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HIV Testing Rates in VHA 2009-2011

for Health Care Providers

HIV Testing Rates in VHA 2009-2011

This slideset summarizes scientific and policy issues related to HIV testing and presents expanded data on testing for HIV across the VA as of the end of calendar year 2011

HIV Testing Rates in VHA 2009-2011

Notes to the Slides

Slide 1: HIV Testing Rates in VA 2009-2011

Title Slide

Slide 2: HIV in US

According to the Centers for Disease Control, HIV infection and AIDS remain major public health concerns in the United States. More than 1.1 million people in the U.S. are living with HIV, and 21% of them are unaware that they are infected. Rates of transmission of HIV are higher among people who do not know that they are infected.

Slide 3: HIV testing in VA

Historically, HIV testing has been restricted in VA by Section 124 of Public Law 100-322. This law required written informed consent and scripted pre- and post-test counseling for HIV testing. It prohibited widespread HIV testing in VA. As of 2009, only 9.2% of Veterans in VA care had documentation of ever being tested for HIV while the Section 124 was in place. When Section 124 of Public Law 100-322 was repealed in October 2008 by Public Law 110-387, VA was able to revise its policy and allow for the promotion of routine HIV testing for all Veterans.

Slide 4: VA HIV Testing Policy Changes August 17, 2009

In August 2009 VA policy changed to make HIV testing routine, rather than risk-based, and to remove the previous requirement for written informed consent and prescribed pre- and post-test counseling for HIV testing. Current policy requires that verbal consent be documented and written information be provided to patients.

Slide 5: VA HIV Testing Rates: Data Collection Methods

The Office of Public Health collected data on HIV testing during 2009, 2010, and 2011 from all VHA facilities. Facilities used a standardized data extract routine to assess the number of Veterans who had HIV testing ever and the number tested in the report year. For those with HIV tests done in the year, the number with positive results was reported. Data are unduplicated at the facility level and were aggregated to the VISN and national levels.

Slide 6: Veterans Ever Tested for HIV by Year 2009-2011

The earliest available national data on HIV testing in VA showed that in 2009, 9.2% of outpatients had documentation of ever being HIV tested. In the latest report year (2011), the number of Veterans tested for HIV had more than doubled, to 20%, representing over 1.2 million Veterans with a documented HIV test in the electronic medical record.

Slide 7: Increases in VA HIV Testing 2009-2011

This slide illustrates that since VA policy was changed in August, 2009, rates of HIV testing have increased each year.

Calculations:

  • % Outpatient ever tested = Number ever tested / number outpatient visits
  • % Outpatient tested in CY = Number tested in CY / number outpatient visits

Slide 8: VA National HIV Testing Data for 2009, 2010 and 2011

This slide displays summary data on HIV testing across the VA system for calendar years 2009, 2010 and 2011. Data for 2009 and 2010 were previously reported in Halloran J, Czarnogorski M, Dursa EK, Volpp BD, Durfee JM, Valdiserri RO, Davey VJ, Ross D. HIV testing in the US Department of Veterans Affairs, 2009-2010. Arch Intern Med. 2012 Jan 9;172(1):61-2.

Slide 9: Veterans Integrated Service Networks (VISNs)

VA is divided into 21 different regions called VISNs. VISN level data was compiled by summing data from all facilities in each VISN.

Slide 10: Percent of Veterans EVER Tested for HIV, by VISN: 2009, 2010, 2011

All 21 VISNs had year over year increases from 2009 to 2011. Interestingly, some of the VISNs with the lowest testing rates in 2009 have the highest HIV testing rates in 2011.

Slide 11: Percent of Veterans EVER Tested for HIV, by Facility in 2011

In 2011, individual facility rates of HIV testing ever being documented ranged from 1.38% to 48.67%

Slide 12: Percentage of HIV Positive Tests in CY 2011, by VISN

This figure displays the percentage outpatients with a HIV positive result on a test performed at the VA during 2011 in each of the 21 VISNs. All VISNs reported rates of positive HIV tests above CDCs threshold for routine HIV screening, which is 0.1%

Slide 13: VA Initiatives to Improve HIV Testing Rates 2009-2011

VA has employed multiple strategies to increase HIV testing, including changes in policy to shift from risk-based to routine testing, to allow verbal consent rather than require written consent, development of a model clinical reminder to prompt routine HIV testing, provision of grant funding for laboratory and clinical practice initiatives and a social marketing campaign targeting both providers and patients.

Slide 14: Conclusions

In conclusion, the following observations can be made:

  • Every VISN had increases in HIV testing rates from 2009-2010
  • Overall, the number of HIV tests performed in VA more than doubled from 2009 to 2011
  • Clinical reminders and grant support had a large impact on increases in HIV testing rates
  • In 2010, all VISNs had an HIV seropositivity rate above the CDC threshold (>0.1%) for routine HIV testing

Slide 15: Summary

In summary:

  • VA is the largest provider of HIV care in the US
  • Routine HIV testing warranted in VA
  • HIV testing is now much simpler
  • Many Veterans in VA care have still not been tested for HIV
  • Progress made in all VISNs; continued progress will require local champions, leadership support, and use of tools such as clinical reminders

Slide 16: Office of Public Health--www.hiv.va.gov

VHA provides online access to extensive HIV related information and resources for both providers and patients on the VA HIV portal at this web site: http://www.hiv.va.gov