HIV Status Awareness Strategies, Interventions, and Evaluation Committee Presentation

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HIV Status AwarenessStrategies, Interventions,
and Evaluation Committee Presentation

• HIV Prevention Planning Council
• October 9, 2008

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• HIV status awareness is the umbrella term for all
  strategies and services that help people know
  their HIV status, such as
• testing
• partner services
• acute detection
• linkage to care
• HIV health education
• risk reduction counseling
• prevention case management
• public information
• public and private partnerships

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In March 2008, the new vision and core strategies
were presented to the HIV Prevention Planning
Councils Scope of Work for 2008
POI Committee
SMTD Committee
SIE Committee
Drivers, Cofactors, Priority Setting Model
PWP Best Practices Models
HIV Status Awareness Structural Approaches
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Why Are We Magnifying HIV Status Awareness?

• The 2006 consensus estimates incidence at 975 per
  year in San Francisco.
• It is estimated that 20-25 of individuals in San
  Francisco who are HIV positive do not know that
  they are infected.
• In San Francisco, 38 of AIDS cases are late
  testers.
• Data from the San Francisco National HIV
  Behavioral Surveillance (NHBS) reported that 43
  of MSM had not tested in the prior 12 months.

• The NHBS also reported that of 120 men who did
  not test in the prior 12 months and then tested
  in the survey, 8 had unrecognized infection.

Serostatus Awareness
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Process for the Development of the Framework
CTL Unit input for elements for testing models
SIE Committee input to develop testing models
SA Work Group reviewed both SIE and CTL input for
development of testing models
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Motion

• The Strategies, Interventions, and Evaluation
  Committee moves that the HPPC approve the
  framework for the HIV status awareness section of
  the Strategies and Interventions chapter of the
  2010 HIV Prevention Plan.

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Background for Framework

• Purpose is to provide the community with a
  framework for developing approaches for HIV
  testing
• Intent is to foster creativity and promote
  different options for testing models
• Defines the required and supplemental elements to
  develop an HIV testing model that is most
  appropriate for the identified target population

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What Would this Section of the Chapter Look Like?

• Narrative
• Written explanation of each of the required and
  supplemental elements for a model for HIV testing
  including
• Brief definition of the element including when
  can you use the different options and why
• Laws, regulations or required protocols
• Chart that provides a visual of required and
  supplemental elements

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Narrative

• Defines HIV status awareness
• Provides the vision for HIV status awareness
• Provides elements for structural changes
• Emphasizes that regardless of what strategies are
  used, all models must address linkage to care
• Describes our support helping to identify people
  know their status at the acute stage of
  infection, which means someone who may have
  become HIV positive in the last 10-14 days
• States that we encourage increasing the frequency
  of HIV testing among high risk individuals

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Framework - Menu of Elements
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Required Elements

• Consent
• Options based on approach include
• Written, HIV-specific consent for confidential
  testing
• Verbal, anonymous testing
• Implied consent for sites offering confidential
  screening in clinical/medical settings

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Required Elements (cont.)

• Documentation
• Options based on approach include
• Full Client Information Form
• Limited Client Information Form
• Options for data collection methods include
• Completed by staff
• Completed by client

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Required Elements (cont.)

• HIV Antibody Test
• Options (based on testing technology approved by
  the FDA)
• Rapid HIV Antibody Test
• Conventional HIV Antibody Test

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Required Elements (cont.)

• Information about HIV and Testing
• (any items required by law)

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Required Elements (cont.)

• Provision of Testing Results if Test is Negative
• Options based on laws and regulations include
• Face-to-face
• Phone call
• Written (letter, card, e-mail)
• Website
• "No news is good news" You will not be
  contacted unless the test result is confirmed HIV
  antibody positive/or RNA positive

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Required Elements (cont.)

• If Test is POSITIVE
• Follow-up if client does not return for
  confirmatory results (non-disclosure)
• Disclosure of results, in person, including
  counseling
• Linkage to medical care (e.g., medical
  appointment made, appointment kept, medical work
  up)
• Discuss partner services
• Partner elicitation if desired

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Supplemental Elements

• Pre-Test Individual Risk Reduction Counseling
• Options include
• Health education
• Window period negotiation
• Risk reduction plan
• Sexual communication discussion
• Injection support (including needles)
• Risk assessment
• RNA/HCV/STD assessment

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Supplemental Elements (cont.)

• Methods to increase access to hard to reach
  populations
• Options include
• Outreach (e.g., individual level, social
  networks)
• Venue-Based Testing
• Mobile Testing

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Supplemental Elements (cont.)

• RNA Testing
• A test conducted through a blood sample that
  detects for virus. The goal is to identify
  someone at the acute stage of infection, which
  means someone who may have become HIV positive in
  the last 10-14 days.
• Including follow-up for acute infection (required)

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Supplemental Elements (cont.)

• Hepatitis C Testing
• Options include
• Assessment/offer (required)
• Test
• Counseling
• Positive disclosure
• Linkage to medical services

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Supplemental Elements (cont.)

• STD Testing
• Options include
• Assessment/offer (required)
• Test
• Counseling
• Positive disclosure
• Linkage to medical services

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Supplemental Elements (cont.)

• HIV Health Education
• Options for mode and methods of delivery of
  education are pending the development of
  regulations for AB2899.

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Supplemental Elements (cont.)

• Prevention Case Management
• Disclosure
• Linkage to care and long-term monitoring of care
  over time
• Linkage to other support services

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Framework - Menu of Elements
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Motion

• The Strategies, Interventions, and Evaluation
  Committee moves that the HPPC approve the
  framework for the HIV status awareness section of
  the Strategies and Interventions chapter of the
  2010 HIV Prevention Plan.

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2008 SIE Committee Members

• Grant Colfax
• Michael Discepola
• Ben Hayes (co-chair)
• Jen Hecht
• Weihaur Lau (co-chair)

• Vasudha Narayanan
• John Newmeyer
• David Weinman
• Luke Woodward

• HPS Staff Dara Geckeler, Eileen Loughran, Israel
  Nieves-Rivera, John Pabustan
• HarderCompany Staff Janise Kim