Evaluation of the sustainability of an intervention to increase HIV testing.
BACKGROUND
Sustainability-the routinization and institutionalization of processes that improve the quality of healthcare-is difficult to achieve and not often studied.


OBJECTIVE
To evaluate the sustainability of increased rates of HIV testing after implementation of a multi-component intervention in two Veterans Health Administration healthcare systems.


METHODS
Quasi-experimental implementation study in which the effect of transferring responsibility to conduct the provider education component of the intervention from research to operational staff was assessed.


METHODS
Persons receiving healthcare between 2005 and 2006 (intervention year) and 2006 and 2007 (sustainability year).


METHODS
Monthly HIV testing rate, stratified by frequency of clinic visits.


RESULTS
The monthly adjusted testing rate increased from 2% at baseline to 6% at the end intervention year and then declined reaching 4% at the end of the sustainability year. However, the stratified, visit-specific testing rate for persons newly exposed to the intervention (i.e., having their first through third visits during the study period) increased throughout the intervention and sustainability years. Increases in the proportion of visits by patients who remained untested despite multiple, prior exposures to the intervention accounted for the aggregate attenuation of testing during the sustainability year. Overall, the percentage of patients who received an HIV test in the sustainability year was 11.6%, in the intervention year 11.1%, and in the pre-intervention year 5.0%


CONCLUSIONS
Provider education combined with informatics and organizational support had a sustainable effect on HIV testing rates. The effect was most pronounced during patients' early contacts with the healthcare system.
Infectious Diseases Section (111-F), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073, USA. matthew.goetz@va.gov
Matthew Bidwell
MB
Goetz
Tuyen
T
Hoang
S Randal
SR
Henry
Herschel
H
Knapp
Henry D
HD
Anaya
Allen L
AL
Gifford
Steven M
SM
Asch
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D015528:HIV Seroprevalence / Q000639:trends; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards* / Q000639:trends; D008875:Middle Aged; D015397:Program Evaluation / Q000379:methods / Q000592:standards* / Q000639:trends; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000592:standards* / Q000639:trends; D055815:Young Adult