HIV testing strongly associated with health care organization resources

BOSTON — Besides patient and provider factors, researchers identified organizational factors — particularly personnel and financial support — that increased the likelihood of HIV testing among high-risk patients, according to new study findings presented here.

"From a research perspective, examining how both patient and organizational characteristics may impact HIV screening adds to the knowledge base explaining factors that predict improved screening," Ann Chou, PhD, MPH, of the VA Greater Los Angeles Health Care System, told Infectious Disease News. "There has been very limited research that focuses on organizational factors as these data are difficult to collect."

Chou and colleagues recommend that health care organizations consider strategies to achieve resource sufficiency and patient care support to promote and improve HIV screening.

For the study, data were pooled from the VA Austin Automation Center to determine patient demographic, risk factors and HIV screening status; and they used the VA's 2007 Clinical Practice Organizations Survey to gather information on facility characteristics from 225 primary care directors.

Fourteen facilities and nearly 50,000 patients were included in the study; 96% were male, 78% were less than 65 years of age, 24% were minorities, 73% earned an income of les than $30,000 and 20% were homeless.

Results indicated the following organizational factors were associated with increased HIV testing: resource sufficiency in personnel and financial support (P=.0018), support staff (P=.0002), space and equipment (P<.0001) and patient care support (P=.001).

The researchers also found that patient factors such as minority status and risk factors, including substance abuse disorder (35%), hepatitis B (25%), hepatitis C (58%) and STD (6%), were positively associated with testing, in addition to receiving care from facilities supported by national or local resources.

"Our findings show that the type and amount of resources are the most important predictors that promote HIV screening," Chou said. "We found that patients who received care from facilities where support was provided from either the national or local level reported a higher likelihood of getting tested when compared with their counterparts at control facilities. These results showed that with some increased support and encouragement when accompanied by audit-feedback reports can significantly improve screening rates. This type of support requires a relatively small effort, but can have significant impact on the process of care. Organizations may adopt these strategies to improve their care delivery." – by Ashley DeNyse

For more information:

• Chou A. #495. Presented at: The IDSA 49th Annual Meeting; Oct. 20-23, 2011; Boston.

Disclosure: The researchers report no relevant financial disclosures.

This is a very important study for several reasons. One, it involved nearly 50,000 patients, so it is clearly representative of the population it examined. Second, it reveals that, even in facilities in one health care system (Department of Veterans Affairs), the frequency of HIV screening was variable. Third, it highlights the need for health care systems, whether public or for-profit, to invest in personnel, space and other resources to facilitate HIV screening and assure that it becomes routine for all people at risk.

Since early detection and appropriate care of HIV-infected people saves lives and costs, and since screening cannot be the sole responsibility of physicians and other providers, investments in assuring increased HIV screening are essential for any health care system to optimally care for its patients.

– Joel D. Ernst, MD

Infectious Disease News Editorial Board member

Disclosure: Dr. Ernst reports no relevant financial disclosures.

The CDC estimates that one in five HIV-positive individuals in the US is unaware of his or her status. To decrease this percentage, we must first understand why some people get tested and others do not. In the study of patients in the VA health system, Chou and colleagues examined which aspects of an organization might influence a person’s decision to be tested. Although this study essentially looked only at men in the VA system, the results are helpful and show that the stronger the organizational structure,

the more likely a person would be tested. Perhaps not surprisingly, those involved with organizations that provide more service, get tested more frequently. In targeting at-risk populations for testing, we must understand what works, and then change our approach and funding accordingly. This study is the first step along that path.

-Stephen M. Smith, MD

Infectious Disease News Editorial Board member

Disclosure: Dr. Smith reports no relevant financial disclosures.

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