Experiences Implementing a Routine HIV Screening Program in Two Federally Qualified Health Centers in the Southern United States.

OBJECTIVE: The southern United States is highly affected by HIV, and community health centers play a key role in addressing the health-care needs of residents of southern cities. In 2012, Southside Medical Care Services ("Southside") in Atlanta, Georgia, and Central Care Community Health Center ("Central Care") in Houston, Texas, began comprehensive programs for routine HIV screening and linkage to HIV care. METHODS: We examined patient-level testing outcomes using medical record-derived data. We also compared the total number of HIV tests and HIV-positive tests in the most recent 12 months of the program with the number of HIV tests and HIV-positive tests during the 12 months prior to the program start. RESULTS: Southside saw 52,437 eligible patients from June 2012 through April 2014; 41,720 (80%) were offered an HIV test, 11,092 (27% of those offered a test) were tested, 75 (0.7% of those tested) had a positive result, and 74 (99% of those with a positive result) were linked to HIV care. Compared with the 12 months prior to the start of routine HIV screening implementation, Southside's routine HIV screening program conducted 5,955 more HIV tests (733% increase) and had 31 more patients who tested positive (238% increase). Central Care saw 22,658 eligible patients from July 2012 to April 2014; 10,904 (48%) were offered an HIV test, 9,909 (91% of those offered a test) were tested, 52 (0.5% of those tested) had a positive result, and 41 (79% of those with a positive result) were linked to HIV care. Compared with the 12 months before routine HIV screening was implemented, Central Care's routine HIV screening program conducted 4,559 more HIV tests (618% increase) and had 36 more patients who tested positive (600% increase). CONCLUSION: Southside and Central Care effectively implemented routine HIV screening programs that dramatically increased their testing volume while also linking the majority of HIV-positive patients to care. Other community health centers should consider similar programs.

How Compliance Measures, Behavior Modification, and Continuous Quality Improvement Led to Routine HIV Screening in an Emergency Department in Brooklyn, New York.

OBJECTIVE: New York State adopted a new HIV testing law in 2010 requiring medical providers to offer an HIV test to all eligible patients aged 13-64 years during emergency room or ambulatory care visits. Since then, Wyckoff Heights Medical Center (WHMC) in Brooklyn, New York, began implementing routine HIV screening organization-wide using a compliance, behavior-modification, and continuous quality-improvement process. METHODS: WHMC first implemented HIV screening in the emergency department (ED) and evaluated progress with the following monthly indicators: HIV tests offered, HIV tests accepted, HIV tests ordered (starting in December 2013), HIV tests administered, positive HIV tests, and linkage to HIV care. Compliance with the delivery of HIV testing was determined by the proportion of patients who, after accepting a test, received one. RESULTS: During August 2013 through July 2014, of 57,852 eligible patients seen in the WHMC ED, a total of 31,423 (54.3%) were offered an HIV test. Of those, 8,229 (26.2%) patients accepted a test. Of those, 6,114 (74.3%) underwent a test. A total of 26 of the 6,114 patients tested (0.4%) had a positive test, and 24 of the 26 HIV-positive patients were linked to HIV medical care. By July 2014, the monthly proportion of patients offered a test was 62%; the proportion of those offered a test who had a test ordered was 98%, and the proportion of those with a test ordered who were tested was 81%. Testing compliance increased substantially at the WHMC ED, from 77% in December 2013 to >98% in July 2014. CONCLUSION: Using compliance-monitoring, behavior-modification, and continuous quality-improvement processes produced substantial increases in offers and HIV test completion. WHMC is replicating this approach across departments, and other hospitals implementing routine HIV screening programs should consider this approach as well.

A Novel Approach to Realizing Routine HIV Screening and Enhancing Linkage to Care in the United States: Protocol of the FOCUS Program and Early Results.

BACKGROUND: The United States health care system remains far from implementing the Centers for Disease Control and Prevention's recommendation of routine human immunodeficiency virus (HIV) screening as part of health care for adults. Although consensus for the importance of screening has grown, innovations in implementing routine screening are still lacking. HIV on the Frontlines of Communities in the United States (FOCUS) was launched in 2010 to provide an environment for testing innovative approaches to routine HIV screening and linkage to care. OBJECTIVE: The strategy of the FOCUS program was to develop models that maximize the use of information systems, fully integrate HIV screening into clinical practice, transform basic perceptions about routine HIV screening, and capitalize on emerging technologies in health care settings and laboratories. METHODS: In 10 of the most highly impacted cities, the FOCUS program supports 153 partnerships to increase routine HIV screening in clinical and community settings. RESULTS: From program launch in 2010 through October 2013, the partnerships have resulted in a total of 799,573 HIV tests and 0.68% (5425/799,573) tested positive. CONCLUSIONS: The FOCUS program is a unique model that will identify best practices for HIV screening and linkage to care.