Background
HIV testing is cost-effective in unselected general medical populations, yet testing rates among those at risk remain low,
even among those with regular primary care. HIV rapid testing is effective in many healthcare settings, but scant research
has been done within primary care settings or within the US Department of Veteran’s Affairs Healthcare System.
Objectives
We evaluated three methods proven effective in other diseases/settings: nurse standing orders for testing, streamlined counseling,
and HIV rapid testing.
Design
Randomized, controlled trial with three intervention models: model A (traditional counseling/testing); model B (nurse-initiated
screening, traditional counseling/testing); model C (nurse-initiated screening, streamlined counseling/rapid testing).
Participants
Two hundred fifty-one patients with primary/urgent care appointments in two VA clinics in the same city (one large urban hospital,
one freestanding outpatient clinic in a high HIV prevalence area).
Measurements
Rates of HIV testing and receipt of results; sexual risk reduction; HIV knowledge improvement.
Results
Testing rates were 40.2% (model A), 84.5% (model B), and 89.3% (model C; p = <.01). Test result receipt rates were 14.6% (model
A), 31.0% (model B), 79.8% (model C; all p = <.01). Sexual risk reduction and knowledge improvement did not differ significantly between counseling methods.
Conclusions
Streamlined counseling with rapid testing significantly increased testing and receipt rates over current practice without
changes in risk behavior or posttest knowledge. Increased testing and receipt of results could lead to earlier disease identification,
increased treatment, and reduced morbidity/mortality. Policymakers should consider streamlined counseling/rapid testing when
implementing routine HIV testing into primary/urgent care.
KEY WORDS nurse-initiated HIV screening - HIV rapid testing - streamlined counseling