A Quality Improvement (QI) Project Aimed at Increasing Screening Rates of HIV and Hepatitis C (HCV) at the 1801 Internal Medicine Resident Clinic: Is Sustainability Achievable?

Background: South Carolina (SC) continues to have some of the highest rates of HIV and HCV in the US. As recently as January 2020, a local news source boasted the headline “Columbia has one of the highest STD rates of any US city, study shows”. In 2019, a QI project implemented at the Prisma Health- USC Internal Medicine Resident Clinic located in Columbia, SC sought to increase screening rates for both viruses by incorporating routine “opt-out “statements at patient triage. Although the project led to a significant hike in screening rates for both during the QI period, it was observed that just 3 months after the QI project ended the percentage of patients who were not asked about “opt -out”  testing at triage rose from 12% to 30% for HIV and 14 to 30% for  HCV. It is expected that this will eventually lead to a decline in screening rates.
Methods: We plan to conduct a single center quality improvement (QI) project at the University of South Carolina (USC) Internal Medicine 1801 Resident Clinic between February 2020 and May 2020. We will incorporate the following statements on the general intake triage form: 1. We test everyone ages 18-65 for HIV. You will be tested today unless you say no. 2. We test everyone ages 18-75 for Hepatitis C. You will be tested today unless you say no. We will also have educational leaflets available at the check- in desk. Data regarding opt status and screening rates of HIV and HCV before and after QI- implementation will then collected using a medical record- based review. Expectations: We expect that implementation of routine “opt out” testing statements on the clinic triage intake form as well as the distribution of educational leaflets at the clinic check- in area, will lead to a decrease in the percentage of eligible patients not asked about “opt- out” testing by 50% for both HIV and HCV. This will hopefully lead to sustainable screening rates averaging 60% of eligible patients for both viruses.