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A System-wide Intervention to Improve HIV Testing in the Veterans Health Administration

  • Matthew Bidwell Goetz
  • Tuyen Hoang
  • Candice Bowman
  • Herschel Knapp
  • Barbara Rossman
  • Robert Smith
  • Henry Anaya
  • Teresa Osborn
  • Allen L. Gifford
  • Steven M. Asch
  • The QUERI-HIV/Hepatitis Program
Original Article

Abstract

Background

Although the benefits of identifying and treating asymptomatic HIV-infected individuals are firmly established, health care providers often miss opportunities to offer HIV-testing.

Objective

To evaluate whether a multi-component intervention increases the rate of HIV diagnostic testing.

Design

Pre- to post-quasi-experiment in 5 Veterans Health Administration facilities. Two facilities received the intervention; the other three facilities were controls. The intervention included a real-time electronic clinical reminder that encourages HIV testing, and feedback reports and a provider activation program.

Patients

Persons receiving health care between August 2004 and September 2006 who were at risk but had not been previously tested for HIV infection

Measurements

Pre- to post-changes in the rates of HIV testing at the intervention and control facilities

Results

At the two intervention sites, the adjusted rate of testing increased from 4.8% to 10.8% and from 5.5% to 12.8% (both comparisons, p < .001). In addition, there were 15 new diagnoses of HIV in the pre-intervention year (0.46% of all tests) versus 30 new diagnoses in the post-intervention year (0.45% of all tests). No changes were observed at the control facilities.

Conclusions

Use of clinical reminders and provider feedback, activation, and social marketing increased the frequency of HIV testing and the number of new HIV diagnoses. These findings support a multimodal approach toward achieving the Centers for Disease Control and Prevention’s goal of having every American know their HIV status as a matter of routine clinical practice.

KEY WORDS

diagnosis HIV testing quality improvement 

Notes

Acknowledgments

This project was supported by a research grant to Drs. Goetz and Asch by the Veterans Health Administration Health Services Research & Development Service (SDP 06–001).

Conflicts of Interest

Matthew Bidwell Goetz: consultancy with Monogram Biosciences, grant support from Gilead Pharmaceuticals, GlaxoSmithKline; Henry D. Anaya: stock ownership in Trinity Biotechnology, which develops biomarker devices, one of which is a test for the HIV virus, and educational support in the form of unrestricted grants from both Trinity Biotechnology and OraSure Technologies; Allen Gifford: royalties for authorship of Living Well With HIV And AIDS, Ball Publishing Company; Steven Asch: unrestricted travel grant from Trinity Pharmaceuticals. The other authors have no conflicts of interest.

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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Matthew Bidwell Goetz
    • 1
    • 2
  • Tuyen Hoang
    • 3
  • Candice Bowman
    • 4
  • Herschel Knapp
    • 3
  • Barbara Rossman
    • 1
  • Robert Smith
    • 4
  • Henry Anaya
    • 3
  • Teresa Osborn
    • 5
  • Allen L. Gifford
    • 6
    • 7
  • Steven M. Asch
    • 2
    • 3
  • The QUERI-HIV/Hepatitis Program
  1. 1.Infectious Diseases Section (111-F)VA Greater Los Angeles Healthcare SystemLos AngelesUSA
  2. 2.David Geffen School of MedicineUCLALos AngelesUSA
  3. 3.General Medicine (111G)VA Greater Los Angeles Healthcare SystemLos AngelesUSA
  4. 4.VA San Diego Healthcare SystemSan DiegoUSA
  5. 5.VISN 22Long BeachUSA
  6. 6.VA Bedford Center for Health Quality, Outcomes & Economic ResearchEdith Nourse Rogers Memorial Veterans HospitalBedfordUSA
  7. 7.Boston University Schools of Public Health and MedicineBostonUSA

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