A system-wide intervention to improve HIV testing in the Veterans Health Administration.
BACKGROUND
Although the benefits of identifying and treating asymptomatic HIV-infected individuals are firmly established, health care providers often miss opportunities to offer HIV-testing.


OBJECTIVE
To evaluate whether a multi-component intervention increases the rate of HIV diagnostic testing.


METHODS
Pre- 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.


METHODS
Persons receiving health care between August 2004 and September 2006 who were at risk but had not been previously tested for HIV infection.


METHODS
Pre- to post-changes in the rates of HIV testing at the intervention and control facilities


RESULTS
At 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.


CONCLUSIONS
Use 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.
Goetz
Matthew Bidwell
MB
Infectious Diseases Section (111-F), VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. matthew.goetz@va.gov
Hoang
Tuyen
T
Bowman
Candice
C
Knapp
Herschel
H
Rossman
Barbara
B
Smith
Robert
R
Anaya
Henry
H
Osborn
Teresa
T
Gifford
Allen L
AL
Asch
Steven M
SM
D015492:AIDS Serodiagnosis / Q000592:standards*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D017010:Reminder Systems; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D014584:User-Computer Interface