Improving HIV Screening Rates in a High Risk Urban Primary Care Resident Clinic

Background: In 2006 the Centers for Disease Control and Prevention recommended that individuals 13 to 64 years of age be screened for HIV regardless of risk factors. This study aimed to increase HIV screening among adults in an urban Atlanta primary care clinic by identifying barriers to HIV screening and implementing changes through an electronic medical record.

Methods: A quality improvement (QI) project using the Institute for Healthcare Improvement Model for Improvement was conducted by residents in an academic primary care clinic from August 2011 to January 2012 to identify barriers to HIV screening. Baseline HIV screening rates were collected, and a test of change (TOC) aimed to improve these rates was implemented. The TOC involved adding a built-in phrase prompting HIV screening to each physician's electronic progress note template. Data on screening rates were recollected after implementation of the TOC.

Results: Residents identified physician factors as the greatest barrier to HIV screening, including remembering to offer screening and order the antibody test, and time constraints for counseling and obtaining consent from patients. At baseline, 20% (N=29) of patients had been previously screened for HIV. Among remaining individuals, HIV screening was offered and ordered for 7.8% (N=9) of individuals. Following implementation of the TOC, HIV screening increased to 86% (N=102) and included one case of newly diagnosed HIV.

Conclusions: At baseline, HIV testing among individuals at a high-risk urban clinic was low. A simple automated reminder added to a physician's electronic note template significantly increased HIV screening rates.