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Multicenter Study
. 2013 Oct;28(10):1311-7.
doi: 10.1007/s11606-013-2420-6. Epub 2013 Apr 19.

Central implementation strategies outperform local ones in improving HIV testing in Veterans Healthcare Administration facilities

Matthew Bidwell Goetz  1 , Tuyen Hoang, Herschel Knapp, Jane Burgess, Michael D Fletcher, Allen L Gifford, Steven M Asch; QUERI-HIV/Hepatitis Program
Affiliations
Multicenter Study

Central implementation strategies outperform local ones in improving HIV testing in Veterans Healthcare Administration facilities

Matthew Bidwell Goetz et al. J Gen Intern Med. 2013 Oct.

Abstract

Background: Pilot data suggest that a multifaceted approach may increase HIV testing rates, but the scalability of this approach and the level of support needed for successful implementation remain unknown.

Objective: To evaluate the effectiveness of a scaled-up multi-component intervention in increasing the rate of risk-based and routine HIV diagnostic testing in primary care clinics and the impact of differing levels of program support.

Design: Three arm, quasi-experimental implementation research study.

Setting: Veterans Health Administration (VHA) facilities.

Patients: Persons receiving primary care between June 2009 and September 2011 INTERVENTION: A multimodal program, including a real-time electronic clinical reminder to facilitate HIV testing, provider feedback reports and provider education, was implemented in Central and Local Arm Sites; sites in the Central Arm also received ongoing programmatic support. Control Arm sites had no intervention

Main measures: Frequency of performing HIV testing during the 6 months before and after implementation of a risk-based clinical reminder (phase I) or routine clinical reminder (phase II).

Key results: The adjusted rate of risk-based testing increased by 0.4 %, 5.6 % and 10.1 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). During phase II, the adjusted rate of routine testing increased by 1.1 %, 6.3 % and 9.2 % in the Control, Local and Central Arms, respectively (all comparisons, p < 0.01). At study end, 70-80 % of patients had been offered an HIV test.

Conclusions: Use of clinical reminders, provider feedback, education and social marketing significantly increased the frequency at which HIV testing is offered and performed in VHA facilities. These findings support a multimodal approach toward achieving the goal of having every American know their HIV status as a matter of routine clinical practice.

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Figures

Figure 1.
Figure 1.
Risk-based HIV testing. Rate of HIV testing among persons seen in primary care clinics during each month of the intervention who had a known risk for HIV infection but no documentation of prior HIV testing. M-2 and M-1 represent rates of HIV testing among such persons during the 2 months prior to implementing the multi-modal intervention
Figure 2.
Figure 2.
Routine HIV testing. Rate of HIV testing among all persons seen in primary care clinics during each month of the intervention who had no documentation of prior HIV testing. Results are shown separately for the sites in the Central Arm that did previously participate in the risk-based HIV testing intervention (Central (Old)) and those that were new to the study (Central (New)) and did not previously participate in the risk-based HIV testing intervention. All sites in the Local Arm had previously participated in the risk-based intervention (Local (Old)). M-2 and M-1 represent rates of HIV testing among such persons during the 2 months immediately prior to implementing the routine testing intervention
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References

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