HIV ANTIBODY TESTING - THE GAP BETWEEN POLICY AND PRACTICE

In response to recent laws regulating human immunodeficiency virus (HI V) antibody testing practices in all federal hospitals, our university -affiliated Veterans Affairs Hospital instituted several interventions designed to increase appropriate testing. Specific hospital policy re quiring restriction of testing to high-risk individuals, provision of pre- and posttest counseling, and documentation of written consent was instituted. In addition, an education campaign to inform physicians o f hospital policy and training of counselors as physician extenders wa s undertaken. To determine the efficacy of these interventions, we rev iewed all HIV antibody tests performed during a subsequent six-month p eriod (n = 221). Only 14% of tests met all hospital policy requirement s. The decision to test was prompted by identification of a risk facto r or other acceptable reason for testing for only 31% of patients. Ris k reduction counseling was provided for only 28% of patients. Written consent was documented for 62% of patients. Health care providers on s urgical services were less likely than others to comply with hospital policy (p < 0.0001). We conclude that an interventional program includ ing specific hospital policy mandates, physician education, and provis ion of trained counselors was not adequate to ensure optimal HIV antib ody testing practices. If this gap between policy and practice is to b e closed, additional interventions, or alternatively modification of p olicy guidelines, will be needed.