SUNY Downstate Health Sciences University is advancing innovative approaches to routine HIV and hepatitis C (HCV) screening in its Emergency Department (ED), a critical access point for patients in Central Brooklyn. Despite state mandates and Ending the Epidemic (ETE) goals, screening in high-volume EDs often suffers from “implementation fatigue.” To address this challenge, STAR Program faculty and hospital partners launched a multifaceted initiative—supported by Gilead’s FOCUS Program—that has already shown measurable success.

The project included key system changes: modifying the electronic health record to replace opt-in consent language (“Would you like an HIV test?”) with opt-out language (“I will test you unless you tell me not to”) and automated alerts indicating unscreened patients. These adjustments, coupled with leadership support, staff training, and patient education materials, more than doubled HIV testing uptake within the first 60 days. Routine HCV screening was also integrated into nurse triage workflow, leading to a more than fourfold increase in HCV testing.

When testing rates began to decline, the team introduced low-cost quality improvement strategies such as executive oversight, data monitoring, daily ED huddle updates, and case-based learning. These interventions quickly restored testing volume, resulting in an average of 4.6 HIV tests and 3.7 HCV tests per day by mid-2025. Importantly, all patients with new HIV diagnoses were successfully linked to care, as were several out-of-care patients identified through screening.

This work—led by Alexis Fields, MPH, Assistant Director of the FOCUS Program and Dr. Jessica Yager, Medical Director of STAR and the FOCUS Program at SUNY Downstate, together with an interdisciplinary team—will be presented at the New York State Ending the Epidemic Summit in December 2025 under the title “Sustaining Routine HIV and HCV Screening in a Brooklyn Emergency Department: A Quality Improvement Approach to Combat Implementation Fatigue.” It demonstrates how aligning policy, technology, and practice can transform routine screening and linkage to care in safety-net hospitals, accelerating progress toward ending the HIV and HCV epidemics.

Authors: Alexis K. Fields, MPH; Steven R., AS, MPM; Cynthia L. Benson, DO, FACEP, MPH, MBA; Jessica E. Yager, MD, MPH.