2066. Introduction of a Universal HIV Screening Electronic Health Record Alert at a Midwest Academic Health System

Abstract

Abstract Background Universal human immunodeficiency virus (HIV) testing is recommended for patients ages 13-64 at least once by the Centers for Disease Control and Prevention. Screening lags behind these recommendations. Methods We performed an analysis of the current state of HIV screening at three university-based internal medicine and one internal medicine/pediatrics clinics serving counties with HIV prevalence in 2020 from 51/100,000 to 176/100,000. We completed a chart review to examine current screening practices and conducted an electronic survey of primary care providers inquiring about awareness of universal screening recommendations and barriers to screening. Based on this analysis, we implemented an automated electronic health record (EHR) reminder for HIV screening for patients aged 15-64 during health maintenance exams. Our primary outcome was the number of patients screened for HIV pre-intervention (2017-July 2021) and post-intervention (August 2021-December 2021). We used odds ratio to compare the proportion of tests which were false positive and true positive pre- vs post-intervention. To evaluate the effect of the intervention on total HIV tests ordered across the institution, we used control chart methodology. Results Survey response rate was 59% for residents (n=97) and 18% for faculty (n=29). 93% were aware of the screening recommendation. The most common barrier to screening was forgetting to screen (Figure 1). Pre-intervention, 25% of reviewed charts (n=4393) received recommended HIV screening. Post-intervention, HIV testing increased across the institution by 49% (Figure 2) and weekly testing was consistently three standard deviations above the mean compared to pre-intervention (Figure 3). The proportion of true positive tests decreased (p< 0.05). Figure 1.Common Reasons for Not Performing Universal HIV ScreeningFigure 2.Summary of HIV Testing 2017-2021Figure 3.Control Chart for HIV Testing by Week 2017-2021 Conclusion Implementation of an automated HIV screening EHR reminder increased HIV screening. The proportion of true positive tests decreased, likely due to the low prevalence of HIV in our community Disclosures All Authors: No reported disclosures.