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

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.