Study Suggests Intervention to Increase HIV Testing Can Be Successfully Implemented by Non-Research Staff
The benefits of identifying and treating asymptomatic HIV-infected individuals are well known, yet 21% of the 1.1 million people infected with HIV in the U.S. remain undiagnosed. In a previous multi-modal intervention, undertaken in 2005, investigators with VA/HSR&D’s HIV/HCV Quality Enhancement Research Initiative (QUERI) doubled HIV testing rates in at-risk Veterans receiving care at two VAMCs. This study reports on the one-year results of implementing this program in two other VA facilities where the research team played a much smaller part in the implementation of the intervention. Researchers introduced the program to primary care staff and provided local facility champions with relevant clinical reminder software and recommendations for reducing organizational barriers. In addition, whereas the principal responsibility for the provider-activation component of the intervention was previously borne by research staff, non-research staff now took on these responsibilities. Components of the intervention included: real-time electronic clinical reminder; quarterly audit-feedback system; removal of organizational barriers (e.g., by using nurse-based pretest counseling); and a provider activation program (e.g., provider and patient educational materials). Investigators examined provider-level (e.g., number of providers), patient-level (e.g., demographics, HIV risk factors), and facility-level (e.g., patient load) factors, and compared HIV testing rates among Veterans at each site, including one control site.
- An intervention to increase HIV testing among Veterans that combines informatics, organizational support, and provider activation can be successfully implemented by non-research staff. Increases in HIV testing were similar to those seen in facilities where research staff played an active role.
- The annual rate of HIV testing among at-risk Veterans increased by 6% and 16% after the end of the first year for the two sites to which the project was newly exported, and where non-research staff were responsible for implementation. In contrast, for the original two implementation sites where research staff played a major role, testing rates increased by 9% and 12%.
- There was no change in the rate of testing at the one control site that did not participate in the project.
- Veterans at different sites had different risk factors; for example, Veterans with HIV risk factors at Site A were more likely to have a history of homelessness and injection drug use. However, none of these differences were judged to be meaningful.
- Authors note that even with differences between the original and “export” sites (e.g., strength of academic affiliations, emphasis on specialized services), the successful implementation and similar increases in HIV testing rates across patient and sub-facility levels provides further support for the generalizability of the intervention.
This study was funded through VA/HSR&D’s HIV/Hepatitis Quality Enhancement Research Initiative (HIV/HCV-QUERI; SDP 06-001) located in Los Angeles, CA and Bedford. Drs. Goetz, Hoang and Knapp are part of HIV/HCV-QUERI.
Goetz M, Hoang T, Knapp H, et al. Exportability of an Intervention to Increase HIV Testing in the Veterans Health Administration. Joint Commission Journal on Quality and Patient Safety December 2011;37(12):553-59.