Rapid Testing & Clinic Flow

1. Rapid Testing & Clinic Flow Analyzing the Integration of HIV Testing into THE FLOW OF Family Planning Clinics January 29, 2009

2. Objectives • Discuss the 2006 CDC Revised recommendations for HIV testing and the benefits of those recommendations to family planning. • Describe how to efficiently integrate HIV pre-test and post-test counseling in to the family planning clinic flow.

3. CDC Recommendations Revised September 2006 Goal is to encourage providers in all healthcare setting to offer routine HIV screening

4. Why Should FP Providers Test? • CDC recommendations are clear that testing is beneficial. • Testing is part of good medical care. • Studies show the patient already thinks we are doing this testing. • Women don’t have a clear understanding of their risks .

5. STD Testing - Women Ages 18 to 44

6. HIV TestingWomen Ages 18 to 44

7. CDC Recommendations Key Differences from Old Guidance • Screening of patients 13 to 64 • High Risk patients should be tested at least annually • Incorporation of HIV Consent into General Medical Consent • HIV Prevention Counseling not REQUIRED

8. Screening Patients 13 to 64 This age group includes the ages of people who are most likely to be infected and not know it

9. Screening High Risk Patients Testing recommended at least annually

10. Consent CDC recommends incorporation of consent for HIV screening into the general medical services consent State Laws - Laws related to HIV testing http://www.ucsf.edu/hivcntr/StateLaws/Index.html

11. Counseling and Screening New recommendations separate counseling from testing in busy health-care settings

12. Impact on Family Planning • Screening patients 13 to 64 • Patients attending family planning are within age range recommended for routine testing • Many FP patients do not have other HCP outside of their FP provider

13. Recommendations • Test “high risk” patients at least annually Any patient presenting with STD symptoms, those that have been diagnosed with an STD or report other “high risk” behavior should always be encouraged to test.

14. CDC Estimate CDC breakdown of time required before testing: • Introduction & orientation (2-4 minutes) • Enhancement of client’s self-perception of risk (2-3 minutes) • Explore most recent risk incident (2-3 minutes) • Review previous risk reduction experiences (2-4 minutes) • Synthesis of risk incident and risk pattern (2-4 minutes) 10-18 minutes total

15. CDC Estimate CDC breakdown of time after Testing • Provide test results (2-10 minutes) • Negotiate risk reduction plan (4-5 minutes) • Identify sources of support and provide additional referrals (3-4 minutes) • Provide appointment card/reminder for follow-up (1 -2 minutes) 10-21 total

16. Realistically How can we add HIV testing with minimal disruption to clinic flow and additional time?

17. Family Planning Experience • Introduction and orientation to the HIV “session” • CDC estimates that this would take between 2 to 4 minutes Actual additional time…none – we already do this

18. Family Planning Experience • Enhancement of clients self-perception of risk CDC estimates that this would take between 2 to 3 minutes Actual additional time …none – we already do this • Explore the specifics of most recent risk incident CDC estimates that this would take between 2 to 3 minutes Actual additional time…none – we already do this

19. Family Planning Experience • Review previous risk reduction experiences • CDC estimates that this would take between 2 to 4 minutes Actual - this should only take 1 to 2 additional minutes

20. Family Planning Experience • Negotiate risk reduction plan • CDC estimates 4 to 5 minutes Actual time… 1 – 2 minutes

21. Family Planning Experience • Identify sources of support and provide additional referrals • CDC estimates 3-4 minutes Actual additional time … likely none • Provide appointment card • CDC estimates 1-2 minutes Actual additional time…30 – 45 seconds

22. Family Planning Experience – A Summary • CDC estimates 20 -39 minutes to do HIV testing • Due to the nature of our work – HIV testing will take approximately an additional 8 to 12 minutes

23. Benefits for Family Planning • Our patients expect to discuss sensitive issues with us • Patients believe that HIV Testing is already occurring

24. Resources • AIDS Education and Training Center National Resource Center – PPT on HIV Screening and Women’s Health curriculumwww.aidsetc.org • Centers for Disease Control and Prevention (CDC) • CDC National Prevention Information Network (NPIN) (800) 458-5231 • CDC National STD/AIDS Hotline • (800) 342-AIDS (English) • (800) 344-7432 (Spanish) • (800) 243-7889 (TTY) • State Laws - Laws related to HIV testing can be found at: http://www.ucsf.edu/hivcntr/StateLaws/Index.html

25. Resources, continued • Health Research and Educational Trust (HRET) • ED HIV Test Guide http://www.edhivtestguide.org/EDHIChoo-4074.html • HRET and CDC • FDA-Approved Rapid HIV Antibody Screening Tests-Purchasing Details http://www.hret.org/hret/programs/content/rpd2.pdfDi • National HIV/AIDS Clinicians’ Consultation Center http://www.ucsf.edu/hivcntr/ • Family Health International • Establishing Referral Networks for Comprehensive HIV Care in Low-Resource Settings http://www.synergyaids.com/documents/RefNetsGuide2.pdf

26. Thank you for your time and interest