United States Department of Veterans Affairs
 Health Care
Grant program aims to increase HIV testing rate in VA
two men review a script
Veteran and video producer Kyle Hausmann-Stokes reviews lines with Ron Newberry from the Respiratory Care Department. Hausmann-Stokes produced a 90-second video to raise awareness on HIV testing.

The Department of Veterans Affairs is working hard to get as many Veterans as possible tested for human immunodeficiency virus (HIV). Field-based pilot programs are an important first step in the campaign to increase routine HIV testing.

VHA’s Office of Clinical Public Health awarded eight grants in FY 2010 to fund projects targeting the low HIV testing rate in the VA health system. Less than 10% of VA patients have ever been tested for HIV/AIDS. In 2009, only 2.5% of 5.7 million patients were tested for HIV, but early data from the VA Medical Centers hosting the grant programs indicate that they have significantly increased testing.

The Pacific Islands Healthcare System was one of the grant recipients.

“I’m impressed with the progress, considering we really only started the rapid-testing on October 20th, and I’m also impressed with the acceptance by the Veterans,” said Jim Reisen, RN, Infection Control nurse at VA Pacific Islands Health Care System. Just a few months into the pilot program, Reisen said they are well on their way to reaching their goal of a 10% increase in HIV screening.

In fact, the Pacific Islands Health Care System saw more than seven times the number of HIV tests carried out from October to November 2010 compared to the same months in 2009. These marked improvements were evident among all the grant participants, providing VA with field-tested strategies for a nation-wide campaign.

The program has also been improved by eliminating some of the paperwork for testing.

Over the past year, policies such as written informed consent and risk-based HIV testing have been eliminated at VA facilities in favor of routine HIV testing. Now all Veterans are provided with HIV risk and testing information and can take the test with just a verbal consent. Some facilities have chosen to use an electronic clinical reminder built into VA’s computerized medical record to prompt primary care physicians to offer HIV testing to all Veterans. The HIV testing clinical reminder is not mandatory in VA, but is an effective way to remind providers to offer the test.

audience at training seminar
Wichita VA Medical Center’s Patient Aligned Centered Teams receive HIV updated training through the Kansas AIDS Education and Training Center.

Trial and success

Getting tested for Veterans in Honolulu, Hawaii, is as easy as walking into the lobby at the main campus of the Pacific Islands Healthcare System. Using the rapid HIV test procedure, in 20 minutes the patients have their test results.

“When flu season happens, we set up a clinic in our lobby and we give the flu shot to every Veteran who comes through our door. We had already given about 7,000 flu shots, so we started giving rapid HIV tests,” Reisen said.

A mobile flu shot cart is used to ensure Veterans’ privacy during the procedure and Reisen plans to use some of their grant money to make more modifications to the lobby. The biggest challenge facing the Pacific Islands Healthcare System is training and implementing these testing practices at the Community Based Outpatient Clinics (CBOCs) and Vet Centers throughout their 2.4 million square mile territory.

Reisen said they have already brought staff from the satellite facilities to the main campus for training and plan to follow up with quarterly visits, monitoring progress and proficiency credentials. They are looking forward to expanding the test system to cover their homeless program as well.

“If we can make it work at our CBOCs, there’s nobody in the country who can’t make it work,” he said. “As far as the Veterans, they actually love it. We just ask them once and if they say no, we don’t pressure them.

“When it comes to culture change, sometimes it’s better to take it slow – instead of making it mandatory.”

Dispelling myths

The Montana VA Healthcare System faces a similar challenge in implementing new testing procedures at over a dozen clinics and Vet Centers across the state. Despite Montana’s low HIV prevalence, just 31 new cases were diagnosed in 2009 in the entire state; the number of cases is gradually increasing each year.

“In Montana as a whole, there’s a perception of having a low prevalence rate. People may or may not screen for it and as a patient, they may or may not ask for it. The test was: Were we truly a low prevalence state, or did we just not test enough?” explained Jonna Brenton, RN, Women Veteran Program Manager for the VA Montana Healthcare System.

Their first step was to organize a training seminar led by infectious disease physician, Dr. David M. Graham, to educate health care providers. Dr. Graham came to the Montana VA with extensive experience in HIV health care, just as the grant program was launching.

The seminar covered recent trends in HIV epidemiology, at the global, national and statewide level; recommendations from the U.S. Centers for Disease Control and Prevention on routine HIV testing; state guidelines for HIV testing; and best practices for rapid HIV testing.

The lecture was videotaped and Brenton said they plan to send out copies of the DVD and the accompanying presentation slides to their CBOCs. VA Montana is partnering with the State of Montana Department of Health and Human Services and the Northwest AIDS Education and Training Center to implement rapid HIV testing. The clinics will launch rapid HIV testing in January 2011.

“Once we establish it in our clinics, then our goal is to roll that out to our emergency clinics, urgent care and behavioral health,” said Brenton. “We just wanted to be able to have another option to provide patients.”

VA Montana has had a dramatic increase in HIV testing since activating a clinical reminder that prompts providers to offer an HIV test to all patients. Before the clinical reminder was put in place, their lab averaged 6 to 7 tests each week. Now they process over 800 each month.

Just another test

“It’s no longer really a death sentence, you can live with HIV and you can live full lives,” said Laurie Pfeiffer, RN and Women Veteran Program Manager at the Wichita VA Medical Center.

To raise awareness about their HIV screening project, the pilot program in Wichita reached out to Veterans with a 90 second public service announcement produced by Operation Iraq Freedom Veteran Kyle Hausmann-Stokes. The video highlights VA’s proactive stance on healthcare and encourages all Veterans, regardless of their age, race, gender, or risk factors, to just “say yes” to an HIV test beginning December 1, 2010 — World AIDS Day.

Veterans visiting a medical facility will be given an educational brochure about HIV and then watch the short video.

“It really encourages Veterans to just make it part of their routine health care,” Pfeiffer said. The second short video will be out before the end of the year and focuses on “giving hope to HIV positive Veterans” and remind them of the treatment options and support available at VA.

Patients are offered a portal to comprehensive HIV health care through VA that looks after their mental and emotional health, as well as their physical well-being.

Like many other VA facilities, the Wichita VA has partnered with one of their state’s HIV programs. Working with the Kansas AIDS Education and Training Center (KAETC) through the Targeted Outreach Education Project (TOEP) and the Kansas Ryan White Program, enables the VA Medical Center to reach more Veteran patients and offer the best HIV care available.

“We want to say, as the VA, here’s what we’re doing for you: We’re here with treatment, we’re here with spiritual support, whatever you need to help you with this disease process,” said Pfeiffer.

Related link:
  HIV/AIDS Program