Implementation and Evaluation of a VISN-Based Program to Improve HIV Screening and Testing: One Year Outcome

Goetz MB, Hoang T, Bowman C, Knapp H, Anaya H, Felicio L, Smith R, Osborn T, Gifford A, Asch S. Implementation and Evaluation of a VISN-Based Program to Improve HIV Screening and Testing: One Year Outcome. Paper presented at: VA HSR&D National Meeting; 2007 Feb 22; Arlington, VA.

Objectives: Although the prevalence of HIV infection for VHA patients in care is above the 0.5% prevalence rate at which routine HIV testing is cost-effective, HIV testing is done in < 40% of at-risk patients. Provider surveys indicate that among the barriers to testing are lack of provider prioritization and the time needed for pre- and post-test counseling. In response, we have implemented a multi-component quality improvement intervention. Methods: This project uses a context-specific clinical reminder (CR) embedded within CPRS to prompt providers to offer HIV testing to persons with known risk factors such as prior hepatitis B/C infection, substance abuse, or STDs. 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. The project has been implemented in 2 VHA facilities (including all substations) in VISN22; the other 3 VISN22 facilities serve as controls. Results: After 10 months the adjusted rate of offering testing (i.e., screening) to previously untested, at-risk individuals increased from 18 to 50% at intervention site A and from 18% to 51% at site B; the adjusted rate of actual testing increased from 6 to 12% at site A and from 6 to 14% at site B. All increases were significant at p < 0.05. The baseline screening and testing rates at the control facilities were 5% at baseline and did not increase. Implications: These data indicate that the coordinated use of audit/feedback, provider activation, and removal of systemic barriers significantly increases HIV testing rates and thus allows early diagnosis and treatment for these vulnerable patients. We plan to evaluate the durability/sustainability of the intervention effect and the costs of HIV testing. Impacts: We are beginning to implement and evaluate this program throughout VISN22. The lessons learned in this project will also likely inform efforts to meet the new CDC guidelines that all adults under the age of 65 be offered HIV testing and that high-risk individuals be tested on a yearly basis.