Incorporating HIV test Counseling Testing and Referral into

Incorporating HIV test Counseling, Testing and Referral into an Adolescent Clinic– The St. Chris experience Tahniat Ansari, MD MPH Assistant Professor of Pediatrics Drexel University College of Medicine St. Christopher’s Hospital for Children

Who we are • Our staff – 4 front desk, 3 medical assistants, 1 charge nurse, 3 nurse practitioners, 3 health educators, 3 physicians, pediatric residents, medical students • 2 clinics – North Philadelphia -medically underserved area – Central Philadelphia

Family Planning Demographics • Confidential free reproductive care for ages 12 -21 y/o males and females • Over 10, 000 visits per year • A little over 3, 000 individual patients • African American = Hispanic >>> Caucasian > Asian • 99% below poverty

Family Planning Based Clinic • Annual exams – complete physical, pelvic/male GU exam, Pap smear, GC/CT testing, RPR, HIV testing • Six month checks – GC/CT testing • Acute care visits – vaginal complaints, ECP • Walk in pregnancy test clinic • Health educator only visit – BC start/check, ECP

HIV Test Counseling

ES • 14 year old female • Referred from our high school health resource center for treatment of Chlamydia • Further questioning: sexually active with one partner for the past 1 month, didn’t use a condom “one time”.

HIV Test Counseling • Who: clinicians, health educator specialists, …front staff, medical assistants • When: Incorporated into almost visit as a part of preventive health topics and risk reduction counseling • What: ABC’s discussed. Counseling tailored to patient’s developmental level and understanding. Written information also provided. Brochures, Posters, Power point presentation

HIV Testing

CR • 16 year old female • Here for routine “gyn” exam, refused blood work because she “hates needles” • Complains of itchy vaginal discharge • Further history: sexual initiation 6 months ago, history of 2 different partners, intermittent condom use • Physical exam: 2 tatoos, normal except green frothy vaginal discharge

HIV Testing • Conventional serum: MA draw 2 tubes of blood as a part of triage. 1 is sent for RPR testing, the other can be sent by the patients request for HIV testing • Rapid: 20 minutes – Oral – Finger stick • Follow-up – Appointments made 2 weeks after testing for results – Tracking sheet

Follow-Up Tracking Sheet Post test counselor: Patient Name/Medical Record #: Test date: Result date: Post-test date: HIV result: reactive, non reactive, inconclusive Form kept as first paper in the chart. Can be completed anytime the patient returns to clinic.

Positive HIV Test Referral

BC • • 19 year old male Here for a routine physical exam Only complaint: fatigue, sore throat for 3 weeks Further questioning: – Recent rash on palms and soles, now healed. Weight loss. – Sexually active with history of 3 males partners, condoms + • Physical exam: multiple non tender enlarged lymph nodes, large shallow healing ulcers in the throat

HIV Test Referral • Partnership with Immunology/HIV clinic at St. Chris – Safety net created: Clinicians and counselors develop a plan prior to patient arriving. – St. Chris Immunology: a physician and/or social worker and/or peer counselor is available immediately. – They make immediate arrangements to begin care.

HIV test Integration-2+ Years • Every Annual • Six month check up • Positive GC/CT/Trich if no test in previous 3 months • Pregnancy • Unprotected sex • Walk-in rapid testing “WRAP”

Lessons Learned • Create culture---work as a team, get “buyin”, identify “champions”, positive reinforcement • Teach confidentiality to staff, ensure patient confidentiality • Use every opportunity, be flexible, be creative • Make it easy

Lessons Learned • Partnership – Outside resources – Patients • Patience and persistence • Don’t be afraid---plan for the worst • Breathe

The Real Workforce • Health educators: Jenny Brice, May Lo, Mark Miller • Drs. Levine, Acquavella • NPs- Dale Drucker, Chris Hoyler, Lynn Yates • MAs-Myteesha, Relonda, Cely • Front desk- Christy, Lydia, La. Tonya, Richena • Family Planning Council support