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BACKGROUND/RATIONALE:
With the availability of effective medications, early diagnosis of HIV reduces mortality and treatment costs. Patients diagnosed and treated avoid hospitalizations, and can reduce risky behaviors thus preventing further HIV transmission. In 2006 the Centers for Disease Control and Prevention (CDC) released new recommendations that all patients between the ages of 13 and 64 be offered HIV testing , regardless of risk status. However even among those at high risk, less than 1/3 of veterans have been tested for HIV. Consequently, improving HIV testing in the VA is a leading priority in the QUERI-HIV/Hepatitis strategic plan.
Primary care providers often say that they know little about how to initiate a conversation with their patients about the sensitive topics of HIV risk behavior, and HIV testing. Providers have a difficult time discussing HIV with patients and often handle it awkwardly. Providers need specific strategies for communicating about HIV in primary care settings, because of they face multiple health priorities, limited time, and a sensitive and complex topic. In addition, the requirement in VA that providers obtain written informed consent for HIV testing may further intensify the difficulty of the discussion.
OBJECTIVE(S):
The goal of this project is to develop and implement a patient-centered communication intervention to encourage routine HIV screening in VA primary care. We will use qualitative methods to: (1) conduct a formative evaluation of existing patient and provider educational materials designed by the National Center for HIV/AIDS at the Center for Disease Control to increase HIV testing; (2) assess barriers and facilitators to HIV testing conversations in VA from both patient and provider perspectives; (3) develop a brief HIV communication intervention for VA providers, building on the formative evaluation and tenets of patient-centered communication for shared decision-making and (4) pilot the training of VA providers in use of this intervention.
METHODS:
We will conduct focus groups with providers and with patients. These focus groups will evaluate CDC designed materials to encourage HIV testing, and will assess barriers and facilitators to HIV testing in VA. We will conduct qualitative analyses of the focus groups and design a brief communication intervention for providers in the form of a single-session training and a brief information card. We will then implement the intervention at both sites. One month after the intervention, we will conduct a summative evaluation with the providers to debrief and receive feedback on the ease of use of the communication skills provided and the reference card.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
The findings from the pilot intervention in this project will lead to broader implementation of a communication skills training for routine HIV testing in VA. This type of intervention is timely as VA providers become more aware of the CDC recommendations for routine HIV testing. The implementation of a communication intervention such as the one we will design may increase detection of HIV disease in veterans and lead to improved health outcomes for those infected.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Special (Underserved, High Risk) Populations
DRE:
Communication and Decision Making, Quality of Care, Prevention
Keywords:
Communication -- doctor-patient, HIV/AIDS, Screening
MeSH Terms:
none
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