P5.030 New Avenues For Proactive HIV Testing in Primary Care Required: A Trend Analysis of Twenty Years of HIV-Related Consultations in Dutch General Practise

Abstract Background South Carolina (SC) remains one of the most heavily affected states for both HIV and HCV infections. Males account for the majority of cases. Implementation of universal opt-out testing has improved screening rates but not much has been published describing the characteristics of those who opt out of testing. This becomes important as 10-50% of patients have opted out in previous studies. Methods Between February and August 2019, we conducted a quality improvement (QI) project which implemented opt- out HIV-HCV testing at a single primary care resident clinic in SC with the primary aim of increasing screening rates for HIV-HCV by 50%. Secondary aims included describing the demographic characteristics of the opt-out population. Persons were considered eligible for testing if they were between the ages of 18-65 years for HIV and 18-74 years for HCV. This was prior to the USPSTF 2020 guidelines which recommend HCV screening for adults aged 18-79 years. A retrospective chart review was used to obtain screening rates, opt status and demographic data. Logistic regression and the firth model were used to determine linkages between categorical variables. We present 3-month data. Results 1253 patients were seen between May 1, 2019- July 31, 2019 (See Table 1). 985 (78%) were eligible for HIV testing. 482 (49%) were tested for HIV as a result of our QI project and all tests were negative. 212 (22%) of eligible patients opted out of HIV testing. Males were 1.59 times more likely to opt out (p=0.008). (see Table 2,3) Regarding HCV, 1136 (90.7%) were deemed eligible for testing. 503 (44%) were tested for HCV as a result of our QI project. 12 (2.4%) were HCV antibody positive with viremia. 11 (90%) of antibody positive with viremia cases were in the 1945-1965 birth cohort (see Table 4). 244 (21%) opted out of HCV testing. Males and persons without a genitourinary chief complaint were more likely to opt out (p=0.02). Table 1: Demographic characteristics of the population seen at the internal medicine resident clinic between May- July 2019 Table 2: Relationship between demographic variables and the odds of being tested for HIV or HCV within the last 12 months. Logistic Model. Table 3: Relationship between demographic variables and the odds of opting out of testing for HIV or HCV. Firth Model. Conclusion Although implementation of routine HIV-HCV opt-out testing led to increased screening rates for both HIV and HCV, roughly 1 in 5 eligible patients chose to opt out of testing. Males were more likely to opt out despite accounting for the majority of newly diagnosed HCV cases. Future studies investigating drivers for opting-out in the male population could improve testing and assist with early diagnosis. Table 4: Characteristics of patients newly diagnosed with HCV positive with viremia. Disclosures All Authors: No reported disclosures

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HIV testing in primary care

The Lancet HIV ◽

10.1016/s2352-3018(15)00064-8 ◽

2015 ◽

Vol 2 (6) ◽

pp. e217-e218 ◽

Cited By ~ 1

Author(s):

Amanda D Castel ◽

Irene Kuo

Keyword(s):

Primary Care ◽

Hiv Testing

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Supporting the Integration of HIV Testing Into Primary Care Settings

American Journal of Public Health ◽

10.2105/ajph.2012.300767 ◽

2012 ◽

Vol 102 (6) ◽

pp. e25-e32 ◽

Cited By ~ 8

Author(s):

Janet J. Myers ◽

Lucy Bradley-Springer ◽

Mi-Suk Kang Dufour ◽

Kimberly A. Koester ◽

Stephanie Beane ◽

...

Keyword(s):

Primary Care ◽

Hiv Testing ◽

Primary Care Settings

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Effectiveness and cost-effectiveness of implementing HIV testing in primary care in East London: protocol for an interrupted time series analysis

BMJ Open ◽

10.1136/bmjopen-2017-018163 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018163 ◽

Cited By ~ 2

Author(s):

Werner Leber ◽

Lee Beresford ◽

Claire Nightingale ◽

Estela Capelas Barbosa ◽

Stephen Morris ◽

...

Keyword(s):

Primary Care ◽

Time Series ◽

General Practice ◽

Cost Effectiveness ◽

Hiv Testing ◽

Cost Effective ◽

Interrupted Time Series ◽

Rapid Hiv Testing ◽

Post Trial ◽

Implementation Programme

IntroductionHIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised controlled trial, we showed that providing training and rapid point-of-care HIV testing at general practice registration (RHIVA2 intervention) in Hackney led to cost-effective, increased and earlier diagnosis of HIV. However, interventions effective in a trial context may be less so when implemented in routine practice. We describe the protocol for an MRC phase IV implementation programme, evaluating the impact of rolling out the RHIVA2 intervention in a post-trial setting. We will use a longitudinal study to examine if the post-trial implementation in Hackney practices is effective and cost-effective, and a cross-sectional study to compare Hackney with two adjacent boroughs providing usual primary care (Newham) and an enhanced service promoting HIV testing in primary care (Tower Hamlets).Methods and analysisService evaluation using interrupted time series and cost-effectiveness analyses. We will include all general practices in three contiguous high HIV prevalence East London boroughs. All adults aged 16 and above registered with the practices will be included. The interventions to be examined are: a post-trial RHIVA2 implementation programme (including practice-based education and training, external quality assurance, incentive payments for rapid HIV testing and incorporation of rapid HIV testing in the sexual health Local Enhanced Service) in Hackney; the general practice sexual health Network Improved Service in Tower Hamlets and usual care in Newham. Coprimary outcomes are rates of HIV testing and new HIV diagnoses.Ethics and disseminationThe chair of the Camden and Islington NHS Research Ethics Committee, London, has endorsed this programme as an evaluation of routine care. Study results will be published in peer-reviewed journals and reported to commissioners.

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A randomized trial of computer-based reminders and audit and feedback to improve HIV screening in a primary care setting

International Journal of STD & AIDS ◽

10.1258/ijsa.2008.008423 ◽

2009 ◽

Vol 20 (8) ◽

pp. 527-533 ◽

Cited By ~ 18

Author(s):

V Sundaram ◽

L C Lazzeroni ◽

L R Douglass ◽

G D Sanders ◽

P Tempio ◽

...

Keyword(s):

Risk Assessment ◽

Primary Care ◽

Health Care ◽

Hiv Testing ◽

Health Care System ◽

Control Group ◽

Hiv Screening ◽

Risk Behaviours ◽

Primary Care Clinics ◽

Computer Based

Despite recommendations for voluntary HIV screening, few medical centres have implemented screening programmes. The objective of the study was to determine whether an intervention with computer-based reminders and feedback would increase screening for HIV in a Department of Veterans Affairs (VA) health-care system. The design of the study was a randomized controlled trial at five primary care clinics at the VA Palo Alto Health Care System. All primary care providers were eligible to participate in the study. The study intervention was computer-based reminders to either assess HIV risk behaviours or to offer HIV testing; feedback on adherence to reminders was provided. The main outcome measure was the difference in HIV testing rates between intervention and control group providers. The control group providers tested 1.0% ( n = 67) and 1.4% ( n = 106) of patients in the preintervention and intervention period, respectively; intervention providers tested 1.8% ( n = 98) and 1.9% ( n = 114), respectively ( P = 0.75). In our random sample of 753 untested patients, 204 (27%) had documented risk behaviours. Providers were more likely to adhere to reminders to test rather than with reminders to perform risk assessment (11% versus 5%, P < 0.01). Sixty-one percent of providers felt that lack of time prevented risk assessment. In conclusion, in primary care clinics in our setting, HIV testing rates were low. Providers were unaware of the high rates of risky behaviour in their patient population and perceived important barriers to testing. Low-intensity clinical reminders and feedback did not increase rates of screening.

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Routine HIV Testing in Primary Care Clinics: A Study Evaluating Patient and Provider Acceptance

Journal of the Association of Nurses in AIDS Care ◽

10.1016/j.jana.2011.06.005 ◽

2012 ◽

Vol 23 (1) ◽

pp. 87-91 ◽

Cited By ~ 7

Author(s):

Sharon E. Valenti ◽

Susan M. Szpunar ◽

Louis D. Saravolatz ◽

Leonard B. Johnson

Keyword(s):

Primary Care ◽

Hiv Testing ◽

Primary Care Clinics ◽

Routine Hiv Testing

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Qualitative evaluation of a pilot educational intervention to increase primary care HIV-testing

BMC Family Practice ◽

10.1186/s12875-019-0962-3 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Joanna M. Kesten ◽

Charlotte F. Davies ◽

Mark Gompels ◽

Megan Crofts ◽

Annette Billing ◽

...

Keyword(s):

Primary Care ◽

Hiv Testing ◽

Educational Intervention ◽

Qualitative Evaluation

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Policy Interventions Shaping HIV Prevention: Providers’ Active Role in the HIV Continuum of Care

Health Education & Behavior ◽

10.1177/1090198118760681 ◽

2018 ◽

Vol 45 (5) ◽

pp. 714-722 ◽

Cited By ~ 3

Author(s):

Rogério M. Pinto ◽

Susan S. Witte ◽

Prema L. Filippone ◽

C. Jean Choi ◽

Melanie Wall

Keyword(s):

Primary Care ◽

Hiv Prevention ◽

Hiv Testing ◽

Support Services ◽

Behavioral Interventions ◽

Continuum Of Care ◽

High Impact ◽

Dose Effect ◽

Care And Support ◽

Hiv Continuum Of Care

The U.S. Centers for Disease Control and Prevention (CDC) Diffusion of Effective Behavioral Interventions project has disseminated HIV behavioral interventions (EBIs) across the United States since the 1990s. In 2011, the CDC launched the High-Impact HIV Prevention (HIP) project, providing EBIs plus high-impact services (HIV testing, primary care, and support services). Providers (nurses, social workers, educators) are unable to consistently make linkages; thus, numerous at-risk individuals are not benefitting from HIP. Research on providers’ roles in the HIV Continuum of Care—linking clients to HIV testing, primary care, and support services—is lacking. This article helps fill this gap with evidence that providers exposed to EBIs, whose agencies offer EBIs, more frequently link clients to high-impact services. This is based on diffusion of innovations theory, where individuals in social networks influence one another’s adoption of innovations. We hypothesize that providers are exposed to EBIs via training, reading and hearing about EBIs, and/or discussing EBIs with colleagues. We used cross-sectional data from 379 providers from 36 agencies in New York City. We used multilevel ordinal logistic regression models to test associations between provider exposure to EBIs (agency provides EBIs) and frequency of linkages to high-impact services. Providers exposed to greater numbers of EBIs more frequently link clients to HIV, hepatitis C (HEP-C), and sexually transmitted infections testing; to primary care; and to drug treatment and mental health services. Providers link clients most frequently to primary care and HIV testing and least frequently to HEP-C testing and syringe exchange. Findings suggest a dose effect, with exposure to more EBIs resulting in more linkages. Findings show a staged, evidence-based prevention approach that includes exposure to EBIs, leading to providers linking clients to high-impact services. There needs to be emphasis on inspiring providers to engage with high-impact services at the elevated levels needed to end the epidemic.

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