208798 Planning and Implementing Rapid HIV Testing in Baltimore City: Challenges and Lessons for a Health Department

Wednesday, November 11, 2009: 11:15 AM

Shilpa Bhardwaj, MD MPH , Bureau of STD/HIV Prevention, Baltimore City Health Department, Baltimore, MD
Carolyn Nganga-Good, RN BSN , Bureau of STD/HIV Prevention, Baltimore City Health Department, Baltimore, MD
Rafiq Miazad, MD , Bureau of STD/HIV Prevention, Baltimore City Health Department, Baltimore, MD
Ravikiran Muvva, MPH, MPA , Bureau of STD/HIV Prevention, Baltimore City Health Department, Baltimore, MD
Charlene Brown, MD MPH , Bureau of STD/HIV Prevention, Baltimore City Health Department, Baltimore, MD
Issue

In 2007, Baltimore City Health Department (BHCD) received a Center for Disease Control and Prevention (CDC) grant to implement rapid HIV screening within clinical and outreach settings.

Description

The program commenced with a competitive solicitation, issued by Division leadership, to select implementation sites; hiring of key program personnel, and the creation of site-specific testing and counseling protocols and test result charting instruments through program and site staff. Program personnel devised a training strategy and trained site coordinators in rapid HIV testing and counseling techniques and the program documentation and database requirements.

Lessons Learned

Implementation was delayed because key site stakeholders, particularly Emergency Department (ED) physicians, were inadvertently excluded from the early planning and implementation stages at some sites. Program personnel later convinced ED physicians and mobile outreach staff that rapid HIV testing would not hamper existing work flow. Site counselors and mobile outreach staff became concerned about rapid HIV test accuracy when the program experienced an unusually high number of false positives. Mobile outreach vans did not have space for the confidential provision of results.

Recommendations

With consistent efforts to address internal stakeholder concerns about work flow, accuracy and the use of rapid HIV tests as a routine screening tool, an ED or Community-based organizations can successfully implement rapid HIV testing. Space for confidential counseling is critical for rapid HIV testing in mobile outreach settings. Prospective attention to counseling protocols that include strategies for false positives may reduce program concerns among counselors.

Learning Objectives:
Articulate the steps taken, challenges faced and lessons learned by Baltimore City Health Department in the planning and implementation of Expanded HIV Testing in Baltimore City.

Keywords: HIV/AIDS, Community-Based Public Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an Epidemiologist for the STD HIV Prevention Bureau at the Baltimore City Health Department. I have been involved in planning, organization, implementation and data management for the Expanded HIV Testing Initiative at the department. My past work experience has been in public health programs in developing countries as a Preventive Medicine physician. I have also worked in planning, and coordination of multi-center research trials at Johns Hopkins University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Contemporary Issues in HIV Testing
See more of: HIV/AIDS