Dr. Maggie Czarnogorski

In this month during which we observe Veteran’s Day, I am pleased to share news about an a significant achievement in HIV screening at the U.S. Department of Veterans Affairs: Annual HIV testing rates in Veterans Administration Medical Centers increased significantly between 2009 and 2010. As reported in a Research Letter I co-authored with colleagues for the October 24, 2011, edition of the Archives of Internal Medicine , overall, the VA saw a 140% increase in the number of HIV tests conducted from 2009 to 2010. This included a 47% increase in both the proportion of veterans ever tested for HIV (9.2% to 13.5%) and a 132% increase in proportion of veterans tested in the calendar year (2.5% to 5.8%).

These increases make important contributions to the efforts to achieve the goals of the National HIV/AIDS Strategy, reducing the number of new HIV infections, increasing access to care and improving health outcomes for people living with HIV, and reducing HIV-related disparities.

Facilitators

The increase in HIV testing rates at the VA is the result of several recent developments, including:

• After Congressional repeal of long-standing requirements barring widespread HIV testing and requiring written informed consent in VA facilities, in August 2009 the VA aligned its HIV testing policies with the CDC’s 2006 recommendations on HIV testing.  We now offer voluntary HIV testing to all veterans, regardless of age, as part of routine health care at least once, and annually for those veterans with ongoing risk factors. These policy changes also transitioned VA from requiring written informed consent to oral informed consent for HIV testing. VA also no longer requires that patients receive scripted, standardized pre- and post-test counseling before and after HIV testing. These policy changes have a common goal: to diagnose infection as soon as possible so that Veterans can receive state-of-the-art care and remain healthy for many years to come.
• To support this important policy change, VA has undertaken several initiatives to bring the attitudes and practices of both health care providers and veterans along with the policy change:
  • The VA has made use of electronic health records (EHRs) since the 1990s.  We have been able to leverage this system by adding a clinical reminder about HIV testing for providers who treat veterans. It prompts the primary-care provider to conduct HIV screening for any veteran who had not been screened previously.
  • We have also made grants to support HIV testing in many VA medical centers around the country. These have been used to promote testing in various settings such as mental health, women’s health, homeless veterans programs and in facilities of various sizes and types. These grants have promoted the use of rapid HIV testing, facilitated staff training, as well as the development of patient education activities and materials.
  • Finally, the VA has launched a social marketing campaign, Get Checked: Say Yes to the Test, that reaches out to both VA health care providers and veterans to influence their attitudes and behaviors related to routine HIV testing. It includes videos, brochures, and posters to promote the new policy to providers and encouraging veterans to request HIV testing. Among the messages communicated to patients is that neither an HIV test nor its result will affect a veteran’s VA care or eligibility for VA benefits.

Serving More Nearly 6 Million Veterans Each Year

Given that VA serves nearly six million veterans each year (our analysis showed that 5,713,265 veterans had at least one out-patient visit during calendar year 2009, and 5,888,599 had one in 2010), this policy has the potential to reach a significant number of people who are not aware of their HIV status. Moreover, we know that early diagnosis improves the chance of the patient living a long and healthy life and helps limit transmission of HIV to others.  The VA is well positioned to link those who test positive to care as we are the nation’s largest single provider of HIV care. Veterans with HIV infection in VA care receive HIV care at all 152 VA Medical Centers and throughout all 21 of the VA’s Veterans Integrated Service Networks. To date, nearly 64,000 Veterans have received HIV care in the VA, and in 2009, more than 24,000 Veterans with HIV were receiving care at the VA.

In the months and years ahead, we will continue to collect and analyze data and strive to improve HIV testing rates throughout the entire VA system as we work with our partners across the Federal government and throughout the nation to achieve the goals of the National HIV/AIDS Strategy.