A Novel Approach to Realizing Routine HIV Screening and Enhancing Linkage to Care in the United States: Protocol of the FOCUS Program and Early Results

Sanchez, Travis; Sullivan, Patrick S.; Rothman, Richard E.; Brown, Emily; Fitzpatrick, Lisa; Wood, Angela; Hernandez, Paloma; Nunn, Amy; Serota, Martin; Moreno‐Walton, Lisa

doi:10.2196/resprot.3378

Cited by 23 publications

(25 citation statements)

References 22 publications

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“…The provider views the following as important barriers to HIV testing: the need for a written informed consent; the need for pre-test counseling; uncertainty regarding reimbursement; competing priorities for time; patient’s anticipated reaction; patients’ sense that they did not need the test; lack of resources for performing the test [ 17 ]…”

Section: Methodsmentioning

confidence: 99%

Initial Health Assessments and HIV Screening under the Affordable Care Act

Leibowitz¹,

Garcia-Aguilar

Farrell

2015

PLoS ONE

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BackgroundThe Centers for Disease Control and Prevention (CDC) estimates that 156,300 (95% CI 144,100–165,900) Americans living with HIV in 2012 were unaware of their infection. To increase knowledge of HIV status, CDC guidelines seek to make HIV screening a routine part of medical care. This paper examines how routinely California primary care providers test for HIV and how providers’ knowledge of California’s streamlined testing requirements, use of sexual histories, and having an electronic medical record prompt for HIV testing, relate to test offers.MethodsWe surveyed all ten California health plans offered under health reform’s Insurance Exchange (response rate = 50%) and 322 primary care providers to those plans (response rate = 19%) to assess use of HIV screening and risk assessments.ResultsOnly 31.7% of 60 responding providers reported offering HIV tests to all or most new enrollees and only 8.8% offered an HIV test of blood samples all or most of the time despite the California law requiring that providers offer HIV testing of blood samples in primary care settings. Twenty-eight of the 60 providers (46.6%) were unaware that California had reduced barriers to HIV screening by eliminating the requirement for written informed consent and pre-test counseling. HIV screening of new enrollees all or most of the time was reported by 53.1% of the well-informed providers, but only 7.1% of the less informed providers, a difference of 46 percentage points (95% CI: 21.0%—66.5%). Providers who routinely obtained sexual histories were 29 percentage points (95% CI: 0.2%—54.9%) more likely to screen for HIV all or most of the time than those who did not ask sexual histories.ConclusionChanging HIV screening requirements is important, but not sufficient to make HIV testing a routine part of medical care. Provider education to increase knowledge about the changed HIV testing requirements could positively impact testing rates.

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Section: Methodsmentioning

confidence: 99%

Initial Health Assessments and HIV Screening under the Affordable Care Act

Leibowitz¹,

Garcia-Aguilar

Farrell

2015

PLoS ONE

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“…Integrating screening into the regular clinical workflow made the program scalable, and the active HIV linkage to specialty care was an essential element of its success. 10,17 The UHP collaborative benefited from the New York State HIV testing law, which requires that an HIV test be offered to all patients aged 13-64 years. This law positively affected our health-care providers' acceptability of the project.…”

Section: Lessons Learnedmentioning

confidence: 99%

Integrating Routine HIV Screening in the New York City Community Health Center Collaborative

Rodríguez¹,

Lester²,

Connelly-Flores³

et al. 2016

Public Health Rep

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“…4 Funding for the testing subsequently switched to a grant from the Gilead Sciences FOCUS program, which has been described previously. 21 Specifically, we sought to institutionalize the policies started in the earlier, federally funded demonstration project. We wanted to establish both the default of offering HIV testing to all, without attempting to obtain a history of high-risk behavior before testing, and the expectation that all front-line nurses in the intake area were to offer testing.…”

Section: Introductionmentioning

confidence: 99%

Establishing an HIV Screening Program Led by Staff Nurses in a County Jail

Spaulding

Kim

Corpening

et al. 2015

Journal of Public Health Management and Practice

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Context HIV testing in jails provides an opportunity to reach individuals outside the scope of traditional screening programs. The rapid turnover of jail populations has, in the past, been a formidable barrier to offering routine access to testing. Objective To establish an opt-out, rapid HIV testing program, led by nurses on the jail staff, that would provide undiagnosed yet infected detainees opportunities to learn their status regardless of their hour of entry and duration of stay. Design Jail nurses offered rapid, opt-out HIV testing Setting Fulton County Jail (FCJ) in Georgia, United States. Participants 30,316 persons booked to FCJ. Intervention In late 2010, we performed a preliminary evaluation of HIV seroprevalence. Starting January 1, 2011, HIV testing via rapid oral mucosal swab was offered to entrants. In March 2013, fingerstick was substituted. Detainees identified as positives were assisted with linkage to care. Main outcome measures To estimate an upper limit of overall HIV prevalence among entrants, we determined seroprevalence by age and gender group. To measure program performance, we checked offer and acceptance rates for tests and rate of linkage to care among previously known and newly identified HIV+ detainees. Results The initial seroprevalence of HIV in FCJ was at least 2.18%. Between March 2013 and February 2014, 89 new confirmed positives were identified through testing. During these 12 months, 20,947 bookings were followed by an offer of HIV testing (69.10% offer rate), and 17,035 persons accepted (81.32% acceptance rate). A total of 458 previously and newly identified persons were linked to HIV care. Linkage was significantly higher among those aged 40 years and older (p<0.05). Conclusions A nurse-led, rapid HIV testing model successfully identified new HIV diagnoses. The testing program substantially decreased the number of persons who are HIV-infected but unaware of their status and promoted linkage to care.

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A Novel Approach to Realizing Routine HIV Screening and Enhancing Linkage to Care in the United States: Protocol of the FOCUS Program and Early Results

Cited by 23 publications

References 22 publications

Initial Health Assessments and HIV Screening under the Affordable Care Act

Initial Health Assessments and HIV Screening under the Affordable Care Act

Integrating Routine HIV Screening in the New York City Community Health Center Collaborative

Establishing an HIV Screening Program Led by Staff Nurses in a County Jail

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