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Overview
This demonstration project addresses
Strategy One of the Advancing HIV Prevention
Initiative: making HIV testing a routine
part of medical care. It is designed to
evaluate the feasibility and sustainability
of offering HIV testing to eligible clients
as a routine part of non-HIV-related medical
care in clinical settings. Although the
routine offering of HIV testing is the
ultimate goal, some project areas will offer
alternative strategies (e.g., offering
testing to a randomly chosen subset of the
patient population) because of operational
issues, such as staffing or physical plant
limitations or other concerns. Persons who
test positive will be linked into HIV
treatment and care while at the testing
site, local community health centers, or
other settings. The demonstration project
will examine the feasibility and success of
using the recently approved OraQuick® rapid
HIV test in these settings by tracking
barriers to implementation, acceptance
rates, and costs.
The four health departments funded under
this demonstration project have each
identified three clinical sites at which HIV
testing will be offered. These 12 sites
include an emergency room, a dental clinic,
and an inpatient unit, as well as acute care
clinics. All sites have met the requirement
of being high HIV prevalence settings. To
varying degrees, each site will follow the
same basic process for offering HIV rapid
testing as a routine part of medical care:
- Approach the client and ask if he or
she would like to take a free HIV test.
- Go to a private room to explain the
test and administer the rapid HIV test.
- Collect demographic and risk
information.
- If result is negative: inform client.
- If result is preliminary positive:
inform client, and offer confirmatory
testing.
- For preliminary positives: introduce
client to the HIV or infectious disease
staff to have blood drawn for the
confirmatory test.
Each site will test between 1,500 and
6,000 persons per year (depending on the
site), and the sites will facilitate access
to care for at least 80% of those who test
positive. Recruitment periods will
correspond to peak client flow through the
various clinics. These data will be compared
with historical HIV testing patterns at each
of the project sites.
Goals
The overarching goals of this project are
to:
- demonstrate the feasibility of
conducting routine HIV rapid testing
within medical facilities;
- increase access to voluntary HIV rapid
testing in medical settings; and
- demonstrate effective linkages of
persons diagnosed with HIV within
medical settings to medical evaluation,
treatment, prevention, and other
appropriate services.
Collaborator Projects
Wisconsin: The Division of
Public Health HIV/AIDS Program is funding
three clinics (Health Care for the Homeless,
16th Street Community Health Center medical
clinic, and 16th Street Community Health
Center behavioral clinic) in Milwaukee to
perform rapid tests as part of this project.
All three of the clinics will offer the
tests to everyone who meets the basic
eligibility requirements. Rapid HIV testing
(OraQuick®) will be offered to all eligible
persons.
Massachusetts: The
Department of Public Health HIV/AIDS Bureau
is funding three clinics—two in Boston
(Boston Medical Center Adult Primary Care
Unit and Boston Medical Center Menino
Pavilion) and one in Lowell (Lowell
Community Health Center). Menino Pavilion is
the only inpatient unit in the demonstration
project. At the Adult Primary Care Unit and
Lowell Community Health Center, designated
providers will offer all of their patients
the opportunity to be tested. Testing will
be offered to patients at the Menino
Pavilion site as time and staffing allow.
Rapid HIV testing (OraQuick®) will be
offered to all selected patients.
Los Angeles: The County
Department of Health Services Office of AIDS
Program and Policy is funding three sites
within the city (LA Free Clinic, Clínica
Monseñor Oscar Romero, and LA County USC
Hospital). Because of the size of the sites
or manpower constraints, Los Angeles project
sites will not offer testing to everyone,
but instead will randomly select patients
(e.g., every third person to sign in will be
offered testing). Rapid HIV testing (OraQuick®)
will be offered to all selected patients.
New York State: All of
these sites are located in the Bronx,
including the only emergency room and dental
clinic involved in this project. All New
York sites (Bronx-Lebanon Hospital
Center’s Dental Clinic, Open Access
Clinic, and Emergency Department) are able
to offer HIV tests to all eligible patients
who come into the clinic, as time and
staffing allows. Funding is through the New
York State Department of Health AIDS
Institute. Rapid HIV testing (OraQuick®)
will be offered to all eligible patients. In
addition, patients at the dental clinic may
choose oral HIV testing (OraSure®).
Project Milestones
- Funding announcement: April 2003
- Selection of contractors: July 2003
- Investigator meetings: November 2003;
possible second meeting in Fall 2004
- Rapid test implementation: April 2004
for most sites
- Site visits: November 2003 –
February 2004 for implementation of site
visits;
other site visits will be planned as
needed
Data Collection
All sites will collect data on the
acceptance rate (i.e., how many of the
people who were offered testing agreed to be
tested), as well as on clients’
demographics, risk behaviors, and testing
histories. Sites will report data on CD4 and
viral load blood tests; the administration
of these tests indicates that the patient
has received positive confirmatory test
results and entered into care.
Clinical sites will also solicit feedback
from the persons who receive the tests, such
as whether they considered the setting
appropriate for HIV testing and counseling.
If clients have previously received a
traditional HIV test, they will also be
asked to compare receiving a preliminary
positive from a rapid test (with a week or
more wait for a confirmatory test result) to
the traditional HIV testing method, which
takes a week or more for the initial result.
Results to Date
All sites have initiated testing.
Although limited quantitative data have been
generated, invaluable information regarding
operational issues and how best to develop
and implement similar programs has been
generated through meetings, one-on-one
discussions with sites, and site visits.
This type of information is particularly
useful because one of the goals of these
demonstration projects is to develop
guidelines of best practices for use by
other health departments and clinical
settings interested in implementing similar
projects.
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