Improving Provider-Patient Communication about Routine HIV Testing in VA

In 2006 the CDC released new recommendations that all patients between the ages of 13 and 64 be offered opt-out HIV testing regardless of risk status, suggesting that providers routinely order HIV testing unless the patient declines. This study sought to understand patient and provider perspectives on the adoption of routine HIV testing within the VA healthcare system. Investigators conducted four focus groups with 28 Veterans and two focus groups with 13 primary care providers at two VAMCs. Veterans and providers discussed key issues that help or hinder conversations about – and achievement of HIV testing during primary care visits. Discussions focused on perspectives on HIV testing becoming routine, what information should be communicated to patients and how, and procedural issues that hinder HIV testing.

Findings show that Veterans and providers agreed that the implementation of routine HIV testing, treating HIV like other chronic diseases, and removing requirements for written informed consent and pre-test counseling would benefit both Veterans and public health. Veterans wished to have HIV testing routinely offered by providers so that they could decide whether or not to be tested; they also believed that routine testing would help de-stigmatize HIV. Six steps for providers to use in communicating about routine testing also were identified, such as raising the topic of HIV testing, reassuring the Veteran that he/she is not showing clinical signs of the disease, and responding to Veteran questions about HIV. The authors propose further research to explore implementation of routine testing guidelines, examining both an opt-out approach as proposed by the CDC, as well as the more patient-centered approach proposed in the article.

Bokhour B, Solomon J, Knapp H, Asch S, and Gifford A. Barriers and facilitators to routine HIV testing in VA primary care. Journal of General Internal Medicine October 2009;24(10):1109-1114.

This study was funded by HSR&D. Drs. Bokhour, Solomon, and Gifford are part of HSR&D’s Center for Health Quality, Outcomes and Economic Research. Drs. Asch and Gifford also lead VA/HSR&D’s HIV/Hepatitis Quality Enhancement Research Initiative (QUERI).