HIV/HBV/HCV Triple Screening in Primary Care

Design: This will be a randomized controlled cross-over trial, testing different order panels for screening blood tests for human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Study participants will be primary care providers. Participating providers will be randomized to either a control arm (no changes to currently available orders) or a triple-testing order panel intervention arm (order panel with screening tests for all three bloodborne viruses (BBVs) selected by default when a provider attempts to order a screening test for at least one BBV through the study order panels). These order panels will only be triggered if the provider orders a virus BBV screening test based on their normal practice and standard of care for their patient. Providers will see which orders are selected prior to signing (finalizing) them; therefore, this study will be unblinded. To mitigate the effect of unblinding, providers will switch arms halfway through the study, defined as 6 months or the point at which a total of 1000 patients have BBV test orders, whichever comes first. Outcomes/endpoints: The investigators will compare incidences of HIV, HBV, and HCV diagnoses between the two arms, estimate number of cases missed by not triple-testing, estimate laboratory costs per arm, and measure patient encounters per arm.