221396 Evaluation of Readiness to Implement Nurse-Initiated Rapid Testing at High Prevalence Primary Care Settings within the VA

Monday, November 8, 2010

Jaimi Butler, MA , Quality Enhancement Research Initiative for HIV and Hepatitis (QUERI-HIV/HEP), US Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, Los Angeles, CA
Jeffrey Solomon, PhD , Center for Health Quality, Outcomes and Economic Research, US Department of Veterans Affairs, ENRM Veterans Hospital, Bedford, MA
Joya Golden, MSW , Quality Enhancement Research Initiative for HIV and Hepatitis (QUERI-HIV/HEP), US Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, Los Angeles, CA
Barbara G. Bokhour, PhD , Center for Health Quality, Outcomes and Economic Research, US Department of Veterans Affairs, ENRM Veterans Hospital, Bedford, MA
Henry Anaya, PhD , Health Services Research and Development, US Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
Discuss potential barriers, facilitators, and/or unintended consequences to nurse-based rapid HIV testing in a relevant healthcare setting.

Keywords: HIV/AIDS, Screening

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I have over six years of qualitative and quantitative research experience in academic and professional settings. Further, I possess a masterís degree in biological anthropology and am currently a research associate and project manager conducting implementation research related to HIV screening within the US Department of Veterans Affairs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.