title: Utilization and access to antiretroviral genotypic resistance testing and results within the US Department of Veterans Affairs.
abstract: OBJECTIVE
  We sought to characterize variation in the use of HIV genotypic resistance tests and how results were reported.
  
  
  METHODS
  Clinicians and laboratory managers at all Veterans Affairs (VA) medical centers were asked to complete a survey in March 2003 regarding HIV resistance testing practices.
  
  
  RESULTS
  Surveys from 131 of 150 sites were returned. Forty-eight percent of HIV clinicians indicated that US Department of Health and Human Services guidelines were the usual basis for ordering tests. Although between 12% and 31% of respondents indicated that they always, sometimes, seldom, or never ordered resistance tests in patients with acute or chronic HIV infection, >70% ordered tests in adherent patients with treatment failure. Among the 32 centers with >200 patients in care, 13 +/- 8 (mean +/- standard deviation) tests were performed per 100 patients in care during 2002. Forty-nine percent of clinicians said that tests were helpful, but only 33% expressed confidence in using test results. Only 40% of sites entered results in the VA electronic medical record.
  
  
  CONCLUSIONS
  Ordering patterns for HIV resistance tests differed significantly among VA sites. A minority of clinicians indicated confidence in the use of test results. A consistent system to capture and present complete results was absent.
authors.affiliation: Infectious Diseases Section, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. matthew.goetz@med.va.gov
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.forename: Mark
authors.initials: M
authors.lastname: Holodniy
authors.forename: June S
authors.initials: JS
authors.lastname: Poulton
authors.forename: Fred H
authors.initials: FH
authors.lastname: Rodriguez
authors.forename: Michael O
authors.initials: MO
authors.lastname: Rigsby
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D024882:Drug Resistance, Viral / Q000235:genetics*; D005838:Genotype; D006678:HIV / Q000187:drug effects / Q000235:genetics*; D015658:HIV Infections / Q000188:drug therapy*; D008499:Medical Records; D017211:Treatment Failure; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*
chemical_list: D019380:Anti-HIV Agents