Program Spotlight: Grady Patient Access to Routine HIV Testing Through FOCUS


Frontlines of Communities in the United States, FOCUS, is a Gilead Sciences-funded program that seeks to transform routine opt-out HIV testing and linkage to care into a standard of medical care. Grady’s FOCUS program, which began in July 2013, aims to reduce the spread of HIV in metro Atlanta—an area with the highest HIV prevalence in Georgia and among the highest HIV prevalence in the U.S.

Through the FOCUS program, more than 80,000 Grady patients have been tested for HIV over the course of the past three years. This testing has led to 571 new HIV diagnoses and identification of more than 400 known HIV positive patients who were out of care. The majority of new diagnoses were identified in Grady’s Emergency Care Center. FOCUS medical social workers provide assistance with linkage to HIV-related medical care and social support services.

The FOCUS program is integrated at triage in 13 Grady Health Center sites, including the Emergency Care Center, four Primary Care Center pods, the International Medicine Clinic, Walk-In Center, and six neighborhood health centers. The program represents collaboration across many Grady Health Center departments, nurses, physicians, APPs, information technology, finance and grant support, and all levels of leadership.

Grady’s FOCUS team is led by Dr. Bijal Shah, an assistant professor in Emory’s Department of Emergency Medicine. Shah works closely with Emory and Grady providers, including Dr. Anne Daul (Emory; Emergency Care Center), Dr. Sara Turbow (Emory; Primary Care Center), Dr. Miranda Gillespie (Grady, Neighborhood Health Center), Heather Freiman (Emory, FOCUS program coordinator), and the FOCUS social workers Adam Barnette (Grady) and Tyania McConnell (Grady).

Despite the progress made at Grady over the last three years, the frequency of new diagnoses and advanced-stage diagnoses have not decreased over time, highlighting the importance of continued routine HIV screening.

Insight from Dr. Bijal Shah, Grady FOCUS Program Director

A 21-year-old patient was identified and diagnosed with HIV during routine triage-based test offer and order in the Emergency Department in January 2015. On the day of HIV diagnosis, the patient presented to the Emergency Department with a sore throat. In the year prior to the new diagnosis the patient was seen twice in the ED for symptoms associated with sexually transmitted infections and was tested for HIV both times—his most recent negative HIV test was in June 2014.

This patient highlights the ongoing need for routine testing – per program guidance, he was tested at almost exactly six-month intervals (January 2014, June 2014 and January 2015). The integration of non-risk based HIV screening in the ED triage process was critical in identifying this patient’s HIV status.

This feature was written by Elizabeth Johnson, Communications Coordinator for Emory at Grady.