312347
Building a sustainable routine HIV screening program in an urban Chicago health system
Description: In August 2011, Sinai implemented clinician-initiated, routine HIV screening throughout its health system which includes two emergency departments, inpatient floors in two hospitals, and outpatient clinics. To launch the routine screening process several key strategies and components were established: (1) Top testers were identified amongst senior medical leadership to influence their colleagues to test; (2) The electronic medical record (EMR) was augmented to document HIV test offers, consent, tests, and results; (3) Custom reports were developed to access real time data from the EMR; (4) A linkage to care process was established for anyone who tested positive including the use of a patient navigator and identification of area clinics to treat patients; and (5) presentations for nurses, residents, and attending physicians were prepared on HIV screening.
Lessons Learned: As of January 2014, Sinai routinely tested 10,430 people with the inpatient floors doing the majority of the testing. 61 people were newly diagnosed and 78% have been linked to care. There were 31% of individuals who were dually diagnosed with AIDS. Four persons, who were newly diagnosed, ranged from 65-76 years of age which exceeds the upper limit of CDC’s 2006 HIV testing recommendations. Since December 2012, 4 persons have been identified with acute HIV infection.
Recommendations: Successful implementation of a clinician-initiated HIV testing program requires commitment from medical and administrative leadership, an internal marketing strategy to educate staff and patients about the availability of HIV screening, dedicated staff to coordinate screening efforts and linkage to care until these responsibilities are absorbed by clinical staff, and a constant review of testing volume, results, and quality indicators to make program adjustments. Finally, robust screening must include the inpatient areas especially in health systems with very busy ED’s to ensure the fewest missed opportunities for screening.
Learning Areas:
Administration, management, leadershipPlanning of health education strategies, interventions, and programs
Public health or related laws, regulations, standards, or guidelines
Learning Objectives:
Discuss strategies for developing a sustainable routine HIV screening program in an urban medical center
Keyword(s): HIV/AIDS, Hospitals
Qualified on the content I am responsible for because: I have been the program manager and senior epidemiologist for this program since January 2013 and have worked for over 10 years in the HIV field implementing and managing HIV programs including syringe exchange, HIV outreach, and direct observed therapy programming.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.
Qualified on the content I am responsible for because: I have been the principal investigator for multiple federally funded grants and private grants focusing on HIV testing, linkage and retention in HIV care. I have presented and written on HIV testing program development for emergency departments, clinics and hospitals. I am qualified to give this presentation because I am an HIV care provider, infectious disease physician who has worked in research in HIV testing for the past 14 years.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.