The BPHC TB Clinic has offered HIV counseling and testing to all clinic patients since 1991. Most patients seen in the clinic are non-USA-born and present with latent TB infection. Since the introduction of HIV counseling and testing the staff has consistently had difficulty integrating the service into clinical practice. There was no standard mechanism for assessment of HIV risk, and referral to the HIV Counselors was sporadic. Barriers identified by the Clinic staff included: 1)Time constraint during clinic sessions; 2)Discomfort with HIV risk assessment, especially questions regarding sexual behavior and drug use; 3)Cross-cultural issues; 4)Confidentiality; and 5)Conflicting diagnostic and treatment agendas. In response to the concerns, TB Control Program and AIDS Services managers developed a three-part training program for al TB Clinic professional and outreach staff. The objectives identified were: 1)Educate staff about the HIV/AIDS epidemic outside the US (focusing on countries of origin of most TB Clinic patients; 2)Identify challenges to integration of HIV risk assessment,counseling, and testing into clinical practice; 3)Develop risk assessment skills; 4)Address cross-cultural issues in HIV risk assessment; 5)Develop a risk assessment tool; 6)Integrate HIV risk assessment into clinical practice. Prior to the training and development of the tool, <10% of all clinic patients were approached for counseling and <8% actually agreed to HIV testing. Since implementation of the tool, 25% of clients have documentation of a completed HIV risk assessment; HIV testing of clinic patients has increased by 32%, and seroprevalence is calculated at 2.4%
Learning Objectives: Identify diagnostic and treatment conflicts related to HIV risk assessment and TB prevention; Articulate strategies for education and skill-building focusd on HIV risk assessment; Identify components of a culturally appropriate HIV risk assessment
Keywords: Assessments, TB
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.