Implementing Opt-Out HIV screening in the ambulatory assessment unit: A quality improvement project

Abstract

Patients infected with HIV benefit from early diagnosis, allowing initiation of highly effective treatment to reduce the risk of complications and onward infection. Current NICE guidelines recommend routine screening in all individuals accessing healthcare where the population prevalence exceeds 2/1000 1,2 . The prevalence of diagnosed HIV is 1.23/1000 in Oxfordshire. Despite this, over 30% of patients are diagnosed late with a low CD4 count. In this quality improvement project (QIP), we set out to normalise HIV testing in the ambulatory assessment unit by adopting an opt-out testing approach. Our aim was to screen 90% of patients per month by December 2020. The QIP was first established in November 2018. The second was embarked in 2019, but impeded by the recent pandemic. Our third cycle was from September 2020 toDecember 2020. The percentage of AAU patients undergoing HIV screening was recorded each month by trust data analysts. Key interventions implemented include: * Distribution of poster prompts. * Creation of a medical referral ‘autotext’ template. * Education of nursing/healthcare assistant staff. * Introduction of a multidisciplinary group of “HIV champions”