3058 — Qualitative Assessment of Implementing Routine Rapid HIV Testing

Anaya HD (VA Greater Los Angeles Healthcare System, QUERI-HIV/Hep), Feld JE (VA Greater Los Angeles Healthcare System, QUERI-HIV/Hep), Golden JF (VA Greater Los Angeles Healthcare System, QUERI-HIV/Hep), Bokhour B (VA QUERI-HIV/Hep, Center for Health Quality, Outcomes, and Economics Research (CHQOER), Boston University)

Objectives:
To explore and document barriers, facilitators, and unintended consequences of implementing nurse-based rapid testing (NRT) model of HIV testing.

Methods:
Using modified snow-ball techniques, we recruited 18 VA Los Angeles Outpatient Center (LAOPC) staff for semi-structured interviews 3 months post NRT launch at LAOPC; 4 key stakeholders/administrators and 14 front-line practitioners certified in HIV RT in the following areas: mental health, community care, substance use disorder, walk-in, and dental clinics. Interviews explored the following: rapid versus conventional HIV testing, the use of nurses and other staff to administer and interpret HIV tests, organizational and personal willingness to adopt/support NRT. Moreover, issues related to job performance, task comprehension, and unintended consequences of NRT were examined.

Results:
Interview responses suggest high levels of interest in continued NRT efforts: 11 of 14 practitioners rated routine NRT as ‘very important’ compared to testing for other chronic diseases. Interestingly, despite high levels of patient and provider interest in NRT following the NRT training launch, only 6 of 13 certified practitioners had administered a RT; 7 of 13 performed standard referrals to either walk-in clinic or to informally-designated primary care RN who emerged as the main HIV RT representative. The suggestibility of such HIV RT implementation varied according to provider motivation and service area. Interviews yielded distinct information regarding potential barriers and facilitators associated with HIV RT implementation.

Implications:
Distinct themes emerged as barriers/facilitators to practitioner adoption of routine HIV RT. Tentative themes include the importance of: congruence of HIV RT with perceived roles and responsibilities (i.e. preventative and medical versus non-medical, urgent care); practitioner confidence/efficacy for entire HIV RT processes; clinical workload/staffing as sufficient for uptake of routine testing versus risk-based testing; attainment of designated HIV RT clinical support across multiple departments (i.e.; dentistry, primary care, mental health, social work.); consistency of staff implementation trainings that is tailored; site-specific to departmental service logistics and mechanics; and desired expansion of HIV RT training to include LVNs.

Impacts:
The assessment and qualitative analysis of implementing routine HIV RT has important implications for estimating organization impacts associated with operations and changes in care delivery. Local policies (including allowing LVNs to participate in rapid testing) have been initiated. These qualitative findings will be used as the basis of future efforts at implementing routine HIV rapid testing at other local and national VA facilities.