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Enhancing HIV Testing Rates Among Veterans: The Impact of the MultiVISN Quality Improvement Project

The MultiVISN Quality Improvement Project aims to significantly improve HIV testing rates among veterans who might be unaware of their HIV status. Currently, 21% of HIV-positive individuals in the U.S., including many veterans, remain untested, increasing their risk for AIDS-related complications. This project utilizes decision support systems, policy enhancements, and multimedia resources to engage staff and promote testing. Initial results from VISN 22 facilities show a remarkable two- to threefold increase in testing among at-risk patients, highlighting the importance of proactive outreach in healthcare.

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Enhancing HIV Testing Rates Among Veterans: The Impact of the MultiVISN Quality Improvement Project

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  1. MultiVISN Quality Improvement Improving HIV Testing Rates Herschel Knapp, Ph.D.

  2. Background • Many HIV infected patients do not know their status • CDC: 21% of the 1.1 million HIV+ persons in the US are unaware • 50 - 70% of VA patients with risk factors have not been tested • 50% of newly diagnosed patients have < 200 CD4 cells • High risk of AIDS-related complications • Less likelihood of immune recovery • Patients often have multiple, missed opportunities for early testing

  3. Benefits of Knowing HIV Status • Increases the benefits of anti-retroviral therapy • Increased immune recovery • Increased length of life • Increased quality of life • Lower viral loads reduce risk of transmission • Knowledge of infection reduces risky behavior

  4. What is the MultiVISNQuality Improvement Project? • Objective • Improve healthcare of veterans • Goal • Identify HIV positive veterans and refer for care • Means • Decision support • Policy support • Staff engagement • Multimedia resources

  5. Success to Date VISN 22 Los Angeles, Loma Linda, San Diego, and Southern Nevada VA facilities More than 200% increase in HIV testing among at-risk patients

  6. Yearly HIV Testing Rate Pre- / Post-Intervention Program implementation increases HIV testing rates two – threefold at all sites Intervention Year Control Site A Site B Site C Site D Site E

  7. QUERI-HIV Components

  8. Clinical Reminder

  9. HIV Clinical Reminder Triggers • Hepatitis B / C infection or risk factors • Substance abuse • Sexually transmitted disease • Needn’t wait for HIV Clinical Reminder to offer a test • Not a performance measure • Site-wide (not provider) level of analysis • Trigger for 10% - 15% of patients

  10. Patient Media

  11. Provider Media

  12. As of 8/17/2009, written informed consent NO LONGER REQUIRED. Verbal consent is sufficient. HIV clinical reminder automatically pastes an entry in the NOTES: The patient has verbally consented to HIV testing. An HIV antibody test has been ordered. Verbal Consent

  13. Quarterly statistical feedback HIV testing rate Rate of clinical reminder resolution New materials & methods as needed Ongoing Support

  14. Tips for Proposing HIV Testing Asymptomatic patients are unlikely to request a test; they’re waiting for us to offer the test.

  15. Tips for Proposing HIV Testing • Would you like a free HIV test? • As a veteran, you’re entitled to an HIV test. • In addition to doing some tests to check for cholesterol, diabetes, etc., we’re now offering HIV testing. Would you like us to check for HIV infection?

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