title: Influence of providers and nurses on completion of non-targeted HIV screening in an urgent care setting.
abstract: BACKGROUND
  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.
authors.affiliation: Division of Allergy and Infectious Diseases, University of Washington, 1959 NE Pacific St, BB545, 98195 Seattle, WA, USA.|Fred Hutchinson Cancer Research Center, M1B-140 1100 Fairview Ave N, Seattle, WA 98109, USA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Bender Ignacio
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Grey/Bigelow 740, 55 Fruit St, 02114 Boston, MA, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Chu
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 North Wolfe Street, W6508, 21205 Baltimore, MD, USA.
authors.forename: Melinda C
authors.initials: MC
authors.lastname: Power
authors.affiliation: Department of Surgery, Johns Hopkins Hospital, 600 N Wolfe St, 21287 Baltimore, MD, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Douaiher
authors.affiliation: Harvard Medical School, Tosteson Medical Education Center, 260 Longwood Ave, 02115 Boston, MA, USA.
authors.forename: Jordan D
authors.initials: JD
authors.lastname: Lane
authors.affiliation: Department of Medicine, CHC Urgent Care, Massachusetts General Hospital Chelsea Healthcare Center, 151 Everett Ave, 02150 Chelsea, MA, USA.|Department of Medicine, Harvard Medical School, 25 Shattuck St, 02115 Boston, MA, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Collins
authors.affiliation: Department of Medicine, Harvard Medical School, 25 Shattuck St, 02115 Boston, MA, USA.|Department of Medicine, Mount Auburn Hospital, 330 Mount Auburn Street, 02138 Cambridge, MA, USA.
authors.forename: Valerie E
authors.initials: VE
authors.lastname: Stone
keywords: HIV; Patient care; Screening; Urgent care