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HIV Testing in Adults Receiving Care from the Veterans Health Administration (VHA)

Gifford AL, Bowman, Goetz, Chen, Hoang, Mole, Slipchenko, Sugar, Asch. HIV Testing in Adults Receiving Care from the Veterans Health Administration (VHA). Presented at: VA HSR&D National Meeting; 2007 Feb 21; Arlington, VA.

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Abstract:

Objectives: Although routine HIV testing is cost-effective and broadly recommended in VA and national guidelines for patients in medical care, studies show low HIV testing rates in selected primary care settings. We assembled national data from the VHA to assess rates of HIV testing, and factors associated with HIV testing in veterans in care at high risk for HIV. Methods: Data were analyzed from veterans nationwide with = 2 primary care visits between 6/2004 and 5/2005. Patients at highest risk for HIV (N = 424,789) were identified using the electronic medical record (diagnosis of hepatitis B, hepatitis C, sexually transmitted disease [STD], substance abuse). Receipt of HIV testing was any record of an HIV test done in VHA lab data from 1999-2005. Provider reports of whether patients had received non-VA HIV testing were also available for a large regional subset of patient data. Factors independently associated with HIV testing were identified using logistic regression. Results: Of veterans in primary care and at high HIV risk, only 71,862 (17%) were HIV tested within the VA. In the regional subset provider report of outside-facility HIV testing was only 2%. Individual hospital testing rates varied from 1.7% to 49.2%. After adjusting for hospital differences in testing, higher testing rates were seen in non-whites (African-American OR 1.21 [95%CI 1.16,1.26]; Hispanic OR 1.14 [95%CI 1.08,1.21] vs White), younger patients (age 35-44 OR 2.67 [95%CI 2.47,2.88]; age 45-54 OR 2.08 [95%CI 1.95,2.22]; age 55-64 OR 1.62 [95%CI 1.54,1.71] vs age > 65), and those never married (OR 1.36 [95%CI 1.32,1.41] vs married). Among clinical risk factors, odds ratio for testing was highest for those diagnosed with STD (OR 1.98 [95%CI 1.86,2.10]), and somewhat lower for those diagnosed with substance abuse (OR 1.51 [95%CI 1.44,1.57]). Implications: HIV testing is significantly underused throughout the VHA system, even in patients in primary care, and at high HIV risk. Outside-VHA testing is unlikely to explain the deficit. White, married, and older patients at HIV risk are less often tested. Programs are needed to increase HIV testing in primary care. Impacts: QUERI-HIV/HCV projects are now underway to implement higher rates of HIV testing in VA primary care.





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