title: Central implementation strategies outperform local ones in improving HIV testing in Veterans Healthcare Administration facilities.
abstract: BACKGROUND
  Pilot data suggest that a multifaceted approach may increase HIV testing rates, but the scalability of this approach and the level of support needed for successful implementation remain unknown.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a scaled-up multi-component intervention in increasing the rate of risk-based and routine HIV diagnostic testing in primary care clinics and the impact of differing levels of program support.
  
  
  METHODS
  Three arm, quasi-experimental implementation research study.
  
  
  METHODS
  Veterans Health Administration (VHA) facilities.
  
  
  METHODS
  Persons receiving primary care between June 2009 and September 2011 INTERVENTION: A multimodal program, including a real-time electronic clinical reminder to facilitate HIV testing, provider feedback reports and provider education, was implemented in Central and Local Arm Sites; sites in the Central Arm also received ongoing programmatic support. Control Arm sites had no intervention
  
  
  METHODS
  Frequency of performing HIV testing during the 6 months before and after implementation of a risk-based clinical reminder (phase I) or routine clinical reminder (phase II).
  
  
  RESULTS
  The adjusted rate of risk-based testing increased by 0.4 %, 5.6 % and 10.1 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). During phase II, the adjusted rate of routine testing increased by 1.1 %, 6.3 % and 9.2 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). At study end, 70-80 % of patients had been offered an HIV test.
  
  
  CONCLUSIONS
  Use of clinical reminders, provider feedback, education and social marketing significantly increased the frequency at which HIV testing is offered and performed in VHA facilities. These findings support a multimodal approach toward achieving the goal of having every American know their HIV status as a matter of routine clinical practice.
authors.affiliation: Infectious Diseases Section (111-F), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA, mgoetz@ucla.edu.
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.forename: Tuyen
authors.initials: T
authors.lastname: Hoang
authors.forename: Herschel
authors.initials: H
authors.lastname: Knapp
authors.forename: Jane
authors.initials: J
authors.lastname: Burgess
authors.forename: Michael D
authors.initials: MD
authors.lastname: Fletcher
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
mesh_terms: D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000592:standards; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D018570:Risk Assessment / Q000379:methods; D014481:United States; D058014:Veterans Health / Q000592:standards*