Evaluating the implementation of nurse-initiated HIV rapid testing in three Veterans Health Administration substance use disorder clinics

Conners, Erin E.; Hagedorn, Hildi; Butler, Jaimi N.; Felmet, Kandi; Hoang, Tuyen; Wilson, Phill; Klima, Gloria; Sudzina, E; Anaya, Henry D.

doi:10.1258/ijsa.2012.012050

Cited by 13 publications

(20 citation statements)

References 11 publications

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“…(25) Finally, VHA has had numerous successes expanding HIV testing beyond the primary care provider to include other points of contact such as emergency department care (26), nurse initiated rapid testing (27) and mental health. (28) Our study covers the five years prior to this change and the two years post. Therefore, the very high rates of HIV seropositivity seen in our study likely reflect risk-based rather than universal testing.…”

Section: Discussionmentioning

confidence: 99%

STI Diagnosis and HIV Testing Among OEF/OIF/OND Veterans

Goulet

Martinello²,

Bathulapalli³

et al. 2014

Medical Care

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Importance Patients with an STI diagnosis should be tested for HIV, regardless of previous HIV test results. Objective Estimate HIV testing rates among recent service Veterans with an STI diagnosis and variation in testing rates by patient characteristics. Design, setting, and participants The sample comprised 243,843 Veterans who initiated Veterans Health Administration (VHA) services within one year after military separation. Participants were followed for two years to determine STI diagnoses and HIV testing rates. We used relative risks regression to examine variation in testing rates. Main outcomes and measures We used VHA administrative data to identify STI diagnoses and HIV testing and results. Results Veterans with an STI diagnosis (n=1,815) had higher HIV testing rates than those without (34.9% vs. 7.3%, p<0.0001), but were not more likely to have a positive test result (1.1% vs. 1.4%, p=0.53). Among Veterans with an STI diagnosis, testing increased from 25% to 45% over the observation period; older age was associated with a lower rate of testing, while race and ethnicity, multiple deployments, PTSD, and substance abuse disorders were associated with a higher rate. Conclusions and Relevance Since VHA implemented routine HIV testing, overall rates of testing have increased. However, among Veterans at significant risk for HIV because of an STI diagnosis, only 45% had an HIV test in the most recent year of observation. Other patient characteristics such as alcohol and drug abuse were associated with being tested for HIV. Providers should be reminded that an STI is a sufficient reason to test for HIV.

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Section: Discussionmentioning

confidence: 99%

STI Diagnosis and HIV Testing Among OEF/OIF/OND Veterans

Goulet

Martinello²,

Bathulapalli³

et al. 2014

Medical Care

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“…Within HIV facilities, 15 studies explored micro level integration [33][34][35][36][37]48,49,52,[61][62][63]67,[69][70][71], one described meso level clinical integration [60] and five described macro level integration [45,50,57,73,74]. Similarly, within substance use facilities, the majority of studies were micro level integrations (n =1 2 ) [40,41,44,47,51,58,59,66,68,76,77,79,80,82], with three meso level integrations [46,56,65]. In other facilities, three studies described micro level integration [38,39,53], two described meso level integration [42,43] and two described macro level integration [55,78].…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Integrating HIV and substance use services: a systematic review

Haldane

Cervero-Liceras

Chuah

et al. 2017

Journal of the International AIDS Society

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Introduction: Substance use is an important risk factor for HIV, with both concentrated in certain vulnerable and marginalized populations. Although their management differs, there may be opportunities to integrate services for substance use and HIV. In this paper we systematically review evidence from studies that sought to integrate care for people living with HIV and substance use problems.Methods: Studies were included if they evaluated service integration for substance use and HIV. We searched multiple databases from inception until October 2015. Articles were screened independently by two reviewers and assessed for risk of bias.Results and discussion: 11,057 records were identified, with 7616 after removal of duplicates. After screening titles and abstracts, 51 met the inclusion criteria. Integration models were categorized by location (HIV, substance use and other facilities), level of integration from mirco (integrated care delivered to individuals) to macro (system level integrations) and degree of integration from least (screening and counselling only) to most (care for HIV, substance use and/or other illnesses at the same facility). Most reported descriptive or cohort studies; in four randomized control trials integrated activities improved patient outcomes. There is potential for integrating services at all facility types, including mobile health services. While services offering screening only can achieve synergies, there are benefits from delivering integrated treatment for HIV and substance use, including ease of referral to other mental health and social services.Conclusions: Our review used a wide range of databases and conference archives to increase representation of papers from low- and middle-income countries. Limitations include the overrepresentation of studies from the United States, and the descriptive nature of the majority of papers. The evidence reviewed shows that greater integration offers important benefits in both patient and service outcomes but further research and outcome reporting is needed to better understand innovative and holistic care models at the complex intersection of substance use and HIV services.

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“… 61 Besides quantitative reporting, the qualitative documentation of measures was also impaired. Measures such as ease of testing (as in procedure), 16 , 50 , 58 workflow integration 19 , 29 , 52 , 62 , 63 (38%), the impressions of participants, 16 perception of patients, 52 perceptions of performance 58 (2/81, 3%), and the ease of test execution 41 , 53 were reported. These measures also need to be defined.…”

Section: Resultsmentioning

confidence: 99%

“… 49 , 72 ( i ) Partner notification: Partner notification or referral rates (proportions) were documented in only 4 studies. Notification was reported either as the number 19 or as the proportion 72 of participants who disclosed their serostatus with their partners or as the proportion of patients who would recommend an HIV self-test to others. 48 Partner referral was also documented qualitatively.…”

Section: Resultsmentioning

confidence: 99%