CDC Testing Recommendations: What Are the Training Implications?

1. CDC Testing Recommendations: What Are the Training Implications? Kathleen Clanon, MD Amanda Newstetter, MSW October 2, 2007

2. Agenda Overview • Introduction • Challenges of teaching the new recommendations • Small group discussion of training activities, barriers, successes • Large group debriefing and discussion about follow-up plans

3. Objectives After this session, participants will be able to: • Explain the rationale for CDC’s revised testing recommendations • Identify targetted care settings • List care sites’ implementation challenges • Identify two resources to assist with implementation issues • Develop a strategy for prioritizing audiences for training and technical assistance.

4. New/Revised CDC HIVScreening Recommendations • Routine HIV screening test for all persons 13-64 in health care settings, not based on risk • Opt-out design; include HIV test consent with general consent for care • Delinking of traditional prevention counseling from testing. Revised Recommendationsfor HIV Testing - CDC 9/06 CA Health and SafetyCode Sec. 120990

5. Points for Clarification • The new recommendations don’t specify RAPID TESTING, they address ROUTINIZING TESTING, whether rapid or not. • The new/revised recommendations apply to testing in medical settings, and NOT to testing that is paid for via the California State Office of AIDS Counseling and Testing program.

6. Rationale for the Change in Recommendations • Increased case finding • Earlier case finding, so better response to HIV treatment • Prevention of spread

7. Experts among us… How many people here have planned or delivered a training on the CDC recommendations? -Yes -No

8. Choosing Our Audiences Need and impact approach • STD clinics • Labor & delivery units • Urgent care/EDs • Primary care • Substance abuse clinics

9. Choosing Our Audiences Ease of implementation approach • Ryan White recipients • Inpatient/labor & delivery units • STD/Family Planning clinics • Primary care sites • CHCs

10. Choosing Our Audiences AETC/LPS priorities approach • Sites serving the Latino community • Sites serving other minorities • Sites indigent population • Sites serving other underserved populations

11. How Are You Choosing Your Training Audiences? • Need/potential impact approach • Ease of implementation approach • AETC/LPS strategic priorities approach

12. Implementation Issues: What Barriers are our Audiences Facing? • Consent Issues • Opt-in/Opt-out • State differences in law • The consent debate: Exceptionalism v. routinization • Confidentiality and chart documentation • Scope of practice issues

13. Implementation Issues (cont) • Performing the test in a busy clinic -Cost and reimbursement -Patient flow issues -Rapid v. non-rapid test • Communicating results and linking to care

14. Consent Issues • These CDC recommendations do not supersede state and local laws that govern HIV testing. • Legal requirements related to informed consent and pretest counseling differ among states. • Proof of consent may be important to preserve in settings where capacity to consent is questionable or population is vulnerable. MMWR Sept 2006; 55 (RR14): 1-17- AETC NRC 1/07

15. Assembly Bill 682Pending Changes to CA Law

16. Consent Issues: The Debate Exceptionalism vs. Routinization

17. Training Challenges Which of the following do you feel poses the largest training challenge? -Audiences don’t see this as their job -Lack of support/concern about the recommendations -Practical challenges ($, flow, etc.) -New audience for us, no connections

18. Training and Other Resources SEERESOURCESDOCUMENT

19. Next up: Sharing Information • 5 minutes: Fill out the experience form • 20 minutes: Small group discussion • 10 minutes: Report back