Transcript Implementing Rapid HIV Testing in New York State

Implementing Rapid HIV
Testing
in New York State
Mara San Antonio-Gaddy
Director
Bureau of Direct Program Operations
NYSDOH, AIDS Institute
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
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
Aspects of Implementing Rapid Testing
• Planning
• Training
• Client satisfaction
• Program evaluation
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
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
Laboratory Training
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
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
Evaluation of Staff Training (continued)
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%
Results From Staff Assessment
Proportion of counselors who felt "very confident"
about rapid HIV testing skills at 12-week follow-up (n=40)*
Delivering a preliminary HIV positive result to a client
Delivering an HIV negative result to a client
Interpreting the result of a rapid HIV test
Performing the rapid HIV test as part of counseling
Performing the rapid HIV test correctly
Providing counseling for rapid HIV testing
Offering clients the rapid HIV testing option
0%
Pre-Training
Post-Training
12-Week Follow-up
10%
20% 30%
40% 50% 60%
70% 80%
*p<0.001, change from pretest to 12-w eek follow -up for all items except
delivering an HIV positive result to a client (p<0.01).
90% 100%
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
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
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
ACT Testing Data by Test Type
2003 n=19,471 2004 n=20,990
120.0%
Percentage
100.0%
80.0%
2003
60.0%
2004
40.0%
20.0%
0.0%
Rapid
Oral
Venipuncture
Type of Test
Unknow n
Testing Trends in the Bureau of Direct Program Operations
1997 through 2004
25000
Number of Tests
20000
15000
To tal Co mmunity
Tests
To tal Co rrectio nal
Tests
To tal Tests
10000
5000
0
1997
1998
1999
2000
2001
Year
2002
2003
2004
Rapid Reactive Clients
April 2003 through December 2004
207 rapid reactive clients (100% received rapid test results)
186 (89.9%) clients accepted 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
21 (10.1%) clients declined
confirmatory testing
174 (93.5%) clients had
WB positive results
3 (75%) did not
138 (79.3%) clients
receive their results received their results
117 (84.8%) changed status
from Anonymous to
Confidential
36 (20.7%) did
not receive results
125 (90.6%) clients were
referred to care
83 (66.4%) were known
to have accessed care
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
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: [email protected]