Make the Test Normal
Instructions on how to integrate routine HIV testing in VA Women's Health Clinics using the Patient Aligned Care Teams (PACT) model.
Scene 1: Hello there. My name is Kathryn Havens. I am the physician director of the Women's Health Pact team at the Zablocki VA in Milwaukee Wisconsin.
Scene 2: I want to talk to you about how our team revolutionized the way we care for women Veterans around HIV screening.
Scene 3: HIV infection has changed a lot in the past thirty years. In the 1980s, it was seen as a fatal, ravaging disease of healthy, young immune systems. In the early 1990's people with HIV/AIDS were treated with handfuls of pills every day, and many died in spite of these treatment efforts.
Scene 4: Since that time, huge advances have been made in the diagnosis of HIV, treatment, and the quality of life. HIV is now is a chronic disease, like diabetes or high cholesterol. If diagnosed early it can often be managed with one pill a day.
Scene 5: With treatment, a woman with HIV can diminish transmission of this virus to her babies and loved ones dramatically, and live a long and healthy life.
Scene 6: We screen 87% of all Veterans for cholesterol. We screen 68% for blood sugar. But we screen only 20% of our Veterans for HIV.
Scene 7: So our PACT team asked, why are so few women screened for HIV? Is it that the patients don't want to be tested?
Scene 8: Last year 30,000 Vets were surveyed nationally and 73% said they would be "very likely" to get the HIV test if their doctor recommended it. However, only 9% reported they had even been asked in the previous 12 months.
Scene 9: Why aren't we doctors suggesting screening for this chronic disease like we do for others?
Scene 10: Our PACT team, two design researchers from the Illinois Institute of Technology, Institute of Design, our hospital infection control and quality control nurses, and Milwaukee community AIDS advocates all put our heads and our hearts together.
Scene 11: Here's what we found out!
- Not surprisingly doctors are very busy.
- Some providers assume their patients aren't at high risk for HIV. But how do we know who's at risk? The patient knows her own story but not always that of her partner, especially if the risk exposure was long ago.
- Some providers dread an uncomfortable and drawn-out conversation about sexual and drug history.
- Some providers are not sure which guidelines of care to follow. The CDC, for example, recommends screening all sexually active women once a year. The VA, the Institute of Medicine, and the United States Preventive Task Force offer other different suggestions.
Some providers have little experience in taking care of patients who are positive with HIV positive. They may not be aware of all of the available resources for clinical support that the VA offers to our patients.
Scene 13: Given all of these complex factors, how can we ask patients more often if they'd like an HIV test?
Scene 14: The VA has already made a great transition to Patient Aligned Care teams. So our PACT team took the next step and educated ourselves about HIV testing. Our goal was to make the HIV test a normal part of the excellent care that we give everyday.
Scene 15: Last year we expanded the roles of our LPNs who draw routine labs to ask each woman if she wanted the test. There are no sex or drug questions, just "would you like the test?" Verbal consent was documented. The extra tube was drawn and the provider approved the order. Condoms and additional education were offered to each woman, and rarely refused.
Scene 16: Here's what happened.
Scene 17: In three months over 400 women were tested for HIV, in our women's health clinic here at the Zablocki VA.
Scene 18: We found that the providers were delighted to improve screening, and our patients appreciated knowing their HIV status and the open conversation about prevention.
Scene 19: And there's more. You can't ask a question, or improve screening without having a thorough process in place for resources and treatment. So . . .
Scene 20: If a woman was HIV negative, a letter was sent to inform her of her results, with educational materials included about how she could continue taking good care of herself.
Scene 21: If the woman was HIV positive, she was invited into the clinic to meet with both her primary care team and the infectious disease nurse. A thorough history was obtained at that point and special labs drawn. The woman had time to learn about her disease in a comfortable and supportive environment, and then in her next visit with the infectious disease physician, treatment was initiated, if needed. Our patient left knowing that she had an integrated team to care for her.
Scene 22: The best part of this story is that your PACT team can do it too. Make it simple. Just ask: "Do you want an HIV test today?"
Scene 23: We created a tool kit to help your PACT team start.
Scene 24: This project would not have been possible without grant support to identify new ways to improve HIV testing for women Vets. We received a grant from the Office of Public Health and the Women Veterans Health Care group at the Veterans Health Administration. We also thank Dr. Judith Gregory, Cornelia Bailey and Amanda Geppert of the Illinois Institute of Technology, Institute of Design. And, finally, the Zablocki VA Women's Pact Team! Thank you for listening.