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Influence of providers and nurses on completion of non-targeted HIV screening in an urgent care setting

Rachel A Bender Ignacio19*, Jacqueline Chu2, Melinda C Power3, Jeffrey Douaiher4, Jordan D Lane5, Jeffrey P Collins67 and Valerie E Stone78

  • * Corresponding author: Rachel A Bender Ignacio rbi13@uw.edu

  • † Equal contributors

Author Affiliations

1 Division of Allergy and Infectious Diseases, University of Washington, 1959 NE Pacific St, BB545, 98195 Seattle, WA, USA

2 Department of Medicine, Massachusetts General Hospital, Grey/Bigelow 740, 55 Fruit St, 02114 Boston, MA, USA

3 Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 North Wolfe Street, W6508, 21205 Baltimore, MD, USA

4 Department of Surgery, Johns Hopkins Hospital, 600 N Wolfe St, 21287 Baltimore, MD, USA

5 Harvard Medical School, Tosteson Medical Education Center, 260 Longwood Ave, 02115 Boston, MA, USA

6 Department of Medicine, CHC Urgent Care, Massachusetts General Hospital Chelsea Healthcare Center, 151 Everett Ave, 02150 Chelsea, MA, USA

7 Department of Medicine, Harvard Medical School, 25 Shattuck St, 02115 Boston, MA, USA

8 Department of Medicine, Mount Auburn Hospital, 330 Mount Auburn Street, 02138 Cambridge, MA, USA

9 Fred Hutchinson Cancer Research Center, M1B-140 1100 Fairview Ave N, Seattle, WA 98109, USA

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AIDS Research and Therapy 2014, 11:24  doi:10.1186/1742-6405-11-24

Published: 4 August 2014

Abstract

Introduction

Despite recommendations by the Centers for Disease Control (CDC) that all adults be offered non-targeted HIV screening in all care settings, screening in acute-care settings remains unacceptably low. We performed an observational study to evaluate an HIV screening pilot in an academic-community partnership health center urgent care clinic.

Methods

We collected visit data via encounter forms and demographic and laboratory data from electronic medical records. A post-pilot survey of perceptions of HIV screening was administered to providers and nurses. Multivariable analysis was used to identify factors associated with completion of testing.

Results

Visit provider and triage nurse were highly associated with both acceptance of screening and completion of testing, as were younger age, male gender, and race/ethnicity. 23.5% of patients completed tests, although 36.0% requested screening; time constraints as well as risk perceptions by both the provider and patient were cited as limiting completion of screening. Post-pilot surveys showed mixed support for ongoing HIV screening in this setting by providers and little support by nurses.

Conclusions

Visit provider and triage nurse were strongly associated with acceptance of testing, which may reflect variable opinions of HIV screening in this setting by clinical staff. Among patients accepting screening, visit provider remained strongly associated with completion of testing. Despite longstanding recommendations for non-targeted HIV screening, further changes to improve the testing and results process, as well as provider education and buy-in, are needed to improve screening rates.

Keywords:
HIV; Screening; Patient care; Urgent care