Improving HIV Screening and Receipt of Results by Nurse-Initiated Streamlined Counseling and Rapid Testing

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• 作者：Henry D. Anaya PhD (1)
  Tuyen Hoang PhD (1)
  Joya F. Golden BA (1)
  Matthew Bidwell Goetz MD (1) (10)
  Allen Gifford MD (1) (5)
  Candice Bowman PhD RN (1) (2)
  Teresa Osborn RN (6)
  Douglas K. Owens MD (7) (8)
  Gillian D. Sanders PhD (9)
  Steven M. Asch MD ; MPH (1) (3) (4)
  
• 关键词：nurse ; initiated HIV screening ; HIV rapid testing ; streamlined counseling
• 刊名：Journal of General Internal Medicine
• 出版年：2008
• 出版时间：June 2008
• 年：2008
• 卷：23
• 期：6
• 页码：800-807
• 全文大小：163KB
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• 作者单位：Henry D. Anaya PhD (1)
  Tuyen Hoang PhD (1)
  Joya F. Golden BA (1)
  Matthew Bidwell Goetz MD (1) (10)
  Allen Gifford MD (1) (5)
  Candice Bowman PhD RN (1) (2)
  Teresa Osborn RN (6)
  Douglas K. Owens MD (7) (8)
  Gillian D. Sanders PhD (9)
  Steven M. Asch MD, MPH (1) (3) (4)
  
  1. Veterans Affairs (VA) Quality Enhancement Research Initiative for HIV and Hepatitis (QUERI-HIV/HEP) and Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Health Services Research and Development (HSRD) Center of Excellence, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
  10. Infectious Diseases Section, Department of Medicine, VA Greater Los Angeles Healthcare System and the David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
  5. VA New England Healthcare System, Bedford, MA, USA
  2. The Center for Research in Patient Oriented Care, VA San Diego Healthcare System, La Jolla, CA, USA
  6. VA VISN22, Long Beach, CA, USA
  7. VA Palo Alto Healthcare System, Palo Alto, CA, USA
  8. Stanford University School of Medicine, Stanford, CA, USA
  9. Duke University School of Medicine, Durham, NC, USA
  3. Division of General Internal Medicine and Health, Services Research (GIM and HSR), UCLA School of Medicine, Los Angeles, CA, USA
  4. RAND Health, Santa Monica, CA, USA
  

文摘

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 or 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 Two hundred fifty-one 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--lt;.01). Test result receipt rates were 14.6% (model A), 31.0% (model B), 79.8% (model C; all p--lt;.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 posttest 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.