1. 1 TITLE X FAMILY PLANNING/HIV INTEGRATION PROJECT Opt Out Process Michael Brannon M.S. HIV/STD Prevention Program Manager (713) 439-6295 mbrannon@hcphes.org Website: http://www.hcphes.org

2. 2 HCPHES HIV Opt-Out Screening Process The goals of this presentation is to describe: Previous HIV Testing procedures. Current testing procedures. and what occurs when Family Planning patients opt out of HIV testing services within HCPHES health clinics.

3. 3 HCPHES HIV Opt-Out Screening Process Prior to FY 2006 the following testing procedures were in place. Two HIV Counselors were housed between the 5 HCPHES Health Clinics. Patients were screened by the nursing staff then referred to the HIV counselor for counseling and testing. For walk-in patients, front office staff would refer those individuals directly to the HIV Counselors for counseling and testing.

4. 4 HCPHES HIV Opt-Out Screening Process Patients were required to sign a separate consent form giving approval to be HIV tested. HIV Prevention counseling was performed on all referred patients. Anonymous and confidential testing was offered. HIV Counselors performed venipuncture on all FP patients receiving HIV testing.

5. 5 HCPHES HIV Opt-Out Screening Process All test results were forwarded back to the HIV counselors for review and filing. The HIV counselor provided all test results Results were housed in a separate locked file in the HIV Counselors office at each clinic site. Most patients referred to the HIV counselors refused HIV testing. An average of 2500 unduplicated patients out of about 7100 patients were HIV tested. (HCPHES 2005 FPAR)

6. 6 HCPHES HIV Opt-Out Screening Process Effective February 2006 HCPHES implemented the Family Planning (FP) HIV Integration Process. This process includes providing the ABC’s of HIV prevention education to all FP patients regardless of testing acceptance or refusal. A-Abstinence, B-Be faithful, C-Condoms use. Also universal HIV screening and testing of all FP patients was implemented. The general consent for medical care is used to encompass consent for HIV testing. Prevention counseling is no longer required. Anonymous testing is no longer offered.

7. 7 HCPHES HIV Opt-Out Screening Process Patients identified as high risk are referred to the HIV Counselor/Educator for enhanced prevention counseling. Patient high risk criteria consist of the following: Any previous or present STD. Multiple partners or recent partner change. Walk-in patients seeking HIV/STD services. Rider 33 patients (Reporting potential child abuse)

8. 8 For Maternity Patients HIV screening is included in the routine panel of prenatal screening tests for all pregnant women. Since repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women. HCPHES support this recommendation, but does not require repeat screening. HCPHES HIV Opt-Out Screening Process

9. 9 New Procedures Eligibility Screening Completion of the patient general consent form Interview and screening is performed by the nursing staff or clinician. All testing that will be performed is explained to the patients. The patients informed of their right of refusal to any testing (the right to Opt-Out of any provide services are explained). All unduplicated patients and patients returning after one year, are HIV tested unless they opt out of the service. If the patient “Refuses services”, this is documented on progress notes within the medical records. The refusal is also documented into QS Insight, HCPHES Electronic Client Data Management System.

10. 10 HCPHES HIV Opt-Out Screening Process New Procedures (cont.) Patients assessed to be high risk are referred to the HIV Counselor/Educator for enhanced prevention counseling after the initial clinical screening. All positive results are provided by the HIV Counselor/Educator. HIV Rapid testing and standardized testing is performed. Nurses, clinicians and HIV Counselors/Educator provide negative HIV test results. All test results are filed in the patients medical record and housed in the health clinics medical records room.

11. 11 HCPHES HIV Opt-Out Screening Process Conclusion. Currently opt out data is being collected from all clinic sites.