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Vaz-Pinto I, Ortega E, Chivite I, Butí M, Turnes-Vázquez J, Magno-Pereira V, Rocha M, Garrido J, Esteves-Santos C, Guimaraes M, Mourão T, Martínez Roma M, Guilera V, Llaneras-Artigues J, Barreira-Díaz A, Pérez Cachafeiro S, Daponte Angueira S, Xavier E, Vicente M, Garrido G, Heredia MT, Medina D, García Deltoro M. Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention. Front Public Health 2024; 11:1268888. [PMID: 38328544 PMCID: PMC10847218 DOI: 10.3389/fpubh.2023.1268888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Background Around 57,000 people in Spain and Portugal currently living with HIV or chronic hepatitis C are unaware of their infection. The COVID-19 pandemic severely disrupted screening efforts for these infections. We designed an intervention to increase and sustain opportunistic blood-borne virus (BBV) screening and linkage to care (SLTC) by implementing the TEST model. Methods The Plan Do Study Act (PDSA) method of quality improvement (QI) was implemented in 8 healthcare organizations (HCOs), including four hospitals, two clusters of community health centers, and two community-based organizations (CBOs). Baseline assessment included a review of BBV SLTC practices, testing volume, and results 12 months before the intervention. Changes in BBV testing rates over time were measured before, during, and after the COVID-19 lockdowns in 2020. A mixed ANOVA model was used to analyze the possible effect on testing volumes among HCOs over the three study periods. Intervention BBV testing was integrated into normal clinical flow in all HCOs using existing clinical infrastructure and staff. Electronic health record (EHR) systems were modified whenever possible to streamline screening processes, implement systemic institutional policy changes, and promote QI. Results Two years after the launch of the intervention in screening practices, testing volumes increased by 116%, with formal healthcare settings recording larger increases than CBOs. The start of the COVID-19 lockdowns was accompanied by a global 60% decrease in testing in all HCOs. Screening emergency department patients or using EHR systems to automate screening showed the highest resilience and lowest reduction in testing. HCOs recovered 77% of their testing volume once the lockdowns were lifted, with CBOs making the fullest recovery. Globally, enhanced screening techniques enabled HCOs to diagnose a total of 1,860 individuals over the research period. Conclusions Implementation of the TEST model enabled HCOs to increase and sustain BBV screening, even during COVID-19 lockdowns. Although improvement in screening was noted in all HCOs, additional work is needed to develop strong patient linkage to care models in challenging times, such as global pandemics.
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Affiliation(s)
- Inês Vaz-Pinto
- HIV-AIDS Functional Unit, Hospital de Cascais Dr. José de Almeida (HCASCAIS), Cascais, Portugal
| | - Enrique Ortega
- Unidad de Enfermedades Infecciosas, Consorci Hospital General Universitari de València (HVALENCIA), Valencia, Spain
| | - Ivan Chivite
- Unidad de Enfermedades Infecciosas, Hospital Clínic i Provincial de Barcelona (HClinic), Barcelona, Spain
| | - María Butí
- Servicio de Hepatología, Hospital Universitari Vall d'Hebron (HVHEBRON), Barcelona, Spain
- CIBER Enfermedades Hepáticas y Digestivas del Instituto Carlos III, Madrid, Spain
| | | | - Vítor Magno-Pereira
- Serviço de Saúde da Região Autónoma da Madeira (SMADEIRA), Madeira, Portugal
- Universidade da Madeira, Madeira, Portugal
| | - Miguel Rocha
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | | | - Catarina Esteves-Santos
- HIV-AIDS Functional Unit, Hospital de Cascais Dr. José de Almeida (HCASCAIS), Cascais, Portugal
| | - Mafalda Guimaraes
- HIV-AIDS Functional Unit, Hospital de Cascais Dr. José de Almeida (HCASCAIS), Cascais, Portugal
| | - Tomás Mourão
- HIV-AIDS Functional Unit, Hospital de Cascais Dr. José de Almeida (HCASCAIS), Cascais, Portugal
| | - María Martínez Roma
- Unidad de Enfermedades Infecciosas, Consorci Hospital General Universitari de València (HVALENCIA), Valencia, Spain
| | - Vanessa Guilera
- Unidad de Enfermedades Infecciosas, Hospital Clínic i Provincial de Barcelona (HClinic), Barcelona, Spain
| | | | - Ana Barreira-Díaz
- Servicio de Hepatología, Hospital Universitari Vall d'Hebron (HVHEBRON), Barcelona, Spain
| | | | | | - Elisa Xavier
- Serviço de Saúde da Região Autónoma da Madeira (SMADEIRA), Madeira, Portugal
| | | | | | | | - Diogo Medina
- Gilead Sciences, Madrid and Lisbon, Spain and Portugal
| | - Miguel García Deltoro
- Unidad de Enfermedades Infecciosas, Consorci Hospital General Universitari de València (HVALENCIA), Valencia, Spain
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