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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1097 — Barriers and Facilitators to Implementing a Multimodal Intervention to Increase HIV Testing

Henry SR, and Saifu H, HIV/Hepatitis C QUERI; Bokhour BG, Center for Healthy Quality, Outcomes, and Economic Research (CHQOER); HIV/Hepatitis QUERI; Fix GM, CHQOER; HIV/Hepatitis & eHealth QUERIs; Goetz MBKnapp HFletcher MBurgess J, and Asch SM, HIV/Hepatitis C QUERI;

HIV testing offers significant benefits, yet many Veterans in VA care remain untested. Increasing HIV testing in VA is a major initiative, requiring novel approaches to implementing this evidence-based practice. This study examined barriers and facilitators to implementing a multimodal intervention to increase HIV testing.

We implemented an HIV testing intervention using social marketing, clinical reminders (CR’s), and performance feedback to facilitate testing at 16 VA medical centers in three VISNs. We conducted qualitative formative evaluation at each site, using the PARiHS framework, to understand the context, evidence, and facilitation of implementation. Prior to the implementation, we conducted 50 interviews with HIV lead clinicians, primary care lead clinicians, nurse managers, and social workers to identify perceived barriers and facilitators to HIV testing, and 41 follow-up interviews four to six months afterwards to identify which perceived barriers had been addressed by the intervention and which interventional factors facilitated an increase in HIV testing rates.

Pre-implementation, providers indicated that lack of resources, CR overload, onerous consent processes, stigma, communicating positive test results, and concerns about linking individuals to care were significant barriers. Concerns for patient welfare, professional responsibility, viewing CRs as helpful, and organizational support were key to facilitating testing. Providers noted a need for education about HIV testing and simplifying the consent and testing process. Post-implementation interviews indicated that several of these perceived barriers had been addressed. However, other barriers endured, including concerns about HIV stigma and management of patients who test positive.

Providers found the multimodal intervention effective in addressing many pre-implementation concerns, including the potential burden of an additional clinical reminder. Several barriers remained and need to be addressed in the future. Addressing organizational and attitudinal barriers can facilitate increasing HIV testing rates in VA through interventions incorporating clinical reminders, provider education, and performance feedback.

This study indicates that interventions to implement HIV testing can be successful when utilizing proven quality improvement techniques, addressing providers’ perceptions of the evidence, and taking into consideration the local context of implementation. Attending to concerns about persistent stigma associated with HIV may further help this effort.

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