Improving HIV testing rates in patients with community-acquired pneumonia in a low HIV prevalence region

BackgroundLocal HIV testing policy is based on clinician assessment of risk factors and HIV indicator conditions, with patient consent required before testing. This project aimed to increase HIV testing among hospital inpatients with community-acquired pneumonia, reduce reliance on clinician judgement, and promote more equitable testing practices.MethodsAdult hospital inpatients (aged ≥16 years) with community-acquired pneumonia discharged between July and November 2024 were included, irrespective of specialty, and assessed for evidence of HIV testing within the preceding 12 months. Weekly HIV testing rates were monitored throughout the project as a series of quality improvement measures were introduced. These included a hospital grand round presentation, safety briefing, targeted education, guideline updates, an electronic community-acquired pneumonia-HIV order set, and educational posters.ResultsA total of 894 hospital inpatients with community-acquired pneumonia were included, of whom 148 (17%) were tested for HIV. Testing rates increased from 4% at baseline to 29% following successive interventions and rose by 3.6% per week over the study period (IRR 1.036, 95% CI 1.01-1.063; p = 0.005). Pathway-embedded interventions produced more sustained improvements than education alone. Male patients were more likely to undergo HIV testing than female patients (19.8% vs 13.0%; χ² (1) = 7.67, p = 0.006), with the greatest disparity observed among patients aged 50-69 years (35.3% vs 8.6%; χ² (1) = 21.7, p < 0.001). Testing rates also differed significantly by age group (p < 0.001), being highest among patients aged 30-49 years and lowest among those aged ≥70 years. All 148 HIV tests were negative.ConclusionsHIV testing improved significantly following sequential interventions, with pathway-embedded system changes producing more sustainable improvements than education alone. Persistent age- and sex-related disparities suggest clinician risk perception continues to influence HIV testing practices. Low-prevalence settings should consider electronic testing pathways, automated prompts, and the feasibility of opt-out testing approaches.