Evaluating the Implementation of Nurse-Initiated HIV Rapid Testing in VA Substance Use Disorder Clinics.

Hagedorn HJ. Evaluating the Implementation of Nurse-Initiated HIV Rapid Testing in VA Substance Use Disorder Clinics. Paper presented at: American Public Health Association Annual Meeting and Exposition; 2011 Nov 2; Washington, DC.

Objective: To link individuals with substance use disorders (SUDs) to HIV testing by implementing and evaluating a variant of our previously successful nurse-initiated HIV oral rapid testing (NRT) strategy at three VA SUD clinics. Methods: 1. Training: - Evidence for NRT - Training in the use of a computerized clinical reminder (CCR) - 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 Results: Local laboratory data showed the following rates of testing over a six month period: Site 1: 178 Site 2: 9 Site 3: 65 Qualitative results: 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 CCR as a prompt for testing - Awareness of the population's risk and a positive attitude towards HIV testing - Offering guidance on how to provide support to preliminary positive patients Conclusions: Besides 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. Point-of-care NRT can be easily and sustainably incorporated into SUD clinics with minimal impact on nurse workflow and time. Learning Areas: Conduct evaluation related to programs, research, and other areas of practice Program planning Public health or related nursing Public health or related research Learning Objectives: Design a sustainable nurse-initiated HIV rapid test program in substance use disorder clinics Keywords: Substance Abuse, Nurses Presenting author's disclosure statement: Qualified on the content I am responsible for because: I was the project coordinator and oversaw the implementation and evaluation of the implementation research being presented. Any relevant financial relationships? No I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation