Leveraging EHR Tools and Workflow Changes to Normalize Routine HIV Screening

Author Biographical Info

Brandi Stewart is a Family Nurse Practitioner and Doctor of Nursing Practice (DNP) candidate at The University of Texas Health Science Center at Houston, with anticipated graduation in May 2026. She is board-certified in HIV medicine and is passionate about advancing health equity through evidence-based preventive care. Her scholarly work focuses on increasing HIV screening and early detection in underserved and rural populations.

Date of Doctor of Nursing Practice Project Completion

Summer 8-1-2025

Faculty Advisor

Dr. Lisa Thomas

Abstract

Purpose: This quality improvement project aimed to increase human immunodeficiency virus (HIV) screening rates by implementing an opt-out screening model supported by provider education and an electronic health record (EHR)-based recommendation tool in three rural clinics within a nonprofit primary care network.

Background: HIV screening remains suboptimal in many rural areas, where late diagnoses and care gaps persist. Prior to the intervention, the organization’s average screening rate was 61.7%. Barriers included provider bias, inconsistent workflows, and lack of standardized prompts in the EHR.

Methodology: The intervention utilized the Plan-Do-Study-Act framework and was carried out from January to May 2025. Educational sessions were conducted for providers and staff, and the Azara plugin, an EHR-based tool that identifies eligible patients who have never been screened, was deployed. Weekly site rounding supported adoption, and a change to wellness visit templates in April 2025 removed the optional HIV screening question to standardize workflows.

Results: Screening rates improved or were maintained across all pilot sites. Clinic 1 increased from 33.1% to 35.7%, Clinic 2 rose from 23.1% to 34.9%, and Clinic 3 remained high, moving from 56.5% to 56.7%. Hepatitis C virus (HCV) screening also improved across all clinics, despite not being targeted. Organization-wide HIV screening increased from 61.7% in May 2024 to 65.3% in May 2025, with the most significant gain occurring in March 2025 when opt-out screening was expanded across the network.

Implications: These findings support integrating opt-out screening into routine care using EHR prompts and provider education. The intervention demonstrated early success in improving screening behavior, standardizing workflows, and enhancing preventive care in rural settings.

Keywords

HIV screening, opt-out testing, quality improvement, electronic health record, rural health, USPSTF Guidelines, Preventive Health

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