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HIV Testing of At Risk Patients in a Large Integrated Health Care System

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Abstract

Objective

Early identification of HIV infection is critical for patients to receive life-prolonging treatment and risk-reduction counseling. Understanding HIV screening practices and barriers to HIV testing is an important prelude to designing successful HIV screening programs. Our objective was to evaluate current practice patterns for identification of HIV.

Methods

We used a retrospective cohort analysis of 13,991 at-risk patients seen at 4 large Department of Veterans Affairs (VA) health-care systems. We also reviewed 1,100 medical records of tested patients. We assessed HIV testing rates among at-risk patients, the rationale for HIV testing, and predictors of HIV testing and of HIV infection.

Results

Of the 13,991 patients at risk for HIV, only 36% had been HIV-tested. The prevalence of HIV ranged from 1% to 20% among tested patients at the 4 sites. Approximately 90% of patients who were tested had a documented reason for testing.

Conclusion

One-half to two-thirds of patients at risk for HIV had not been tested within our selected VA sites. Among tested patients, the rationale for HIV testing was well documented. Further testing of at-risk patients could clearly benefit patients who have unidentified HIV infection by providing earlier access to life-prolonging therapy.

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Acknowledgments

This research was supported by the Health Services Research and Development Service, Department of Veterans Affairs (HII-99047-1), and in part by the National Institute of Health, National Institute on Drug Abuse (grant R01 DA15612-01). The views expressed here are those of the authors and do not necessarily reflect those of the Department of Veterans Affairs. This work was presented in part as an abstract at the 2002 conference of the Society for Medical Decision Making (Owens DK, Sundaram V, Lazzeroni LC, Douglass LR, Tempio P, Sanders GD, Holodniy M. HIV testing appropriateness and predictors of HIV infection in department of veterans affairs health care systems. Medical Decision Making 2002; 22:534).

Potential Financial Conflicts of Interest

None disclosed.

Author information

Authors and Affiliations

  1. VA Palo Alto Healthcare System, Palo Alto, CA, USA

    Douglas K. Owens MD, MS, Vandana Sundaram MPH, Lena R. Douglass BS, Patricia Tempio BS, Mark Holodniy MD & Leila H. Borowsky MPH

  2. Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University, 117 Encina Commons, Stanford, CA, 94305-6019, USA

    Douglas K. Owens MD, MS, Vandana Sundaram MPH & Gillian D. Sanders PhD

  3. Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, CA, USA

    Laura C. Lazzeroni PhD

  4. Division of Infectious Diseases & Geographic Medicine, Stanford School of Medicine, Stanford, CA, USA

    Mark Holodniy MD

  5. Duke Clinical Research Institute, Duke University, Durham, NC, USA

    Gillian D. Sanders PhD

  6. VA San Francisco Healthcare System, San Francisco, CA, USA

    Vera M. Shadle MHA, MHS & Peter Jensen MD

  7. VA San Diego Healthcare System, San Diego, CA, USA

    Valerie C. McWhorter MD, Teodora Agoncillo BS & Samuel A. Bozzette MD, PhD

  8. VA New York Harbor Healthcare System, New York, NY, USA

    Noreen Haren MPH, Darlene Chavis & Michael S. Simberkoff MD

  9. VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA

    Elizabeth M. Yano PhD

  10. Department of Health Services, UCLA School of Public Health, Los Angeles, CA, USA

    Elizabeth M. Yano PhD

Authors
  1. Douglas K. Owens MD, MS
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  2. Vandana Sundaram MPH
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  3. Laura C. Lazzeroni PhD
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  4. Lena R. Douglass BS
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  5. Patricia Tempio BS
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  6. Mark Holodniy MD
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  7. Gillian D. Sanders PhD
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  8. Vera M. Shadle MHA, MHS
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  9. Valerie C. McWhorter MD
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  10. Teodora Agoncillo BS
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  11. Noreen Haren MPH
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  12. Darlene Chavis
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  13. Leila H. Borowsky MPH
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  14. Elizabeth M. Yano PhD
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  15. Peter Jensen MD
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  16. Michael S. Simberkoff MD
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  17. Samuel A. Bozzette MD, PhD
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Corresponding author

Correspondence to Douglas K. Owens MD, MS.

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Owens, D.K., Sundaram, V., Lazzeroni, L.C. et al. HIV Testing of At Risk Patients in a Large Integrated Health Care System. J GEN INTERN MED 22, 315–320 (2007). https://doi.org/10.1007/s11606-006-0028-9

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  • DOI: https://doi.org/10.1007/s11606-006-0028-9

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