Implementation of CDC HIV Testing Recommendations: The AETC Perspective

1. Implementation of CDC HIV Testing Recommendations: The AETC Perspective Donna E. Sweet, MD, MACP Professor of Medicine The University of Kansas School of Medicine - Wichita

3. AETC Activity Snapshot July 2006-June 2007 • 64,500 unduplicated learners • 32% RN, ARNP, NP • 24% MD, PA • 28% Other

4. AETC Activity Snapshot July 2006-June 2007 • Top Five Training Topics: • antiretroviral therapy • diagnostic tests and disease progression • adherence • clinical manifestations of HIV • comorbidities

5. 1 3 6 7 4 clinic 2 clinic 9 8 clinic 9 8 5

6. “We Don’t Have AIDS In My Community!” “I don’t take care of those kind of people.”

7. The Brochure • AETC Mission Statement • Project Sponsorship • Brief program explanation • Program incentives • Continuing education possibilities • Meal • Resource Materials • ALL FREE!! • Reply section Targeted Outreach Education Project It is often difficult for health care providers to be out of their offices for extended periods of time and/or to travel long distances in order to attend educational programs. The Targeted Outreach Education Project (TOEP) was developed as a way to provide direct education to health care providers across Kansas by bringing the educational programming to you! These individualized, “targeted” programs will include (but not be limited to) discussions about the basic science and epidemiology of HIV/AIDS, updates on antiretroviral treatment and adverse drug reactions, the need for routine testing, changes in testing theory and methodology, and a hands-on demonstration of the new rapid testing process. Secondary aspects of TOEP are to distribute the newest educational materials and resources on the various aspects of HIV infection, and to conduct an ongoing statewide educational needs assessment. TOEP programs may be done in a variety of ways, the most popular being the 1, 1-1/2, or 2 hour formal presentation, or the “Come and Go” (for those unable to get away for an extended amount of time, TOEP faculty will be available to discuss issues of HIV/AIDS and answer your questions while you get a bite to eat). A meal will be served in conjunction with all programs, a collaborative effort with the Kansas Area Health Education Centers (AHECs) will provide support and continuing education credits for some project participants (formal presentations only), and the program is free of charge!

8. Educational Materials

9. Results of the 6 month follow up survey As a result of/since the KAETC HIV education program attended: 52%Providers had seen HIV-infected patients 41% Had conducted at least informal risk assessments 34% Had conducted at least informal sexual history assessments 3% Had conducted Rapid HIV tests 31% Had conducted Standard HIV tests 9% Had given Referrals for HIV testing

10. Results of the 6 month follow up survey Profession specific questions(to check for info retention): Medical Professionals: 96% would offer routine HIV testing to ALL the following: -an apparently healthy but sexually active female -a patient presenting with an STD -an apparently healthy but sexually active male -an apparently healthy pregnant woman -an apparently healthy patient with a history of recent substance abuse

11. San Francisco Area AIDS Education and Training Center, University of California, San Franciscoat San Francisco General Hospital Curriculum with slides and Handout http://www.ucsf.edu/sfaetc/CURRICULA/HIVTESTING.html

12. New England AETC • Doing a lot of training activities, especially in Mass. and Conn. – L&D, ED, primary care settings • Blending testing with other training topics such as MRSA; utilizing well known/respected presenters • Have had to “sell” the program, but with good response; concerns about informed consent and funding

13. New York / New Jersey AETC • Doing a mix of large collaborative conferences, TA, monographs, and clinical support tools • Prior provider relationships have helped create a demand for training; very positive response • Complications: NY/NJ laws don’t follow Recommendations; concern about funding for test kits and program sustainability

14. Pennsylvania / Mid Atlantic AETC • Level 1 and 2 presentations and TA done in all states; tools created on how to reconcile state laws and Recommendations • HIV Testing is #1 needs assessment request; over 2000 requests • Mixed response: Perceived burden shift from reconciling laws and Recommendations to financial/logistics/time, absence of linkages for, and increased cost of new positives; 50/50 split on informed consent issue (consumers vs. providers)

15. Southeast AETC • On-site training workshops for EDs, FQHCs, and state health department testing funds grantees; Testing Toolkit • Marketing to identified newly funded state testing contracts; spontaneous requests; incorporating info into training updates • Finding that staff buy-in more important than leadership/ administration enthusiasm for successful training; linkage to care and false positive policies needed for new testing sites

16. Florida / Caribbean AETC • Trainings for Corrections RNs; producing training materials for EDs; more focus on Why? and Laws than “How To” • Having to sell the program; materials requested by state health department • Positive response via follow up surveys

17. Midwest ATEC • Collaborative programming, TA, material/product development • Marketing program; development of materials requested by state health department • Acceptance of Recommendations spreading, especially in EDs; funding for test kits is a strong concern

18. Pacific AETC • Development of resource manuals for testing implementation in L&D hospitals and primary care CHCs • Integrating pieces into all training and TA • Mostly positive response to curriculum in both product and approach; some resistance

19. Common Threads • Recommendations integrated into existing programming • Multi-faceted implementation strategies: direct training, materials development, TA • About 50/50 “selling” program vs. spontaneous request • Mostly positive response, but some resistance • Common Concerns : • State laws vs. Recommendations • Funding for test kits and increased case loads • False positive rates in low incidence areas