Improving HIV Screening with Improving HIV Screening with Rapid Testing Rapid Testing

and Streamlined Counselingand Streamlined Counseling

Henry D. Anaya, PhD Henry D. Anaya, PhD

Steven M. Asch, MD MPH, Tuyen Hoang, PhD, Steven M. Asch, MD MPH, Tuyen Hoang, PhD, Joya F. Golden, BA, Matthew B. Goetz, MD, Joya F. Golden, BA, Matthew B. Goetz, MD, Allen Gifford, MD, Candice Bowman, PhD Allen Gifford, MD, Candice Bowman, PhD

RNRN

Most people worldwide Most people worldwide unawareunaware of their HIV status of their HIV status

• 45 million infected with HIV worldwide 45 million infected with HIV worldwide

• 95%95% unaware of HIV-positive status unaware of HIV-positive status

• Those aware of HIV status Those aware of HIV status lower HIV-risk lower HIV-risk behaviorsbehaviors

• Even those in care don’t get HIV testedEven those in care don’t get HIV tested

Why don’t people in care get HIV testing?Why don’t people in care get HIV testing?

Barrier

– Counseling takes time

– MDs don’t prioritize prevention

– Patients don’t return for results

Intervention

– Streamlined counseling

– Nurse-based screening

– HIV rapid testing

HIV Rapid TestingHIV Rapid Testing

Study designStudy 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)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 RandomizationEnrollment and Randomization

Agreed to participate 283

Enrolled 189 Excluded 94

Usual Care Nurse Screening Nurse Screening + Rapid Test

62 64 63

Not between 18-65 yrs

HIV test within past year

Not competent to consent

Characteristics of patient populationCharacteristics of patient population

Usual Care

Nurse Screening

Nurse Screening + RT/SC

Race/ethnicity African-American 35.5 42.2 52.4 White 37.1 31.3 27.0 Latino 22.6 17.2 11.1 Age 18-40 12.9 23.5 17.4 41-50 45.2 31.3 28.6 51-65 41.9 45.3 54.0 Educational Attainment

<HS/HS graduate 27.4 28.2 28.6 Some college 51.6 48.4 48.7 College graduate 21.0 23.4 23.3 Annual income <10K 43.1 43.8 34.0 10,001-30K 41.2 31.3 39.6 30,001-50K 13.7 16.7 13.2 50,001->80K 2.0 8.4 13.2

Results: HIV test ordered?Results: HIV test ordered?

40.3%

84.4%*92.1%*

0102030405060708090

100

Usual Care Nurse Screening Nurse Screening +Rapid Test

*p=<.001

HIV Results received?HIV Results received?

16.1%

40.6%*

82.5% **

0102030405060708090

100

Usual Care Nurse Screening Nurse Screening +Rapid Test

*p=<.003 **p=<.001

ConclusionsConclusions

• 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

ImplicationsImplications

• Expansion into nationwide VA delivery system

• Basis for other outreach efforts

• Integration into similar healthcare systems