1. Implementing Rapid HIV Testing in New York State Mara San Antonio-Gaddy Director Bureau of Direct Program Operations NYSDOH, AIDS Institute

2. NYSDOH ACT Program Description Publicly funded program that offers free, anonymous HIV counseling and testing as a dedicated service Variety of clinic sites in communities, state and county correctional facilities HIV Counselors are non-laboratory staff

4. NYS Rapid Testing Demonstration Pilot NYS Anonymous Counseling and Testing (ACT) program conducted a pilot to examine use of “point of care” rapid testing Pilot period was from April 2003 – June 2003 Pilot sites (10) were chosen based on profile of higher risk clients Examined: –Impact rapid testing had on clients and staff  Clients surveyed for acceptance and why they choose specific testing methods  Effectiveness of staff training in relation to comfort levels conducting rapid testing

5. Aspects of Implementing Rapid Testing Planning Training Client satisfaction Program evaluation

6. Planning for Rapid Test Implementation Coordination with various entities –Laboratory staff –Community and correctional partners at clinic sites Development of policies, procedures and quality assurance guidance documents Apply for CLIA permit

7. Counselor Training Required staff to review all product and lab testing information prior to attending the training 2 day training that included lecture and hands-on laboratory training and proficiency testing and practice Pre and post training evaluation and follow-up evaluation at 3 months

8. Laboratory Training

9. Training Tools Used Pre/post rapid test session “video clips” Rapid test manual: script, QA logs, policies, procedures and test interpretation guide Staff challenged to correctly interpret rapid devices Hands-on practice processing test and interpreting results Role plays and practice of new messages with rapid test results Direct observation of staff

10. Evaluation of Staff Training  47 staff were trained  Counselor surveys were conducted pre/post training and 12 weeks after implementation  Counselor Characteristics  Gender  30% Male  70% Female

11.  Counselor Characteristics (continued)  Race  30% White  32% African American/Black  36% Hispanic/Latino(a)  2% Other  Experience  < 3 years 32%  4 – 10 years 34%  > 10 years 34% Evaluation of Staff Training (continued)

12. Results From Staff Assessment

13. Rolling-out Rapid HIV Testing Staggered approach On-site technical assistance during regional start-up Review of quality assurance procedures, i.e., documentation instructions on QA logs Observation of rapid test counseling session

14. Roll- out (continued) Lessons learned shared with each site as rollout progressed Policies and procedures refined with additional experience On-site trainers provided a comfort level for staff on start-up Client survey of new technology

15. Client Survey Results Clients preferred a rapid test over standard testing (97%) Main reason clients chose a rapid test was because they could get same day results Clients chose oral fluid standard testing because they did not like needles Clients chose standard blood testing because they trusted the accuracy of the results 68% of the clients who responded stated that it was important to very important to have a testing choice

18. Rapid Reactive Clients April 2003 through December 2004 207 rapid reactive clients (100% received rapid test results) 186 (89.9%) clients accepted confirmatory testing 21 (10.1%) clients declined confirmatory testing 8 (4.3%) clients had WB negative results 8 (100%) received their results 4 (2.2%) clients had WB Indeterminate results 1 (25%) received the result 3 (75%) did not receive their results 174 (93.5%) clients had WB positive results 138 (79.3%) clients received their results 36 (20.7%) did not receive results 125 (90.6%) clients were referred to care 117 (84.8%) changed status from Anonymous to Confidential 83 (66.4%) were known to have accessed care

19. Considerations for Implementation Implementation needs planning and takes time Tailor training and implementation to type of program, staff qualifications and type of clients served Continuous monitoring assists staff Conduct Quality Assurance activities

20. Questions? More information can be found at the following web site: www.health.state.ny.us/nysdoh/hivaids/rapid For specific questions, please submit electronically to: hivct@health.state.ny.us