1291. Comparison of Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) Screening Rates Before and After Implementation of a Quality Improvement (QI) Project Aimed at Incorporating Routine “Opt-Out” Testing at a Primary Care Resident Clinic in Columbia, SC

Abstract

BackgroundSouthern states account for the majority of new cases of Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) in the United States. Despite this, routine screening for these viruses in asymptomatic individuals remains low and patients often present with advanced disease.MethodsWe examined the screening rates for HIV and HCV before and after implementation of a Quality Improvement (QI) project aimed at routine “opt out” testing in asymptomatic individuals. The QI project was implemented at a single primary care clinic in February 2019 and will continue until August 2019. Persons were considered eligible for testing if they were between the ages of 18–65 years for HIV and 18–74 years for HCV. Screening rates were determined by calculating the percentage of eligible patients tested within the study period and compared with baseline screening rates of patients seen June–July 2018. Characteristics of the study population were valued by using descriptive statistics. Chi-square test was used to compare categorical variables. A significance level of P < 0.05 was considered statistically significant. We present 4-week data.Results532 patients were seen for the month of February 2019 (347 (65%) females and 185 (35%) males). Mean age was 57 years (SD = 19). Patients seen were predominantly black females. After QI implementation, the screening rate for HIV was 45% compared with the baseline screening rate of 30% (P = 0.014). Similarly, the screening rate for HCV was 47.2% compared with baseline screening rate of 20% (P < 0.001). Gender, age, chief complaint and insurance coverage did not impact screening rates. The major reason persons were not screened was opting out due to patient preference. 34% of eligible persons opted out of HIV testing, while 33% of eligible persons opted out of HCV testing. Provider engagement was initially high but tapered off. No new cases of HIV were found. 4 new cases of HCV with active viremia were identified.ConclusionWhile the implementation of routine “opt-out” testing significantly increased the percentage of individuals screened, a significant number of people are still choosing to opt out of testing. The percentage of persons opting out is higher than that seen in previous studies and may be contributing to the southern epidemic. Disclosures All authors: No reported disclosures.