Abstract

Improving HIV Screening with Rapid Testing and Streamlined Counseling

Anaya H.¹, Asch S.²

¹United States Department of Veteran''s Affairs, Los Angeles, United States, ²US Department of Veteran's Affairs, Los Angeles, United States

Objectives: HIV testing is cost-effective in unselected general medical populations, yet rates of testing among those at-risk remain below optimal, even among those with regular primary care. The specific aims of this project are: • To determine whether nurse-based referral for traditional HIV counseling/testing will improve screening rates compared to current testing procedures. • To determine whether nurse-based rapid testing with streamlined counseling improves screening rates more than nurse-based referral for traditional testing and counseling alone.

Methods: A parallel-group, controlled study was conducted in the primary/urgent care clinics of the Los Angeles VA. Eligibility was based on same-day appointment; age (18-65); no HIV test in past year; unknown HIV status. One hundred sixty six patients were randomized to one of three screening models: Model A: patients urged to discuss testing with physician (control). Model B: nurses offered traditional counseling/testing. Model C; nurses offered streamlined counseling/rapid testing. Interventions were performed by nurses in addition to regular clinic duties.

Results/findings: Model A: 22 patients (40.7%) had test ordered; Model B: 48 (84.2%) had test ordered; Model C: 51 (92.7%) had test ordered. Of 22 patients in Model A with a test order, 9 (40.9%) received results; of 48 patients in Model B with test order, 25 (52.1%) received results; of 51 patients in Model C with test order, 46 (90.2%) received results.

Conclusions: Results show that both interventional models will likely result in higher screening rates than traditional HIV testing models in primary care.

Impact Statements: HIV rapid testing has been shown to be effective in conveying results. Increased rates of testing could lead to earlier disease identification, increased treatment and reduced morbidity/mortality. Reduced counseling intensity might free staff resources. As the VA is the largest HIV care provider in the US, it would be beneficial for policymakers to consider implementing rapid testing regularly.

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