Expanded HIV Testing and Linkage to Care: Conventional vs. Point-of-Care Testing and Assignment of Patient Notification and Linkage to Care to an HIV Care Program

Bares, Sara H; Eavou, Rebecca; Bertozzi-Villa, Clara; Taylor, Michelle; Hyland, Heather; McFadden, Rachel; Shah, Syed G.; Pho, Mai T.; Walter, James J.; Badlani, Sameer; Schneider, John A.; Prachand, Nik; Benbow, Nanette; Pitrak, David

doi:10.1177/00333549161310s113

Cited by 17 publications

(23 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Participants' suggestions to disconnect testing from clinical settings and limit interactions with health care providers (i.e., testing kiosks, HIVST kits, community testing) may assist with reducing negative perceptions about HIV testing experiences. While non-clinical testing may help reduce stigma, it is also important to identify ways to improve linkage to care for people tested in community settings [26,27]. Faith-based and community-based leaders could not only help change norms about HIV as a taboo topic, but also serve as an ongoing local voice for testing promotion and awareness, filling in the gaps between larger public events like health fairs that promote HIV testing.…”

Section: Discussionmentioning

confidence: 99%

“Meet people where they are”: a qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North Carolina

et al. 2020

View full text Add to dashboard Cite

Background: HIV testing programs in the United States aim to reach ethnic minority populations who experience high incidence of HIV, yet 40% of African Americans have never been tested for HIV. The objective of this study is to identify community-based strategies to increase testing among African Americans in both urban and rural areas. Methods: This study conducted focus group discussions (FGDs) informed by community-based participatory research principles to examine African American's concerns and ideas around HIV testing and HIV self-testing. Participants included highly affected (i.e., PLWH, MSM, PWID, low-income, teens and young adults) populations from African American communities in North Carolina, aged 15 years and older. We digitally transcribed and analyzed qualitative data using MAXQDA and axial coding to identify emergent themes.Results: Fifty-two men and women between 15 to 60 years old living in urban (n=41) and rural (n=11) areas of North Carolina participated in focus group discussions. HIV testing barriers differed by HIV testing setting: facilitybased, community-based, and HIV self-testing. In community-based settings, barriers included confidentiality concerns. In facility-based settings (e.g., clinics), barriers included negative treatment by healthcare workers. With HIV self-testing, barriers included improper use of self-testing kits and lack of post-test support. HIV testing facilitators included partnering with community leaders, decentralizing testing beyond facility-based sites, and protecting confidentiality.(Continued on next page)

show abstract

Section: Discussionmentioning

confidence: 99%

“Meet people where they are”: a qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North Carolina

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Providers’ concern for follow up on abnormal tests further inhibits the willingness to offer screening, particularly in settings such as the emergency department (ED) where they are more likely to encounter patients who do not otherwise access the healthcare system [39, 44–46]. Establishing institutional policies that support providers in these areas have been successful in overcoming these barriers, including personnel trained in notification and linkage procedures [47–50].…”

Section: Care Continuum Entry Interventionsmentioning

confidence: 99%

“…PLWH who are aware of their HIV infection but not retained in care are now understood to contribute to a significant number of new transmission events, and efforts for re-engagement can begin with the testing event [57]. Universal screening programs implemented in places such as the ED have found that up to 50% of positive HIV tests occur in those already aware of their diagnosis, many of whom are out of care [47]. This group has been difficult to link back to care and novel strategies are being identified to address this problem such as the CDC’s Data to Care program funded through local health departments, as well as using surveillance data to identify and reach these individuals [58–60].…”

Section: Care Continuum Entry Interventionsmentioning

confidence: 99%

Care continuum entry interventions

McNulty

Schneider

2018

Aids

View full text Add to dashboard Cite

: The current review re-conceptualizes seek and test strategies, particularly given the changing importance of HIV testing as care continuum entry for persons irrespective of their HIV status. Care continuum entry advances previous seek and test strategies for client engagement with two next-generation functions: use of testing to engage (or re-engage) HIV negative clients in preexposure prophylaxis (PrEP) care; and testing individuals who may already be known positives for care continuum re-entry. We review existing seek and test strategies for most impacted community members with a goal of optimizing care continuum entry as we move towards HIV transmission elimination. These strategies are context, sub-group, community and epidemic-specific. This review is timely, given the initiation of routine PrEP care, which shifts and broadens our conceptualization of care continuum entry triggered by the HIV testing event. In addition, as the epidemic becomes more concentrated, focusing on re-engagement of HIV-infected persons becomes increasingly important given that transmission events involve both those acutely and newly infected as well as the large numbers who may not be virally suppressed. We start with examination of routine testing in healthcare settings, emphasizing its potential role in re-engagement for persons out of care. Subsequently, we describe risk-based testing to identify key populations. We then review network-based approaches and their impact on the epidemic. We close with future directions for individual and combination care continuum entry strategies most relevant to elimination of HIV transmission in the United States.

show abstract

“…Indeed, EDs have become an important setting for routine HIV testing because ED patients are often disproportionately affected by HIV and may have limited access to primary care. [4][5][6][7] With routine opt-out HIV testing, EDs have uncovered thousands of new HIV diagnoses and have engaged patients at each stage of the HIV care continuum. [8][9][10][11][12][13] EDs, however, often offer little in regards to HIV prevention services for those who test negative for HIV.…”

Section: Introductionmentioning

confidence: 99%

Which Patients in the Emergency Department Should Receive Preexposure Prophylaxis? Implementation of a Predictive Analytics Approach

Ridgway

Almirol

Bender

et al. 2018

AIDS Patient Care and STDs

View full text Add to dashboard Cite

Emergency Departments (EDs) have the potential to play a crucial role in HIV prevention by identifying and linking high-risk HIV-negative clients to preexposure prophylaxis (PrEP) care, but it is difficult to perform HIV risk assessment for all ED patients. We aimed to develop and implement an electronic risk score to identify ED patients who are potential candidates for PrEP. Using electronic medical record (EMR) data, we used logistic regression to model the outcome of PrEP eligibility. We converted the model into an electronic risk score and incorporated it into the EMR. The risk score is automatically calculated at triage. For patients whose risk score is above a given threshold, an automated electronic alert is sent to an HIV prevention counselor who performs real time HIV prevention counseling, risk assessment, and PrEP linkage as appropriate. The electronic risk score includes the following EMR variables: age, gender, gender of sexual partner, chief complaint, and positive test for sexually transmitted infection in the prior 6 months. A risk score ≥21 has specificity of 80.6% and sensitivity of 50%. In the first 5.5 months of implementation, the alert fired for 180 patients, 34.4% (62/180) of whom were women. Of the 51 patients who completed risk assessment, 68.6% (35/51) were interested in PrEP, 17.6% (9/51) scheduled a PrEP appointment, and 7.8% (4/51) successfully initiated PrEP. The measured number of successful PrEP initiations is likely an underestimate, as it does include patients who initiated PrEP with outside providers or referred acquaintances for PrEP care.

show abstract

Expanded HIV Testing and Linkage to Care: Conventional vs. Point-of-Care Testing and Assignment of Patient Notification and Linkage to Care to an HIV Care Program

Abstract: Lead organizations such as UCM were able to assist and oversee HIV screening and linkage to care for HIV patients diagnosed at community sites. HIV screening and linkage to care can be accomplished by incorporating standard testing for HIV into routine medical care.

Cited by 17 publications

References 22 publications

“Meet people where they are”: a qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North Carolina

“Meet people where they are”: a qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North Carolina

Care continuum entry interventions

Which Patients in the Emergency Department Should Receive Preexposure Prophylaxis? Implementation of a Predictive Analytics Approach

Contact Info

Product

Resources

About