Goetz MB (VA Greater Los Angeles Healthcare System (GLAHCS)), Hoang T
(VA GLAHCS), Henry SR
(VA GLAHCS), Knapp H
(VA GLAHCS), Anaya H
(VA GLAHCS), Osborn T
(VISN 22 Network Office), Gifford A
(VA Bedford HCS), Asch S
We have previously reported that a multi-component quality improvement intervention that uses a clinical reminder (CR), organizational changes, clinic-level feedback, and a provider activation program significantly increased the rate at which at-risk patients underwent HIV diagnostic testing over a 12-month period at two VISN22 facilities. We now report on the sustainability of this intervention after two years in the original two facilities and on the initial effectiveness of this intervention at two other VISN22 facilities.
This project uses a context-specific CR embedded within CPRS to prompt providers to offer HIV testing to persons with known risk factors for infection. This is complemented by clinic-level feedback regarding HIV testing as well as education and social marketing to encourage providers to prioritize HIV testing. We also streamlined the HIV counseling process to reduce the time for pre-testing from 20 to 2-3 minutes and allowed telephone notification of negative test results. During the first year, the project was actively implemented in 2 VHA facilities (A&B) in VISN22, while facilities C&D served as controls. Subsequently, the intensity of provider activation programs was decreased at facilities A&B, while the program was implemented in two other VISN22 facilities (C&D).
During the first year, the cumulative rate at which at-risk individuals had ever been tested for HIV infection increased from 16 – 22% to 24 - 34% at the active intervention facilities (A&B; p < 0.05). In contrast, the cumulative rate of testing at the control facilities was 14 – 18% and did not change. During the subsequent year, the cumulative rates of testing further increased to 28 – 37% at facilities A&B (p < 0.05). Meanwhile, after implementation at facilities C&D, the rates of cumulative HIV testing increased from 14% to 20.1% (facility C, month 5) and from 23% to 29.4% (facility D, month 4).
These data from a multi-station single VISN intervention indicate that the coordinated use of audit/feedback, provider activation and removal of systemic barriers can provide a sustained significant increased rate of HIV testing and thus allow early diagnosis and treatment for these vulnerable patients.
The lessons learned in this project will inform efforts within the VA to meet the new CDC guidelines that all adults under the age of 65 be offered HIV testing.