3133 — Factors Affecting the Likelihood of HIV Screening among High-Risk Patients
Chou AF, Yano EM, Burgess J, and Hoang T, VA Greater Los Angeles Healthcare System; Gifford A, Bedford VA; Asch S, Palo Alto VA; Goetz MB, VA Greater Los Angeles Healthcare System;
Full HIV treatment benefits are not being realized as 25% of about 1.2 million HIV-infected persons are unaware of their disease. In addition to provider/patient factors, organizational barriers may impede disease identification and treatment. The study objective is to understand organizational factors in predicting the likelihood of HIV screening in high-risk patients.
Our analytic dataset combined: (1) quality data from the provider activation program (PAP), (2) patient data from VA Austin Automation Center (AAC), and (3) facility data from Clinical Practice Organizations Survey (CPOS). First, PAP employed a cross-sectional design comparing 3 arms to study HIV screening, varied by resource levels. Second, AAC provided patient HIV screening status. Third, CPOS surveyed 225 primary care directors on facility characteristics. We generated scores from factor analyses to describe organizational factors. We used hierarchical generalized linear modeling to estimate likelihood of HIV testing as a function of these factors, controlling for patient demographics, risk factors, and facility clustering effect.
The study included 49,584 patients from 14 facilities, with 96% being male, 78% <65 years, and 24% minority; 73% earned an income of <$30,000, and 20% were homeless. Patients reported these risk factors: (1) 35% has substance abuse disorder, (2) 25% Hepatitis B, (3) 58% Hepatitis C, and (4) 6% STD. Multivariate results showed that patient factors (e.g., minority status and risk factors) were positively associated with testing. Organizational factors associated with increased likelihood of testing were resource sufficiency in personnel and financial support (p = 0.0018), support staff (p = 0.0002), space and equipment (p <0.0001), and patient care support (p = 0.001). Patients receiving care from facilities supported by national or local resources reported higher likelihood of testing.
To promote better testing, our findings showed that health care organizations should target minority patients and those with risk factors and consider strategies to achieve resources sufficiency and patient care support.
Identifying and treating asymptomatic HIV-infected individuals are highly cost-effective with vast reduction in morbidity and mortality. Findings related to organizational factors enable organizations to achieve and sustain better testing rates through developing strategies that identify specific types of resources and their allocation.