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Infectious disease screening lab panel for homeless patients: A retrospective review at a large academic health system

Homelessness is an epidemic in the United States, with an estimated hundreds of thousands of people homeless on any given night.1 Such individuals experience a high rate of infection, including human immunodeficiency virus (HIV), tuberculosis (TB), and other infectious diseases, which may be due to barriers to care, lack of access to sexual protection such as condoms, and limited social services, among other causes.1 The emergency department (ED) and inpatient wards are sources of intake and evaluation for homeless individuals seeking medical care, given infrequent access to preventive or primary care. Moreover, homelessness is an independent risk factor for seeking emergent care, suggesting the importance of offering comprehensive care in the ED setting.2 In 2019, California state law has mandated that all individuals who identify as homeless have “been offered or referred for screening for infectious diseases common to the region, as determined by the local health department.”3 We sought to observe how a required panel of laboratory tests for infectious diseases ordered in the ED for homeless patients at an academic health system helped to identify those infected with HIV, hepatitis B, tuberculosis, syphilis, gonorrhea, and chlamydia.