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Description:In the Rapid HIV Screening in an Urban Pediatric Primary Care Clinic intervention, rapid HIV screening is implemented as standard practice of a pediatric primary care clinic using repeated cycles of the Plan-Do-Study-Act (PDSA) model. Rapid HIV screening procedures are based on guidelines from the Centers for Disease Control and Prevention for HIV screening using an opt-out approach. The PDSA model is used to ensure successful implementation of the rapid HIV screening intervention , and involves a quality improvement team that consists of medical directors, nurse managers, social workers, and certified health educators who plan implementation strategies to change practice that affects service quality (plan), conduct implementation strategies identified in the “Pl an” phase (do), rapidly assess the intervention and reflect on collected data at the end of each implementation phase (study), and reassess progress toward rapid screening and successful strategies (act). The intervention was assessed during a baseline per iod and four iterative cycles during which services are enhanced for each successive cycle. The baseline period implementation includes serology screening as standard practice. During this period, clinic providers receive information on HIV screening guide lines and are responsible for identifying patients in need of HIV screening. Cycle 1 includes the implementation of rapid HIV screening in the clinic conducted by trained certified health educators (CHEs), with screening dependent on referral by a provider . All clinic staff and providers receive training on the rapid HIV screening procedures, including how to refer patients to CHEs using a pager system. During Cycle 2, CHEs are co-located with providers in provider workrooms for greater improvement in patient care and to improve accessibility of rapid screening services. In Cycle 3, CHEs continue to be co-located with providers, but proactively approach eligible patients (determined by reviewing medical records of scheduled patients) at any opportunity during the clinical encounter, without provider referrals. During Cycle 4, CHEs continue to be co-located with providers and proactively approach patients, but also track missed opportunities for screening by documenting reasons why rapid HIV screening was not completed
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