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Implementation of an Opt-Out Outpatient HIV Screening Program.

Cameron T Miller¹, Kristin S Alvarez¹, Ank E Nijhawan¹

¹From the University of Texas Southwestern Medical Center, Dallas, Texas (CTM); Parkland Health, Center of Innovation and Value, Dallas, Texas (KSA); University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, Dallas, Texas (AEN); Parkland Health, Center of Innovation and Value, Dallas, Texas (VS); Parkland Health, HIV Services, Dallas, Texas (LT); Medical Director COPC, Parkland Health, Dallas, Texas (RP); University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, Dallas, Texas (HLK).

Journal of the American Board of Family Medicine : JABFM

|August 30, 2024

Summary

Implementing targeted interventions significantly boosted Human Immunodeficiency Virus (HIV) screening rates by over fivefold in an urban safety-net hospital. This quality improvement initiative successfully increased early HIV diagnosis and linkage to care, particularly among older adults.

Keywords:

Electronic Medical Records HIV Testing Health Care Disparities Primary Health Care Public Health Quality Improvement Screening

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Area of Science:

Public Health
Infectious Disease Prevention
Healthcare Quality Improvement

Background:

Despite CDC and USPSTF guidelines, Human Immunodeficiency Virus (HIV) screening rates remain suboptimal.
Low screening rates necessitate quality improvement initiatives to reach eligible populations.

Purpose of the Study:

To evaluate the effectiveness of interventions aimed at increasing HIV screening among eligible patients in an urban safety-net hospital.
To assess the impact of electronic alerts and provider incentives on HIV screening uptake.

Main Methods:

A quality improvement study compared HIV screening rates pre- and post-intervention over two 12-month periods.
Interventions included stepwise electronic alerts and financial incentives for providers.
Screening proportions were analyzed for eligible outpatient individuals.

Main Results:

Average monthly HIV screening increased 5.1-fold, from 7.8% to 39.8% (P < .01).
Significant increases in screening were observed across all age groups, with the greatest relative increases in those aged 55-64 (7.5-fold) and 65+ (9.3-fold).
Screening rates for Hispanic individuals rose from 7.9% to 43.6% (P < .01), and 85.4% of newly diagnosed HIV cases were linked to care within 30 days.

Conclusions:

Targeted interventions for primary care clinicians effectively enhance HIV screening rates, especially in older populations.
Earlier HIV diagnosis and prompt linkage to care are crucial components of strategies to end the HIV epidemic.