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J Gen Intern Med. 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.

Author information

1
Infectious Diseases Section (111-F), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA, mgoetz@ucla.edu.

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.

PMID:
23605307
PMCID:
PMC3785651
DOI:
10.1007/s11606-013-2420-6
[Indexed for MEDLINE]
Free PMC Article

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