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Attributes of an independently self-sustaining implementation: nurse-administered HIV rapid testing in VA primary care.

Knapp H, Anaya HD, Goetz MB. Attributes of an independently self-sustaining implementation: nurse-administered HIV rapid testing in VA primary care. Quality management in health care. 2010 Oct 1; 19(4):292-7.

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BACKGROUND: Human immunodeficiency virus (HIV) oral rapid testing (RT) has the potential to facilitate the expansion of such diagnostics to front line providers, specifically clinical nursing staff. Training, policy requirements, and implementation methods used to launch such services have not been widely explored. OBJECTIVES: To evaluate the sustainability of a nurse-initiated HIV-RT intervention at 1 veterans affairs primary care clinic for 1 year. METHODS: Policies were implemented, enabling nurses to carry out HIV RTs. Willing RNs voluntarily enrolled in a 2-part in-service designed to teach pre- and posttest counseling techniques, administering, interpreting, and entering results in the patient's medical records. RESULTS: RNs administered a steady rate of HIV RTs (monthly mean = 25, SD = 3) along with an unexpected increase in HIV blood testing among other clinical staff, leading to a 70% (P < .0001) site-wide increase in HIV testing, with RNs accounting for one-third of these tests. CONCLUSION: In light of the researchers' 1-shot launch efforts, the steady rate of HIV RTs among RNs over the course of a year, combined with the concurrent progressive increase in HIV (blood) testing administered by MDs, PAs, and NPs stands as an anomaly in light of existing implementation science literature.

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