HIV testing of at risk patients in a large integrated health care system.
OBJECTIVE
Early identification of HIV infection is critical for patients to receive life-prolonging treatment and risk-reduction counseling. Understanding HIV screening practices and barriers to HIV testing is an important prelude to designing successful HIV screening programs. Our objective was to evaluate current practice patterns for identification of HIV.


METHODS
We used a retrospective cohort analysis of 13,991 at-risk patients seen at 4 large Department of Veterans Affairs (VA) health-care systems. We also reviewed 1,100 medical records of tested patients. We assessed HIV testing rates among at-risk patients, the rationale for HIV testing, and predictors of HIV testing and of HIV infection.


RESULTS
Of the 13,991 patients at risk for HIV, only 36% had been HIV-tested. The prevalence of HIV ranged from 1% to 20% among tested patients at the 4 sites. Approximately 90% of patients who were tested had a documented reason for testing.


CONCLUSIONS
One-half to two-thirds of patients at risk for HIV had not been tested within our selected VA sites. Among tested patients, the rationale for HIV testing was well documented. Further testing of at-risk patients could clearly benefit patients who have unidentified HIV infection by providing earlier access to life-prolonging therapy.
Owens
Douglas K
DK
VA Palo Alto Healthcare System, Palo Alto, CA, USA. owens@stanford.edu
Sundaram
Vandana
V
Lazzeroni
Laura C
LC
Douglass
Lena R
LR
Tempio
Patricia
P
Holodniy
Mark
M
Sanders
Gillian D
GD
Shadle
Vera M
VM
McWhorter
Valerie C
VC
Agoncillo
Teodora
T
Haren
Noreen
N
Chavis
Darlene
D
Borowsky
Leila H
LH
Yano
Elizabeth M
EM
Jensen
Peter
P
Simberkoff
Michael S
MS
Bozzette
Samuel A
SA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D006679:HIV Seropositivity / Q000097:blood; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs