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Welcome to CDC course: “Fundamentals of Waived Rapid HIV Testing and Prevention Counseling” Sponsored by the Northwest AIDS Education and Training Center.

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Presentation on theme: "Welcome to CDC course: “Fundamentals of Waived Rapid HIV Testing and Prevention Counseling” Sponsored by the Northwest AIDS Education and Training Center."— Presentation transcript:

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2 Welcome to CDC course: “Fundamentals of Waived Rapid HIV Testing and Prevention Counseling” Sponsored by the Northwest AIDS Education and Training Center and the Idaho Family Planning, STD and HIV Program Your Trainers Today: Judy Thorne, MPA HIV Education Coordinator, Master of Public Health Program, Idaho State University/Boise and Jan Nissl, RN Healtwise, Inc. and St. Luke’s Regional Medical Center

3 Thank you for having us! Goals for today… Reminder: completion of forms (PIF’s, evaluations) Learning Objectives: Identify at least 2 benefits to waived testing Understand the testing/counseling process Role play the client-centered approach Problem solve potential rapid test scenarios Develop local referrals/resources

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5 What are the current stats for HIV and AIDS?

6 Adults and Children Living with HIV/AIDS Total: 40+ million Data from UNAIDS N. America 1.2 million Caribbean 420,000 Latin America 1.5 million Western Europe 550,000 Sub-Saharan Africa 28.5 million Asia & Pacific 6.6 million Australia & New Zealand 15,000 North Africa 500,000 Eastern Europe 1 million

7 Idaho’s numbers?

8 HIV in Idaho – Prevalence * *Idaho diagnoses only, with additional 20-25% undiagnosed  District  District  District  District  District  District  District Total HIV AIDS 1,044 (As of Sept. 2008)

9 True/False: The yr old age group is most affected by HIV in Idaho

10 Idaho HIV positive by age at diagnosis

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12 Older Adults 11-15% of U.S. AIDS cases in over 50 group Challenges: access to health care, income, social support minority and ethnic groups age –stigma –barriers: misdiagnosed OIs

13 2006 CDC Guidelines Routine voluntary screening for all persons aged (normalize testing) Opt-out testing and counseling not required Repeat HIV screening yearly for those with known risk Routine screening for all pregnant women -repeat screening in 3 rd trimester in areas with high HIV rates

14 Rapid HIV Testing Provides same-day results. Detects HIV antibodies (exposure) not virus Offsets no-return rate (2.1 million tests yearly) –31% of positives do not return for results. –39% of negatives do not return for results. Increases ability to reduce new HIV infections (CDC). Allows people to know their status (21% are unaware of their HIV infection).

15 What are some advantages for rapid testing?

16 Advantages of Rapid Test Know HIV status (KYS) Earlier access to care for all clients Decreased transmission Effective treatment available –Healthcare workers Cost effective Success stories – pregnancy (decline in neonatal transmission to <1%)

17 What symptoms might a person present with?

18 Acute Retroviral Syndrome Fever Lymphadenopathy Pharyngitis Rash Myalgia/arthralgia Diarrhea Headache Nausea/Vomiting Hepatosplenomegaly Weight loss Thrush Neurologic symptoms  96%  74%  70%  54%  32%  27%  14%  13%  12%  CDC. Guidelines for using antiretroviral agents… MMWR 2002;51(RR-7)

19 Opportunistic Infections

20 What populations of people may not actively seek testing and why?

21 Missed Opportunities for Testing Pregnant women: –Who do not receive regular if any prenatal care –Who are not offered testing Immigrant populations Injection drug users Homeless individuals Historically; lesbian, gay, bisexual, transgender, questioning (LGBTQ) individuals do not seek care Those not considered at risk (i.e. older adults)

22 Why advocate for rapid HIV testing?

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24 2007 Updated HIV Treatment Guidelines Antiretroviral therapy should be initiated in patients with history of an AIDS defining illness or with a CD4 T-cell count <350 cells/mm3 Treatment for the following groups regardless of CD4 T- cell count: –pregnant patients –patients with HIV-associated nephropathy –patients co-infected with hepatitis B when treatment for hepatitis B virus is indicated *Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents December 1, 2007

25 What is HIV

26 Life Cycle of HIV-1

27 Antiretroviral Strategies Penetration Transcription Uncoating Reverse Transcription Integration Translation Processing Assembly Release CD4 Analogues NRTI’s NNRT’s Integrase Inhibitors TAT Inhibitors Protease Inhibitors Interferons Fusion Inhibitors Entry Inhibitors Maturation Inhibitor

28 Resources for Consultation Local experts identified for PEP (ID consultant, hospital epidemiologist) National Clinicians’ Postexposure Prophylaxis Hotline (PEPline), telephone

29 HIV Services Clinics in Boise, Pocatello, Spokane serving north Idaho (Ryan White Grantees) –Counseling and confidential testing –Comprehensive medical care –Case management –Adherence counseling –Mental health –Support groups –Clinical trials –Education

30 Web Sites to Access the Guidelines

31 Guidelines

32 State Laws Applicable to HIV Testing and Counseling Idaho Reportable Diseases (39-602) Confidentiality and Disclosure (39-609) (relates to informed consent) Unlawful to Transmit (39-608) Minors – Consent to Treatment ( ) Public Law Spousal Notification “good faith effort be made to notify marriage partners”

33 Idaho Code web-site link www. idahohealth.org (click on STD/AIDS information, Idaho Code)

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35 Overview Integrating HPC into the Rapid HIV Test Process Before TestingDuring TestingAfter Testing Tasks 1.Introduce & orient client to session (includes obtaining informed consent & assessing readiness) 2.Identify client’s risk behavior & circumstances 3.Identify client’s safer goal behavior 4.Develop action plan 5.Make referrals & provide support 6.Summarize & close session QA Tasks Throughout the Rapid Test Process: Program Management Training, Documentation and Records Troubleshooting Safe Work Practices HIV Prevention Counseling Steps

36 Integrating HIV Prevention Counseling with Rapid HIV Testing 1. Introduce and orient the client to the session 2. Identify client's risk behavior and circumstances 3. Identify client's safer goal behavior 4. Develop an action plan 5. Make referrals and provide support 6. Summarize and close the session The Six Steps of HIV Prevention Counseling (HPC) Conduct STEPS 4, 5, & 6 of HPC Give test results Explain the meaning and facilitate a confirmatory test, if preliminary positive Interpret results Conduct STEPS 2 & 3 of HPC (While the test is being processed) Facilitate HIV testing process: QA Testing Universal Precautions Assess clients’ readiness to take test & receive test results in the same day STEP 1 HPC Risk Screening* Information on tests and obtain informed consent Provide

37 Why do you need my name?

38 Discuss & Explain Informed ConsentInformed Consent Names-reporting StateNames-reporting State Confidential TestingConfidential Testing Age or Parental ConsentAge or Parental Consent

39 It’s not about you…

40 It is all about me… (as in your client) I want to be comfortable.I want to be comfortable. –Is your testing environment appropriate? I want to leave satisfied.I want to leave satisfied. –Are they leaving with what they came in for? I want to be listened to and heard.I want to be listened to and heard. –Are you making eye contact? Is your paper away? Are you out from behind that desk? I would like answers to my questionsI would like answers to my questions The customer is always rightThe customer is always right

41 HIV and AIDS

42 The Basics HIV antibody test not AIDS TestHIV antibody test not AIDS Test TransmissionTransmission Think through a reactive result today. What would comfort them?Think through a reactive result today. What would comfort them?

43 So what does that mean?

44 The results are in… Be prepared to explain and speak correctly about the test you have chosen.Be prepared to explain and speak correctly about the test you have chosen. –Preliminary Positive/Reactive NOT Positive –Manufacture’s Guidelines –Screening vs. Confirmatory »This all can be given to them beforehand

45 Window Period

46 So I had unprotected sex last night… Three Months (97%)Three Months (97%) Many within 25 daysMany within 25 days 6 months for those in high risk categories6 months for those in high risk categories –IDU, Partners of POZ – in some cases HRH, MSM –Or just explain 3% take 6 months and let them decide. ***Remind them their partners have a window period too.

47 Then where can I go?

48 What other tests or referral… Sexually Transmitted Infections/STD’sSexually Transmitted Infections/STD’s Hepatitis CHepatitis C PregnancyPregnancy Hepatitis A & B Vaccinations (MSM, ?)Hepatitis A & B Vaccinations (MSM, ?) PAPPAP Birth ControlBirth Control

49 Who am I going to tell?

50 Supports Does anyone know you are here today?Does anyone know you are here today? Is that someone you would call?Is that someone you would call? How do you think you would respond to a reactive result today?How do you think you would respond to a reactive result today? –Now be sure it does not appear that you can see the result, already. Be sure they understand process if result is reactive and how involved you personally or your agency will be.

51 Follow up & Follow Through

52 You need another test… Review Window PeriodReview Window Period Encourage condom use during this timeEncourage condom use during this time –Though you may have received a negative result today, you may still have the virus and you could transmit to your partner. –Having HIV also makes you susceptible to other Sexually Transmitted Infections –Make the Referral

53 Essentials during a CTR session: Maintain client-centered focus Explain various test options Explain possible results in a rapid test Explain reactive test/confirmatory testing/state reporting prior to obtaining informed consent Assess readiness for results in 20 minutes Obtain signature for informed consent Run test Allow client to guide action plan Provide test results in neutral manner Assist client as needed (confirmatory testing, resources)

54 JEAN

55 What is important to key into about her friends?What is important to key into about her friends? –Confidentiality –Support What about her boyfriend?What about her boyfriend? –Prison Stats –Injection Drug Use/Hepatitis C What is her risk reduction plan, does she need a follow up and when?What is her risk reduction plan, does she need a follow up and when?


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