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Routine HIV Screening in Health Care Settings

Routine HIV Screening in Health Care Settings. Overcoming Barriers to Routine HIV Screening . David Spach, MD Clinical Director Northwest AIDS Education and Training Center Professor of Medicine, Division of Infectious Diseases University of Washington Seattle.

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Routine HIV Screening in Health Care Settings

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  1. Routine HIV Screening in Health Care Settings Overcoming Barriers to Routine HIV Screening David Spach, MDClinical DirectorNorthwest AIDS Education and Training CenterProfessor of Medicine, Division of Infectious DiseasesUniversity of Washington Seattle This project was funded under cooperative agreement number U65/PS000821from the Centers for Disease Control and Prevention (CDC). 

  2. Overcoming Barriers to Routine ScreeningSummary of Key Recommendations • Logistical Issues in Clinical Settings • Inadequate Reimbursement for Testing • Lack of Adequate Education on HIV Testing • State Laws may Conflict with CDC Recommendations • Concerns for Cost-effectiveness of Routine Screening

  3. Overcoming Barriers to Routine ScreeningSummary of Key Recommendations • Logistical Issues in Clinical Settings • Inadequate Reimbursement for Testing • Lack of Adequate Education on HIV Testing • State Laws may Conflict with CDC Recommendations • Concerns for Cost-effectiveness of Routine Screening

  4. Overcoming Barriers to Routine ScreeningLogistical Issues in the Clinical Setting

  5. Potential Barriers to Routine Screening in Multiple Health Care Settings

  6. Analysis of Barriers to Routine Screeningin Multiple Health Care Settings Prenatal EmergencyDepartment Other MedicalSettings Source: Burke RC, et al. AIDS. 2007;21: 1617-24.

  7. Analysis of Barriers to Routine Screeningin Multiple Health Care Settings Prenatal EmergencyDepartment • Insufficient Time • Burdensome Consent Process • Perception that Clients had Low HIV Risk Other MedicalSettings Source: Burke RC, et al. AIDS. 2007;21: 1617-24.

  8. Overcoming Logistical Issues in Clinical Settings Written Consent ShouldNot be Required Prevention Counseling Not Required in Conjunction with HIV Screening Routine HIV Screening for All Patients Aged 13-64 Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  9. Overcoming Logistical Issues in Clinical Settings Source: Zetola NM, et al. PLOS. 2007;21:1617-24.

  10. Impact of Simplified HIV Consent Process on HIV Testing Rates Source: Zetola NM, et al. PLOS. 2007;21:1617-24.

  11. Impact of Simplified HIV Consent Process on HIV Testing Rates Source: Zetola NM, et al. PLOS. 2007;21:1617-24.

  12. Overcoming Barriers to Routine ScreeningSummary of Key Recommendations • Logistical Issues in Clinical Settings • Inadequate Reimbursement for Testing • Lack of Adequate Education on HIV Testing • State Laws may Conflict with CDC Recommendations • Concerns for Cost-effectiveness of Routine Screening

  13. Reimbursement for HIV Testing Source: CDC. MMWR 2006;55(no. RR-14):1-17.

  14. Reimbursement for HIV Testing2009 Medicare & Medicaid Coverage www.cms.hhs.gov/mcd/viewtrackingsheet.asp?from2=viewtrackingsheet.asp&id=229&

  15. Reimbursement for HIV TestingAmerican Academy of HIV Medicine Coding Guidelines http://www.aahivm.org/

  16. Reimbursement for HIV TestingAmerican Academy of HIV Medicine Coding Guidelines CPT Codes http://www.aahivm.org/

  17. Overcoming Barriers to Routine ScreeningSummary of Key Recommendations • Logistical Issues in Clinical Settings • Inadequate Reimbursement for Testing • Lack of Adequate Education on HIV Testing • State Laws may Conflict with CDC Recommendations • Concerns for Cost-effectiveness of Routine Screening

  18. Lack of Adequate Education on HIV Testing Lack of Awareness of CDC Recommendations for HIV Screening Misperception Regarding Client Acceptance Lack of Training on Interpreting Results

  19. Educational Resources for HIV TestingCDC HIV Testing in Healthcare Settings Website http://www.cdc.gov/hiv/topics/testing/healthcare/index.htm

  20. Educational Resources for HIV TestingAIDS Education and Training Centers (AETC) Regional AETCs AETC National Resource Center http://www.aids-etc.org/

  21. Educational Resources for HIV TestingNational HIV/AIDS Clinicians’ Consultation Center http://www.nccc.ucsf.edu/home

  22. Overcoming Barriers to Routine ScreeningSummary of Key Recommendations • Logistical Issues in Clinical Settings • Inadequate Reimbursement for Testing • Lack of Adequate Education on HIV Testing • State Laws may Conflict with CDC Recommendations • Concerns for Cost-effectiveness of Routine Screening

  23. State Specific HIV Testing Laws

  24. State Specific HIV Testing LawsVariable Compatibility with CDC Recommendations

  25. Information on State Specific HIV Testing LawsNCC Compendium of State Testing Laws http://www.nccc.ucsf.edu/consultation_library/state_hiv_testing_laws/

  26. Overcoming Barriers to Routine ScreeningSummary of Key Recommendations • Logistical Issues in Clinical Settings • Inadequate Reimbursement for Testing • Lack of Adequate Education on HIV Testing • State Laws may Conflict with CDC Recommendations • Concerns for Cost-effectiveness of Routine Screening

  27. Overcoming Barriers to Routine ScreeningSummary of Key Recommendations • Logistical Issues in Clinical Settings • Inadequate Reimbursement for Testing • Lack of Adequate Education on HIV Testing • State Laws may Conflict with CDC Recommendations • Concerns for Cost-effectiveness of Routine Screening

  28. Cost Effectiveness of HIV Screening in HAART Era Source: Sanders GD, et al. N Engl J Med. 2005;352:570-85.

  29. Cost Effectiveness of HIV Screening in HAART EraStudy Background • Markov decision model - Used to estimate health benefits and costs of performing voluntary HIV screening in health care settings • Model factors - Voluntary HIV screening of a population - Natural history of HIV and AIDS - Costs and health consequences of transmission of HIV - Costs and health consequences of HAART Source: Sanders GD, et al. N Engl J Med. 2005;352:570-85.

  30. Cost Effectiveness of HIV Screening in HAART EraResults: Analysis of One Time Screening Cost and benefit to partner excluded Incremental Cost-Effectiveness of Screening ($/quality-adjusted life-years) Prevalence of Unidentified HIV (%) Sensitivity Analysis of the Effect of the Prevalence of Unidentified HIV on the Incremental Cost-Effectiveness of One-Time Screening, as Compared with Current Practice New Sexual Relationship Source: Sanders GD, et al. N Engl J Med. 2005;352:570-85. Figure Reproduced with permission from the Massachusetts Medical Society

  31. Cost Effectiveness of HIV Screening in HAART EraResults: Analysis of One Time Screening Cost and benefit to partner excluded Incremental Cost-Effectiveness of Screening ($/quality-adjusted life-years) Prevalence of Unidentified HIV (%) Sensitivity Analysis of the Effect of the Prevalence of Unidentified HIV on the Incremental Cost-Effectiveness of One-Time Screening, as Compared with Current Practice New Sexual Relationship Source: Sanders GD, et al. N Engl J Med. 2005;352:570-85. Figure Reproduced with permission from the Massachusetts Medical Society

  32. Cost Effectiveness of HIV Screening in HAART EraResults: Analysis of One Time Screening Cost and benefit to partner excluded Cost and benefit to partner included Incremental Cost-Effectiveness of Screening ($/quality-adjusted life-years) Prevalence of Unidentified HIV (%) Sensitivity Analysis of the Effect of the Prevalence of Unidentified HIV on the Incremental Cost-Effectiveness of One-Time Screening, as Compared with Current Practice New Sexual Relationship Source: Sanders GD, et al. N Engl J Med. 2005;352:570-85. Figure Reproduced with permission from the Massachusetts Medical Society

  33. Cost Effectiveness of HIV Screening in HAART EraConclusion “… the cost-effectiveness of screening is well within the range of that of other commonly accepted health care interventions.” Source: Sanders GD, et al. N Engl J Med. 2005;352:570-85.

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

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