Routine HIV Screening in - PowerPoint Presentation

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Routine HIV

Screening in Health Care Settings

David Spach, MD

Clinical DirectorNorthwest AIDS Education and Training CenterProfessor of Medicine, Division of Infectious DiseasesUniversity of Washington Seattle

This project was funded under cooperative agreement number U65/PS000821

from the Centers for Disease Control and Prevention (CDC). 

Counseling and Linking to Care

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Counseling and Linking to Care

C

ommunicating HIV Test Results

Counseling and Connecting to Services Importance of Engagement in Care Resources for Referral

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Counseling and Linking to Care

C

ommunicating HIV Test Results

Counseling and Connecting to Services Importance of Engagement in Care Resources for Referral

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Communicating Test Results

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Communicating a

Negative HIV Test Result

Does not require direct personal contact Counsel high-risk persons

- Periodic retesting for high risk persons

- HIV prevention measures

HIV Negative

-

Source: CDC. MMWR 2006;55(RR-14):1-17.

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Communicating a

Positive HIV Test Result

Provide result by direct personal contact Disclose result

confidentially

Ensure client understands test result

Positive

+

Source: CDC. MMWR 2006;55(RR-14):1-17.

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Communicating a

Preliminary Positive HIV Test

Reactive Rapid HIV Test Result

Provide result by direct personal contact

Explain result is a preliminary positive Explain that HIV has

not

been confirmed Discuss importance of follow-up testing

+

Preliminary Positive

Source: CDC. MMWR 2006;55(RR-14):1-17.

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Communicating

Indeterminate HIV Test Result

Provide result by direct personal contact

Explain test results are unclear

Ask about recent exposure to HIV

Discuss importance of follow-up testing

Indeterminate

?

Source: CDC. MMWR 2006;55(RR-14):1-17.

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Counseling and Linking to Care

C

ommunicating HIV Test Results Counseling and Connecting to Services Importance of Engagement in Care

Resources for Referral

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Counseling a Client with Newly Diagnosed HIV

Provide basic information about HIV & AIDS

Explain effective treatments available for HIV Discuss reducing risk of HIV transmission to others

HIV-Infected

+

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Connecting to Services

HIV-Infected

+

Support Services

HIV Prevention Services

Clinical Care

Source: CDC. MMWR. 2006;55(RR-14):1-17.

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Reporting and Notification

Source: CDC. MMWR. 2006;55(RR-14):1-17.

HIV-Infected

+

Document HIV Test

Result

Partner Notification

Report HIV to Health Department

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Connecting to Services, Reporting, & Notification

Source: CDC. MMWR. 2006;55(RR-14):1-17.

HIV-Infected

+

Support Services

HIV Prevention Services

Clinical Care

Reporting and Notification

Document HIV Test Result

Partner Notification

Report HIV to Health Department

Connecting to Services

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CDC 2008 Recommendations for Partner Services

Source: CDC. MMWR 2008;57:1-63.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e1030a1.htm

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Counseling and Linking to Care

C

ommunicating HIV Test Results Counseling and Connecting to Services Importance of Engagement in Care

Resources for Referral

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Linkage to Medical Care After a New HIV Diagnosis

Source:

Torian

LV, et al. Arch Intern Med. 2008;168:1181-7.

New York City

Persons newly diagnosed with HIV infection in NYC (

n = 1,928)Routine surveillance to determine time to initiation of care

New York

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Linkage to Medical Care After a New HIV Diagnosis

Source:

Torian

LV, et al. Arch Intern Med. 2008;168:1181-7.

Within 3 Months

Later than 3 Months

Never

64%

19%

17%

Analysis: Time to Initiation of Care

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Linkage to Medical Care After a New HIV Diagnosis

Source:

Torian

LV, et al. Arch Intern Med. 2008;168:1181-7.

64%

19%

17%

“Predictors for delayed care were as follows:

(1) diagnosis at a community testing site, city correctional system,

or

Department

of Health sexually transmitted diseases or

tuberculosis

clinics

versus a site with

colocated

primary medical care;

(2) injection drug use; and

(3) location of birth outside the United States.”

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Sequential Pathway of HIV Testing

Source:

Walensky

RP, et al. Clin Infect Dis. 2007;45(Suppl 4):S248-54.

Client agrees to undergo HIV testing

Health care

professional recommends HIV

test

Client receives HIV test result

If HIV-infected,

client linked to appropriate care site

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Sequential Pathway of HIV Testing

Source:

Walensky

RP, et al. Clin Infect Dis. 2007;45(Suppl 4):S248-54.

Client agrees to undergo HIV testing

Health care professional

recommends HIV

test

Client receives HIV test result

If HIV-infected,

client linked to appropriate care site

Linking to care: critical element in making routine HIV screening cost effective

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Counseling and Linking to Care

C

ommunicating HIV Test Results Counseling and Connecting to Services Importance of Engagement in Care

Resources for Referral

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Resources for Linking to Care

Health Resources Services Administration (HRSA)

American Academy of HIV Medicine (AAHIVM) AIDS Education and Training Centers (AETC) HIV Medicine Association (HIVMA)

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HRSA: Ryan White-Funded Clinics

http://

hab.hrsa.gov

/

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Locating Ryan White-Funded Clinics

http://

granteefind.hrsa.gov/searchbyprogram.aspx?select

=H76&index=192&year=

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American Academy of HIV Medicine: Find a Provider

http://

www.aahivm.org/index.php?option

=com_comprofiler&task=

usersList

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American Academy of HIV Medicine

Review of Best Practices and Primer for Clinicians

http://

www.aahivm.org/index.php?option

=

com_content&task

=

category&sectionid

=4&id=194&Itemid=253

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Educational Resources for HIV Testing

AIDS Education and Training Centers (AETC)

http://www.aids-etc.org

/

Regional

AETCs

AETC National Resource Center

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HIV Medicine Association (HIMVA)

http://

www.hivma.org

/

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Acknowledgement

The project was funded under cooperative agreement number U65/PS000821 from the Centers for Disease Control and Prevention (CDC).