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Improving HIV Screening and Receipt of Results by Nurse-Initiated Streamlined Counseling and Rapid Testing

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Abstract

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.

Objectives

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

Design

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).

Participants

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).

Measurements

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.

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Acknowledgments

The authors would like to thank Genia Williamson, Leslie Lange, Brenda Rue, Alicia Alcantara, Jamie Feld, Anne Taylor, and Jesse Dwyer for assistance in the development of this manuscript.

This research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, Project number IIR 04–023. Dr. Asch is the principal investigator at the VA Greater Los Angeles Healthcare System. The views expressed in this article are those of the author(s) and do not necessarily represent the views of the United States Department of Veterans Affairs. The Veterans Health Administration supported this study but had no input in the design or reporting or decision to submit this paper for publication. HIV rapid tests were donated by Orasure Technologies. The opinions expressed in this manuscript are solely the authors’ and do not necessarily reflect those of the US Department of Veterans Affairs. This study was reviewed and sanctioned by a US Department of Veterans Affairs Internal Review Board process.

Conflict of Interest Statement

The first author owns stock in a biotechnology company that develops biotechnological products, one of which is a rapid test for diagnosing the HIV virus. The first author also received an unrestricted grant to support dissemination of research results from two HIV rapid testing device manufacturers, and this grant supported author no. 8 as well. Author no. 4 has received both honoraria and grant support in the past 3 years.

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Authors and Affiliations

  1. Veterans Affairs (VA) Quality Enhancement Research Initiative for HIV and Hepatitis (QUERI-HIV/HEP) and Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Health Services Research and Development (HSRD) Center of Excellence, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA

    Henry D. Anaya PhD, Tuyen Hoang PhD, Joya F. Golden BA, Matthew Bidwell Goetz MD, Allen Gifford MD, Candice Bowman PhD RN & Steven M. Asch MD, MPH

  2. The Center for Research in Patient Oriented Care, VA San Diego Healthcare System, La Jolla, CA, USA

    Candice Bowman PhD RN

  3. Division of General Internal Medicine and Health, Services Research (GIM and HSR), UCLA School of Medicine, Los Angeles, CA, USA

    Steven M. Asch MD, MPH

  4. RAND Health, Santa Monica, CA, USA

    Steven M. Asch MD, MPH

  5. VA New England Healthcare System, Bedford, MA, USA

    Allen Gifford MD

  6. VA VISN22, Long Beach, CA, USA

    Teresa Osborn RN

  7. VA Palo Alto Healthcare System, Palo Alto, CA, USA

    Douglas K. Owens MD

  8. Stanford University School of Medicine, Stanford, CA, USA

    Douglas K. Owens MD

  9. Duke University School of Medicine, Durham, NC, USA

    Gillian D. Sanders PhD

  10. Infectious Diseases Section, Department of Medicine, VA Greater Los Angeles Healthcare System and the David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Matthew Bidwell Goetz MD

Authors
  1. Henry D. Anaya PhD
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  2. Tuyen Hoang PhD
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  3. Joya F. Golden BA
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  4. Matthew Bidwell Goetz MD
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  5. Allen Gifford MD
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  6. Candice Bowman PhD RN
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  7. Teresa Osborn RN
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  8. Douglas K. Owens MD
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  9. Gillian D. Sanders PhD
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  10. Steven M. Asch MD, MPH
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Corresponding author

Correspondence to Henry D. Anaya PhD.

Appendices

Appendix 1: 2007 United States Department of Veteran’s Affairs Federally Mandated Pre-HIV Counseling Elements

The meaning, sensitivity and specificity of the HIV tests.

The potential social ramifications of a positive test result.

Policies and guidelines for confidentiality of the test results.

Policy on non-discrimination in health care services for patients with HIV infection and the health care services available in the VA.

Policy and guidelines on disclosure to public health authorities.

Policy on disclosure to spouse and/or sexual partner.

Measures to be taken for prevention of HIV transmission.

Information relative to authorized disclosures, either with or without consent of HIV test or treatment records.

Appendix 2: Composite Variable: HIV Knowledge

  1. 1.

    One can get HIV by having sexual intercourse with an infected person without using a condom.

  2. 2.

    One can get HIV by sharing drug needles with an infected person.

  3. 3.

    An HIV-infected woman can infect her unborn child.

  4. 4.

    One is not likely to get HIV using public facilities, such as buses and telephones.

  5. 5.

    One is not likely to get HIV by kissing an HIV-infected person on the cheek.

  6. 6.

    Not only homosexuals need to worry about contracting AIDS.

  7. 7.

    People who are HIV-positive are easy to pick out of a crowd even if they have not developed AIDS.

  8. 8.

    One is not likely to get HIV by attending school with an HIV-infected person.

  9. 9.

    HIV-infected individuals could look and feel fine and be unaware that they could still spread the disease.

  10. 10.

    AIDS is not just a gay man’s disease.

  11. 11.

    Women are not at very low risk of getting HIV.

  12. 12.

    One is not likely to get HIV using public toilets.

  13. 13.

    One is not likely to get HIV from an animal or mosquito bite.

Appendix 3: Composite Variable: Sexual Risk

  1. 1.

    What are your chances of getting infected with HIV?

  2. 2.

    With how many casual sex partners have you engaged in high-risk sex?

  3. 3.

    Have you had sex with this casual partner within the past 12 months?

  4. 4.

    During the last 12 months, with how many people have you had sexual intercourse?

  5. 5.

    Have you engaged in any of the following behaviors in the past 12 months?

Had sex with a partner who at the time was any of the following: another man (for male respondents), a man who has had sex with other men (for female respondents), a person who has injected non-prescription drugs, a person who has tested HIV-positive for HIV/AIDS?

OR:

Have you used any of the following substances in the past 12 months: injected non-prescription drugs, or used marijuana, cocaine, or hallucinogens (e.g., LSD mushrooms)?

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Anaya, H.D., Hoang, T., Golden, J.F. et al. Improving HIV Screening and Receipt of Results by Nurse-Initiated Streamlined Counseling and Rapid Testing. J GEN INTERN MED 23, 800–807 (2008). https://doi.org/10.1007/s11606-008-0617-x

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  • DOI: https://doi.org/10.1007/s11606-008-0617-x

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