HIV Testing Just Got A Lot Easier:

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HIV Testing Just Got A Lot Easier ACTS Assess /
Consent / Test / Support
RWCA Grantee Meeting August 29, 2006 Donna
Futterman, MD Prof. of Clinical Pediatrics,
AECOM Director, Adolescent AIDS Program
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Unfinished Business

• HIV is the worst epidemic in history
• 40,000 new cases each year 25-50 among youth
• 1 in 4 (?300,000) HIV Americans dont know
  theyre infected
• 80 of young HIV gay and bisexual men didnt
  know their status
• 41 of those diagnosed HIV were diagnosed with
  AIDS within one year of their positive HIV test

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Taking Care of Business

• Case finding hasnt kept up with treatment
  advances
• Patients overwhelmingly accept HIV testing when a
  provider recommends it
• Routing testing found cost/care effective in
  settings with .05 HIV prevalence
• The mobilization for prenatal testing missed a
  golden opportunity to routinize screening for
  all, but it remains a successful model for how to
  proceed

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Why Dont Providers Routinely Test?

• Research of providers revealed not enough time,
  not enough experience, not aware of risk
• Study commissioned by AAP, conducted by
  professional qualitative research firm
• Interviewed 55 Bronx-based providers and
  administrators in public and private settings
• Key findings informed ACTS initiative

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Its Time for a Paradigm Shift! HIV
testing has become such a huge obstacle that many
providers and patients prefer to sail around it.
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Fast Facts on ACTS

• ACTS is a concise, comprehensive system that
  makes provider-delivered HIV testing feasible in
  clinical care settings
• Provides instruction tools for making
  operational and clinical practice changes
• Meets CDC and DOH testing requirements
• Condenses 45-minute process to 5-10 minutes
• Allows for better allocation of counseling
  resources

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The Pocket Guide to ACTS
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Elements of the ACTS System

• Meeting with the HIV coordinator, clinic
  administrator and medical director to develop
  implementation plan
• Academic detailing session(s) to train clinic
  staff how to use ACTS
• ACTS manual and toolkit containing information,
  materials and resources for providers, clinic
  staff and patients

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Laying the Foundation for ACTS with Key Staff

• Address Philosophical Barriers
• Skepticism about patients HIV risk
• Other health problems viewed as priority
• Concerns about loss of prevention
• Address Logistical Barriers
• Which staff will test
• Documentation consent forms
• Patient flow results follow-up
• Billing issues

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ACTS Site Prep Checklist
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Training Staff to Utilize ACTS

• Academic Detailing
• Provider-led training
• Catered
• Follow-up trainings with new staff
• Ongoing Support
• Regular meetings with key staff to problem-solve
  barriers
• Ongoing data reporting to all staff via meetings
  and newsletters

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ACTS Materials
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Patient Education
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ACTS in ACTIONResults from a Randomized Control
Trial

• 10 Bronx clinics randomized to receive ACTS rapid
  counseling in late 2004
• Divided into 5 ACTS Sites 5 Control Sites
• Data collected on HIV testing rates
• Eligible patients included those age 15-64,
  non-maternity patients

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ACTS in ACTIONACTS Sites Double HIV Testing
Rates

ACTS begun
p lt .05
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ACTS in ACTION

• Continued regional national dissemination
• Expansion of ACTS to Bronx control sites in
  September 2006
• Ongoing implementation
• CDC-sponsored South Africa Youth Clinics
• Pediatric ER at Montefiore
• National Assembly on School-Based Health Care

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(No Transcript)
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Contact Us / Order Materials
Donna Futterman, MD DFutterman_at_AdolescentAIDS.org
Stephen Stafford StephenS_at_AdolescentAIDS.org Ado
lescent AIDS Program Childrens Hospital at
Montefiore Adolescent core of the NY/NJ
AETC 718-882-0232 AdolescentAIDS.org 8.29.06