How Patient Visit Planning Has Improved HIV Screening Rates Among FQHC Patients in Detroit

Problem: In Michigan, HIV prevalence continues to increase because the number of new diagnoses is larger than the number of deaths. Detroit has the highest HIV prevalence rates in the state. In 2022, Detroit had more NEW HIV cases than the other top 20 cities with largest HIV counts combined. The percentage of new HIV diagnoses that were diagnosed late, in 2020 was16.2%. A late HIV diagnosis is defined as having an AIDS diagnosis within three months of initial HIV diagnosis, leading to poorer outcomes. The CDC recommends that everyone between the ages of 13 and 64 should get tested for HIV at least once as part of routine health care. Early HIV diagnosis improves patient outcomes, reduces the burden of undiagnosed HIV, and limits transmission.

Rational: Patient visit planning helps the patient and physician conduct a face-to-face visit more effectively by gathering and organizing information and adding orders ahead of time so they can devote more attention during the visit to interpreting, discussing, and responding to that information, and addressing patient needs. HIV screening is done within the clinics; staff efforts immediately impact/improve health outcomes and quality data.

Approach: Patient visit planning protocol developed based on feedback from providers and medical assistants (MAs) regarding needs, workflow, and implementation in clinics: use of AZARA DRVS platform for patient visit planning; initially focused on 3 major cancer screening metrics: colonoscopy, mammogram, and pap smears; protocol included built-in order sets in electronic medical records (EMR) for MAs to use when chart prepping for visits; expanded to include other elements of adult wellness visits including HIV screening.

Results: HIV screening average for our clinics increased from an overall 42% in 2021 to an overall 58% this year; and one of our individual health centers reached 77%. The health center average in the state of Michigan is 33% for 2023.

Addressing barriers: Shortly after PVP was introduced to clinics, a survey went out to providers and MAs to determine how it was going, including any barriers to PVP in the clinics. Several steps were taken to address those barriers identified and help improve the PVP process in the clinics, including training, regular feedback and follow-up, reinforcement, enhanced PVP instructions, including alerts with specific directions for MAs to follow when prepping charts, the use of order sets in EMR to reduce time and create common workflows across sites, and integration of AZARA directly into EMR.

Conclusion: Nearly 40% of new HIV infections are transmitted by people who don’t know they have the virus. For people with undiagnosed HIV, testing is the first step to accessing treatment for maintaining a healthy lifestyle and preventing HIV transmission. Integrating patient visit planning HIV testing into primary care daily workflow can improve HIV testing at a population level while using a patient-centered approach.