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.

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