ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Individuals at risk for HIV often face barriers to routine outpatient care which were exacerbated during the COVID-19 pandemic, creating a need and an opportunity to leverage hospital admissions for HIV screening. DESCRIPTION OF PROGRAM/INTERVENTION: This resident-led quality improvement project ran from 10/01/2020 to 6/30/2021 and aimed to increase rates of HIV screening among inpatients on the Medicine service at Zuckerberg San Francisco General Hospital (ZSFG), an urban safety net hospital. The QI intervention was informed by an initial gap analysis and consisted of three components: provider education, targeted outreach including biweekly performance metrics with peer comparisons, and electronic health record (EHR) optimizations. A pre-existing multidisciplinary care team was available to provide follow-up for positive test results, facilitating rapid linkage to HIV care. MEASURES OF SUCCESS: Given the high prevalence of HIV risk factors in this population, appropriate screening was defined as having an HIV test within the past 6 months. Our target for appropriate HIV screening was 55% of hospitalized patients on the Medicine service without a known HIV diagnosis, an increase of 10% from baseline. As a secondary goal, we sought to increase resident education about HIV as measured by pre- and post- intervention surveys. FINDINGS TO DATE: Among patients admitted during the intervention period (N = 1701), there was a 17.6% absolute increase in HIV screening rates compared to baseline (N = 885) (45.3% v. 62.9%, p < 0.001). To assess the impact of our intervention on previously identified differences in screening rates by gender, race, and language, we conducted post-intervention subgroup analyses. These results demonstrated persistently lower screening rates among females (59.6% v. 64.6%, p = 0.044), Asians (55.0% v. 64.5, p < 0.01), and patients speaking Chinese-based languages (53.5% v. 63.8, p = 0.01). Comparisons of pre- and post-intervention survey data showed an increase in provider comfort and knowledge across all domains assessed. KEY LESSONS FOR DISSEMINATION: Quality improvement interventions including education, targeted outreach, and EHR optimization can increase HIV screening rates of hospitalized patients. We found that despite improvement in overall screening rates, disparities persisted for women, Asians, and non-English speaking patients. Targeted interventions to address these disparities in HIV screening are needed. Inpatient providers are well-poised to help address HIV screening gaps, particularly for underserved patient populations who may face increased barriers to routine HIV prevention services.