A Modeling Analysis of Strategies for Allocating Emergency Department HIV and Syphilis Screening Funds in California
Abstract
Introduction: Using an open enrollment process in 2023, California funded 28 emergency departments (EDs) to implement or expand HIV and syphilis screening programs. California’s 2026 state budget now commits an additional $60 million, over six years, to renew support for this screening. How renewed funds are allocated will determine which communities they reach. This analysis establishes a framework derived from public information to simulate and compare several funding strategies, highlighting the tradeoffs across disease burden, geographic reach, and social vulnerability.
Methods: Publicly available data were used to construct ED-level profiles for the 282 EDs in the 35 California counties with populations exceeding 100,000. Profiles were then linked to corresponding HIV and syphilis burden (z-score), measures of social vulnerability for the surrounding service area , and socioeconomic and demographic characteristics of the population each ED serves. At a 28 ED award scale, allocation strategies (random selection, prior 2023 awardees, federal priority-county targeting, ranking on burden alone, and a composite of burden, vulnerability, and visit volume) were then compared, simulating ED participation across 100,000 Monte Carlo draws at 70% participation. Sensitivity analyses included varied (50% and 90%) participation and a larger (n=64) ED award scale. Analyses were conducted in 2026.
Results: No single strategy performed best. Ranking on burden alone reached the highest…
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