution (χ²=11.42; P <.001) and racial distribution (χ²=15.81; P <.001).

Why it matters

Clinician-initiated HIV screening in busy emergency departments depends on providers remembering to identify eligible patients and order tests during time-pressured encounters. This creates opportunities for implicit bias to influence who gets tested. Automated systems remove that discretionary step, potentially reducing disparities in who receives screening. The demographic shifts observed suggest that manual screening may systematically miss cases among women and racial minorities—populations already disproportionately affected by HIV.

Implementation in high-volume settings

The study author noted that EHR-driven automation represents a primary tool for achieving diagnostic equity and meeting universal screening targets in high-volume clinical environments. The approach maintained detection effectiveness while expanding reach to underrepresented groups.

The research was supported by Gilead Sciences, Inc., and findings were first reported at the United States Conference on HIV/AIDS 2026 by Infectious Disease Advisor.