Article

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

UCLA David Geffen School of Medicine Los Angeles CA USA
Journal of General Internal Medicine (Impact Factor: 3.42). 08/2008; 23(8):1200-1207. DOI: 10.1007/s11606-008-0637-6

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

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

DesignPre- 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.

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

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

ResultsAt 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.

ConclusionsUse 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.

Download full-text

Full-text

Available from: Herschel Knapp, Aug 28, 2015
0 Followers
 · 
143 Views
  • Source
    • "We have successfully employed this succinct model to carry out implementation projects at more than 25 sites throughout the nationwide VA system, including several sites outside the VA (Anaya et al., 2012; Goetz et al., 2008; Knapp, Anaya, & Goetz, 2010; Anaya et al., under review). These implementations have largely been characterized by successful deployment and independent sustainability over time, streamlining healthcare delivery at these sites. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The process of quality improvement may involve enhancing or revising existing practices or the introduction of a novel element. Principles of Implementation Science provide key theories to guide these processes, however, such theories tend to be highly technical in nature and do not provide pragmatic nor streamlined approaches to real-world implementation. This paper presents a concisely comprehensive six step theory-based Implementation Science model that we have successfully used to launch more than two-dozen self-sustaining implementations. In addition, we provide an abbreviated case study in which we used our streamlined theoretical model to successfully guide the development and implementation of an HIV testing/linkage to care campaign in homeless shelter settings in Los Angeles County.
    Journal for Healthcare Quality 11/2012; 34(6):27-35. DOI:10.1111/j.1945-1474.2012.00220.x
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We assessed the extent to which Centers for Disease Control and Prevention (CDC) recommendations have influenced routine HIV testing among Massachusetts community health center (CHC) personnel, and identified specific barriers and facilitators to routine testing. Thirty-one CHCs were enrolled in the study. We compared those that did and did not receive funding support from the federal Ryan White HIV/AIDS Program. An anonymous survey was administered to a maximum five personnel from each CHC, including a senior administrator, the medical director, and three medical providers. Overall, 137 participants completed the survey. Among all CHCs, 53% of administrators reported having implemented routine HIV testing at their CHCs; however, only 33% of medical directors/providers reported having implemented routine HIV testing in their practices (p<0.05). Among administrators, 60% of those from Ryan White-supported CHCs indicated that both they and their CHCs were aware of CDC's recommendations, compared with 27% of administrators from non-Ryan White-supported CHCs. The five most frequently reported barriers to the implementation of routine HIV testing were (1) constraints on providers' time (68%), (2) time required to administer counseling (65%), (3) time required to administer informed consent (52%), (4) lack of funding (35%), and (5) need for additional training (34%). In a multivariable logistic regression model, the provision of on-site HIV testing by nonmedical staff resulted in increased odds of conducting routine HIV testing (odds ratio [OR] = 9.84, 95% confidence interval [CI] 1.77, 54.70). However, the amount of time needed to administer informed consent was associated with decreased odds of providing routine testing (OR=0.21, 95% CI 0.05, 0.92). Routine HIV testing is not currently being implemented uniformly among Massachusetts CHCs. Future efforts to increase implementation should address personnel concerns regarding time and staff availability.
    Public Health Reports 01/2011; 126(5):643-52. DOI:10.2307/41639415 · 1.64 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUNDSustainability—the routinization and institutionalization of processes that improve the quality of healthcare—is difficult to achieve and not often studied. OBJECTIVETo evaluate the sustainability of increased rates of HIV testing after implementation of a multi-component intervention in two Veterans Health Administration healthcare systems. DESIGNQuasi-experimental implementation study in which the effect of transferring responsibility to conduct the provider education component of the intervention from research to operational staff was assessed. PATIENTSPersons receiving healthcare between 2005 and 2006 (intervention year) and 2006 and 2007 (sustainability year). MEASUREMENTSMonthly HIV testing rate, stratified by frequency of clinic visits. RESULTSThe monthly adjusted testing rate increased from 2% at baseline to 6% at the end intervention year and then declined reaching 4% at the end of the sustainability year. However, the stratified, visit-specific testing rate for persons newly exposed to the intervention (i.e., having their first through third visits during the study period) increased throughout the intervention and sustainability years. Increases in the proportion of visits by patients who remained untested despite multiple, prior exposures to the intervention accounted for the aggregate attenuation of testing during the sustainability year. Overall, the percentage of patients who received an HIV test in the sustainability year was 11.6%, in the intervention year 11.1%, and in the pre-intervention year 5.0% CONCLUSIONSProvider education combined with informatics and organizational support had a sustainable effect on HIV testing rates. The effect was most pronounced during patients’ early contacts with the healthcare system.
    Journal of General Internal Medicine 12/2009; 24(12):1275-1280. DOI:10.1007/s11606-009-1120-8 · 3.42 Impact Factor
Show more