3137 — Patient, Provider, and Facility Factors Associated with Routine HIV Testing and Refusal
Goetz MB, Hoang T, Knapp H, Burgess J, and Fletcher M, VA Greater Los Angeles Healthcare System; Gifford AL, VA New England Healthcare System; Asch S, VA Palo Alto Healthcare System; for VA QUERI-HIV/Hepatitis ,
We previously demonstrated that a multi-modal intervention that utilizes a clinical reminder, provider activation, audit-feedback, and removal of organizational barriers doubled HIV testing rates in at-risk individuals receiving care in one VISN, and report elsewhere its successful deployment in three more VISNS in promoting routine HIV testing per current VA policies. We sought to determine the patient, provider, and facility factors associated with HIV testing and test refusal in the larger implementation.
All patients regardless of any known risk for HIV infection, previously-not-tested and seen at the 15 facilities from 3 VISNs which received the intervention were stratified into groups by their demographics (age, race, marital status), risk factors for HIV infection (e.g., homelessness, drug use, prior sexually transmitted diseases or infection by Hepatitis B or C viruses), the types of provider who saw the patients (gender, degree), and the types of facility where they were seen (based on patient load, baseline HIV testing rates and the prevalence of known HIV infection). Changes in adjusted testing rates and refusal rates (as documented in health factors generated by clinical reminder responses) from 6-month pre- and post-intervention periods were compared among patient strata.
The magnitude of the increases in testing rates were significantly higher among <65 year-old patients than 65+ year-old (14% vs. 10%); among patients seen by trainees rather than by staff (23% vs. 10%); and among patients seen at the facilities with small patient loads than large patient loads (12% vs. 7%), high baseline testing rates than low baseline rates (13% vs. 9%), and high HIV-risk prevalence than low HIV-risk prevalence (13% vs. 9%). Refusal rates were lower among those under 65 (22% vs. 32%) and among patients seen by trainees (17% vs. 27%). All reported comparisons are statistically significant at p <.001.
Although HIV testing rates increased across all patient, provider and facility strata, the interventional was most effective in younger patients, smaller facilities with high baseline testing rates, and with trainees.
These data can guide revision of interventional protocols to better target those least affected.