title: HIV testing of at risk patients in a large integrated health care system.
abstract: 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.
authors.affiliation: VA Palo Alto Healthcare System, Palo Alto, CA, USA. owens@stanford.edu
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
authors.forename: Vandana
authors.initials: V
authors.lastname: Sundaram
authors.forename: Laura C
authors.initials: LC
authors.lastname: Lazzeroni
authors.forename: Lena R
authors.initials: LR
authors.lastname: Douglass
authors.forename: Patricia
authors.initials: P
authors.lastname: Tempio
authors.forename: Mark
authors.initials: M
authors.lastname: Holodniy
authors.forename: Gillian D
authors.initials: GD
authors.lastname: Sanders
authors.forename: Vera M
authors.initials: VM
authors.lastname: Shadle
authors.forename: Valerie C
authors.initials: VC
authors.lastname: McWhorter
authors.forename: Teodora
authors.initials: T
authors.lastname: Agoncillo
authors.forename: Noreen
authors.initials: N
authors.lastname: Haren
authors.forename: Darlene
authors.initials: D
authors.lastname: Chavis
authors.forename: Leila H
authors.initials: LH
authors.lastname: Borowsky
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Peter
authors.initials: P
authors.lastname: Jensen
authors.forename: Michael S
authors.initials: MS
authors.lastname: Simberkoff
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Bozzette
mesh_terms: 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