TESTING FOR HIV INFECTION:How to offer the test and deliver test results                Carol Q Galper, Ed.D.             ...
Arizona AIDS Education and Training Center (AETC)                              Mission The mission of the Arizona AIDS Edu...
Objectives 1. Describe the rationale for HIV screening 2. Practice offering an HIV test and giving    HIV test results to ...
My primary profession/discipline is…    1.   Physician    2.   Physician Assistant    3.   Nurse Practitioner    4.   Nurs...
I discuss HIV testing with my patients…     1.   Always     2.   Sometimes     3.   Never     4.   Not Applicable
What do you think is the number one reasonproviders are reluctant to discuss HIV withpatients?    1.   Not enough time    ...
Source of HIV Tests and Positive Tests• 38% - 44% of adults age 18-64 have been tested• 16-22 million persons age 18-64 te...
Awareness of Serostatus Among Peoplewith HIV and Estimates of Transmission     ~25%   Unaware         Accounting for:     ...
Reasons for testing: late versus early testers    Supplement to HIV/AIDS Surveillance, 2000-2003  100%                    ...
Offering an HIV testExplain rationale for HIV screening   • Improves patient care   • Reduces HIV transmissionsNormalize t...
Delivering the negative test result1. State the result in a direct, neutral tone   “This means you don’t have HIV”   Avoid...
What are some concerns about tellingpatients they have a positive test result?   1.   I don’t know what to say, or how to ...
Delivering a Positive Result • State result in a direct, neutral tone, and wait for patient’s   response    - Provide for ...
Delivering a Positive Result • State result in a direct, neutral tone, and wait for   patient’s response    “Your HIV test...
Delivering a Positive Result • State result in a direct, neutral tone, and wait for patient’s   response    - Provide for ...
Sources of Emotional Support • Who can patient turn to now?   -   Friend   -   Family member   -   Partner   -   Counselor...
HIV Infection and Medical Care • Patient may need basic information about what   HIV infection means    - For their own he...
Link to Medical Services • Link to HIV care    - Make first appointment if you will provide care yourself    - Refer to pr...
Transmission • Answer questions about HIV transmission • May want to notify current partners, from   last 6-12 months, sin...
Discuss Disclosure • Explore whether the patient is able to talk   about the implications of the positive results   “How d...
HIV Partner Services(Partner Counseling and Referral Services) • Assist persons living with   HIV with telling their   par...
How Do Patients Feel About HealthDepartment Partner Services? Survey of persons w/recently reported HIV • 84% agreed (some...
Delivering a Positive Result • State result in a direct, neutral tone, and wait for patient’s   response    - Provide for ...
Link to Needed Services •   Review patients options for medical care •   Provide specific written referrals •   Limit refe...
Ask What’s Most Importantto do First • Work with your patient to make a plan for   the next few hours or days “We’ve talke...
Close the Session,But Not the Door • “Warm handoff” is the standard of care “It’s important to take this one step at a tim...
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AETC Testing for HIV Infection Bittenbender

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  • What is the window period?What is an example of a situation in which you would advise someone to be re-tested?What can you do to stay negative?
  • AETC Testing for HIV Infection Bittenbender

    1. 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. 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. 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. 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. 5. I discuss HIV testing with my patients… 1. Always 2. Sometimes 3. Never 4. Not Applicable
    6. 6. What do you think is the number one reasonproviders are reluctant to discuss HIV withpatients? 1. Not enough time 2. Low Prevalence 3. Fear / concern of offending patient 4. Other
    7. 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. 8. Awareness of Serostatus Among Peoplewith 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. 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. 10. Offering an HIV testExplain rationale for HIV screening • Improves patient care • Reduces HIV transmissionsNormalize the test • “I offer a test to all my patients”Know your clinic’s consenting process ahead of time.
    11. 11. Delivering the negative test result1. State the result in a direct, neutral tone “This means you don’t have HIV” Avoid medical jargon2. Check and respond to patient’s reaction3. 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. 12. What are some concerns about tellingpatients 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. 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” 13
    14. 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.” 14
    15. 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” 15
    16. 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. 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.” 17
    18. 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?” 18
    19. 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?” 19
    20. 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. 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 21
    22. 22. How Do Patients Feel About HealthDepartment 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. 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” 23
    24. 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. 25. Ask What’s Most Importantto 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. 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.” 26
    27. 27. Role Play!

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