Evaluation of Readiness to Implement Nurse-Initiated Rapid Testing at High Prevalence Primary Care Settings within the VA

BACKGROUND Specific patient subgroups of US veterans are at high risk of HIV infection, including minorities, substance users, the mentally ill, and homeless. HIV has now become a treatable chronic disease with more attention directed to barriers associated with current screening/testing methods.

OBJECTIVES: This project is evaluating the barriers and facilitators to implementation of nurse-initiated HIV rapid testing (NRT) at two high HIV prevalence VA Medical Centers (VAMC). Having previous success in other healthcare settings, NRT is now being tested in primary care (PC).

METHODS: Prior to a multi-year staggered rollout at two VAMCs, semi-structured qualitative interviews with key and frontline informants were conducted. Field notes were analyzed for content and themes.

RESULTS: Interviews with 34 stakeholders from a mid-Atlantic urban VAMC revealed concern regarding patient/provider time especially with nurse's already overburdened and short staffed. Further, many voiced concern regarding logistics. Overall, most informants professed a need for an increase in HIV testing and were generally in favor of NRT in PC as a means to reach that goal. IMPLICATIONS/CONCLUSIONS While results suggest support for NRT, its potential in becoming established routine care is uncertain. Workload and staffing issues require novel testing approaches (e.g. designated HIV testing days). To elicit buy-in from frontliners, increasing nurses' positive engagement in NRT will be necessary.

Site-specific data and comparisons between sites will guide future VA HIV testing efforts and elucidate NRT feasibility.