Improving HIV Screening with
Rapid Testing
and Streamlined Counseling
Henry D. Anaya, PhD
Steven M. Asch, MD MPH, Tuyen Hoang, PhD,
Joya F. Golden, BA, Matthew B. Goetz, MD,
Allen Gifford, MD, Candice Bowman, PhD RN
Most people worldwide
unaware of their HIV status
• 45 million infected with HIV worldwide
• 95% unaware of HIV-positive status
• Those aware of HIV status lower HIV-risk
behaviors
• Even those in care don’t get HIV tested
Why don’t people in care get HIV testing?
Barrier
Intervention
– Counseling takes time
– Streamlined counseling
– MDs don’t prioritize
prevention
– Nurse-based screening
– Patients don’t return
for results
– HIV rapid testing
HIV Rapid Testing
Study design
Patients randomized to one of three models:
• Usual Care (UC)
• Nurse-based screening (NBS)
• Nurse-based screening + rapid
testing/streamlined counseling (NBS+RT/SC)
Study design (cont’d)
Endpoints
• HIV Test order
• Receipt of HIV test
results
• Patient knowledge
• Cost-effectiveness
Covariates
• Demographics
• HIV risk factors
• Comorbid
conditions (TB,
STDs, HEP B/C)
Enrollment and Randomization
Agreed to participate
283
Not between 18-65 yrs
Enrolled 189
Excluded 94
HIV test within past year
Not competent to consent
Usual Care
62
Nurse Screening
64
Nurse Screening
+ Rapid Test
63
Characteristics of patient population
Usual
Care
Nurse
Screening
Nurse Screening
+ RT/SC
Race/ethnicity
African-American
White
Latino
35.5
37.1
22.6
42.2
31.3
17.2
52.4
27.0
11.1
Age
18-40
41-50
51-65
12.9
45.2
41.9
23.5
31.3
45.3
17.4
28.6
54.0
Educational
Attainment
<HS/HS graduate
Some college
College graduate
27.4
51.6
21.0
28.2
48.4
23.4
28.6
48.7
23.3
Annual income
<10K
10,001-30K
30,001-50K
50,001->80K
43.1
41.2
13.7
2.0
43.8
31.3
16.7
8.4
34.0
39.6
13.2
13.2
Results: HIV test ordered?
100
90
80
70
60
50
40
30
20
10
0
84.4%*
40.3%
Usual Care
*p=<.001
92.1%*
Nurse Screening
Nurse Screening +
Rapid Test
HIV Results received?
100
90
80
70
60
50
40
30
20
10
0
82.5% **
40.6%*
16.1%
Usual Care
*p=<.003 **p=<.001
Nurse Screening
Nurse Screening +
Rapid Test
Conclusions
• HIV Test order
– Nurse Screening increased test order
compared to Usual Care;
– Slight increase w/ addition of
Rapid Test/Streamlined Counseling
• Receipt of HIV results
– Nurse Screening increased receipt of results
compared to Usual Care;
– Significant increase w/ addition of
Rapid Test/Streamlined Counseling
Implications
• Expansion into nationwide VA delivery system
• Basis for other outreach efforts
• Integration into similar healthcare systems