Improving HIV Screening Rates at an Academic Teaching Institution Internal Medicine Resident Clinic

Introduction: Human immunodeficiency virus (HIV) affects over a million individuals in the United States. Thirteen percent of people with HIV don’t know they have the virus. Washington DC has among the highest rates of HIV in the nation. An important step in the fight against HIV is screening tests, which everyone is recommended to have at least once in his/her life. The goal of this study is go increase HIV screening during annual physical examinations at the George Washington University Internal Medicine Residents Clinic by 25%. Methods: We performed a retrospective chart review of all patients who presented for annual physical examination from July 2016 to January 2017. Rates of HIV screening were determined by search for any laboratory record of an HIV test or documentation by the provider in the clinic visit note. Baseline rates were determined and rates after four subsequent interventions (PDSA cycles) aimed to increase screening rates: email reminders, macro utilization education, patient education posters in rooms, and pocket cards of recommended screening guidelines for residents. Results: Baseline data revealed that 67.6% of patients had ever had HIV screening. In order to meet our predetermined goal of a 25% increase in screening rates, rates would need to increase to 85% of patients. Post-intervention #1 (email reminder to providers), the rate was 64.8%. Post-intervention #2 (macro utilization education), the rate was 69.6%. Post-intervention #3 (posters in patient rooms), the rate was 77.0%. Preliminary results for post-intervention #4 (pocket cards of recommended screening guidelines for residents), the rate was 90%, though a final numbers of this last intervention are still pending analysis. Discussion: HIV screening is a known effective tool in preventing the spread of sexual transmitted diseases. In addition to patient education, focusing on reminding providers of this importance is essential to increasing the rates of testing. Our study demonstrated that direct patient education/exposure and reminder tools for physicians are two possible ways to increase the rate of HIV screening. While preliminary data shows promise in provider reminders such as pocket cards, final analysis of this effect is currently underway. The effects are compounded and do not reflect any single intervention at a time, demonstrating the importance of a multi-focal approach towards increasing screening rates