236397 Challenges and facilitators of implementing nurse-initiated rapid HIV testing in high prevalence primary care settings within the U.S. Department of Veterans Affairs

Wednesday, November 2, 2011

Jeffrey Solomon, PhD , Center for Health Quality, Outcomes and Economic Research, Veterans Affairs Medical Center, Bedford, MA
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
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 , VA New England Healthcare System, Center for Health Quality, Outcomes & Economic Research, US Department of Veterans Affairs, Bedford, MA
Katherine Hare, BS , Washington DC Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Washington, DC
Barbara Kertz, MS , Michael E. DeBakey Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Houston, TX
Virginia Kan, MD , Washington DC Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Washington, DC
Maria Rodriguez-Barradas , Michael E. DeBakey Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Houston, TX
Herschel Knapp, PhD, MSSW , 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
Henry Anaya, PhD , Health Services Research and Development, US Department of Veterans Affairs, VA Greater Los Angeles Healthcare System, Los Angeles, CA
Erin Conners, MPH , Liver Research Center, San Francisco Veteran Affairs Medical Center, San Francisco, CA
Of the U.S. HIV positive population, 25% are unaware of their status. Widespread HIV testing is important so treatment can be initiated for those seropositive. Nurse-initiated rapid HIV testing (NRT) is a promising strategy for increasing HIV testing within primary care (PC). With little understanding of the challenges and facilitators of NRT, our objective was to examine NRT implementation in Veterans Affairs (VA) PC settings.

We conducted a qualitative evaluation of NRT in two urban VA PC clinics. Pre-implementation interviews (T1) with nurses, providers and other key stakeholders elicited perspectives on the anticipated challenges and facilitators. With NRT implementation underway, providers and nurses were interviewed (T2) about actual challenges and facilitators experienced. Qualitative thematic analysis was performed on interview fieldnotes and content was thematically organized.

In T2, nurses identified unanticipated experiences implementing NRT not anticipated in T1. Despite nurses' concerns in T1 about the burdens of adding NRT to their clinical responsibilities, nurses found NRT not to be burdensome and instead straightforward and uncomplicated. Negative unanticipated experiences concerned delays in documenting NRT results because of limitations of the VA's computerized patient record system. Although not initially mentioned by participants, research staff observed that patients occasionally did not receive results during visits, as was expected. However, in interviews, participants revealed that patients did, shortly thereafter, receive results.

While the majority of anticipated problems with NRT did not occur in actual implementation, there were still several challenges. Further initiatives should address such issues in order to most successfully improve HIV testing rates.

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

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

Keywords: HIV/AIDS, Nurses

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I oversee implementation research projects on HIV screening programs.
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: HIV/AIDS Prevention Strategies
See more of: HIV/AIDS