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Routine HIV Screening in Health Care Settings

Routine HIV Screening in Health Care Settings. Counseling and Linking to Care. 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 Counseling and Linking to Care 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. Counseling and Linking to Care • Communicating HIV Test Results • Counseling and Connecting to Services • Importance of Engagement in Care • Resources for Referral

  3. Counseling and Linking to Care • Communicating HIV Test Results • Counseling and Connecting to Services • Importance of Engagement in Care • Resources for Referral

  4. Communicating Test Results

  5. 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.

  6. 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.

  7. Communicating a Preliminary Positive HIV TestReactive 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.

  8. 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.

  9. Counseling and Linking to Care • Communicating HIV Test Results • Counseling and Connecting to Services • Importance of Engagement in Care • Resources for Referral

  10. 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

  11. Connecting to Services Clinical Care + Support Services HIV Prevention Services HIV-Infected Source: CDC. MMWR. 2006;55(RR-14):1-17.

  12. Reporting and Notification Document HIV Test Result + Report HIV to Health Department Partner Notification HIV-Infected Source: CDC. MMWR. 2006;55(RR-14):1-17.

  13. Connecting to Services, Reporting, & Notification Reporting and Notification Connecting to Services Document HIV Test Result Clinical Care + Report HIV to Health Department Support Services Partner Notification HIV Prevention Services HIV-Infected Source: CDC. MMWR. 2006;55(RR-14):1-17.

  14. CDC 2008 Recommendations for Partner Services http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e1030a1.htm Source: CDC. MMWR 2008;57:1-63.

  15. Counseling and Linking to Care • Communicating HIV Test Results • Counseling and Connecting to Services • Importance of Engagement in Care • Resources for Referral

  16. Linkage to Medical Care After a New HIV Diagnosis New York New York City Persons newly diagnosed with HIV infection in NYC (n = 1,928) Routine surveillance to determine time to initiation of care Source: Torian LV, et al. Arch Intern Med. 2008;168:1181-7.

  17. Linkage to Medical Care After a New HIV Diagnosis Never 17% Later than 3 Months 19% Within 3 Months 64% Analysis: Time to Initiation of Care Source: Torian LV, et al. Arch Intern Med. 2008;168:1181-7.

  18. Linkage to Medical Care After a New HIV Diagnosis 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.” 19% 64% Source: Torian LV, et al. Arch Intern Med. 2008;168:1181-7.

  19. Sequential Pathway of HIV Testing Health care professional recommends HIV test Client agrees to undergo HIV testing Client receives HIV test result If HIV-infected, client linked to appropriate care site Source: Walensky RP, et al. Clin Infect Dis. 2007;45(Suppl 4):S248-54.

  20. Sequential Pathway of HIV Testing Health care professional recommends HIV test Client agrees to undergo HIV testing 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 Source: Walensky RP, et al. Clin Infect Dis. 2007;45(Suppl 4):S248-54.

  21. Counseling and Linking to Care • Communicating HIV Test Results • Counseling and Connecting to Services • Importance of Engagement in Care • Resources for Referral

  22. 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)

  23. HRSA: Ryan White-Funded Clinics http://hab.hrsa.gov/

  24. Locating Ryan White-Funded Clinics http://granteefind.hrsa.gov/searchbyprogram.aspx?select=H76&index=192&year=

  25. American Academy of HIV Medicine: Find a Provider http://www.aahivm.org/index.php?option=com_comprofiler&task=usersList

  26. American Academy of HIV MedicineReview of Best Practices and Primer for Clinicians http://www.aahivm.org/index.php?option=com_content&task=category&sectionid=4&id=194&Itemid=253

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

  28. HIV Medicine Association (HIMVA) http://www.hivma.org/

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

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