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BACKGROUND/RATIONALE:
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.
OBJECTIVE(S):
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
FINDINGS/RESULTS:
Testing rates were 40.2% (Model A), 84.5% (Model B), and 89.3% (Model C) (p=<.01). Rates of receipt of test results were 14.6% (Model A), 31.0% (Model B), 79.8% (Model C) (all p=<.01). Reduction in sexual risk and HIV knowledge improvement did not differ significantly between traditional versus streamlined counseling.
IMPACT:
If the interventions are as successful as we hypothesize, widespread implementation would lead to critically important health benefits for veterans: 1) Increased rates of testing, which would lead to earlier identification of disease, increased treatment and decreased HIV transmission, morbidity and mortality; 2) Lower screening costs without decrements in either patient knowledge or acceptability.
The CDC has made identification of people with HIV a national priority. The VA has an opportunity to provide national leadership in elucidating how best to identify people living with HIV and ensure access to state-of-the-art care.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems, Special (Underserved, High Risk) Populations
DRE:
Quality of Care, Treatment, Communication and Decision Making
Keywords:
Communication -- doctor-patient, HIV/AIDS, Screening
MeSH Terms:
none
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