Improving HIV screening and receipt of results by nurse-initiated streamlined counseling and rapid testing

Abstract

BACKGROUND: HIV testing is cost-effective in unselected general medical populations, yet testing rates among those at risk remain low, even among those with regular primary care. HIV rapid testing is effective in many healthcare settings, but scant research has been done within primary care settings or within the US Department of Veteran's Affairs Healthcare System. OBJECTIVES: We evaluated three methods proven effective in other diseases/settings: nurse standing orders for testing, streamlined counseling, and HIV rapid testing. DESIGN: Randomized, controlled trial with three intervention models: model A (traditional counseling/testing); model B (nurse-initiated screening, traditional counseling/testing); model C (nurse-initiated screening, streamlined counseling/rapid testing). PARTICIPANTS: Two hundred fifty-one patients with primary/urgent care appointments in two VA clinics in the same city (one large urban hospital, one freestanding outpatient clinic in a high HIV prevalence area). MEASUREMENTS: Rates of HIV testing and receipt of results; sexual risk reduction; HIV knowledge improvement. RESULTS: Testing rates were 40.2% (model A), 84.5% (model B), and 89.3% (model C; p=