Journal of General Internal Medicine

, Volume 28, Issue 10, pp 1311–1317

Central Implementation Strategies Outperform Local Ones in Improving HIV Testing in Veterans Healthcare Administration Facilities

  • Matthew Bidwell Goetz
  • Tuyen Hoang
  • Herschel Knapp
  • Jane Burgess
  • Michael D. Fletcher
  • Allen L. Gifford
  • Steven M. Asch
  • the QUERI-HIV/Hepatitis Program
Original Research

DOI: 10.1007/s11606-013-2420-6

Cite this article as:
Goetz, M.B., Hoang, T., Knapp, H. et al. J GEN INTERN MED (2013) 28: 1311. doi:10.1007/s11606-013-2420-6



Pilot data suggest that a multifaceted approach may increase HIV testing rates, but the scalability of this approach and the level of support needed for successful implementation remain unknown.


To evaluate the effectiveness of a scaled-up multi-component intervention in increasing the rate of risk-based and routine HIV diagnostic testing in primary care clinics and the impact of differing levels of program support.


Three arm, quasi-experimental implementation research study.


Veterans Health Administration (VHA) facilities.


Persons receiving primary care between June 2009 and September 2011


A multimodal program, including a real-time electronic clinical reminder to facilitate HIV testing, provider feedback reports and provider education, was implemented in Central and Local Arm Sites; sites in the Central Arm also received ongoing programmatic support. Control Arm sites had no intervention


Frequency of performing HIV testing during the 6 months before and after implementation of a risk-based clinical reminder (phase I) or routine clinical reminder (phase II).


The adjusted rate of risk-based testing increased by 0.4 %, 5.6 % and 10.1 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). During phase II, the adjusted rate of routine testing increased by 1.1 %, 6.3 % and 9.2 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). At study end, 70–80 % of patients had been offered an HIV test.


Use of clinical reminders, provider feedback, education and social marketing significantly increased the frequency at which HIV testing is offered and performed in VHA facilities. These findings support a multimodal approach toward achieving the goal of having every American know their HIV status as a matter of routine clinical practice.


HIV/AIDS implementation research quality improvement diagnosis 

Supplementary material

11606_2013_2420_MOESM1_ESM.pdf (64 kb)
ESM 1(PDF 63 kb)

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Matthew Bidwell Goetz
    • 1
    • 2
  • Tuyen Hoang
    • 3
  • Herschel Knapp
    • 3
  • Jane Burgess
    • 3
  • Michael D. Fletcher
    • 3
  • Allen L. Gifford
    • 4
    • 5
  • Steven M. Asch
    • 6
    • 7
  • 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 Medicine at UCLALos AngelesUSA
  3. 3.General Medicine (111G)VA Greater Los Angeles Healthcare SystemLos AngelesUSA
  4. 4.VA Bedford Center for Health Quality, Outcomes & Economic ResearchEdith Nourse Rogers Memorial Veterans HospitalBedfordUSA
  5. 5.Boston University Schools of Public Health and MedicineBostonUSA
  6. 6.VA Palo Alto Health Care SystemPalo AltoUSA
  7. 7.Division of General Medical DisciplinesStanford University School of MedicinePalo AltoUSA

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