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Evaluation of Human Immunodeficiency Virus Screening in Veterans Health Administration Outpatient Clinics

Report Information

Issue Date
Report Number
15-04925-469
VA Office
Veterans Health Administration (VHA)
Report Author
Office of Healthcare Inspections
Report Type
Comprehensive Healthcare Inspection Program
Recommendations
2
Questioned Costs
$0
Better Use of Funds
$0
Congressionally Mandated
No

Summary

Summary
OIG conducted a systematic review of the Veterans Health Administration’s outpatient clinics to evaluate for compliance with selected VHA requirements regarding human immunodeficiency virus (HIV) screening. The objectives were to determine whether outpatient clinics complied with the requirements to: (1) identify an HIV Lead Clinician; (2) establish local policies and procedures; (3) provide HIV screening as part of routine medical care; and (4) document informed consent for HIV testing. We performed this focused review at 56 VA facilities through a review of facility documents, evaluation of the electronic health records of 1,990 outpatients, and discussion with facility staff. We estimated that 96.3 percent (95% CI: 88.96–98.85) of facilities identified a Lead HIV Clinician, and 92.6 percent (95% CI: 84.09–96.75) of facilities established policies, procedures, and guidelines for HIV screening. We estimated that clinicians offered screening to 66.4 percent (95% CI: 64.32–68.48) of outpatients, and an additional 4.6 percent (95% CI: 3.78–5.64) of outpatients were offered screening. We did not find documentation of the offer of screening in 28.9 percent (95% CI: 26.99–30.98) of electronic health records. We estimated that clinicians documented oral informed consent in 75.1 percent (95% CI: 71.28–78.64) and written informed consent in 6.6 percent (95% CI: 4.77–9.05) of records for outpatients screened for HIV. We also estimated that informed consent was not documented in 18.3 percent (95% CI: 15.20–21.79) of records for outpatients screened for HIV. We recommended that the Under Secretary for Health, in conjunction with Veterans Integrated Service Network and facility senior managers, ensure that clinical staff offer HIV screening as part of routine medical care and document informed consent for HIV testing.

Open Recommendation Image, SquareOpenClosed and Implemented Recommendation Image, CheckmarkClosed-ImplementedNot Implemented Recommendation Image, X character'Closed-Not Implemented
No. 1
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with Veterans Integrated Service Network and facility senior managers, ensure that clinical staff offer HIV screening as part of routine medical care and that managers monitor compliance.
No. 2
Closed and Implemented Recommendation Image, Checkmark
to Veterans Health Administration (VHA)
We recommended that the Under Secretary for Health, in conjunction with Veterans Integrated Service Network and facility senior managers, ensure that clinicians document informed consent for HIV testing and that managers monitor for compliance. VA Office