Improving HIV Screening and Receipt of Results by Nurse-Initiated Streamlined Counseling and Rapid Testing

  • Henry D. Anaya
  • Tuyen Hoang
  • Joya F. Golden
  • Matthew Bidwell Goetz
  • Allen Gifford
  • Candice Bowman
  • Teresa Osborn
  • Douglas K. Owens
  • Gillian D. Sanders
  • Steven M. Asch
Original Article

Abstract

Background

HIV testing is cost-effective in unselected general medical populations, yet testing rates among those at risk remain low, even among those with regular primary care. HIV rapid testing is effective in many healthcare settings, but scant research has been done within primary care settings or within the US Department of Veteran’s Affairs Healthcare System.

Objectives

We evaluated three methods proven effective in other diseases/settings: nurse standing orders for testing, streamlined counseling, and HIV rapid testing.

Design

Randomized, controlled trial with three intervention models: model A (traditional counseling/testing); model B (nurse-initiated screening, traditional counseling/testing); model C (nurse-initiated screening, streamlined counseling/rapid testing).

Participants

Two hundred fifty-one patients with primary/urgent care appointments in two VA clinics in the same city (one large urban hospital, one freestanding outpatient clinic in a high HIV prevalence area).

Measurements

Rates of HIV testing and receipt of results; sexual risk reduction; HIV knowledge improvement.

Results

Testing rates were 40.2% (model A), 84.5% (model B), and 89.3% (model C; p = <.01). Test result receipt rates were 14.6% (model A), 31.0% (model B), 79.8% (model C; all p = <.01). Sexual risk reduction and knowledge improvement did not differ significantly between counseling methods.

Conclusions

Streamlined counseling with rapid testing significantly increased testing and receipt rates over current practice without changes in risk behavior or posttest knowledge. Increased testing and receipt of results could lead to earlier disease identification, increased treatment, and reduced morbidity/mortality. Policymakers should consider streamlined counseling/rapid testing when implementing routine HIV testing into primary/urgent care.

KEY WORDS

nurse-initiated HIV screening HIV rapid testing streamlined counseling 

Notes

Acknowledgments

The authors would like to thank Genia Williamson, Leslie Lange, Brenda Rue, Alicia Alcantara, Jamie Feld, Anne Taylor, and Jesse Dwyer for assistance in the development of this manuscript.

This research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Project number IIR 04–023. Dr. Asch is the principal investigator at the VA Greater Los Angeles Healthcare System. The views expressed in this article are those of the author(s) and do not necessarily represent the views of the United States Department of Veterans Affairs. The Veterans Health Administration supported this study but had no input in the design or reporting or decision to submit this paper for publication. HIV rapid tests were donated by Orasure Technologies. The opinions expressed in this manuscript are solely the authors’ and do not necessarily reflect those of the US Department of Veterans Affairs. This study was reviewed and sanctioned by a US Department of Veterans Affairs Internal Review Board process.

Conflict of Interest Statement

The first author owns stock in a biotechnology company that develops biotechnological products, one of which is a rapid test for diagnosing the HIV virus. The first author also received an unrestricted grant to support dissemination of research results from two HIV rapid testing device manufacturers, and this grant supported author no. 8 as well. Author no. 4 has received both honoraria and grant support in the past 3 years.

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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Henry D. Anaya
    • 1
  • Tuyen Hoang
    • 1
  • Joya F. Golden
    • 1
  • Matthew Bidwell Goetz
    • 1
    • 10
  • Allen Gifford
    • 1
    • 5
  • Candice Bowman
    • 1
    • 2
  • Teresa Osborn
    • 6
  • Douglas K. Owens
    • 7
    • 8
  • Gillian D. Sanders
    • 9
  • Steven M. Asch
    • 1
    • 3
    • 4
  1. 1.Veterans Affairs (VA) Quality Enhancement Research Initiative for HIV and Hepatitis (QUERI-HIV/HEP) and Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Health Services Research and Development (HSRD) Center of ExcellenceVA Greater Los Angeles Healthcare SystemLos AngelesUSA
  2. 2.The Center for Research in Patient Oriented CareVA San Diego Healthcare SystemLa JollaUSA
  3. 3.Division of General Internal Medicine and Health, Services Research (GIM and HSR)UCLA School of MedicineLos AngelesUSA
  4. 4.RAND HealthSanta MonicaUSA
  5. 5.VA New England Healthcare SystemBedfordUSA
  6. 6.VA VISN22Long BeachUSA
  7. 7.VA Palo Alto Healthcare SystemPalo AltoUSA
  8. 8.Stanford University School of MedicineStanfordUSA
  9. 9.Duke University School of MedicineDurhamUSA
  10. 10.Infectious Diseases Section, Department of MedicineVA Greater Los Angeles Healthcare System and the David Geffen School of Medicine at UCLALos AngelesUSA

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