Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3003 — Improving HIV Screening with Nurse-Based Rapid Testing and Streamlined Counseling

Anaya HD (VA) , Asch SM (VA), Hoang T (VA), Goetz MB (VA), Gifford A (VA), Bowman C (VA), Golden JF (VA), Knapp H (VA)

Objectives:
Testing for HIV has been shown to be cost effective in unselected general medical populations, yet rates of testing among those at risk remain far below optimal, even among those with regular primary care. The specific aims of this project are: • To determine whether nurse-based referral for traditional HIV testing and counseling will improve screening rates compared to current testing procedures. • To determine whether nurse-based rapid testing with streamlined counseling improves screening rates more than nurse-based referral for traditional testing and counseling alone.

Methods:
A parallel-group, controlled study was conducted in the primary/urgent care clinics of the West Los Angeles VA. Eligibility was based on same-day appointment; age (18-65); no prior HIV test in past year; unknown HIV status. One hundred sixty six patients were randomized to one of three screening models: Model A: patients urged to discuss testing with their physician (control), Model B: nurses offered traditional counseling/testing, Model C: nurses offered streamlined counseling/rapid testing. Interventions were performed by nurses in addition to their regular clinic duties.

Results:
Model A: 22 patients (40.7%) had test ordered; Model B: 48 (84.2%) had test ordered; Model C: 51 (92.7%) had test ordered. Of 22 patients in Model A with a test order, 9 (40.9%) received results; of 48 patients in Model B with test order, 25 (52.1%) received results; of 51 patients in Model C with test order, 46 (90.2%) received results.

Implications:
Results show that both interventional models will likely result in higher screening rates than traditional HIV testing models in primary care.

Impacts:
HIV rapid testing has been shown to effectively convey results to patients, which is especially salient given the approximately 300,000 persons in the US alone who are unaware of their HIV-positive status. Increased rates of testing could lead to earlier identification of disease, increased treatment, and reduced morbidity and mortality. Reduced intensity of counseling might free staff resources. As the VA is the largest HIV care provider in the US, it would be beneficial for VA policymakers to consider implementing rapid testing on a regular basis.