Successful integration of rapid HIV screening into an urban family planning/OB/GYN clinic

Issues: Heterosexual HIV transmission now accounts for 78% of new infections in U.S. It is critical that family planning (FP) and OB/GYN clinics offer HIV screening as part of routine care (CDC 2006). FP clinic staff needs training and a streamlined consent/counseling model to successfully integrate opt-out screening.

Description: In 2003, an urban FP/OB/GYN clinic launched an opt-out rapid HIV screening program. All patients were offered HIV testing, regardless of risk. The program included a full-time dedicated HIV counselor embedded in the clinic, semiannual HIV educational programs to staff, a physician referral system, and immediate care linkage for positives.

Lessons Learned: 2,413 clinic patients were screened. Fifteen HIV-infected pregnant women were identified during prenatal screenings; all infant transmissions were prevented. 2006 had a 0.93% patient seropositivity rate (7.8% for walk-ins). The overall HIV screening rate increased from 34% in 2003 to 67% in March 2006 with 94% of prenatal patients screened. After three years testing was transitioned to permanent clinic staff. Program challenges included addressing training needs, lack of staff time to perform additional testing, lack of a streamlined counseling model to fit into busy clinic.

Recommendations: Identify key stakeholders and gain support from administration and clinic managers. Provide ongoing trainings and incentives to increase knowledge of HIV and buy-in of their role in educating patients. Create population appropriate education materials, consents, and brief counseling/testing model that integrates seamlessly into clinic flow.