1. TESTING FOR HIV INFECTION:
How to offer the test and deliver test results
Carol Q Galper, Ed.D.
Principle Investigator
Alyssa Bittenbender, MPH
Program Director
2. Arizona AIDS Education and Training Center (AETC)
Mission
The mission of the Arizona AIDS Education and Training Center is
to provide healthcare professionals with the knowledge and skills
necessary to provide outstanding care to people living with HIV
and AIDS.
Who we serve
Physicians, dentists, nurses, mid-level practitioners (NP, PA),
pharmacists and mental health workers will have access to
training from peer colleagues who possess expertise in the
management and treatment of HIV disease.
www.AETC-Arizona.org
3. Objectives
1. Describe the rationale for HIV screening
2. Practice offering an HIV test and giving
HIV test results to patients
3. Evaluate a newly diagnosed patient’s
immediate needs and make a short-term
plan.
4. My primary profession/discipline is…
1. Physician
2. Physician Assistant
3. Nurse Practitioner
4. Nurse
5. Case manager
6. Community Health Worker
7. Other
5. I discuss HIV testing with my patients…
1. Always
2. Sometimes
3. Never
4. Not Applicable
6. What do you think is the number one reason
providers are reluctant to discuss HIV with
patients?
1. Not enough time
2. Low Prevalence
3. Fear / concern of offending patient
4. Other
7. Source of HIV Tests and Positive Tests
• 38% - 44% of adults age 18-64 have been tested
• 16-22 million persons age 18-64 tested annually in U.S.
HIV tests* HIV+ tests**
Private doctor/HMO 44% 17%
Hospital, ED, Outpatient 22% 27%
Community clinic (public) 9% 21%
HIV counseling/testing 5% 9%
Correctional facility 0.6% 5%
STD clinic 0.1% 6%
Drug treatment clinic 0.7% 2%
*National Health Interview Survey, 2002
**Suppl. to HIV/AIDS surveillance, 2000-2003
8. Awareness of Serostatus Among People
with HIV and Estimates of Transmission
~25%
Unaware Accounting for: ~54%
of of New
Infection Infections
~75% Marks, et al
Aware of AIDS 2006;20:1447-50
Infection
~46%
of New
Infections
People Living with New Sexual Infections
HIV/AIDS: 1,039,000- Each Year: ~32,000
1,185,000
9. Reasons for testing: late versus early testers
Supplement to HIV/AIDS Surveillance, 2000-2003
100%
Late (Tested < 1 yr before AIDS dx)
80%
Early (Tested >5 yrs before AIDS dx)
60%
40%
20%
0%
Illness Self/partner Wanted to Routine Required Other
at risk know check up
10. Offering an HIV test
Explain rationale for HIV screening
• Improves patient care
• Reduces HIV transmissions
Normalize the test
• “I offer a test to all my patients”
Know your clinic’s consenting process ahead of time.
11. Delivering the negative test result
1. State the result in a direct, neutral tone
“This means you don’t have HIV”
Avoid medical jargon
2. Check and respond to patient’s reaction
3. Explain the window period and advise on
re-testing if needed
What is an example of a situation in which you
would advise someone to be re-tested?
12. What are some concerns about telling
patients they have a positive test result?
1. I don’t know what to say, or how to say it
2. Fear of how the patient will respond
3. Fear of how I (the provider) will respond
4. What can I do that will be helpful?
5. I don’t know where to refer patients
6. Other
13. Delivering a Positive Result
• State result in a direct, neutral tone, and wait for patient’s
response
- Provide for immediate needs
• Address individual needs and concerns
- Sources of emotional support
- Information about HIV infection and medical care
- Information about transmission and partner notification
• Make a short-term plan
- Link to needed services
- Ask what’s most important to do first
- “Close the session, but not the door”
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14. Delivering a Positive Result
• State result in a direct, neutral tone, and wait for
patient’s response
“Your HIV test from last week is positive……..In other words,
the test shows that you do have HIV.”
• Provide for immediate needs
“You look really shocked. This must be hard to take in.”
“What is first on your mind right now?”
“Many people I’ve talked with have expressed similar feelings
when they learn they have a positive result.”
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15. Delivering a Positive Result
• State result in a direct, neutral tone, and wait for patient’s
response
- Provide for immediate needs
• Address individual needs and concerns
- Sources of emotional support
- Information about HIV infection and medical care
- Information about transmission and partner notification
• Make a short-term plan
- Link to needed services
- Ask what’s most important to do first
- “Close the session, but not the door”
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16. Sources of Emotional Support
• Who can patient turn to now?
- Friend
- Family member
- Partner
- Counselor
- Faith community
“Who do you trust that you can tell
about this positive test?”
“How have you handled stressful situations
like this in the past? How can that work
for you now?”
17. HIV Infection and Medical Care
• Patient may need basic information about what
HIV infection means
- For their own health
“What would you like to ask about HIV and your health?”
- For their partner’s health
“What do you think this means for your partner’s health?”
• With appropriate care, HIV is a manageable chronic
infection
“Medical care will be very important because, although HIV is not
curable, there are good treatments that help keep people well.”
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18. Link to Medical Services
• Link to HIV care
- Make first appointment if you will provide care yourself
- Refer to provider with patient’s insurance
- Refer to Ryan White clinics
> Become familiar with local care networks
“What about health care? Do you have insurance to cover
that? If not, we can help you find a doctor.”
“Who do you plan to see for medical care? When do you
expect to make your first appointment?”
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19. Transmission
• Answer questions about HIV transmission
• May want to notify current partners, from
last 6-12 months, since last HIV test
“Knowing you have HIV, what are your
concerns about giving HIV to someone else?”
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20. Discuss Disclosure
• Explore whether the patient is able to talk
about the implications of the positive results
“How do you think your partner will react when
you tell him?”
• Screen for domestic violence
“Have you ever been in a relationship where your
partner hurt you, threatened you, forced sexual
contact, or tried to control your life?”
21. HIV Partner Services
(Partner Counseling and Referral Services)
• Assist persons living with
HIV with telling their
partner(s) about possible exposure
• Provide partners with access to testing and
other prevention services
• Voluntary and confidential
• Services available through local health
department
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22. How Do Patients Feel About Health
Department Partner Services?
Survey of persons w/recently reported HIV
• 84% agreed (somewhat/strongly) health
department should routinely offer everyone
diagnosed with HIV help in notifying
partners
• 20% would want help in notifying at least
one partner from last 6 months
Golden et.al. JAIDS 32: 196-202 2003 22
23. Delivering a Positive Result
• State result in a direct, neutral tone, and wait for patient’s
response
- Provide for immediate needs
• Address individual needs and concerns
- Sources of emotional support
- Information about HIV infection and medical care
- Information about transmission and partner notification
• Make a short-term plan
- Link to needed services
- Ask what’s most important to do first
- “Close the session, but not the door”
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24. Link to Needed Services
• Review patients options for medical care
• Provide specific written referrals
• Limit referrals to one or two
• Encourage follow through
• Appropriate referrals may include
- Drug treatment facilities
- Mental Health
- Social Services
25. Ask What’s Most Important
to do First
• Work with your patient to make a plan for
the next few hours or days
“We’ve talked about a lot, what’s most
important for you to deal with first?”
“What do you plan to do today when you leave
here?”
26. Close the Session,
But Not the Door
• “Warm handoff” is the standard of care
“It’s important to take this one step at a time.
I’ll call you tomorrow to see how it’s going.”
“You may think of other questions after you
leave today. Feel free to call me or come
back.”
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