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HIV Counseling, Testing and Referral (CTR) Services at Boston Medical Center

HIV Counseling, Testing and Referral (CTR) Services at Boston Medical Center. Center for HIV/AIDS Care and Research (CHACR). Vanessa J. Sasso, MSW Manager, HIV CTR Program. Background. Over 1 million people are living with HIV in the US Approximately 25% don’t know it

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HIV Counseling, Testing and Referral (CTR) Services at Boston Medical Center

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  1. HIV Counseling, Testing and Referral (CTR) Services at Boston Medical Center Center for HIV/AIDS Care and Research (CHACR) Vanessa J. Sasso, MSW Manager, HIV CTR Program

  2. Background • Over 1 million people are living with HIV in the US • Approximately 25% don’t know it • Approximately 40K new cases of HIV per year • 40 - 50% of all new HIV cases develop AIDS within 1 year of first testing HIV positive CDC

  3. Major Objectives of our CTR Program • Find all HIV+ patients • Link all HIV+ patients to care • Prevent new cases of HIV

  4. Testing Sites at BMC • Adult Primary Care Clinic • Patients mostly referred by physicians/ Some routine testing • Project TRUST Drop-in Center • Harm reduction center/ Clients acknowledge risk • Other: Community venues i.e. Dimock Detox, BPHC Needle Exchange Van, MALE Center • Urgent Care Center / ED • Hierarchical routine screening/ Patients typically don’t utilize PCP’s • Inpatient Medical Service • Hierarchical routine screening/ Some physician referrals • Public Health STD Clinic • All patients receiving STD screens offered HIV CTR

  5. Program Data (2006)

  6. Overview • One of the first CTR sites in the nation • Largest case reporter in MA • High volume testing program • Originally only drop in testing; now fully integrated into medical system • Pioneered routine hospital based testing • Piloted Urgent Care/Emergency Room testing • Piloted rapid testing for MDPH

  7. Testing “Technologies” Offered • Traditional • Venipuncture • OMT (OraSure) • Rapid Testing (OraQuick Advance)

  8. Rapid vs. Traditional • With Traditional Tests: • Pre-test Counseling Session (Visit #1) • 2 weeks for result to come back • HIV counselor can prepare for positive results and plan for linkage to care • Post-test Counseling Session (Visit #2) • Loss to follow-up: ~85% overall return rate within our program, CDC reports a national average of ~30%

  9. Rapid vs. Traditional • With Rapid Tests: • Same day test results • No “preparation time” for HIV Counselor • Explanation of test result meaning • Negative • Preliminary positive and/or Reactive • Essentially 100% of negatives get results • Immediate linkage to care

  10. Pre-test Counseling Changes • It is now one visit (pre- and post-test counseling in one visit) • Patient acceptance and competency for testing assessed initially • Consent form must specify need for confirmatory serum sample (Patient needs to understand RT is a screening tool) • Risk/demographic data collected while test is running • If reactive/preliminary positive, immediate blood draw and linkage to care occurs

  11. Rapid vs. Traditional • Monthly we are doing ~100% rapid testing • Linkage to care for HIV+ increased from 85% to ~100% • Community satisfaction!

  12. Implementation of Rapid Testing • Specialized staff training • Coordination with BMC’s Department of Laboratory Medicine and MDPH

  13. Rapid Testing Roll-Out Staff Training • Rapid Test Trainings: • Massachusetts Department of Public Health (MDPH) • BMC’s Department of Laboratory Medicine • Counselors now wear two hats: Counselor and Lab Tech!

  14. Laboratory Medicine • Buy-in and support from Laboratory Director • CLIA • Point of Care Coordinator • Monitors QA/QC • Trains and evaluates Counselors; Approves competency and ongoing proficiency • Approves paperwork and documentation • Enters results into BMC medical records

  15. Logistics • Designed special rolling mobile testing carts • proper lighting, temperature and work space • Lid on the cart can be closed while test is running so counselor and/or patient is not distracted • Counselors are now delivering a preliminary diagnosis to the client • More staff time is dedicated to paperwork and performing the test • Storage and cost of kits and controls

  16. Conclusion • Dedicated staff instrumental • Major institutional commitment required • Laboratory support and involvement crucial • Actual supply costs high • Inpatient and outpatient clinical areas well suited for hierarchical routine testing • Routine testing facilitates testing and improves case identification • Linkage to care for HIV+ patients is crucial and rapid testing helps facilitate immediate linkage to care

  17. Acknowledgements Collaborators Funding • Paul Skolnik • Jon Hall • Jeff Greenwald • Kim Gregory • Joann Crain • All of the 11 HIV Counselors • MDPH • CDC • BMC

  18. QUESTIONS?

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