Improving Adherence to the HIV Testing Algorithm With Resident Physician Intervention

• Published in: American journal of clinical pathology 2019-09, Vol.152 (Supplement_1), p.S149-S150
• Main Authors: Johnson, Kimberly, Buchan, Blake, Colon-Franco, Jessica
• Format: Article
• Language: English
• Subjects: Algorithms; HIV; Human immunodeficiency virus; Immunoassay; Medical tests; Statistical analysis
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/ajcp/aqz130.019

Abstract Introduction The CDC recommends the following algorithm for HIV testing: (1) a screening HIV-1/HIV-2 Ag/Ab immunoassay, (2) HIV-1/HIV-2 antibody differentiation immunoassay, and, if these results are discordant, (3) HIV-1 nucleic acid test (NAT). Final interpretation of this algorithm depends on its completion. To assess the adherence of this algorithm, a retrospective chart review was performed to reveal that 31% of discordant results were not followed up by NAT. A prospective interventional study was devised to improve adherence to the algorithm. Methods A retrospective chart review was performed on all HIV testing performed from January 2017 to June 2018. The patients with discordant results without NAT were identified. These results then prompted a prospective interventional study. Starting in November 2018, a daily automated report was created to identify patients with discordant results and no NAT ordered after 48 hours. This report prompted the client services department to either call the provider if they were an outside client and tell them to contact the pathology resident, or call the resident directly if the provider was an internal client. The resident then provided guidance to order NAT. The total number of patients with discordant results with the intervention was monitored for adherence to the algorithm indicated by clinicians ordering the NAT. Preliminary data from November 2018 to March 2019 were analyzed and compared to the original data. Results The retrospective data revealed a total of 71 patients with discordant results and 22 (31%) did not have NAT testing. The preliminary prospective data revealed a total of 27 patients with discordant results and 3 (11%) did not have NAT testing. These data were found to be statistically significant with P = .04 with a chi-square test. Conclusion Resident physician intervention has significantly improved the adherence to the HIV testing algorithm based on preliminary data.