235765 Implementation of Nurse-Initiated HIV Rapid Testing in VA Substance Use Disorder Clinics

Wednesday, November 2, 2011: 12:50 PM

Erin Conners, MPH , 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
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
Hildi Hagedorn, PhD , Quality Enhancement Research Initiative for Substance Use Disorders, VA Minneapolis Health Care System, Minneapolis, MN
Patricia Wilson, RN, MSN, MA , Substance Use Disorder Clinic, VA Pittsburgh Healthcare System, Pittsburgh, PA
Kandi Felmet, BS , Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
Helen Bonanomi, MSN, RN-BC, CARN , Substance Use Disorder Clinic, West Los Angeles VAMC, Los Angeles, CA
Gretchen Haas, PhD , Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
Gloria Klima, MA , Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA
Eileen Sudzina, BS, MT (ASCP) , Laboratory, VA Pittsburgh Healthcare System, Pittsburgh, PA
Henry Anaya, PhD , Health Services Research and Development, US Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, Los Angeles, CA
Objective: To link individuals with substance use disorders (SUDs) to HIV testing by implementing and evaluating a variant of our previously successful nurse-initiated HIV oral rapid testing (NRT) strategy at three VA SUD clinics.

Methods:

1. Training: - Evidence for NRT - Training in the use of a computerized clinical reminder (CCR) - Instructions on the HIV oral rapid test - Patient education strategies

2. Implementation: - Installation of an HIV rapid test CCR and CPRS template - An individualized testing procedure for each sub-clinic based on respective clinic flow

3. Qualitative interviews with nursing staff

4. Quantitative evaluation of HIV testing rates

Results:

Local laboratory data showed the following rates of testing over a six month period:

Site 1: 178

Site 2: 9

Site 3: 65

Qualitative results:

Barriers - Lack of support from the lab or providers who are required to sign off on nurse point-of-care testing - Resistance from some staff to expand their duties to include routine medical procedures

Facilitators - The CCR as a prompt for testing - Awareness of the population's risk and a positive attitude towards HIV testing - Offering guidance on how to provide support to preliminary positive patients

Conclusions: Besides timely receipt of results, HIV rapid testing in SUD clinics allows patients to be tested by a provider that is familiar to them in a setting that is convenient and comfortable.

Point-of-care NRT can be easily and sustainably incorporated into SUD clinics with minimal impact on nurse workflow and time.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Public health or related nursing
Public health or related research

Learning Objectives:
Design a sustainable nurse-initiated HIV rapid test program in substance use disorder clinics

Keywords: Substance Abuse, Nurses

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the project coordinator and oversaw the implementation and evaluation of the implementation research being presented.
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.

See more of: Substance Use & HIV/AIDS
See more of: HIV/AIDS