title: Implementation of National HIV Screening Recommendations in the Indian Health Service.
abstract: BACKGROUND
  The Indian Health Service (IHS), a federal agency, provides direct patient care to an estimated 1.9 million American Indian/Alaska Native patients across a large and decentralized network of health facilities. The IHS sought to implement HIV screening of adults and adolescents per national recommendations. The IHS facilities received technical support such as electronic clinical reminders (ECRs) and sample HIV-testing policies.
  
  
  OBJECTIVE
  To determine what facility-wide policy and practices were associated with high HIV screening rates.
  
  
  METHODS
  Survey of clinical directors of 61 federal health facilities on use of ECRs, testing policies/standing orders, and other factors associated with HIV screening. These results were correlated with HIV screening performance results for each facility as derived from the IHS national database.
  
  
  RESULTS
  A total of 51 (84%) of 61 facilities were interviewed. In univariate analysis, factors that were correlated with higher rates of HIV screening were having an HIV screening standing order (unadjusted odds ratio [UOR] 8.7, 95% confidence interval [CI] 2.0-37.3), sexually transmitted disease (STD) screening standing order (UOR 5, CI 1.1-21.7), having an HIV ECR in place for a year or longer (UOR 10.2, CI 2.8-37.5), and inclusion of both providers and nurses in offering HIV screening (UOR 4.8, CI 1.4-16.7). In multivariate analysis, ECRs (adjusted odds ratio [AOR] 9.1, 95% CI 1.8-45.1) and STD standing orders (AOR 7.4, 95% CI 1.1-51.0) remained significantly associated with higher HIV screening.
  
  
  CONCLUSIONS
  Policy and practice interventions such as ECRs and standing order/testing policies and delegation of screening are correlated with high HIV screening, are scalable across health networks, and will be used for improving other infectious disease screening indicators in such as STD and hepatitis C.
authors: Indian Health Service Division of Epidemiology and Disease Prevention, Albuquerque, NM, USA brigg.reilley@ihs.gov.
authors: Brigg
authors: B
authors: Reilley
authors: Northwest Portland Area Indian Health Board, Portland, OR, USA.
authors: Jessica
authors: J
authors: Leston
authors: Centers for Disease Control and Prevention, CDC/NCHHSTP/DSTDP, Phoenix, AZ, USA.
authors: Scott
authors: S
authors: Tulloch
authors: Indian Health Service, Rockville, MD, USA.
authors: Lisa
authors: L
authors: Neel
authors: Indian Health Service, Phoenix, AZ, USA.
authors: Megan
authors: M
authors: Galope
authors: Centers for Disease Control and Prevention, CDC/NCHHSTP/DSTDP, Phoenix, AZ, USA.
authors: Melanie
authors: M
authors: Taylor
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D057286:Electronic Health Records; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology*; D006801:Humans; D007198:Indians, North American; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D017010:Reminder Systems; D014481:United States; D016549:United States Indian Health Service; D055815:Young Adult
keywords: American Indian/Alaska Native; HIV; electronic clinical reminders; policy; public health; screening; testing
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