Clinical Scorecard: Common Missed Chances for Timely HIV Detection in a Standard Opt-out Testing Setting in Atlanta
At a Glance
Category
Detail
Condition
HIV infection with delayed diagnosis
Key Mechanisms
Routine opt-out HIV testing with electronic health record alerts to prompt testing; missed opportunities defined as no HIV testing within one year before diagnosis despite healthcare encounters
Target Population
Adults attending safety-net healthcare system encounters in Atlanta, Georgia
Care Setting
Emergency department, urgent care, outpatient (including primary care), and inpatient settings within a safety-net hospital system
Key Highlights
70% of newly diagnosed HIV individuals had no HIV testing in the year prior to diagnosis (missed opportunities).
Missed testing opportunities were more common in outpatient and primary care visits compared to emergency department visits.
Sexual health–related encounters and STI testing were associated with lower odds of missed opportunities and earlier HIV diagnosis.
Guideline-Based Recommendations
Diagnosis
Implement routine opt-out HIV testing for all individuals aged 13–64 years without risk assessment.
Conduct annual HIV screening for persons at higher risk of HIV acquisition.
Use electronic health record-based best practice alerts to prompt HIV testing if no test was done in the prior 6–12 months.
Management
Normalize HIV testing language to reduce stigma and increase acceptance.
Integrate HIV testing into standard care workflows across emergency, urgent care, outpatient, and inpatient settings.
Monitoring & Follow-up
Track testing rates, reactive test results, and new HIV diagnoses to evaluate opt-out testing program effectiveness.
Monitor CD4 counts at diagnosis to assess impact of earlier testing on disease progression.
Risks
Missed opportunities for HIV testing can lead to delayed diagnosis and higher likelihood of advanced immunosuppression (CD4 <350 cells/mm3).
Prioritization of other alerts (e.g., COVID-19) may reduce effectiveness of HIV testing prompts.
Patient & Prescribing Data
Adults newly diagnosed with HIV in a safety-net healthcare system with prior healthcare encounters
Most newly diagnosed patients had no HIV testing in the year before diagnosis despite healthcare encounters, indicating gaps in testing implementation especially in primary care and nonsexual health visits.
Clinical Best Practices
Enhance opt-out HIV testing procedures particularly in primary care and nonsexual health outpatient visits.
Utilize electronic health record alerts effectively to prompt timely HIV testing.
Focus on sexual health–related encounters and STI testing as opportunities to reduce missed HIV diagnoses.
Address competing priorities in clinical alert systems to maintain HIV testing visibility.
by Sarah F Gruber, Megan Schwinne, Rishika Iytha, Emma J Hollenberg, Chad Robichaux, Valeria D Cantos, Jonathan A Colasanti, Anna Q Yaffee, Sara Turbow, Eric Leue, Andrés Camacho-González, Yun F Wang, Meredith H Lora
