HIV Testing Just Got A Lot Easier:

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HIV Testing Just Got A Lot Easier Putting ACTS
into Action
AETC NRC Training Exchange May 23, 2006 Donna
Futterman, MD Stephen Stafford
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Todays Agenda

• The Tipping Point for Routine HIV Testing
• The Evolution / Intelligent Design of HIV CT
• Results from ACTS in Action
• A Users Guide to the ACTS Approach Tools
• ACTS Role Play
• Questions Discussion

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Unfinished Business

• HIV is the worst epidemic in history
• 40,000 new cases each year 25-50 among youth
• 1 in 4 (?300,000) HIV Americans dont know
  theyre infected
• 80 of young HIV gay and bisexual men didnt
  know their status
• 41 of those diagnosed HIV were diagnosed with
  AIDS within one year of their positive HIV test

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Taking Care of Business

• Case finding hasnt kept up with treatment
  advances
• Patients overwhelmingly accept HIV testing when a
  provider recommends it
• The mobilization for prenatal testing missed a
  golden opportunity to routinize screening for
  all, but it remains a successful model for how to
  proceed

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Routine Testing The Benefits

• REDUCES HIV TRANSMISSION
• HIV people who know their status reduce
  high-risk sex by about 50
• Lower viral loads from ARVs also reduce Tx
• PROLONGS LIFE
• HIV treatment can increase survival by many years
  and improve quality of life

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Routine Testing Best Practice

• 2003, CDC issues Advancing HIV Prevention New
  Strategies for a Changing Epidemic calling for
  routine testing in communities with 1 HIV
  prevalence
• 2005, routing testing found cost/care effective
  in settings with .05 HIV prevalence
• CDC, HRSA DOHs working toward routine testing
  by streamlining counseling consent
• ACTS makes provider-delivered routine testing
  feasible in various care settings

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Keeping Up with the Times

• 1986
• Environment
• No effective treatment
• Discrimination against those infected MSM, IDU,
  immigrants sex workers
• Policy
• CT regulations often written to limit testing
• mandated counseling
• written consent

• 2006
• Environment
• Many effective treatments
• HIV discrimination reduced at-risk populations
  have changed
• Policy
• CT regulations remain largely unchanged
• separates CT from routine medical care
• prevention value of pre-test counseling minimal

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Why Dont Providers Routinely Test?

• 2001 qualitative research investigated HCP
  motivators and barriers impacting HIV testing of
  adolescents
• Commissioned by AAP, conducted by professional
  qualitative research firm
• Interviewed 55 Bronx-based providers and
  administrators in public and private settings
• Key findings informed ACTS initiative

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Not Enough Time,Not Enough Experience,Not
Aware of Risk

• Found that conventional HIV testing is
• time-intensive
• specialized
• stigmatized
• separated from routine care

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Its Time for a Paradigm Shift! HIV
testing has become such a huge obstacle that many
providers and patients prefer to sail around it.
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• The Provider Imperative
• Less Referring, More Screening
• YOU can help solve the solvable problem of
  finding the 300K unidentified HIV patients
• YOU can provide links to effective prevention
  counseling
• YOU can engage HIV patients into early care
• YOU are an essential player in the team that will
  meet public health HIV/AIDS goals

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Fast Facts on ACTS

• ACTS is a concise, comprehensive system that
  makes provider-delivered HIV testing feasible in
  clinical care settings
• Provides instruction tools for making
  operational and clinical practice changes
• Meets CDC and DOH testing requirements
• Condenses 45-minute process to 5-10 minutes
• Allows for better allocation of counseling
  resources

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ACTS in ACTIONResults from a Randomized Control
Trial

• 10 Bronx clinics randomized to receive ACTS rapid
  counseling in late 2004
• Divided into 5 ACTS Sites 5 Control Sites
• Data collected on HIV testing rates
• Eligible patients included those age 15-64,
  non-maternity patients

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ACTS in ACTIONACTS Sites Double HIV Testing
Rates
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Elements of the ACTS System

• Meeting with the HIV coordinator, clinic
  administrator and medical director to develop
  implementation plan
• Academic detailing session(s) to train clinic
  staff on ACTS
• ACTS manual and toolkit containing information,
  materials and resources for providers, clinic
  staff and patients

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Laying the Foundation for ACTS with Key Staff

• Address Philosophical Barriers
• Skepticism about patients HIV risk
• Other health problems viewed as priority
• Concerns about loss of prevention
• Address Logistical Barriers
• Which staff will test
• Documentation consent forms
• Patient flow results follow-up
• Billing issues

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ACTS Site Prep Checklist
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Training Staff to Utilize ACTS

• Academic Detailing
• Provider-led training
• Catered
• Follow-up trainings with new staff
• Ongoing Support
• Regular meetings with key staff to problem-solve
  barriers
• Ongoing data reporting to all staff via meetings
  and newsletters

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ACTS Materials
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Its All in the Manual
Part I ACTS HIV Counseling and Testing
System ACTS Pocket Card Talking Points for
Translating ACTS into Action Essential
Forms Patient Education Part II ACTS
Backgrounders Chapter 1 HIV Counseling
Delivering Results Chapter 2 HIV Testing
Procedures Chapter 3 Working with Special
Populations Chapter 4 Prevention
Essentials Chapter 5 The ACTS Imperative Part
III - Resources
concise
comprehensive
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The Pocket Guide to ACTS
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ACTS Talking Points
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Forms
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ACTS Chart Stickers
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ACTS Update Newsletter
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Patient HIV Info Brochures
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The Deal
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The A in ACTS
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Talking Points Page 10 ACTS PRE Screen Page 24
Reality-Based Prevention Counseling Page 78
Transmission Basics The Risk Continuum
ConceptPage 75
Taking a Sexual and Drug Use History Page 77
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The C in ACTS
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The T in ACTS
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The S in ACTS
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Talking Points Delivering HIV Results

• Give results and allow time to process
• Rapid
• Conventional
• Discuss meaning of results
• Provide support
• Link to care
• Discuss prevention
• Review HIV reporting and partner notification
  options
• Screen each name for domestic violence risk

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Putting ACTS into ACTIONWho Benefits?

• Your Patients
• Your Practice
• Do what many providers cant / wont do
• Bill for additional counseling visit
• Participate in national pilot intervention
• Our Community
• Help us fine-tune ACTS understand how it works
• Do your part to make ACTS a model for others
• Be on record as having solved this problem!
• Public Health

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ACTS in ACTIONFuture Plans for ACTS

• Continued regional national dissemination
• Presentation of ACTS at 2006 International AIDS
  Conference Ryan White Clinical Care Conference
  in August
• Expansion of ACTS to Bronx control sites in
  September 2006
• Ongoing implementation
• CDC-sponsored South Africa Youth Clinics
• Pediatric ER at Montefiore
• National Assembly on School-Based Health Care

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Hearing ACTS in Action

• Alex
• 36 year old white male
• Engaged to be married in 6 months
• Visiting for routine BP check-up
• Keisha
• 40 year old African American woman
• Divorced mother of 3, dating 1 man exclusively
• Visiting for a vaginal infection

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Questions Discussion
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Take a few moments toevaluate this
presentation.Visithttp//www.aidsetc.org/aidset
c?pagecf-acts-evalto quickly submit your
comments
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Contact Us / Order Materials
Donna Futterman, MD DFutterman_at_AdolescentAIDS.org
Stephen Stafford StephenS_at_AdolescentAIDS.org Mic
helle Lyle, MPH MLyle_at_AdolescentAIDS.org Adolesce
nt AIDS Program Childrens Hospital at
Montefiore 718-882-0232 AdolescentAIDS.org 5.23.0
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