1. Routine HIV Screening in Health Care Settings David Spach, MD Clinical Director Northwest AIDS Education and Training Center Professor of Medicine, Division of Infectious Diseases University of Washington Seattle This project was funded under cooperative agreement number U65/PS000821 from the Centers for Disease Control and Prevention (CDC). Counseling and Linking to Care

2. Communicating HIV Test Results Counseling and Connecting to Services Importance of Engagement in Care Resources for Referral

3. Counseling and Linking to Care Communicating HIV Test Results Counseling and Connecting to Services Importance of Engagement in Care Resources for Referral

4. Communicating Test Results

5. Negative Communicating a Negative HIV Test Result Does not require direct personal contact Counsel high-risk persons - Periodic retesting for high risk persons - HIV prevention measures HIV Negative - Source: CDC. MMWR 2006;55(RR-14):1-17.

6. Positive Communicating a Positive HIV Test Result Provide result by direct personal contact Disclose result confidentially Ensure client understands test result Positive + Source: CDC. MMWR 2006;55(RR-14):1-17.

7. Preliminary Positive Communicating a Preliminary Positive HIV Test Reactive Rapid HIV Test Result Provide result by direct personal contact Explain result is a preliminary positive Explain that HIV has not been confirmed Discuss importance of follow-up testing + Preliminary Positive Source: CDC. MMWR 2006;55(RR-14):1-17.

8. Indeterminate Communicating Indeterminate HIV Test Result Provide result by direct personal contact Explain test results are unclear Ask about recent exposure to HIV Discuss importance of follow-up testing Indeterminate ? Source: CDC. MMWR 2006;55(RR-14):1-17.

9. Counseling and Linking to Care Communicating HIV Test Results Counseling and Connecting to Services Importance of Engagement in Care Resources for Referral

10. Counseling a Client with Newly Diagnosed HIV Provide basic information about HIV & AIDS Explain effective treatments available for HIV Discuss reducing risk of HIV transmission to others HIV-Infected +

11. Connecting to Services HIV-Infected + Support Services HIV Prevention Services Clinical Care Source: CDC. MMWR. 2006;55(RR-14):1-17.

12. Reporting and Notification Source: CDC. MMWR. 2006;55(RR-14):1-17. HIV-Infected + Document HIV Test Result Partner Notification Report HIV to Health Department

13. Connecting to Services, Reporting, & Notification Source: CDC. MMWR. 2006;55(RR-14):1-17. HIV-Infected + Support Services HIV Prevention Services Clinical Care Reporting and Notification Document HIV Test Result Partner Notification Report HIV to Health Department Connecting to Services

14. CDC 2008 Recommendations for Partner Services Source: CDC. MMWR 2008;57:1-63. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr57e1030a1.htm

15. Counseling and Linking to Care Communicating HIV Test Results Counseling and Connecting to Services Importance of Engagement in Care Resources for Referral

16. Linkage to Medical Care After a New HIV Diagnosis Source: Torian LV, et al. Arch Intern Med. 2008;168:1181-7. New York City Persons newly diagnosed with HIV infection in NYC (n = 1,928) Routine surveillance to determine time to initiation of care New York

17. Linkage to Medical Care After a New HIV Diagnosis Source: Torian LV, et al. Arch Intern Med. 2008;168:1181-7. Within 3 Months Later than 3 Months Never 64% 19% 17% Analysis: Time to Initiation of Care

18. Linkage to Medical Care After a New HIV Diagnosis Source: Torian LV, et al. Arch Intern Med. 2008;168:1181-7. 64% 19% 17% “Predictors for delayed care were as follows: (1) diagnosis at a community testing site, city correctional system, or Department of Health sexually transmitted diseases or tuberculosis clinics versus a site with colocated primary medical care; (2) injection drug use; and (3) location of birth outside the United States.”

19. Sequential Pathway of HIV Testing Source: Walensky RP, et al. Clin Infect Dis. 2007;45(Suppl 4):S248-54. Client agrees to undergo HIV testing Health care professional recommends HIV test Client receives HIV test result If HIV-infected, client linked to appropriate care site

20. Sequential Pathway of HIV Testing Source: Walensky RP, et al. Clin Infect Dis. 2007;45(Suppl 4):S248-54. Client agrees to undergo HIV testing Health care professional recommends HIV test Client receives HIV test result If HIV-infected, client linked to appropriate care site Linking to care: critical element in making routine HIV screening cost effective

21. Counseling and Linking to Care Communicating HIV Test Results Counseling and Connecting to Services Importance of Engagement in Care Resources for Referral

22. Resources for Linking to Care Health Resources Services Administration (HRSA) American Academy of HIV Medicine (AAHIVM) AIDS Education and Training Centers (AETC) HIV Medicine Association (HIVMA)

23. HRSA: Ryan White-Funded Clinics http://hab.hrsa.gov/

24. Locating Ryan White-Funded Clinics http://granteefind.hrsa.gov/searchbyprogram.aspx?select=H76&index=192&year=

25. American Academy of HIV Medicine: Find a Provider http://www.aahivm.org/index.php?option=com_comprofiler&task=usersList

26. American Academy of HIV Medicine Review of Best Practices and Primer for Clinicians http://www.aahivm.org/index.php?option=com_content&task=category&sectionid=4&id=194&Itemid=253

27. Educational Resources for HIV Testing AIDS Education and Training Centers (AETC) http://www.aids-etc.org/ Regional AETCsAETC National Resource Center

28. HIV Medicine Association (HIMVA) http://www.hivma.org/

29. Acknowledgement The project was funded under cooperative agreement number U65/PS000821 from the Centers for Disease Control and Prevention (CDC).