Lessons Learned: Giving HIV Positive Results

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Lessons Learned Giving HIV Positive Results

• The Door A Center of AlternativesAdolescent
  Health Center
• Carolyn Glaser, L.C.S.W.
• Supervisor, Health Education
• and Outreach
• June 2007

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The Door Adolescent Health Center

• 1876 HIV Tests given in 2006
• 4 positive results
• 7 Health Educators
• 268 tests per Health Educator

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The Door Adolescent Health Center

• A LOW AMOUNT OF
• POSITIVE RESULTS
• A HIGH AMOUNT OF
• STAFF ANXIETY

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The Door A Center of Alternatives

• The mission of The Door is to empower young
  people to reach their potential by providing
  comprehensive youth development services in a
  caring, supportive environment, where young
  people are treated with respect and
  confidentiality.

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Services Provided at The Door

• Health Care
• Counseling
• Education
• Arts and Recreation
• Legal
• Career

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HIV Testing Demographics 2006

• 1876 Young People Tested
• 79 female
• 21 male
• 1 under the age of 15
• 32 between the ages of 15-17
• 41 between the ages of 18-19
• 26 over the age of 20
• 46 Black
• 35 Latino
• 5 Asian
• 7 White
• 7 Other
• 81 Conventional testing

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Adjustments Made for Implementing Rapid Testing

• Not offered to walk-in patients only to those
  with appointments.
• Use of venipuncture rather than the finger stick
  or oral swab.
• Having a Social Worker or Senior Counselor on
  call during the hours that testing is offered.
• Staff training.

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The Adolescent Health Centers HIV Rapid Testing
Training

• One day training for the entire Adolescent Health
  Center staff tailored specifically to meet our
  needs with a focus on delivering a positive
  result.
• Learn appropriate language to use when delivering
  positive results, what needs to be covered in the
  post-test counseling session, anticipate patient
  reactions and needs.
• Utilization of role playing.
• Forum for staff to discuss their anxieties.
• Give staff confidence they are already
  comfortable with and skilled at delivering bad
  news.

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Immediate Steps following Notification of a
Preliminary Positive Result

• The Health Educator who performed the pretest
  counseling informs the Supervisor of Health
  Education or her designee. Brief planning and
  supportive supervision takes place.
• The Social Worker or Senior Counselor on duty is
  notified and placed on standby.
• The medical provider scheduled to see the patient
  is notified and placed on standby.
• The Health Educator delivers the result.

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The First Post-test Counseling Session Includes
the Following

• The exploration of thoughts and feelings.
  (Includes screening for suicidal ideation.)
• A review of the meaning of the preliminary
  positive result.
• Access the physical and emotional stability of
  the young person. (Existing support systems,
  housing, income, mental health needs,
  employment/education.)
• Determine immediate referrals necessary based on
  the stabilization assessment.
• A discussion regarding medical care and the
  Adolescent Health Centers linkages to primary
  care providers.
• A review of the ways to prevent the spread of the
  HIV infection.

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The First Post-test Counseling Session Includes
the Following (cont.)

• A conversation about the patients current and
  past partners and partner notification.
• A screening for domestic violence.
• Appointment scheduling for a confirmatory test
  and a discussion regarding the likelihood of a
  positive confirmatory test result.
• A conversation with the young person about how
  s/he will immediately cope with the diagnosis.
  (Example Who will they tell? What will they do
  if they get very anxious or upset? What will
  they do for the rest of that day/week?)

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Following the Post-test Counseling Session

• A blood sample is automatically sent out for the
  confirmatory test.
• Supportive supervision of the staff member
  continues.
• The Health Educator remains in contact with the
  patient as needed while s/he waits for the
  confirmatory result.
• The Health Educator presents the experience at a
  team meeting so the rest of the staff can learn
  from his/her experience.
• The patient returns for the confirmatory result
  and a second post-test counseling session occurs.
  This session will include linkages to care and
  the completion of partner notification.

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