Evaluation of a Clinic-Level Intervention to Increase Anxiety and Depression Screening in an Urban HIV Clinic

Anxiety and depression are common in people living with HIV and associated with low antiretroviral treatment adherence, elevated HIV viral load, and increased mortality. Yet, anxiety and depression are underdiagnosed and undertreated in this population. Implementing a system for routine anxiety and depression screening may overcome barriers to diagnosis. To improve the identification and management of anxiety and depression within an HIV clinic, we engaged HIV clinicians in the design of the workflow, created electronic health record reminders for screening, and trained medical assistants to deliver the screening questions at clinic visits. We evaluated this 24-month quality improvement project using electronic health record data and clinician surveys. From November 2020 to October 2022, 747 patients had 1166 appointments during which anxiety and/or depression screening was due. During year one, anxiety and depression screening were completed at 75% (311/416) and 77% (362/469) of eligible encounters, respectively. During year two, screening was completed at 85% of encounters for anxiety (425/502) and depression (446/524). On average, anxiety screening increased by 2.2% per month (t = 4.24, p < 0.001), and depression screening increased by 1.2% per month (t = 2.82, p = 0.01) after intervention implementation. Patients who screened positive received follow-up. Clinician satisfaction with screening processes increased from baseline to 6 months. Findings suggest that screening for anxiety and depression can improve detection and management in an HIV clinic, while also being acceptable to HIV clinicians.