Improving HIV Screening with Rapid Testing and Streamlined Counseling Henry D. Anaya, PhD Steven M. Asch, MD MPH, Tuyen Hoang, PhD, Joya F. Golden, BA, Matthew B. Goetz, MD, Allen Gifford, MD, Candice Bowman, PhD RN

Most people worldwide unaware of their HIV status 45 million infected with HIV worldwide45 million infected with HIV worldwide 95% unaware of HIV-positive status95% unaware of HIV-positive status Those aware of HIV status lower HIV-risk behaviorsThose aware of HIV status lower HIV-risk behaviors Even those in care don’t get HIV testedEven those in care don’t get HIV tested

Why don’t people in care get HIV testing? Barrier –Counseling takes time –MDs don’t prioritize prevention –Patients don’t return for results Intervention –Streamlined counseling –Nurse-based screening –HIV rapid testing

HIV Rapid Testing

Study design Patients randomized to one of three models: Usual Care (UC) Nurse-based screening (NBS) Nurse-based screening + rapid testing/streamlined counseling (NBS+RT/SC)

Study design (cont’d) Endpoints HIV Test order Receipt of HIV test results Patient knowledge Cost-effectiveness Covariates Demographics HIV risk factors Comorbid conditions (TB, STDs, HEP B/C)

Enrollment and Randomization Agreed to participate 283 Enrolled 189 Excluded 94 Usual Care Nurse Screening Nurse Screening + Rapid Test Not between yrs HIV test within past year Not competent to consent

Characteristics of patient population

Results: HIV test ordered? *p=<.001

HIV Results received? *p=<.003 **p=<.001

Conclusions HIV Test order –Nurse Screening increased test order compared to Usual Care; –Slight increase w/ addition of Rapid Test/Streamlined Counseling Receipt of HIV results –Nurse Screening increased receipt of results compared to Usual Care; –Significant increase w/ addition of Rapid Test/Streamlined Counseling

Implications Expansion into nationwide VA delivery system Basis for other outreach efforts Integration into similar healthcare systems