An integrated care model combining screening for HIV, viral hepatitis and related conditions enabled large-scale testing across a Texas safety-net health system, although relatively few patients with newly identified diagnoses were linked to care, according to findings presented at IDWeek 2026.
The model was implemented across JPS Health Network and Tarrant County Public Health with support from the Gilead FOCUS program. JPS is a large safety-net health system serving a medically and socially complex population across hospital, ambulatory and correctional settings in Tarrant County, Texas. Presenting author James d’Etienne, MD, MBA, chief of the Division of Research and Knowledge Translation at JPS Health Network, and colleagues evaluated the approach.
Integrating screening and referral
The investigators designed the model around the overlap among HIV, hepatitis C, sexually transmitted infections, substance use, serious mental illness and housing instability. These conditions can disproportionately affect patients in safety-net systems, where fragmented care may limit diagnosis and treatment.
JPS expanded an existing opt-out emergency department HIV screening program into an integrated pathway for HIV, hepatitis C, hepatitis B and syphilis. The model used automated electronic medical record triggers, reflex testing and closed-loop referrals to connect emergency department and outpatient care.
The program also included a prevention pathway for patients who screened negative but remained at elevated risk, including those with a history of syphilis. These patients could be directed to behavioral education and optional biomedical prevention, including HIV pre-exposure prophylaxis.
Emergency department clinicians and nurses received training on syndemic testing, stigma-free communication and linkage workflows. The program also combined funding sources to support testing, treatment, patient navigation and ongoing care.
From June 2025 through February 2026, opt-out screening for HIV, hepatitis C and hepatitis B was implemented across emergency and ambulatory settings, with reflex confirmatory testing and centralized navigation. Investigators tracked screening volume, positive test results and linkage to care.
Screening identifies infections, but linkage remains limited
Among 34,288 HIV tests, investigators identified 312 new diagnoses (0.91%), with 50 patients (16%) linked to care. For hepatitis C, 3,688 antibody tests yielded 259 positive results (7%). Investigators identified 74 active infections, with 15 patients (20.3%) linked to care. Hepatitis B screening included 2,378 tests, with 19 positive results (0.8%). One patient was linked to care.
According to the investigators, the integrated workflows also identified overlapping infections and improved coordination across conditions. They concluded that the model enabled large-scale screening and diagnosis across the safety-net system, but low linkage rates highlighted persistent structural barriers after diagnosis. They emphasized the need for stronger patient navigation and integrated care across conditions to improve follow-up and treatment.
Sarah Merchant, MD, MPH; Suzie Limones, TXCHW; Sally Spann, PA-C; and Nanda Reamy, RN, BSN, reported no financial relationships. No disclosures for Dr. d’Etienne were listed in the provided abstract materials.