Reaching the hidden HIV epidemic: Effective tools for implementing routine opt-out screening at community health centers

Issues: Integrating universal, opt-out HIV screening into primary care settings, such as community health centers, is essential to identifying individuals who have been missed by more traditional testing programs.  In the era of 15 minute clinic visits and productivity pressures, health care providers face the challenge of needing streamlined and effective tools to systematically implement public health and preventive care practices.

Description: Routine opt-out HIV screening was integrated at 4 community health centers, encompassing over 20 sites across a large metropolitan area. Implementation strategies included clinician and staff training, coaching, integration of electronic health record (EHR) tools, and peer learning networks.

Lessons Learned: Findings include clinician and staff training resulting in an average increase of 56% in HIV tests provided per month during the first month, and 75% per month after two months. These gains were most sustained when combined with EHR tools and coaching. Findings also underscored the importance of obtaining leadership buy in from multiple sectors of the community health care system, including administrative leadership, medical directors, IT/EHR teams, as well as the care teams delivering services. During the first year of the project, implementing the above strategies for HIV screening resulted in an overall 107% increase from the previous year in the number of HIV tests provided by participating health centers.

Recommendations: These findings support the notion that clinician and staff training, combined with comprehensive support in the form of EHR tools and coaching, is an effective strategy for increasing HIV testing rates in primary care settings.