A Formative Evaluation of Organizational Readiness to Implement Nurse-Initiated HIV Rapid Testing in Two Veterans Health Administration Substance Use Disorder Clinics

• Published in: Journal of HIV/AIDS & social services Vol. 9; no. 1; pp. 7 - 26
• Main Authors: Henry, S. Randal, Hagedorn, Hildi J., Feld, Jamie E., Golden, Joya F., Horns, Hana, Knapp, Herschel E., Anaya, Henry D.
• Format: Journal Article
• Language: English
• Published: Taylor & Francis Group 01-01-2010
• Subjects: Acquired Immune Deficiency Syndrome; evaluation; Health; HIV screening and testing; nurse-initiated HIV rapid testing; Organizational Structure; Patients; Substance Abuse; substance use disorder; Veterans
• ISSN: 1538-1501; 1538-151X
• DOI: 10.1080/15381501003661513

Within the Veterans Health Administration, substance use disorder clinics can be important locations for identifying HIV-infected patients. In this formative evaluation we assessed organizational readiness to implement a nurse-initiated HIV rapid test strategy in two Veterans Health Administration substance use disorder clinics. We conducted 34 quantitative surveys and 21 key informant interviews with front-line staff and management to assess attitudes regarding HIV testing in general and nurse-initiated HIV rapid testing specifically. We also assessed potential organizational impediments and facilitators to the implementation of nurse-initiated HIV rapid testing. Staff agreed that nurse-initiated HIV rapid testing is supported by research evidence, clinical experience, and patient need. Staff differed on the degree to which nurse-initiated HIV rapid test strategy fit within the substance use disorder clinic mission. We identified barriers to the implementation of nurse-initiated HIV rapid testing, including resource limitations, concerns of organizational readiness and patient acceptance of the nurse-initiated HIV rapid testing strategy. Despite these hurdles, the clinics are willing to adopt nurse-initiated HIV rapid testing if supported by appropriate modifications in organizational structure, HIV ordering policies, and specific changes in clinical practices.