ELEVATING THE HIV/HCV SCREENING GAME: AN OPT OUT PROGRAM FOR A HEALTHCARE SYSTEM

ABSTRACT

STATEMENT OF PROBLEM/QUESTION HIV and HCV infections remain a significant cause of morbidity and mortality, yet despite recommendations from numerous agencies (including the CDC and USPTF) screening rates for both HIV and HCV as well as linkage to care remain suboptimal. DESCRIPTION OF PROGRAM/INTERVENTION The Allegheny Health Network is a ten-hospital health care system located in Western PA in and around Pittsburgh/Allegheny county. The Center for Inclusion Health's, a division within AHN, received funding from Gilead Sciences to implement the Frontlines of Communities in the United States (FOCUS) program to expand HIV and HCV screening in an "opt out" model and provide linkage to care fo patients who test positive. As of June 2021, FOCUS project was integrated into 5 EDs and one outpatient IM clinic. The EDs range from 2 inner city, 2 urban and 1 rural hospital. All patients entering the participating ED's are screened for eligibility automatically utilizing an EMR BPA. If the patient is eligible, the BPA will alert the nursing staff of the need for testing. It utilizes an “opt-out script” to offer the testing, consistent with CDC/WHO guidelines and with Act 148 (the PA law that covers permission for HIV consent). Patients who test positive are then linked to care through a Linkage Coordinator who provides notification of results, disease education, appointment scheduling and support to FOCUS screened patients. MEASURES OF SUCCESS Measures of success are Number of patients screened for HIV and HCV infection, Number of patients who screen positive for HIV or HCV infection, Number of patients who screen positive for HIV or HCV infection who are linked to care. FINDINGS TO DATE The volume for both HIV and HCV testing rose progressively in all years after conception of the project, until 2020. A similar pattern occurred for HCV testing. We then assessed the percent of those eligible for HIV and HCV screening who underwent testing. In the year prior to implementation, only 1.3% of those eligible for HIV screening had testing completed. This increased steadily to 16% of those eligible completing testing in 2019. HCV testing had a similar trend going from 1.5% in 2016 to 13.3% in 2019. In 2016, 0.8% of those screened for HIV were positive. This number stayed between 0.1-0.5%. For HCV, the positivity rate was 1.7% in 2016 and ranged from 2.4% to 4.0% afterwards. Linkage to care was variable during the study period, with 46% to 85.7% for HIV positive patients linked and 33% to 73% for HCV positive patients. KEY LESSONS FOR DISSEMINATION Our program showed that HIV and HCV screening can be successfully integrated into a variety of settings. Education to staff and additions to the EMR are needed. However, barriers do exist including competing clinical demands and reliance on providers adopting it into usual care. Also, the stress to the medical system from the Coronavirus pandemic led to a decrease in screening for HIV and HCV seen in 2020. Implementing HIV and HCV screening into unusal settings takes buy-in, effort, and champions to help the program be successful.