At Alameda Health System (AHS), a simple sign in the emergency department (ED) — Expect the Test — is making a big impact. By screening ED patients for HIV, hepatitis C (HCV), and syphilis, AHS is advancing prevention, early diagnosis and timely treatment.
“For many without regular access to care, the ED is where care begins,” said Doug White, MD, emergency physician and ED testing program lead. “By embedding screening into emergency care, we’re reaching patients who might otherwise fall through the cracks including those experiencing homelessness, substance use, or other barriers.”
Launched in 2004 with HIV testing, the program later expanded to include HCV and syphilis testing as well as education and prevention services.
Dr. White shared that expanding the program is crucial for the residents in Alameda County, where HIV, HCV, and syphilis hit underserved communities the hardest. “Because many patients aren’t tested they don’t know they’re infected,” he said.
The Alameda County Public Health Department (ACPHD) reports that around 15% of people with HIV are unaware of their status, while syphilis rates are also increasing, underscoring the need for more screening.
Without enough testing, health gaps widen. African Americans see the highest rates of HIV, more deaths from HCV, and more congenital syphilis. HIV is also on the rise for Latino residents, while people who inject drugs remain most at risk for HCV.
That’s why integrating screening into the EPIC system is so important. It flags eligible ED patients based on age, risk factors and medical history. Most results are ready before discharge, so those who test positive can start treatment and get connected to follow-up care right away.
But making this model work takes more than technology, it relies on a coordinated and compassionate team.
Under Dr. White’s leadership, the grant-funded program is managed by coordinators Molly Burns and Montana Jewett, with linkage navigators providing in-person and phone outreach including Cinthya Mujica Pinto (HIV and HIV prevention), Cedric Rodriquez (HIV), Kevin Del Angel (HCV) and Gabriela Regalado (syphilis).
“EPIC shows us who to test, but our navigators are the bridge to care and support,” said Burns, who also oversees program funding and data collection. “It’s about caring for the whole person, not just the diagnosis.”
Patients are connected to services like housing, food, transportation and insurance. “Supporting patients by tackling these challenges directly is key,” said Mujica Pinto. “That’s how you keep them engaged and focused on their own care.”
This patient-centered model is delivering measurable results.
Highland and San Leandro EDs conduct about 17,000 HIV tests annually, identifying around 100 patients — half newly diagnosed. Of those, 81% are linked to care within 30 days. The Highland ED also detects about 168 chronic HCV cases each year through 13,000 tests.
In early 2025, Highland Hospital expanded syphilis screening to ED patients ages 15 to 44 receiving blood work. The pilot identified 154 cases including eight in pregnant patients highlighting the value of early detection for vulnerable groups.
Beyond the data, the impact is personal. Jewett recalled a young man in his 20s experiencing homelessness who tested positive for HIV at the Highland Hospital ED. He spent an hour with the patient explaining the diagnosis, helping him call his mother for support, and connecting him to treatment and outreach services
“Helping a patient take the first step after testing positive can make all the difference,” Jewett said. “Sometimes that step is just sitting with someone in their fear, offering clarity, and showing them they’re not alone.”