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Introduction
Missed Opportunities for Prevention
CDC’s Efforts
Rapid Testing Workshops
Collaborators
Workshop Goals & Objectives
Workshop Format
Resources and More Information
Introduction
CDC estimates that at the end of 2003, approximately 1.0–1.2 million persons were living with HIV in the United States. Among these, an estimated one quarter (252,000–312,000 persons) of those infected do not know that they have HIV. Two-thirds of new HIV infections are attributed to those who are unaware of their HIV status, with over half of new HIV infections occurring among blacks and Hispanics. Increased HIV testing is critical for slowing the rate of new HIV infections and addressing disparities among those infected with HIV.
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Missed Opportunities for Prevention
For many people newly diagnosed with HIV, HIV testing comes late in the course of their HIV infection, representing months or years of missed opportunities for treatment and prevention. Additionally, a review of the medical histories of individuals newly diagnosed with HIV reveals that many had multiple contacts with the healthcare system in the preceding months, but they had not been tested for HIV infection. Similarly, pregnancy is a particularly important time for HIV testing because the virus can be passed to the fetus before and during birth. Despite existing recommendations promoting HIV testing in pregnancy, some women may not be offered HIV testing during prenatal care, some women may decline such testing, and some women do not receive prenatal care and therefore do not have the opportunity to be tested.
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CDC’s Efforts
In 2003, CDC introduced the initiative
Advancing HIV Prevention: New Strategies for a Changing Epidemic. Two key strategies of this initiative are to make HIV testing a routine part of medical care and to further reduce perinatal transmission of HIV. CDC acknowledged some providers perceived barriers to providing prevention counseling and written informed consent, and advocated streamlined approaches. In 2006, CDC published
Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings, which promote routine opt-out HIV testing in all health care settings for adults and adolescents aged 13-64 years, HIV testing for pregnant women early in prenatal care, and rapid HIV testing at the time of labor for women of unknown HIV status.
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Rapid Testing Workshops
In order to assist health care settings with implementing these new standards of care, CDC has convened two series of regional workshops aimed at implementing rapid HIV testing in two critical settings: labor and delivery units and emergency departments. These workshops will enhance the capacity of hospitals and healthcare providers to increase identification of HIV-infected persons early in their disease progression and to further decrease perinatal HIV transmission in the U.S.
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Collaborators
Collaborating partners working to implement these trainings include:
CDC’s Division of HIV/AIDS Prevention, the
François-Xavier Bagnoud Center (FXBC) at the University of Medicine & Dentistry of New Jersey, the
Health Research and Educational Trust (HRET), the research and education affiliate of the American Hospital Association (AHA),
DB Consulting Group, and the
Academy for Educational Development (AED)
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Workshop Goals & Objectives
The workshops are designed to provide hospital teams with information and resources that will assist them in developing a strategic plan for implementing rapid HIV testing in one or more settings. The goals of these workshops include:
- Providing hospital leaders with current information on the science and technology of rapid HIV testing;
- Offering a workshop environment where hospital leaders can develop the skills that they and their staff will need to implement rapid HIV testing in labor and delivery and emergency departments;
- Supporting hospitals with model policies, educational materials, and other materials that they need to move from planning to implementing rapid HIV testing in labor and delivery and emergency departments; and
- Facilitating hospitals’ development of an action plan that will lead to implementation of rapid HIV testing at their hospital within a timeframe determined by the team.
Specific objectives will depend on the composition of the team and the target locations where rapid testing is to be implemented in each institution (e.g., labor and delivery or emergency departments).
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Workshop Format
The workshops are invitation-only meetings that bring together hospitals from a multi-state region for one and one-half days. The first series of workshops in 2004-2005 focused on the labor and delivery setting. The second series of workshops focuses on emergency departments but also includes labor and delivery. A
schedule for the workshops is available and will be updated as needed.
The hospitals invited to the workshops are selected based on the magnitude of the HIV epidemic among the populations they serve and characteristics of the hospital (such as size, patient volume, payor mix, relationships to educational institutions). Hospital teams consist of senior representatives from hospital administration, legal or risk management, laboratory services, nursing management, and obstetric/emergency medical staff. State and local health departments also play a critical role in this effort and are invited to send representatives to observe the workshops.
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Resources and More Information
Rapid Testing in Emergency Departments and Labor and Delivery (2007)
Rapid Testing in Labor and Delivery (2004-2005)
Replication Guide
The Replication Guide is a step-by-step manual that can be used by health departments, community based organizations, or other interested groups to conduct a strategic planning workshop for hospitals. Back
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