A system-wide intervention to improve HIV testing in the Veterans Health Administration

J Gen Intern Med. 2008 Aug;23(8):1200-7. doi: 10.1007/s11606-008-0637-6. Epub 2008 May 2.


Background: Although the benefits of identifying and treating asymptomatic HIV-infected individuals are firmly established, health care providers often miss opportunities to offer HIV-testing.

Objective: To evaluate whether a multi-component intervention increases the rate of HIV diagnostic testing.

Design: Pre- to post-quasi-experiment in 5 Veterans Health Administration facilities. Two facilities received the intervention; the other three facilities were controls. The intervention included a real-time electronic clinical reminder that encourages HIV testing, and feedback reports and a provider activation program.

Patients: Persons receiving health care between August 2004 and September 2006 who were at risk but had not been previously tested for HIV infection.

Measurements: Pre- to post-changes in the rates of HIV testing at the intervention and control facilities

Results: At the two intervention sites, the adjusted rate of testing increased from 4.8% to 10.8% and from 5.5% to 12.8% (both comparisons, p < .001). In addition, there were 15 new diagnoses of HIV in the pre-intervention year (0.46% of all tests) versus 30 new diagnoses in the post-intervention year (0.45% of all tests). No changes were observed at the control facilities.

Conclusions: Use of clinical reminders and provider feedback, activation, and social marketing increased the frequency of HIV testing and the number of new HIV diagnoses. These findings support a multimodal approach toward achieving the Centers for Disease Control and Prevention's goal of having every American know their HIV status as a matter of routine clinical practice.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • AIDS Serodiagnosis / standards*
  • Female
  • HIV Infections / diagnosis*
  • Humans
  • Logistic Models
  • Male
  • Medical Records Systems, Computerized
  • Middle Aged
  • Quality Assurance, Health Care*
  • Reminder Systems
  • United States
  • United States Department of Veterans Affairs / organization & administration*
  • User-Computer Interface