Presentation on theme: "Incorporating HIV test Counseling, Testing and Referral into an Adolescent Clinic– The St. Chris experience Tahniat Ansari, MD MPH Assistant Professor."— Presentation transcript:
Incorporating HIV test Counseling, Testing and Referral into an Adolescent Clinic– The St. Chris experience Tahniat Ansari, MD MPH Assistant Professor of Pediatrics Drexel University College of Medicine St. Christophers Hospital for Children
Who we are Our staff –4 front desk, 3 medical assistants, 1 charge nurse, 3 nurse practitioners, 3 health educators, 3 physicians, pediatric residents, medical students 2 clinics –North Philadelphia -medically underserved area –Central Philadelphia
Family Planning Demographics Confidential free reproductive care for ages 12-21y/o males and females Over 10,000 visits per year A little over 3,000 individual patients African American = Hispanic >>> Caucasian > Asian 99% below poverty
Family Planning Based Clinic Annual exams –complete physical, pelvic/male GU exam, Pap smear, GC/CT testing, RPR, HIV testing Six month checks –GC/CT testing Acute care visits –vaginal complaints, ECP Walk in pregnancy test clinic Health educator only visit –BC start/check, ECP
HIV Test Counseling
ES 14 year old female Referred from our high school health resource center for treatment of Chlamydia Further questioning: sexually active with one partner for the past 1 month, didnt use a condom one time.
HIV Test Counseling Who: clinicians, health educator specialists, …front staff, medical assistants When: Incorporated into almost visit as a part of preventive health topics and risk reduction counseling What: ABCs discussed. Counseling tailored to patients developmental level and understanding. Written information also provided. Brochures, Posters, Power point presentation
CR 16 year old female Here for routine gyn exam, refused blood work because she hates needles Complains of itchy vaginal discharge Further history: sexual initiation 6 months ago, history of 2 different partners, intermittent condom use Physical exam: 2 tatoos, normal except green frothy vaginal discharge
HIV Testing Conventional serum: MA draw 2 tubes of blood as a part of triage. 1 is sent for RPR testing, the other can be sent by the patients request for HIV testing Rapid: 20 minutes –Oral –Finger stick Follow-up –Appointments made 2 weeks after testing for results –Tracking sheet
Follow-Up Tracking Sheet Post test counselor: Patient Name/Medical Record #: Test date: Result date: Post-test date: HIV result: reactive, non reactive, inconclusive Form kept as first paper in the chart. Can be completed anytime the patient returns to clinic.
Positive HIV Test Referral
BC 19 year old male Here for a routine physical exam Only complaint: fatigue, sore throat for 3 weeks Further questioning: –Recent rash on palms and soles, now healed. Weight loss. –Sexually active with history of 3 males partners, + condoms Physical exam: multiple non tender enlarged lymph nodes, large shallow healing ulcers in the throat
HIV Test Referral Partnership with Immunology/HIV clinic at St. Chris –Safety net created: Clinicians and counselors develop a plan prior to patient arriving. –St. Chris Immunology: a physician and/or social worker and/or peer counselor is available immediately. –They make immediate arrangements to begin care.
HIV test Integration-2+ Years Every Annual Six month check up Positive GC/CT/Trich if no test in previous 3 months Pregnancy Unprotected sex Walk-in rapid testing WRAP
Lessons Learned Create culture---work as a team, get buy- in, identify champions, positive reinforcement Teach confidentiality to staff, ensure patient confidentiality Use every opportunity, be flexible, be creative Make it easy
Lessons Learned Partnership –Outside resources –Patients Patience and persistence Dont be afraid---plan for the worst Breathe
The Real Workforce Health educators: Jenny Brice, May Lo, Mark Miller Drs. Levine, Acquavella NPs- Dale Drucker, Chris Hoyler, Lynn Yates MAs-Myteesha, Relonda, Cely Front desk- Christy, Lydia, LaTonya, Richena Family Planning Council support