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RRP 09-122 – QUERI Project

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RRP 09-122
Implementation of Nurse-Based Rapid Testing in VA SUD Clinics
Henry Anaya PhD
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Funding Period: July 2009 - December 2010

BACKGROUND/RATIONALE:
Individuals with substance use disorders (SUDs) are at higher risk of HIV infection, yet a recent study of US Department of Veterans Affairs (VA) patients with SUDs showed only 20% of these patients had received HIV testing.

OBJECTIVE(S):
Our objective was to increase access to HIV testing for SUD patients by implementing and evaluating a variant of our previously successful nurse-initiated HIV oral rapid testing (NRT) strategy at three VA SUD clinics.

METHODS:
The project employed a mixed-methods design with four components:
1. Training:
- Evidence for NRT
- Training in the use of a computerized clinical reminder (CR)
- Instructions on the HIV oral rapid test
- Patient education strategies
2. Implementation:
- Installation of an HIV rapid test CCR and CPRS template
- An individualized testing procedure for each sub-clinic based on respective clinic flow
3. Qualitative interviews with nursing staff
4. Quantitative evaluation of HIV testing rates

FINDINGS/RESULTS:
Point-of-care NRT was successfully implemented in three VA SUD clinics. Data collected from local laboratory databases showed the following rates of testing over a six month period (from a baseline of 0): Site 1: 65 tests, Site 2: 9 tests, Site 3: 178 tests

Qualitative interviews with nursing staff and supervisors elucidated the following:
BARRIERS
- Lack of support from the lab or providers who are required to sign off on nurse point-of-care testing
- Resistance from some staff to expand their duties to include routine medical procedures
FACILITATORS
- The ease with which the RT could be learned and incorporated into existing nursing duties
- Presence of an on-site and engaged nurse manager
- Existing culture of infectious disease prevention, testing and education in SUD clinics

In addition to the timely receipt of results, HIV rapid testing in SUD clinics allows patients to be tested by a provider that is familiar to them in a setting that is convenient and comfortable.

Future initiatives can be strengthened by:
- Providing hands-on training with using the CCR
- Offering more guidance on how to provide support to preliminary positive patients
- Having regularly scheduled refresher trainings

IMPACT:
Nurse-initiated point of care HIV rapid testing can be successfully and sustainably incorporated into SUD clinics with minimal impact on nurse workflow and time.

PUBLICATIONS:

Journal Articles

  1. Solomon JL, Bokhour BG, Butler J, Golden JF, Hare K, Kertz B, Kan V, Rodriguez-Barradas M, Knapp H, Anaya HD. Sustaining nurse-rapid HIV testing in the U.S. Department of Veterans Affairs: lessons learned from a comparative evaluation. Journal for healthcare quality : official publication of the National Association for Healthcare Quality. 2014 Sep 1; 36(5):26-31.
  2. Conners EE, Hagedorn HJ, Butler JN, Felmet K, Hoang T, Wilson P, Klima G, Sudzina E, Anaya HD. Evaluating the implementation of nurse-initiated HIV rapid testing in three Veterans Health Administration substance use disorder clinics. International Journal of STD & AIDS. 2012 Nov 1; 23(11):799-805.
Conference Presentations

  1. Conners EE, Butler J, Hagedorn H, Wilson P, Felmet K, Bonanomi H, Haas G, Kilma G, Sudzina E, Anaya H. Evaluating the Implementation of Nurse-Initiated HIV Rapid Testing in VA Substance Use Disorder Clinics. Poster session presented at: International Conference on HIV Treatment and Prevention Adherence; 2011 May 1; Miami, FL.
  2. Anaya H, Hagedorn H, Conners EE, Knapp H. Implementation of Nurse-Initiated HIV Rapid Testing in VA Substance Use Disorder Clinics. Paper presented at: VA “One Team toward One Dream” National Quality, Patient Safety and Systems Redesign Conference; 2010 Jun 21; San Francisco, CA.
  3. Anaya H, Butler JN, Conners EE, Knapp H, Hagedorn HJ. Implementation of Nurse-Initiated HIV Rapid Testing in VA Substance Use Disorder Clinics. Poster session presented at: American Conference for the Treatment of HIV; 2010 May 20; Denver, CO.
  4. Anaya H, Butler JN, Knapp H, Hagedorn HJ, Anaya H. Implementation of Nurse-Initiated HIV Rapid Testing in VA Substance Use Disorder Clinics. Paper presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 1; Little Rock, AR.


DRA: Substance Abuse and Addiction
DRE: Diagnosis, Prevention
Keywords: Addictive Disorders, HIV/AIDS, Homeless, QUERI Implementation
MeSH Terms: none

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