291. Using Individualized Provider Feedback to Improve HCV Screening in a High-Volume Emergency Department

Abstract

Background: All models to end the HIV epidemic rely on strategies to identify people living with HIV, encourage sustained care engagement, and promote universal antiretroviral therapy to achieve viral load suppression. HIV testing is the critical first step as it provides entry for both HIV care and HIV prevention services. Busy urban emergency departments (EDs) are uniquely suited for HIV screening programs, but numerous barriers to effective program implementation exist. We describe an ED physician champion model that utilizes feedback intervention theory to providers to increase HIV screening rates. Method(s): In September 2018, our physician champion provided an educational session to ED providers about the importance of HIV screening and the proposed study. From September to December 2018, providers received a monthly e-mail from the ED champion and an automated text message with their individual and peer HIV screening rates. Number and rate of HIV testing performed in the ED were compared to HIV testing in the inpatient and outpatient setting where feedback was not provided. Result(s): On average ED providers evaluated approximately 14 000 patients per month. In the 6 months prior to the intervention, 37.8% of patients had documented HIV screening in the prior 6 years, as compared to 39.5% of patients at the end of December. HIV testing increased 107% from an average of 451 tests per month in the 6 months prior to the intervention to 931 tests sent in December. This was compared with an 18% increase in inpatient screening and a 16% decrease in outpatient screening during the same time period. Conclusion(s): Individualized provider feedback paired with an ED physician champion can lead to an immediate increase in HIV testing. Ongoing studies will determine if this intervention can lead to long-term behavior change.