• To determine whether nurse-based referral for traditional HIV testing and counseling will improve screening rates compared to current testing procedures. To determine whether nurse-based rapid testing with streamlined counseling improves screening rates [ Designated as safety issue: No ]
  

• Secondary aims are to compare patient knowledge of HIV testing prevention practices and their views of the procedures� acceptability after traditional and rapid testing/streamlined counseling. [ Designated as safety issue: No ]
  

Background:

The cumbersome nature and complexity of current counseling and testing procedures have been suggested as reasons that rates of receipt of HIV test results are so low. Because the standard screening test results are unavailable on the same day, many persons do not return for the results. Up to 30% of persons who tested HIV-positive during 2000 and 39% of persons who tested HIV-negative did not return (1). The CDC has recommended that alternate streamlined counseling and testing methods may increase the receipt rates of HIV tests. To address the problems of failing to return for screening results, we plan to incorporate rapid HIV testing into the proposed screening trial.

Objectives:

The specific aims of this project are:

To determine whether nurse-based referral for traditional HIV testing and counseling 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.

To assess the cost-effectiveness of these alternative strategies for HIV testing and counseling.

Secondary aims will compare patient knowledge of HIV testing prevention practices and their views of the procedures� acceptability after traditional and rapid testing/streamlined counseling. To achieve these aims, we propose a robust three-arm randomized controlled trial.

Methods:

We plan a parallel-group randomized controlled trial set in the general medicine and urgent care clinics of the West Los Angeles VA Medical Center (VAMC). All participants will undergo an interview collecting information about HIV risk factors and other predictors of HIV screening, as well as knowledge of HIV test characteristics and prevention. All patients will be randomized to one of three models of screening: Model A: Traditional counseling/testing; Model B: Nurse-based screening + traditional counseling/testing; Model C: Nurse-based screening + streamlined counseling/ rapid testing

The analysis will focus on differences between the three models in rates of screening, receipt of results, knowledge, acceptability and cost-effectiveness

Status:

Analysis completed. Manuscript submitted for review on April 1, 2007. Manuscript returned by editor for revision and resubmission; resubmission due 12-07.

Inclusion Criteria:

Seeing a provider the day of recruitment Between 18-65 years of age Unaware of HIV status Has not had an HIV test in past year Able to communicate fluently in English Competent to consent to participation and HIV testing

Exclusion Criteria:

not between 18-65 yrs. of age aware of HIV status has had HIV test within past year cannot communicate in English deemed incompetent to consent