Introduction of HIV Point-of-Care Testing in Adolescent Primary Care: A Quality Improvement Project

BACKGROUND: HIV, first identified in 1981, remains a persistent public health problem affecting 1.1 million Americans today. Detection is a critical first step to ending the HIV epidemic and the CDC recommends universal HIV screening for all patients 13-64 years of age regardless of risk factors. HIV screening rates are suboptimal especially in adolescent and young adult populations who face unique barriers to screening. The aim of this project was to improve HIV screening rates in adolescent and young adult patients at a large, urban FQHC. LOCAL PROBLEM: In the state of Rhode Island, 1 in 10 persons living with HIV are unaware of their HIV diagnosis with a disproportionate burden of undiagnosed disease falling on adolescents and young adults. At a large FQHC in Providence, R.I., screening rates for adolescents and young adults have been noted to be low. METHODS: A systematic review of the literature revealed six applicable interventions to improve HIV screening rates for the target population. HIV point-of-care testing was the focus of this quality improvement project as research demonstrated it improves screening rates and it aligned with existing clinical workflows. This project was guided by the Chronic Care Model to develop and implement a HIV point-of-care testing protocol in adolescent and young adult primary care. Rapid Plan-Do-Study-Act cycles and Lewin’s Change model steered this process change. INTERVENTION: An HIV point-of-care testing protocol was developed and implemented over a 12-week project focused on universal screening for patients 15-25 years of age. Staff received training and follow up survey regarding acceptance of the new protocol. Patient education on HIV screening and safe sex practices was standardized in this protocol. RESULTS: The introduction of a HIV point-of-care testing protocol resulted in a 16.3% increase in completed HIV screenings from baseline. The project was met with general support from staff with feasibility challenges noted. CONCLUSIONS: HIV point-of-care testing improves HIV screening rates in adolescent and young adult patients. Future quality improvement cycles should address the clinic time constraints and ways to cover the costs of testing to achieve sustainable outcomes