Training and quality assurance for a rapid rest algorithm: Lessons from mplementation, San Francisco, CA 2007

Issue: Before implementing a point-of-care (POC) rapid testing algorithm (RTA), counselors must be trained to perform additional rapid tests and to provide modified counseling messages for clients based on RTA results. Data collection must be modified to collect additional rapid test results. Finally, a quality assurance (QA) program for counseling, testing, referral and data collection must be developed and piloted. Project: To implement a RTA with multiple POC tests, we worked with 5 counseling, testing and referral (CTR) sites in the city of San Francisco, CA to: Identify resources and staff necessary for implementation, develop and pilot standard operating procedures (SOPs), develop and conduct training for all participating staff and develop a QA program for the RTA. Lessons Learned: A site coordinator, counselors and technicians who run the rapid HIV tests were identified for each site. Forms for collection of both CTR and rapid test QA data were designed/modified to monitor the project over time. Over 100 counselors and 25 technicians have been trained in SOPs to date. Direct observation of pre-test counseling and role-play counseling of an RTA-positive client is conducted with each counselor every three months. Monthly QA is conducted, with each technician completing 9 QC tests (HIV-negative, HIV-1, HIV-2 with each test,) all of which have given correct results. Recommendations: A POC testing program using up to three rapid HIV tests is a lot of work. Quality of training and oversight makes such a program possible, and the benefits of POC testing make the additional effort worthwhile.