Improving HIV screening and receipt of results by nurse-initiated streamlined counseling and rapid testing.
BACKGROUND
HIV testing is cost-effective in unselected general medical populations, yet testing rates among those at risk remain low, even among those with regular primary care. HIV rapid testing is effective in many healthcare settings, but scant research has been done within primary care settings or within the US Department of Veteran's Affairs Healthcare System.


OBJECTIVE
We evaluated three methods proven effective in other diseases/settings: nurse standing orders for testing, streamlined counseling, and HIV rapid testing.


METHODS
Randomized, controlled trial with three intervention models: model A (traditional counseling/testing); model B (nurse-initiated screening, traditional counseling/testing); model C (nurse-initiated screening, streamlined counseling/rapid testing).


METHODS
Two hundred fifty-one patients with primary/urgent care appointments in two VA clinics in the same city (one large urban hospital, one freestanding outpatient clinic in a high HIV prevalence area).


METHODS
Rates of HIV testing and receipt of results; sexual risk reduction; HIV knowledge improvement.


RESULTS
Testing rates were 40.2% (model A), 84.5% (model B), and 89.3% (model C; p = <.01). Test result receipt rates were 14.6% (model A), 31.0% (model B), 79.8% (model C; all p = <.01). Sexual risk reduction and knowledge improvement did not differ significantly between counseling methods.


CONCLUSIONS
Streamlined counseling with rapid testing significantly increased testing and receipt rates over current practice without changes in risk behavior or posttest knowledge. Increased testing and receipt of results could lead to earlier disease identification, increased treatment, and reduced morbidity/mortality. Policymakers should consider streamlined counseling/rapid testing when implementing routine HIV testing into primary/urgent care.
Anaya
Henry D
HD
Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. henry.anaya@va.gov
Hoang
Tuyen
T
Golden
Joya F
JF
Goetz
Matthew Bidwell
MB
Gifford
Allen
A
Bowman
Candice
C
Osborn
Teresa
T
Owens
Douglas K
DK
Sanders
Gillian D
GD
Asch
Steven M
SM
D015492:AIDS Serodiagnosis / Q000379:methods*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D019090:Case Management; D019091:Critical Pathways; D037001:Directive Counseling / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009726:Nurses; D011933:Reagent Kits, Diagnostic; D040242:Risk Reduction Behavior; D014481:United States; D014493:United States Department of Veterans Affairs
D011933:Reagent Kits, Diagnostic