Implementing Rapid HIV Testing in Clinical Care Settings: CDCs Capacity Building Experience

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Implementing Rapid HIV Testing in Clinical Care
Settings CDCs Capacity Building Experience
Cindy Getty Team Leader, Training and
Development Capacity Building Branch Division of
HIV/AIDS Prevention National Center for HIV, STD,
and TB Prevention Centers for Disease Control and
Prevention
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Presentation Outline

• Background on the project
• The Project
• Approach
• Target Audience
• Structure
• Lessons Learned
• Results
• Opportunities Ahead

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Background

• 2001 CDC released guidelines recommending routine
  HIV testing for all women in Labor and Delivery
  (LD) settings--2004 protocol for RT
• 2003 AHP strategy included making HIV testing a
  routine part of health care
• During implementation, Health care providers are
  faced with a number of questions

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Questions Providers Face

• What is meant by routine HIV testing and why is
  it important?
• What technology is available?
• How should the issue of consent be addressed?

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Questions Providers Face

• Do we have the capacity to deliver test results
  efficiently and compassionately (if not, how to
  develop it)?
• How should we handle the newly identified
  positives?

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8 meetings for Hospitals to Implement RT in
LD Settings 2004 - 2005

• Baltimore, MD
• Los Angeles, CA
• Houston, TX
• Providence, RI

• Cincinnati, OH
• Raleigh, NC
• Miami, FL
• San Juan, Puerto Rico

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Meeting Details

• Length 1.5 days
• Locations based on regions where legislative
  action or public policy directives were favorable
  for RT in LD settings
• 5 13 hospitals attended each meeting
• Health Department and AETC staff invited as
  observers and resources

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Meeting Objectives

• Provide information on RT in LD settings
• Provide hospital teams with opportunities for
  team-building through strategic planning
• Offer skills-building for implementation of RT
• Facilitate development of a hospital action plan
  for implementation

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Target Audience

• Teams of 4 from each invited hospital
• Chief of OB
• Nursing Director for OB
• Laboratory Director
• Administrator (beginning with the CEO)

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Content 4 Areas

• The Big PictureWhy is routine HIV testing and
  RT important?
• Lessons Learned From the Field
• Strategic Planning for the Hospital Teams
• Specific Skills/Issues (Workshops)

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Lessons Learned from the Meetings

• Framing the experience is important
• Participants brought considerable experience to
  the meetingsneeded supportive information
• Misconceptions regarding Health Care Provider
  role related to local laws and health department
  policies for HIV testing

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Lessons Learned from the Meetings

• Targeted recruiting for the meetings was key
• Often, team members (stakeholders) were not aware
  of what other stakeholders were doing
• Those hospitals without participation of all
  members of their team (stakeholders) were
  significantly hampered in moving forward

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Lessons Learned from the Meetings

• Need to allow plenty of space and time for
  planning among the hospital teamsbuilds teamwork
• Skills-building component key to creating buy-in
  among stakeholders on each hospital team
• RT or conventional testing?
• If RT, then which RT?
• If RT, then role of lab?

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Results

• 70 hospital teams from 28 states/territories
  participated
• Nearly 90 of participating hospitals in
  follow-up interviews decided to implement RT
• Just under 50 of hospitals had already conducted
  training or planned to offer training to staff
  (methods varied)

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Results

• About 1/3 of participants described increased
  team work as a result of the meetings
• Almost all hospitals chose to conduct the test
  through the laboratory rather than point-of-care

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CDC Next Steps

• Finalize evaluation report for LD meetings
• Meet with medical organizations
• Determine provider needs with regard to training
  and implementation

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CDC Next Steps

• Move forward with an implementation plan
• Convene additional strategic planning meetings
  using LD model for Emergency Departments and
  other clinical settings

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4TC Opportunities

• Variety of training opportunities for this topic
• Promote synergy among those working in
  institutions considering routine HIV screening
• Reduce resistance to routine HIV testing
• Influence how HIV test results are delivered and
  referrals are made

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Summary

• Expanded, routine, voluntary, opt-out screening
  in health care settings is needed
• Routine HIV testing poses significant challenges
  to hospitals and other clinical settings
• Strategic planning sessions with key stakeholders
  within organizations does build capacity
• Many opportunities for training

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• Thank you!