hiv testing just got a lot easier: putting acts into action
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HIV Testing Just Got A Lot Easier:
Putting ACTS into ActionAETC NRC Training ExchangeMay 23, 2006
Donna Futterman, MDStephen Stafford
Today’s Agenda
The Tipping Point for Routine HIV Testing
The Evolution / Intelligent Design of
HIV C&T
Results from ACTS in Action
A User’s Guide to the ACTS Approach
& Tools
ACTS Role Play
Questions & Discussion2
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 don’t know they’re infected
80% of young HIV+ gay and bisexual men didn’t know their status
41% of those diagnosed HIV+ were diagnosed with AIDS within one year of their positive HIV test 3
Taking Care of Business
Case finding hasn’t 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 4
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
5
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
6
Keeping Up with the Times1986
Environment No effective
treatment Discrimination
against those infected: MSM, IDU, immigrants & sex workers
Policy C&T regulations often
written to limit testing: mandated counseling written consent
2006Environment Many effective
treatments HIV discrimination
reduced & at-risk populations have changed
Policy C&T regulations
remain largely unchanged:
separates C&T from routine medical care
prevention value of pre-test counseling minimal
7
Why Don’t 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
8
“Not Enough Time,Not Enough Experience,
Not Aware of Risk”
Found that conventional HIV testing is: time-intensive specialized stigmatized separated from routine care
9
It’s Time for a Paradigm Shift!
HIV testing has become such a huge obstacle that many providers and patients prefer to sail around it.
It’s Time for a Paradigm Shift!
HIV testing has become such a huge obstacle that many providers and patients prefer to sail around it.
10
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
11
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
12
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
13
ACTS in ACTIONACTS Sites Double HIV Testing
Rates
0%
5%
10%
15%
20%
25%
2003 2004 2005
Control Average ACTS Average14
Elements of the ACTS SystemMeeting 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
15
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 16
ACTS Site Prep Checklist
17
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
18
ACTS Materials
19
It’s All in the ManualPart I – ACTS HIV Counseling and Testing System
ACTS Pocket CardTalking Points for Translating ACTS into ActionEssential FormsPatient Education
Part II – ACTS BackgroundersChapter 1 – HIV Counseling: Delivering ResultsChapter 2 – HIV Testing ProceduresChapter 3 – Working with Special PopulationsChapter 4 – Prevention EssentialsChapter 5 – The ACTS Imperative
Part III - Resources
concise
comprehensive
20
The Pocket Guide to ACTS
21
ACTS Talking Points
22
Forms
23
ACTS Chart Stickers
24
ACTS Update Newsletter
25
Patient HIV Info Brochures
26
The Deal
27
The “A” in ACTS
28
Transmission Basics: The Risk Continuum ConceptPage 75
Talking Points Page 10ACTS PRE Screen Page 24
Taking a Sexual and Drug Use History Page 77
Reality-Based Prevention CounselingPage 78
29
The “C” in ACTS
30
The “T” in ACTS
31
The “S” in ACTS
32
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
33
Putting ACTS into ACTION:
Who Benefits?Your Patients
Your Practice Do what many providers can’t / won’t 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 Health34
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
35
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
36
Questions & Discussion
37
Take a few moments toevaluate this presentation.
Visithttp://www.aidsetc.org/aidsetc?page=cf-acts-eval
to quickly submit your comments
38
Contact Us / Order MaterialsDonna Futterman, MD
DFutterman@AdolescentAIDS.org
Stephen StaffordStephenS@AdolescentAIDS.org
Michelle Lyle, MPHMLyle@AdolescentAIDS.org
Adolescent AIDS ProgramChildren’s Hospital at Montefiore
718-882-0232AdolescentAIDS.org
5.23.06
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