Abstract
Context: Despite advances in therapy for HIV infection, treatment is often compromised by delayed diagnosis. Strate-gies are needed to improve broad based testing in all medical settings. Objective: To compare HIV screening rates in a primary care setting following implementation of an electronic reminder system to rates produced solely by provider educational efforts. Design: Prospective, observational study of HIV screening, comparing rates during implementation of strategies. Setting: Multiple clinic healthcare system affiliated with a tertiary care medical center. Patients: Veterans receiving care in the clinics affiliated with the Department of Veterans Affairs-Eastern Colorado Healthcare System. Intervention: Provider education and a provider clinical reminder system embedded in the electronic medical record. Main Outcome Measure: Proportion of primary care clinic appointments at which the veteran was screened for HIV infection. Results: The proportion of visits at which screening occurred increased from 2.7% during the provider edu-cation period to 16.7% during the provider clinical reminder period (p < 0.0001). All of the cases identified by the re-minder were antiretroviral therapy candidates, and there was a trend to earlier diagnosis in the screening group than in the diagnostic testing group (CD4 count 329 vs. 109, p = 0.13). Conclusions: An electronic clinical reminder system in a primary care setting is an effective strategy to increase testing for HIV infection, and may lead to fewer delayed diag-noses.
Highlights
There has been tremendous progress in the management of human immunodeficiency virus (HIV) infection since 1981, when the acquired immunodeficiency syndrome was first reported
The proportion of visits at which screening occurred increased from 2.7% during the provider education period to 16.7% during the provider clinical reminder period (p < 0.0001)
There were five positive tests that were ordered to confirm a previously reported diagnosis of HIV infection, and four positive tests performed for diagnostic reasons
Summary
There has been tremendous progress in the management of HIV infection since 1981, when the acquired immunodeficiency syndrome was first reported. In the absence of therapy, HIV infection progresses to AIDS in approximately 10 years, but currently a 25 year-old person with newly diagnosed HIV infection, and access to high quality care, has a life expectancy of 64 years [1]. The benefit of early treatment, early diagnosis of HIV infection has been an elusive goal. Diagnosis and treatment of HIV infection is an important part of the national HIV prevention strategy [3]. Persons who are aware of their infection are less likely to transmit infection to others [4], because they can adopt less risky behaviors, and antiretroviral therapy of HIV-infected persons is an effective prevention strategy. Treatment with antiretroviral agents reduces viral burden in blood and in genital secretions, and in serodiscordant heterosexual couples highly active antiretroviral treatment of the infected partner reduces transmission of HIV 96% [5]
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