Improving HIV Screening With Nurse-Based Rapid Testing/Streamlined Counseling

Summary

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, nor 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: 251 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 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 post-test 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.

Conditions

• Health Care Quality, Access, and Evaluation
• Delivery of Health Care
• Immune System Diseases
• HIV Infections

Interventions

OTHER

Rates of HIV testing and receipt of results

Rates of HIV testing and receipt of results

OTHER

Sexual risk reduction; HIV knowledge improvement

Sexual risk reduction; HIV knowledge improvement

OTHER

Rates of HIV testing and receipt of results

Rates of HIV testing and receipt of results

OTHER

Sexual risk reduction; HIV knowledge improvement

Sexual risk reduction; HIV knowledge improvement

OTHER

Rates of HIV testing and receipt of results

Rates of HIV testing and receipt of results

OTHER

Sexual risk reduction; HIV knowledge improvement

Sexual risk reduction; HIV knowledge improvement

Sponsors & Collaborators

• US Department of Veterans Affairs

  lead FED

Principal Investigators

• Steven M. Asch, MD MPH · VA Greater Los Angeles Healthcare System, West Los Angeles, CA

• Douglas K. Owens, MD MS · VA Palo Alto Health Care System, Palo Alto, CA

Study Design

Allocation

RANDOMIZED

Purpose

DIAGNOSTIC

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

65 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2005-03-31

Primary Completion

2007-01-31

Completion

2007-01-31

Countries

• United States

Study Locations