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Originally developed by: Health Care Education & Training, Inc. HIV Screening and Women’s Health Originally developed by: Health Care Education & Training, Inc. HIV Screening and Women’s Health Section 6: Considerations for Implementation

2007 Contributors from AETC Women’s Health and Wellness Workgroup: § § § § Laura 2007 Contributors from AETC Women’s Health and Wellness Workgroup: § § § § Laura Armas, MD; Texas/Oklahoma AETC Monique M. Clesi; Planned Parenthood of Indiana Andrea Norberg, MS, RN; AETC National Resource Center Tonia Poteat, MPH, MMSc, PA-C; Southeast ATEC (SEATEC) Barbara Schechtman, MPH; Midwest ATEC (MATEC) Karen Sherman, MA; Health Care Education and Training, Inc. Barb Sturbaum, LPN; Planned Parenthood of Indiana Jamie Steiger, MPH; AETC National Resource Center The original curriculum was developed in 2002 by MATEC and Health Care Education & Training, Inc. 2 HIV Screening and Women’s Health

Objectives for Section 6: 1. 2. 3. 4. 3 List major aspects of integrating Objectives for Section 6: 1. 2. 3. 4. 3 List major aspects of integrating HIV services into family planning clinics Describe the importance of knowing your community Describe an effective referral system List protocols and procedures your organization needs to have in place HIV Screening and Women’s Health

Goal for Providing HIV Services in Family Planning Clinics Ensure that all women have Goal for Providing HIV Services in Family Planning Clinics Ensure that all women have the opportunity to know their HIV status. 4 HIV Screening and Women’s Health

Aspects of Integrating HIV Services § § § § § 5 State policies Cost/reimbursements Aspects of Integrating HIV Services § § § § § 5 State policies Cost/reimbursements Type of test –which test Confirmatory testing Management and staff buy-in Basic staff training and ongoing staff needs Support for staff who give test results Chart documentation Referral sources for positive clients HIV Screening and Women’s Health

2001 Title X Program Guidelines on HIV § § § § 6 Educational services 2001 Title X Program Guidelines on HIV § § § § 6 Educational services Referral services Risk assessment Counseling and testing History taking Charting Physical examination HIV Screening and Women’s Health

Musts § § 7 Analyze HIV risk factors and behaviors of all clients Offer Musts § § 7 Analyze HIV risk factors and behaviors of all clients Offer education and counseling on HIV Include HIV risks in medical history taking Do risk reduction counseling if risk behaviors are identified HIV Screening and Women’s Health

Organizational Options § Onsite testing § § 8 Anonymous Confidential What type of test? Organizational Options § Onsite testing § § 8 Anonymous Confidential What type of test? Referral for testing HIV Screening and Women’s Health

Organizational Procedures and Protocols § § § 9 Staff responsibilities Training for staff Quality Organizational Procedures and Protocols § § § 9 Staff responsibilities Training for staff Quality assurance program Notification of test results Referral for care HIV Screening and Women’s Health

Client Risk—An Integrated Risk Assessment § § § § § 10 Client’s concerns Pregnancy Client Risk—An Integrated Risk Assessment § § § § § 10 Client’s concerns Pregnancy history Artificial insemination Blood exposure Pregnancy prevention methods used Past HIV testing Condom use Alcohol/other drug use # of sex partners Gender of sex partner(s) Type of sex (anal, vaginal, oral) § STI history § Hepatitis history § Sex for money or goods § Partner’s alcohol/other drug use § Partner’s sex history § Partner’s criminal history § Partner’s circumcision status § HIV Screening and Women’s Health

Community Risk—Integrate Community Factors § § § § 11 Alcohol and other drug use Community Risk—Integrate Community Factors § § § § 11 Alcohol and other drug use Proportion of older clients based on relationships status Proportion of adolescents Sex workers Prevalence of STIs Unintended pregnancy rate Ex-offenders HIV Screening and Women’s Health

Community Risk—Integrate Community Factors § § 12 Interstate truck stops or rest areas Gathering Community Risk—Integrate Community Factors § § 12 Interstate truck stops or rest areas Gathering places where high risk behaviors take place Immigration and migration Bath houses HIV Screening and Women’s Health

Youth Risk—Understanding Risk Behaviors Youth Risk Behavior Survey (YRBS) among females in grades 9 Youth Risk—Understanding Risk Behaviors Youth Risk Behavior Survey (YRBS) among females in grades 9 -12 in Michigan § 41% have had intercourse § 10% had more than four sex partners § 31% had sex within the last three months § 19% used alcohol or other drugs during most recent episode § 40% did not use a condom during last episode 13 HIV Screening and Women’s Health

Types of Testing § § 14 Confidential Anonymous HIV Screening and Women’s Health Types of Testing § § 14 Confidential Anonymous HIV Screening and Women’s Health

Referral and Deferral of Testing § § 15 Opt-out, if possible Risk reduction for Referral and Deferral of Testing § § 15 Opt-out, if possible Risk reduction for identified risk factors Guidelines for referrals List of referral sites HIV Screening and Women’s Health

Client Records § § 16 Consult with your state health department Informed consent is Client Records § § 16 Consult with your state health department Informed consent is required HIV Screening and Women’s Health

Chart Documentation § § § § Risk assessment Risk reduction plan Referrals for testing Chart Documentation § § § § Risk assessment Risk reduction plan Referrals for testing Deferrals HIV specific medical record release Informed consent Other referrals and ID need § § 17 Medical Psychosocial HIV Screening and Women’s Health

Protocols for Positive Test Results § § § 18 Method of partner notification Partner Protocols for Positive Test Results § § § 18 Method of partner notification Partner notification records Follow-up efforts Risk reduction plan State case report HIV Screening and Women’s Health

Ongoing Staff Training Needs § § § § 19 Base training on evidence from Ongoing Staff Training Needs § § § § 19 Base training on evidence from site reviews Changing community risk factors Knowledge of types of HIV tests Legalities of HIV-related consent forms Legalities of testing/state laws Notification/partner notification Referral sources HIV Screening and Women’s Health

Evaluate Staff Performance § § 20 Observe staff educational sessions Observe testing Observe counseling Evaluate Staff Performance § § 20 Observe staff educational sessions Observe testing Observe counseling Design ongoing training, as needed HIV Screening and Women’s Health

Resources § § AIDS Education and Training Centers www. aidsetc. org Title X Family Resources § § AIDS Education and Training Centers www. aidsetc. org Title X Family Planning Regional Training Centers http: //opa. osophs. dhhs. gov/titlex/ofp-training-granteeslisting. html National HIV/AIDS Clinicians’ Consultation Center (NCCC) www. ucsf. edu/hivcntr Family Health International § 21 Establishing Referral Networks for Comprehensive HIV Care in Low-Resource Settings http: //www. synergyaids. com/documents/Ref. Nets. Guide 2. pdf HIV Screening Health and HIV Reproductive and Women’s Health

References Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and References Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Healthy Youth! State-by-State, Michigan. Retrieved on November 5, 2007 from http: //www. cdc. gov/Healthy. Youth/states/mi. htm Mac. Donald, S. R. , Skor, A. , Socol, M. L. , & Garcia, P. M. (1998). Human immunodeficiency virus infection and women: a survey of missed opportunities for testing and diagnosis. American Journal of Obstetrics and Gynecology, 178(6): 1264 -71. 22 HIV Screening Health and HIV Reproductive and Women’s Health