VA already is the nation’s largest provider of HIV care in the nation, treating more than 24,000 veterans who have tested positive for the virus, and that number is certain to increase with a program to dramatically increase screening of veterans.

That is a positive, according to Maggie Czarnogorski, MD, deputy director, Clinical Public Health Programs, Office of Public Health, Department of Veterans Affairs, because early diagnosis improves the chance of the patient living a long and healthy life and helps limit transmission to others.

VA increased the total number of tests conducted by 140% from 2009 to 2010 (141,337 to 342,293), she says.

In a paper presented by James Halloran, RN, of VA’s Public Health Strategic Healthcare Group, it was noted that the number of veterans tested in 2009 represented only 2.5% of VA’s more than 5.7 million outpatients, and that of all outpatients 524,735 — or 9.2% — had been tested for the virus by VA physicians. However, in 2010, the increase in testing meant that 13.6% of the outpatients had ever been tested for the virus.

Two major policy changes in 2009 enabled significant changes, Czarnogorski explain. The first, she says, was the elimination of the requirement that VA seeks written informed consent and offers counseling before and after the screening test. “It is still the veteran’s choice, but consent can be verbal,” she explains. “It’s important to note that we still require consent; it needs to be written in the record, and written information about HIV tests needs to be provided before the test.”

The other change, she says, was the elimination of a risk-based testing policy and the move to routine testing. VA now expects all veterans to be offered the test at least once in their lifetime, and annually for those with ongoing risk factors. “Until the change was made, it was difficult to promote HIV screening,” says Czarnogorski.