Implementation of CDC HIV Implementation of CDC HIV Testing Recommendations: Testing Recommendations:

The AETC PerspectiveThe AETC Perspective

Donna E. Sweet, MD, MACPDonna E. Sweet, MD, MACPProfessor of MedicineProfessor of Medicine

The University of Kansas School of Medicine The University of Kansas School of Medicine - Wichita- Wichita

AETC Activity Snapshot AETC Activity Snapshot July 2006-June 2007July 2006-June 2007

64,500 unduplicated learners 64,500 unduplicated learners 32% 32% RN, ARNP, NPRN, ARNP, NP24%24% MD, PAMD, PA28% 28% OtherOther

AETC Activity Snapshot AETC Activity Snapshot July 2006-June 2007July 2006-June 2007

Top Five Training Topics:Top Five Training Topics:antiretroviral therapyantiretroviral therapydiagnostic tests and disease diagnostic tests and disease

progressionprogressionadherenceadherenceclinical manifestations of HIVclinical manifestations of HIVcomorbiditiescomorbidities

CHEYENNE RAW LINS DECATUR NORTON

SHERMAN THOMAS SHERIDAN GRAHAM ROOKS

WALLACE

GREELEY

HAMIILTON KEARNEY FINNEY

PHILLIPS

LOGAN GOVE TREGO ELLIS

RUSHNESSLANESCOTTWICHITA

HODGEMAN

PAWNEE

STANTON GRANT HASKELL

STEVENS SEWARD

MEADE CLARK

GRAY

FORD

KIOW A

COMANCHE

BARBERHARPER

KINGMAN

PRATT

MORTON

RENO

EDW ARDS

STAF-FORD

RICE

ELLSW ORTH

LINCOLN

MCPHERSON

HARVEY

SEDGWICK

SUMNER

MARION

DICKINSON

CLAY

WASHINGTONREPUBLICJEWELL

MITCHELL

CLOUD

OSBORNE

RUSSELL

BARTON

OTTAW A

SALINE

SMITH MARSHALL NEMAHA BROWN

RILEY

MORRIS

CHASE

BUTLER GREENWOOD

LYON

OSAGE

WABAUNSEE

DOUGLAS

SHAW NEE

GEARY

POTTAWA-TOMIE

JACKSONATCHISON

JEFF-ERSON

JOHNSON

MIAMIFRANKLIN

LEAVEN-WORTH

WYAN-DOTTE

COFFEYANDERSON LINN

WOODSON ALLEN BOURBON

COW LEY

ELK

CHAUTAUQUA

WILSON NEOSHO

CRAWFORD

LABETTECHEROKEE

MONT-GOMERY

DONIPHAN

Kansas Community Planning Regions

89

clinic

clinic

clinic

““I don’t take I don’t take care of those care of those kind of people.”kind of people.”

“We Don’t Have AIDS In My Community!”

The BrochureThe Brochure AETC Mission StatementAETC Mission Statement Project Sponsorship Project Sponsorship Brief program explanationBrief program explanation Program incentivesProgram incentives

Continuing education Continuing education possibilitiespossibilities

MealMeal Resource MaterialsResource Materials ALL FREE!!ALL FREE!!

Reply sectionReply section

Educational MaterialsEducational Materials

Results of the 6 month follow up Results of the 6 month follow up surveysurvey

As a result of/since the KAETC HIV education programAs a result of/since the KAETC HIV education program

attended:attended:

52%52% Providers had seen HIV-infected Providers had seen HIV-infected patientspatients

41%41% Had conducted at least informal risk Had conducted at least informal risk

assessmentsassessments

34%34% Had conducted at least informal sexual Had conducted at least informal sexual

history assessmentshistory assessments

3%3% Had conducted Rapid HIV tests Had conducted Rapid HIV tests

31%31% Had conducted Standard HIV tests Had conducted Standard HIV tests

9%9% Had given Referrals for HIV testing Had given Referrals for HIV testing

Medical Professionals:Medical Professionals: 96%96% would offer routine HIV testing to would offer routine HIV testing to ALLALL the following: the following:

-an apparently healthy but sexually -an apparently healthy but sexually active female active female-a patient presenting with an STD-a patient presenting with an STD-an apparently healthy but sexually -an apparently healthy but sexually active male active male-an apparently healthy pregnant -an apparently healthy pregnant

womanwoman-an apparently healthy patient with a -an apparently healthy patient with a history of recent substance history of recent substance

abuseabuse

Results of the 6 month follow up Results of the 6 month follow up surveysurveyProfession specific questionsProfession specific questions (to check for info retention):(to check for info retention):

San Francisco Area AIDS Education and San Francisco Area AIDS Education and Training Center, University of California, San Training Center, University of California, San FranciscoFranciscoat San Francisco General Hospital at San Francisco General Hospital Curriculum with slides and HandoutCurriculum with slides and Handout

http://www.ucsf.edu/sfaetc/CURRICULA/HIVTESTING.html

HIV Screening and TestingHIV Screening and TestingSan Francisco Area

AIDS Education and Training Center

University of California, San Francisco

at San Francisco General Hospital

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

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

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)

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

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

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

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

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