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

2. 2 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. HIV Screening and Women’s Health

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

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

5. 5 Aspects of Integrating HIV Services  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

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

7. 7 Musts  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

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

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

10. 10 Client Risk—An Integrated Risk Assessment  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

11. 11 Community Risk—Integrate Community Factors  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

12. 12 Community Risk—Integrate Community Factors  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

13. 13 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 HIV Screening and Women’s Health

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

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

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

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

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

19. 19 Ongoing Staff Training Needs  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

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

21. 21 Resources  AIDS Education and Training Centers www.aidsetc.org www.aidsetc.org  Title X Family Planning Regional Training Centers http://opa.osophs.dhhs.gov/titlex/ofp-training-grantees- listing.html http://opa.osophs.dhhs.gov/titlex/ofp-training-grantees- listing.html  National HIV/AIDS Clinicians’ Consultation Center (NCCC) www.ucsf.edu/hivcntr www.ucsf.edu/hivcntr  Family Health International  Establishing Referral Networks for Comprehensive HIV Care in Low-Resource Settings http://www.synergyaids.com/documents/RefNetsGuide2.pdf http://www.synergyaids.com/documents/RefNetsGuide2.pdf Reproductive Health and HIVHIV Screening and Women’s Health

22. 22 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/HealthyYouth/states/mi.htm http://www.cdc.gov/HealthyYouth/states/mi.htm MacDonald, 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. Reproductive Health and HIVHIV Screening and Women’s Health