title: HIV rapid testing in a Veterans Affairs hospital ED setting: a 5-year sustainability evaluation.
abstract: Routine HIV testing in primary care settings is now recommended in the United States. The US Department of Veterans Affairs (VA) has increased the number of patients tested for HIV, but overall HIV testing rates in VA remain low. A proven strategy for increasing such testing involves nurse-initiated HIV rapid testing (HIV RT). The purpose of this work was to use a mixed methodology approach to evaluate the 5-year sustainability of an intervention that implemented HIV RT in a VA emergency department setting in a large, urban VA medical center to reduce missed diagnostic and treatment opportunities in this vulnerable patient population. In-person semistructured interviews were conducted with providers and stakeholders. Interview notes were qualitatively coded for emerging themes. Quarterly testing rates were evaluated for a 5-year time span starting from the launch in July 2008. Findings indicate that HIV RT was sustained by the enthusiasm of 2 clinical champions who oversaw the registered nurses responsible for conducting the testing. The departure of the clinical champions was correlated with a substantial drop-off in testing. Findings also indicate potential strategies for improving sustainability including engaging senior leadership in the project, engaging line staff in the implementation planning from the start to increase ownership over the innovation, incorporating information into initial training explaining the importance of the innovation to quality patient care, providing ongoing training to maintain skills, and providing routine progress reports to staff to demonstrate the ongoing impact of their efforts.
authors.affiliation: Veterans Affairs Quality Enhancement Research Initiative for HIV and Hepatitis and Center for the Study of Healthcare Provider Behavior, Veterans Affairs Greater Los Angeles Health Services Research and Development Center of Excellence, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA. Electronic address: Herschel.Knapp@va.gov.
authors.forename: Herschel
authors.initials: H
authors.lastname: Knapp
authors.affiliation: Veterans Affairs Quality Enhancement Research Initiative for Substance Use Disorders and Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN; Department of Psychiatry, School of Medicine, University of Minnesota, Minneapolis, MN.
authors.forename: Hildi
authors.initials: H
authors.lastname: Hagedorn
authors.affiliation: Veterans Affairs Quality Enhancement Research Initiative for HIV and Hepatitis and Center for the Study of Healthcare Provider Behavior, Veterans Affairs Greater Los Angeles Health Services Research and Development Center of Excellence, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA; Veterans Affairs Center for the Management of Complex Chronic Conditions and the Quality Enhancement Research Initiative for Spinal Cord Injury, Veterans Affairs Chicago Healthcare System, Chicago, IL.
authors.forename: Henry D
authors.initials: HD
authors.lastname: Anaya
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods / Q000706:statistics & numerical data; D016529:Emergency Nursing; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D015141:Los Angeles; D015397:Program Evaluation