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 HIVHIV-positive status • Those aware of HIV status lower HIVHIV-risk behaviors • Even those in care don’ don’t get HIV tested Why don’ don’t people in care get HIV testing? Barrier HIV Rapid Testing Intervention – Counseling takes time – Streamlined counseling – MDs don’t prioritize prevention – Nurse-based screening – Patients don’t return for results – HIV rapid testing Study design Study design (cont’ (cont’d) Endpoints Covariates Patients randomized to one of three models: • Usual Care (UC) • Nurse-based screening (NBS) • Nurse-based screening + rapid testing/streamlined counseling (NBS+RT/SC) • HIV Test order • Receipt of HIV test results • Patient knowledge • Cost-effectiveness • Demographics • HIV risk factors • Comorbid conditions (TB, STDs, HEP B/C) 1 Enrollment and Randomization Agreed to participate 283 Not between 18-65 yrs Enrolled 189 Excluded 94 Nurse Screening 62 64 Nurse Screening + Rapid Test 63 Results: HIV test ordered? 100 90 80 70 60 50 40 30 20 10 0 92.1%* 84.4%* 40.3% Usual Care Nurse Screening 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 HIV test within past year Not competent to consent Usual Care Characteristics of patient population 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 Nurse Screening *p=<.001 Nurse Screening + Rapid Test *p=<.003 **p=<.001 Conclusions Implications • 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 • Expansion into nationwide VA delivery system • Basis for other outreach efforts • Integration into similar healthcare systems – Nurse Screening increased receipt of results compared to Usual Care; – Significant increase w/ addition of Rapid Test/Streamlined Counseling 2