1. OPA/OFP HIV Prevention Project Annual Technical Support Conference Report from Breakout Sessions – Day 2 Karla Johnson, MSPH Executive Director Development Systems, Inc. Region VII RTC June 14, 2007

2. Internal Challenges & Solutions Challenges  HIV testing viewed as “separate”  Clinic flow for integrating rapid tests Suggested Solutions or Actions  “Relentless” training of staff  Revise clinic flow systems, consent forms to accommodate rapid testing  Use example of open access

3. Internal Challenges & Solutions Challenges  Staff resistance to testing Suggested Solutions or Actions  Train staff on importance of testing and needs of clients  Develop systems that incorporate HIV testing into clinic services

4. Internal Challenges & Solutions Challenge  “Silo” funding - separate staffing, appointment systems, protocols  Sustainability of rapid testing (dependent on OPA funding) Suggested Solutions or Actions  Targeted testing at specific sites  Sliding scale fee for rapid testing

5. Internal Challenges & Solutions Challenges  Burden of paperwork  Writing procedures Suggested Solutions or Actions  Streamline and redefine reporting and documentation requirements  PPFA Clinical Guidelines Manual

6. Internal Challenges & Solutions Challenges  False positive with rapid tests Suggested Solutions or Actions  Training/counseling to prepare staff/clients for false positives  Quality control (i.e. storage issues)

7. Internal Challenges & Solutions Challenges  Staff turnover  Staff burnout Suggested Solutions or Actions  Revisit agency mission statement  Get buy-in from management team  Support professional development  Network with model programs

8. Internal Challenges & Solutions Challenges  Cultural competency Suggested Solutions or Actions  Understand cultural diversity and needs of client population  Provide staff training and follow-up with implementation and support  Counseling supervision & feedback

9. External Challenges & Solutions Challenge  Stigma around HIV Suggested Solutions or Actions  Full implementation of training materials that address stigma  Social marketing and education  Normalize HIV testing

10. External Challenges & Solutions Challenge  Collaboration between HIV/AIDS CPGs and FP agencies Suggested Solutions or Actions  OPA collaborate with CDC to determine how family planning and CPGs can work together

11. External Challenges & Solutions Challenge  State requirements don’t match CDC recommendations (e.g. many require separate HIV consent) Suggested Solutions or Actions  Collaborate with other CBOs, ASOs to advocate for public policy to support best practices

12. External Challenges & Solutions Challenge  Some states require testing sites to run daily controls (huge expense) Suggested Solutions or Actions  Review state laws nationwide to determine extent of this issue  Find models for legislative change

13. External Challenges & Solutions Challenge  Reimbursement (e.g. rapid testing, post-test counseling) Suggested Solutions or Actions  Quantify potential loss of income and consider whether this income could be offset (e.g. sliding scale fees, streamlining)

14. External Challenges & Solutions Challenge  Excessive training requirements Suggested Solutions or Actions  Negotiate less extensive training requirements with authorizing agency for family planning staff

15. External Challenges & Solutions Challenge  Difficulty identifying referral linkages in rural settings Suggested Solutions or Actions  Network with HIV organizations to find out where PLWHA receive care, and seek out those providers for cross-referral