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Overview
Strategies 2 and 3 of the Advancing HIV
Prevention Initiative focus on the
implementation of new models for diagnosing
HIV infections and testing those who are
known to have had potentially infectious
contact with HIV-positive partners. Most
jurisdictions currently offer partner
counseling, testing, and referral services (PCTRS),
through which partners are identified,
counseled, and referred, but often clients
do not follow through with testing. The
recently approved OraQuick® rapid test,
suitable for point-of-care use in field
conditions, presents the opportunity to
increase the number of completed tests as
part of partner notification programs.
Six health departments were awarded
2-year contracts totaling $2.7 million to
conduct demonstration projects that use HIV
rapid testing to improve PCTRS outcomes.
PCTRS provides an opportunity for
HIV-infected persons to notify their sex or
drug using partners of exposure to HIV.
After locating and informing current and
past sex or injection drug using partners of
their exposure to HIV, disease investigation
specialists (DISs) will use a variety of
PCTRS models to offer HIV counseling and
testing to affected partners.
Goals
The goals of this project are to
demonstrate
- the feasibility of conducting rapid
HIV testing within field-based PCTRS,
- alternative approaches to traditional
PCTRS,
- the increased yield of contacts using
continuous PCTRS for HIV-infected
persons who continue to use injection
drugs or be sexually active, and
- effective linkages of persons
diagnosed with HIV through PCTRS to
medical evaluation, treatment,
prevention, and other appropriate
services.
Collaborator Projects
Colorado’s project is a
statewide program offering standard PCTRS.
Colorado is adding the rapid test, which it
will administer at health departments as
well as in clients’ homes and
cars—wherever clients feel most
comfortable. The project will focus on care
for HIV-positive partners, and will also
expand its reach by looking at social
networks of HIV-positive clients.
Chicago is offering
expanded PCTRS, involving 10–15
community-based organizations (CBOs), as
well as 10 of its 39 DISs. Chicago’s
project will offer the rapid test to anyone
who requests it at a participating CBO. When
someone tests positive, a DIS will go out
into the field, locate the partners, and
test them. The project will also use DISs at
other clinics (e.g., STD clinics) to help
identify partners of those who test positive
for HIV in the clinics.
Los Angeles’ program is
similar to Chicago’s. Los Angeles will
work with CBOs (The LA Gay and Lesbian
Center, The AIDS Healthcare Foundation, and
LA Shanti) to offer rapid testing. PCTRS
liaisons will use two avenues to recruit
clients: psychosocial-based services and
medical services. The PCTRS liaisons will
act as DISs based at the CBOs.
Louisiana will offer
traditional PCTRS. Two DISs have been hired
specifically for this project and will be
based in Baton Rouge and New Orleans.
Louisiana will offer rapid testing and has
identified the summer heat as one of its
challenges to testing in the field.
San Francisco is very
different from the other sites in the
project. San Francisco has historically had
a low acceptance of PCTRS. As part of this
demonstration project, San Francisco is
producing flyers and brochures and providing
training to spread the word about PCTRS.
Services are being offered in two ways:
- Traditional PCTRS is still offered at
the San Francisco City Clinic, in which
DISs go out into the community to locate
and test partners of HIV-positive
clients.
- The partner disclosure assistance
program (PDAP) is a client-centered
approach that encourages persons who are
HIV-positive to contact current or past
partners, either in person or via the
Internet, and conduct PCTRS themselves.
Clients are given the tools they need,
including form letters and testing cards
for the partners, which can be used for
free rapid HIV tests.
Wisconsin will offer
traditional PCTRS in most of the state. Not
every city will have a DIS, but those
without these specialists will use the
services of DISs in nearby cities.
Project Milestones
- Funding announcement: April 2003
- Selection of contractors: July 2003
- Investigator meetings: November 2003
- Rapid test implementation: April 2004
for most sites
- Site visits: November 2003 –
February 2004 for implementation site
visits;
other site visits will be planned as
needed.
Data Collection
The project will use CDC-supplied data
forms to collect quantitative data on both
index clients and partners. Currently, these
are hard copy forms; an Access-based form is
under development and will soon be provided
to the sites, along with laptops for data
entry in the field. Qualitative data will be
collected from health departments and DISs
through focus groups and follow-up
interviews with clients who have been
served.
Results to Date
PCTRS sites began testing in May 2004.
Although only limited quantitative data have
been generated, invaluable information
regarding operational issues and how best to
develop and implement similar programs has
been gathered through meetings, one-on-one
discussions with sites, and site visits.
This type of information is particularly
useful because one of the primary goals of
these demonstration projects is to develop
guidelines of best practices for use by
other health departments interested in
implementing similar projects. |
