Tab
Sample PowerPoint
Presentations
1. The Essentials of HIV and AIDS:
Development Systems, Inc., Region VII
(11 pages)
10
2. HIV and Women:
Centers for Disease Control and Prevention
(3 pages)
3. HIV Incidence:
Centers for Disease Control and Prevention
(3 pages)
4. Transitioning to New Centers for Disease
Control and Prevention HIV Testing Guidelines:
Center for Health Training, Region IX
(3 pages)
5. The Basics of Rapid HIV Testing:
Center for Health Training, Region IX
(6 pages)
RELATED MATERIALS
• For more HIV related PowerPoint
presentations see www.cdc.gov
ROADMAP TO INTEGRATION:
HIV Prevention in Reproductive Health
A collaborative
effort between
CDC SMART team
and the Regional
Training Centers
2009
Tab 10: Sample PowerPoint Presentations
The Essentials of HIV and AIDS
HIV / AIDS Basic Biology
Objectives:
By the end of this module
participants will be able to:
Patti Abshier MSPH, MSW
Development Systems, Inc.
1.
2.
3.
What Is HIV?
How Does HIV Function ?
z
HIV is the Human Immunodeficiency Virus.
z
HIV primarily attacks T4 lymphocytes, a type of white
blood cell crucial in fighting infections and in
regulating other immune system responses.
HIV Lifecycle
Discuss the differences between
HIV/AIDS
Explain the life cycle of HIV
Identify the current seroconversion
period for HIV infection and testing
As illustrated in the figure shown below, the HIV
lifecycle can be separated more or less into 6 distinct
phases:
z Entry of the Virus into the Cell
z Reverse Transcription
z Integration
z Viral Protein Expression
z Virus Assembly and Budding
z Maturation
Attachment of the Virus
z
The virus attaches to the host cell by coupling parts of
the viral outer envelope to the host cell’s outer
membrane. The outer membrane of the virus has
special grooves that fit specifically into segments of the
host cell’s outer membrane.
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Penetration of the Virus
z
Next, the virus penetrates the cell membrane to enter
the inside of the cell. Once inside, the virus uses the
cell’s enzymes to eat away its own outer envelope
exposing the viral RNA (genetic building blocks) within.
Biosynthesis
z
Uncoating of the RNA shell
z
Next, the RNA uses the cell’s enzymes to eat away the
protective coat, the capsid surrounding the RNA. This
enables the viral RNA to begin the process of making
copies of the viral genes.
Maturation and Release
The viral RNA is converted to DNA using its own
reverse transcriptase molecules, followed by
replication of the new DNA to form a new double
strand. Next the original cell’s RNA is degraded. This
new DNA is integrated into the host cell’s
chromosomes, which allows it to be transcribed “made”
into several RNA segments as the host cell transcribes
itself and new virus are produced. The time frame may
vary considerably after the DNA has been integrated
into the chromosomes of the cell.
What Is AIDS?
z
As copies of the viral DNA are transcribed into the
RNA, several important things happen. The newly
formed RNA once again uses the cell’s energy and
material to reform an outer membrane coating around
the RNA. Lastly, the viral particles break through the
host cell’s membranes using part of that membrane to
form their own outer envelope. The breaking through
process, known as “budding” may or may not kill the
host cell. Approximately 110,000,000 new viruses are
produced each day in an HIV positive individual who is
not taking any medications designed to reduce viral
replication.
What Is AIDS? - Continued
z
AIDS stands for Acquired Immune Deficiency
Syndrome.
z
AIDS is characterized by the collapse of the body’s
natural immunity against disease. A series of
illnesses occur once the immune system is
impaired. Infections that usually do not seriously
threaten people with normal functioning immune
systems often cause seriously illness for people
diagnosed with AIDS.
z
In 1993, the Centers for Disease Control and Prevention (CDC)
changed the definition of AIDS to include any one of the
following:
– HIV positive and has a T4 cell count below 200 per cubic
micro liter of blood.
– Less than 14 percent T4 cells per cubic micro liter of blood,
with laboratory confirmation of HIV infection.
– Exhibits certain illnesses such as cervical cancer,
candidiasis of the vagina, bronchi, trachea or lungs,
pneumocystis carinii pneumonia (PCP), recurrent
pneumonia, Kaposi’s sarcoma, and numerous other
conditions, with HIV infection confirmed.
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Potential Clinical Symptoms of HIV Infection
What Is AIDS? - Continued
z
A normal immune system will contain between 8001,200 T4 cells per cubic micro liter of blood.
Regardless of an HIV positive individual’s health, a T4
cell count below 200 represents a clinical diagnosis of
AIDS. This change in definition means that symptom
free individuals can be clinically diagnosed with AIDS.
z
z
z
z
z
z
z
HIV Infection: Common Time Frames
z
Window
Period
(3 Months)
HIV Related Illness
Extreme fatigue (70-90%)
Oral hairy leukoplakia and oral candidiasis diseases
(OHL/OC) (10 – 20%)
Persistent fever of 100 degrees but below 102 degrees
(80-90%)
Recurrent drenching night sweats (50%)
Chronic unexplained diarrhea, nausea and vomiting
(30-60%)
Maculopapular Rash (40-80%)
M.Neurologic symptoms (12%)
Window Period/ Seroconversion Period
HIV Positive
& Infectious
Symptom Free
AIDS Diagnosis
The WINDOW PERIOD/SEROCONVERSION PERIOD
is the time between exposure to HIV and when the
immune system has produced enough antibodies
to show up on an HIV Test.
–
Time Frames May Vary From Months to Many
Years
–
Initial Exposure
(It
Can Take up to 10 Years for Symptoms to Manifest or Be Recognizable As HIV Related Symptoms)
The average time from exposure
to AIDS diagnosis is estimated
at approximately 10 years
HIV Disease Progression:
z
HIV disease progression lies on a continuum from
the time of latent infection to the manifestation of
severe immune system damage at the other end of
the spectrum, known as AIDS.
z
HIV progression varies greatly from person to
person, depending upon co-factors including one’s
genetic traits, the strain of the virus encountered,
concurrent infections or disease states, drug and
alcohol use, pregnancy, malnutrition, and
psychological wellness.
This period is very critical, since a person may test
negative while actually being positive. The individual is
infectious during the window period.
On average, most people will seroconvert (have enough
antibodies present to be seen on a test) between 6 to 12
weeks after an exposure to HIV; most people will
seroconvert within 3 months. Therefore, the window
period is defined as three months.
HIV Disease Progression – Continued:
z
HIV infected individuals living healthy lifestyles, both
emotionally and physically, generally progress slower
than other individuals through the disease process.
z
Although individual responses to HIV infection varies
greatly, a few trends have emerged from research:
– Many HIV infected people experience a rapid
decline in CD4 T cell count (T4 Helper Cells) shortly
after seroconversion; however, the rate of T4
depletion levels off to a steady, but gradual
reduction in cell count.
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
HIV Transmission
HIV Disease Progression - Continued:
z
z
Many infected people experience a lengthy period of
time in which their T4 count remains relatively stable.
Indeed, research indicates that the median period for
HIV progression to AIDS is approximately 10 years.
Highly Active Anti-Retroviral Therapy (HAART) can
slow the progress of HIV disease.
Primary Modes Of HIV Transmission
z
Unprotected sexual contact with an infected
person (oral, anal or vaginal):
–
–
–
–
Objectives: By the end of this module
participants will be able to:
1.
2.
3.
List the primary modes of HIV transmission.
Discuss the co-factors of HIV infection after exposure.
Discuss the co-factors of HIV infection by sexual
transmission.
Primary Modes Of HIV Transmission - Continued
z
Exposure to infected blood/blood products:
–
Male to male
Male to female
Female to male
Female to female
–
–
–
Primary Modes Of HIV Transmission - Continued
z
Perinatal exposure to baby of infected mother:
Infected intravenous needles (drugs, steroids, tattoos, and
body piercing)
Blood transfusions (infections from transfusions rarely occur
today)
Mishandling of infected blood-involved operations
Puncture by other HIV contaminated instruments
Co-factors for HIV Infection After Being Exposed
z
Type of bodily fluid contacted:
–
In-utero (and during the birth process)
–
–
While nursing (less common mode of transmission). Prolonged
breast-feeding increases the risk of a woman giving HIV to her
baby by about 14 percent
–
–
–
blood
semen
vaginal/cervical secretions
breast milk
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Co-factors for HIV Infection After Being Exposed Continued
z
Route of entry into the body:
–
–
–
Female to Male Transmission:
–
–
–
Perinatal Transmission:
–
–
–
–
z
Level of maternal viremia (mothers viral load).
Emergence of maternal fast replicating HIV variants (new
strains being created in the mother at a rapid rate).
Co-infection of microbial agents (HPV, Herpes etc.).
Mother’s use of antiretroviral drugs including protease
inhibitors.
Condition of the exposed person:
–
–
–
genetic influences
environmental influences
co-existing infections (i.e., Sexually Transmitted Diseases)
Transmission Co-factors -Continued
z
Lack of circumcision increases the risk of transmission from a
woman.
Other STI’s (sexually transmitted infections), especially those
causing genital lesions increase the risk of transmission from a
woman to a man.
Urethral inflammation increases the risk of transmission due to
microscopic lesions in the urethra.
Transmission Co-factors -Continued
z
Continued
blood to blood: injections and in-utero
semen to blood (following tissue trauma)
blood, semen, or vaginal/cervical secretions through mucous
membranes
Transmission Co-factors
z
Co-factors for HIV Infection After Being Exposed -
Male to Female Transmission:
–
Reason for the greater susceptibility of male to female
transmissions rather than vice versa:
z HIV is more easily transmitted through semen deposits in
the female genital tract
z Small tears in the woman’s vagina (which occur during
sexual contact) provide an entry route for HIV
z Concentration of virus is much greater in semen than in
vaginal fluids
Perinatal Transmission
z
HIV Transmission Can Occur During:
Pregnancy.
Labor and delivery.
– Breastfeeding.
There is a 15-30% chance of perinatal HIV transmission. Studies
indicate that the use of ZDV or AZT by pregnant, HIV-infected
women can reduce the rate of perinatal transmission to 6-8%.
It is recommended that all pregnant women be offered HIV
counseling and testing.
Dr. Ann Morris reported in Barcelona, 2002, HAART including
Protease Inhibitors can be safely used and may decrease rate of
transmission to 1% - 2%.
–
–
z
z
z
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Perinatal Transmission - continued
Breast Feeding Risks
z
z
z
z
The risk of transmission may reach less than 1% in women with
plasma HIV viral load <400 HIV RNA copies/mL on treatment.
The human placenta is a remarkably effective barrier against the
passage of HIV from an infected woman and her developing fetus.
In 90% of pregnancies, the thin tissue layer that separates
maternal blood from the fetal circulation screens out virus and/or
virus-infected maternal cells and prevents them from reaching the
developing fetus.
Although in utero infections can occur throughout pregnancy, it is
likely that most arise late in the gestation period, not long before
delivery.
z
z
z
Prolonged breast-feeding increases the risk of a woman giving
HIV to her baby by about 14 percent. Here are what two studies of
babies born to HIV-positive women show:
Nairobi, Kenya -- At 24 months, 20 percent of formula-fed babies
became infected with HIV, compared to 36 percent of breast fed
babies.
South Africa -- HIV transmission was 12 percent higher in breastfed babies than in formula-fed ones at 15 months.
Antiretroviral Treatments to Reduce Mother-to-Child Transmission of HIV
Laurence Peiperl MD, HIV InSite, University of California San Francisco
Updated April 15, 2002
Available at: http://www.ama-assn.org/special/hiv/newsline/briefing/mother.htm#1
Breast Feeding Risks - Continued
z
z
Mixed feeding (breast + formula) is most dangerous.
Mixed feeding is the most dangerous method, because formula
feeding can irritate the lining of the baby's stomach, making it
easier for the HIV in breast milk to get in and cause an infection. In
a South African study of HIV-positive women and their babies, 36
percent of babies who received mixed feeding were reported
infected compared to about 25 percent of those who were
exclusively breast-fed and 19.5 percent of formula-fed babies.
Occupational Exposure
z
z
z
Blood is the most commonly indicated fluid in HIV infection.
Occupational exposure to HIV most often occurs by a needle stick
injury.
An estimated 378,000 - 756,000 needle sticks occur every year.
•30% are due to recapping,
•30% are due to improper disposal, and
•30% are due to unexpected movement of
patient or another worker.
Occupational Exposure - Continued
z
Through June 2001, there have been 57 reported cases of HIV
infection due to occupational exposure
– 48 percutaneous
– 5 mucous
– 2 both percutaneous and mucous
– 2 unknown
Occupational Exposure - Continued
z
Occupations of workers with Occupational Exposures
–
–
–
–
–
–
–
–
–
49 health care workers were exposed to HIV-infected blood
3 to concentrated virus in a laboratory
1 to visibly bloody fluid
4 to an unspecified fluid
–
–
–
–
19 laboratory workers (16 of whom were clinical laboratory
workers)
24 nurses
6 physicians
2 surgical technicians
1 dialysis technician
1 respiratory therapist
1 health aide
1 embalmer/morgue technician
2 housekeepers/maintenance workers
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Occupational Exposure - Continued
z
CDC is also aware of 138 other cases of HIV infection among
health care workers who report a history of occupational exposure
that do not report other risk factors for HIV infection. For these
individuals, seroconversion after the occupational exposure was
not documented. The number of these health care workers who
acquired their infection through occupational exposure is
unknown.
You Cannot Get HIV From:
z
z
z
z
z
z
z
z
z
z
You Cannot Get HIV From: - Continued
Methods Of HIV Prevention
z
z
z
z
z
z
z
z
z
z
z
A telephone
A drinking fountain
A cat
A drinking glass
Shaking hands
Hugging
Sharing food
Casual touching
A chair
A dog bite
Methods Of HIV Prevention - Continued
z
Viricide
–
–
Non-exposure
–
–
–
z
Abstinence from sexual contact and IV Drug Usage
Universal precautions
Non-penetrative sex
Barrier protection
–
–
–
–
Gloves
Condoms (latex and polyurethane)
Dental dams
Plastic wrap (non-microwaveable)
Condom Sense
z
Cleaning drug paraphernalia with bleach
Disinfecting wounds and spills
A toilet seat
A mosquito bite
A fork, knife or plate
A sneeze
A dry kiss
A public pool
Donating blood
Tears
Sharing a pen or pencil
A bus
Condoms can significantly reduce the risk of
becoming infected with HIV and other sexually
transmitted diseases if they are used correctly and
consistently. They do not provide 100% protection
against HIV, STD, or pregnancy.
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Condom Sense - Continued
z
z
z
z
Condoms made from animal membrane (natural
condoms) are more porous and allow some germs to
pass through (HIV being one of them).
Use only water-based lubricants. Oil-based lubricants,
such as petroleum jelly or cooking oil, can diminish the
strength of latex (up to 70% in less than 30 seconds).
Check the expiration date on each condom package.
Never use outdated or damaged condoms.
Condom Sense - Continued
zNonoxynol-9: research suggest that Nonoxynol-9 does
not provide an additional chemical barrier against HIV
infection and may increase the risk of HIV transmission.
Condom Sense - Continued
z
z
z
z
z
z
z
Store condoms in a cool, dry place.
Heat can damage condoms.
Handle condoms carefully.
Jewelry or fingernails can damage a condom.
Use a condom from start to finish.
Dispose of used condoms carefully.
Never use a condom more than once.
How To Use A Condom
z
PUTTING A CONDOM ON.
– When the penis is erect (before any contact with
–
–
How To Use A Condom - Continued
z
z
TAKING A CONDOM OFF.
– After ejaculation, withdraw the penis while it is still
erect. Hold on to the rim of the condom so that the
condom does not slip off.
– Discard the condom, making sure no body fluids are
spilled.
Avoid further contact until both partners have washed
any area that came in contact with body fluids.
partner), put the condom on the head of the penis.
Gently squeeze the tip of the condom to remove any
air.
Carefully unroll the condom down the shaft of the
penis all the way to the base.
Risk Reduction
z
z
z
z
Education refers to the transmittal of knowledge -- in this case,
knowledge of HIV transmission patterns, risks, and methods to
avoid risk.
Risk reduction counseling entails a dialogue between the health
provider and the client, which may occur in either an individual or
group format.
Structured behavioral interventions may include a combination of
counseling, education, and attempts to alter group norms.
Multiple session, small group or individual counseling are the
intervention formats which have been most frequently used and
which appear to be the most effective.
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Levels of HIV Transmission Risk
HIV Testing – General Information
Mutually Monogamous,
unprotected sex. Both HIV
Negative
z
Mutual Masturbation, Deep
Mouth Kissing (No cuts or
bleeding). HIV status
unknown
Unprotected
Oral Sex (No
cuts or
bleeding
gums)
Inconsistent condom use
(Vaginal and Anal
Intercourse)
z
HIGH
RISK
NO
RISK
of HIV
TRANSMISSION
Continuum of Risk
of HIV
TRANSMISSION
Abstinence /
Postponing Sex,
Massage, Fantasy &
Dry Kissing
Protected Anal,
Vaginal, Oral
intercourse with
Latex Condom (HIV
Status unknown)
Unprotected Vaginal
Intercourse (female
to male & female to
female transmission)
w/ positive partner
Unprotected
Vaginal Intercourse
(male to female
transmission) w/
HIV Positive
Partner
Highest –Risk
Unprotected Anal
Intercourse (with
HIV Positive
Insertive partner).
Test Reliability
z
Test Reliability - Continued
A test’s reliability is measured in two ways; specificity
and sensitivity. Specificity is a measure of a test’s
ability to give a negative result if the sample is
negative. Specificity for the EIA (enzyme-linked
immunosorbent assay) test is approximately 99.7%
correct, giving 3 in 10,000 as a “false positive” result.
Test Reliability - Continued
z
Sensitivity (Continued)
–
–
Approximately 2 to 2.5 million HIV tests are conducted
annually in publicly funded counseling and testing
sites.
In 1996:
– 41% of tests were performed for persons who had
never been tested before.
– 26% of persons who tested positive did not return
for test results.
– 33% of persons who tested negative did not return
for test results.
Essentially, EIA screens for all molecules similar to
those of HIV antibodies; consequently, the EIA will
occasionally give a positive result for a non-HIV
antibody molecule.
The EIA is an excellent screening device for HIV;
however, the possibility of a false positive
necessitates the use of a confirmatory test.
z
Sensitivity, measures the ability of a test to
give a positive result if the sample is positive.
–
–
Sensitivity of the EIA test is nearly 100%; however,
all positive EIA results are confirmed with the
Western blot test before diagnosing someone as
HIV positive.
Whereas the EIA screens for protein molecules
similar to and matching those of HIV antibodies, the
Western Blot, a more expensive test, looks for only
those molecules that are definitely HIV antibodies.
Test Result Interpretation
z
Negative EIA = Negative Test Result
z
Positive EIA + Negative EIA = Negative Result
z
Positive EIA + Positive EIA + Negative Western Blot =
Negative Result
z
Positive EIA + Positive EIA + Positive Western Blot =
Positive Result
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Interpretation And Use Of The Western Blot Assay For
Diagnosis Of HIV-1
z
z
A positive test result should not be
given to a client until a screening test
(EIA) has been repeatedly reactive
(generally 2 times) on the same
specimen and a supplemental, more
specific test, such as the Western Blot,
has been used to validate the result.
CDC criteria for Western Blot
interpretation:
A positive (reactive) result must contain
any two of the following bands:
z p 24.
z gp 41.
z gp 120/ gp 160.
HIV and Substance Abuse
Interpretation And Use Of The Western Blot Assay For
Diagnosis Of HIV-1 - Continued
CDC criteria for Western Blot interpretation:
z
A negative (non-reactive) result contains no bands.
z
An indeterminate (equivocal) result contains any other
band or bands that fail to meet the positive criteria for
diagnosis. It is recommended that a follow-up
specimen be collected and tested no less than 30 days
following the collection of the original specimen.
HIV and Substance Use
DIRECT TRANSMISSION
HIV DISEASE: THE SUBSTANCE USE CONNECTION
Continuing research has revealed, HIV disease and
substance use are interconnected epidemics. The ways
in which the two epidemics interrelate have important
implications for all interventions. The next slide set
represents the relationships between HIV and
Substance Use.
Through injectable drug use
BEHAVIORAL
IMPAIRMENT
CO-FACTOR
Vulnerability to infection
Disease progression
SUBSTANCE
ABUSE
Disinhibition/black-outs
Sex for $/drugs
Hypersexuality
Interactive addiction
INDIRECT TRANSMISSION
Heterosexual partners with HIV
Babies with HIV
Barriers to HIV Prevention w/ Substance Use
z
Individual Barriers
–
z
z
z
z
z
Individual Barriers-continued
–
Cognitive:
z
Barriers to HIV Prevention w/ Substance Use
Lack of awareness regarding personal risk
Incomplete information about (sexual) risk
Lack of knowledge of risk reduction practices
Unawareness of drugs and alcohol as co-factors
Lack of knowledge about sexuality
Affective
z
z
z
z
z
z
z
z
z
Mistrust of (health) authorities
Denial
Fatalism/lack of sense of efficacy
Fear of rejection/abuse from sexual/drug-using partner
Ego investment/identity in sexual behavior/reproduction
Disbelief of risk in absence of symptoms/high prevalence
Disbelief that intimates can do one harm
Embarrassment (around sexuality)
Belief that only unsafe sex is erotic/”macho”
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Barriers to HIV Prevention w/ Substance Use
z
Individual Barriers-continued
–
Barriers to HIV Prevention w/ Substance Use
z
Environmental Barriers
–
Behavioral: Risk behaviors are ubiquitous and often
Family:
z
addictive
z Risk behaviors are private/clandestine---not “visible”
z Drug usage impairing cognition, affect, and behavior
z Undeveloped communication skills around sex
z Lack of experience with risk-reduction behaviors
z Sexual dysfunction
z Risky behaviors do not have immediate negative
consequences
z
z
z
–
Unawareness or irrational fear of personal risk
Denial of/enabling abuse/risk behavior
Resistance to change by member/in system
Parental disapproval of sex education for children
Peers
z
z
As a family
Risk-taking norms/negative supportiveness
Barriers to HIV Prevention w/ Substance Use
z
Environmental Barriers – continued
–
Cultural and Institutional
z Denial of HIV disease problem in lower-incidence areas
z Social taboos/AIDS stigmatization for forcing risk-taking
“underground”
z Subcultural/religious taboos about contraception and sexual
expression
z Mainstream prevention (particularly “just say no”) messages
miss many persons at risk
z Treatment programs full/do not appeal to certain persons
z Failure of many health/human services to deal with
sexuality and chemical dependence in clients
z Socio-economic disempowerment of high-risk persons
Effects of Alcohol and Drugs on HIV Infection
(continued)
z
Using drugs and alcohol can make it easier to forget to
practice safer sex. Even if one's partner is also HIVpositive, it is important to practice safer sex to avoid
getting more HIV (or different types of HIV). In addition,
it's possible to contract other sexually transmitted
diseases (STDs), such as herpes or syphilis. Additional
diseases add to the work your immune system has to
do.
Effects of Alcohol and Drugs on HIV Infection
z
Cocaine stresses the body. Although the high is short,
some parts of the body are still affected for four to five
weeks or more. Even monthly use keeps the body off
balance. People who stop using it often see a rise in Tcells.
z
Street drugs are "cut" with substances that are a
burden to the immune system. Injecting these
substances increases the burden.
Acknowledgements
z
z
z
z
z
z
Centers for Diseases Control and Prevention – HIV/AIDS
Bureau – Available: www.cdc.gov
The Body: Online HIV Reference – Available:
www.thebody.com
AVERT: Online HIV Reference – Available: www.avert.org
AEGiS: Online HIV Reference – Available: www.aegis.com
Center for AIDS Prevention Studies – University of
California San Francisco – Available: www.caps.ucsf.edu
Keiser Family Foundation – Available: www.kff.org
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Opportunities and
Challenges
Transitioning to new
CDC Recommendations
Which test to use
| Clinic flow
| Client counseling
| Personnel
| Giving Results
| Documentation
| Costs
| State laws & funding requirements
Amanda Newstetter, MSW
Center for Health Training
June 14, 2007
OPA HIV Grantee Meeting
1
2
Which Test to Use
Clinic Flow
Routine doesn’t mean rapid
Questions to ask:
|
|
Are we offering testing only?
|
Does testing require 1 or 2
visits?
Standard or Rapid test?
z
Blood, oral, urine
Confidential and/or Anonymous
| Cost
|
z
z
3
4
Clinic Flow- Counseling
Will standard HIV results be
given in person or on the
phone?
Testing everyone or those at
risk?
Clinic Flow cont
What happens after we run the
test?
| Are the same staff counseling,
administering the test and giving
results?
| Where are rapid tests run?
| Can the rapid test be moved
once initiated?
| How long does it take to get the
6 rapid results?
|
|
Are we offering counseling with
testing?
z
z
z
Paradigm shift for many of us
Counseling has been a barrier
May be a requirement of funding
Some clients may still want/need
counseling
| When do we do the counseling?
|
5
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Personnel
|
|
|
|
|
|
Giving Results
Who will conduct all the additional
tests?
How do staff get training?
How do you address staff resistance
to changes?
Do the same staff do the counseling,
test and results?
Do we cross train staff or have
separate HIV staff?
RT: who will follow the positive results
through confirmatory process?
|
|
|
|
|
Who is trained to give positive results?
z RT: are all staff prepared to give positive
results on the spot?
How do you prepare staff for false test
results on RT?
How do you keep staff motivated after first
false or inconclusive results?
Should we change system to “No news is
good news?”
Should we consider giving results over the
phone?
7
8
Documentation
Costs
|
How are HIV results
documented?
|
How are results shared among
staff?
|
Do you know the laws related to
sharing of HIV results?
More tests doesn’t always mean
more money
| RT: only one visit
| No lab revenues with RT
| Different test, different cost
| More tests lowers the cost
| New system may require less
staff training
|
9
10
Transitioning to CDC
Recommendations
Implementation:
Getting Started
| How
far along are your
staff and clinics now?
| What
does your staff and
clinic need to make this
transition?
11
Getting buy-in from
administration
| Educating staff about CDC
recommendations
| Staff meetings to discuss where
we are & where we want to go
| Pilot testing before roll out
| Additional training as needed
|
12
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
How RTCs can help
|
|
|
Facilitate staff discussions/meetings
Staff training
z Overview of CDC recommendations
z Rapid Testing
• Overview
• How to conduct the test
• Giving results – what do they mean?
z Staff values regarding a new approach
z Counseling options
Other Technical assistance
z Analysis of current clinic systems
z Recommendations for systems change
13
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
AGENDA
The Basics of Rapid HIV
Testing
Review of 2006 CDC HIV testing
recommendations
| Issues to consider with rapid
testing
| Considerations when deciding on a
rapid test
| Arizona HIV consent laws
| Breaking the Cycle experience
|
Audio Conference
Amanda Newstetter, MSW
Center for Health Training
Denise Link, PhD, RNP
ASU Breaking the Cycle
February 24, 2009
1
Overview of 2006 CDC HIV
Testing Recommendations
Routine voluntary HIV screening for all
persons aged 13-64 in health care
| Patient notified that testing will be done
unless declined (opt out)
| Separate written consent should not be
required
| Prevention counseling should not be
required
|
|
|
|
Settings with low or unknown
seroprevalence:
z Initiate screening for one year
z Look at seroprevalence
z If less than 1 per 1000 are + continued
screening not warranted
Repeat HIV screening of persons with
known risk at least annually
4
Motivation for New
Recommendations
Rapid HIV Testing:
Opportunities and
Challenges
2.1 million publicly funded tests annually
31% of positives don’t return
z About 25% of people living with HIV are
unaware of their status
There are 60,000 new infections every
year
z
Recommendations Cont.
3
z
|
2
40% of persons with HIV receive an AIDS
dx. within one year
5
|
|
|
|
|
|
|
Which rapid test to use
Clinic flow
Personnel
Giving Results
Documentation
Costs
State laws & funding requirements
6
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Issues to Consider When
Choosing a Rapid Test
Cost
How long does it take to do test
| Time to read the test result
| Blood vs oral fluids
| False test results
| Shelf life
| Your client population/venue
Choosing a test: Cost
|
|
|
|
|
|
|
Varies by test
Varies by volume
Controls cost a lot
Not a big money maker for most
clinics
See handout with purchasing details
7
8
Choosing a Test: Length of
Test
Choosing a Test: Reading
The Test Result
|
The tests are 10-20 minutes
|
What will work best for your flow?
|
What will the client be doing while
waiting for their test result?
9
Do you have 2 minutes or 20 minutes
to read the result?
|
Who will be recording the test results?
|
How will this affect clinic flow?
10
Choosing a Test: Blood vs.
Oral Fluids
|
|
Pros of blood testing
Oral vs. Blood
|
More specific/sensitive
z Less false results
|
Cons of blood testing
z
z
|
Finger stick
z Bio-hazardous
Cons of oral fluid testing
Less specific/sensitive
More false results
z Client confusion
z
11
Pros of oral fluid testing
Easy
Not biohazardous
z Minimal staff training
z
z
z
12
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Choosing a Test: False Test
Results
|
No perfect test
|
Remember: first layer of screening
|
What can you live with?
|
Over prepare staff
13
Choosing a test: Shelf Life
|
6 months for oral fluids
until 3/09
|
Starting March – 12
months
|
Order less often
14
Choosing a test:
Client population & venue
| What
your clients prefer
| Where
Informed Consent vs.
Counseling
| Providing
information is
different from obtaining
informed consent
you are testing
16
Counseling
|
Information about:
Informed Consent
|
HIV transmission
z HIV prevention
z Individual risk assessment
z Meaning of test results
z Where to get more information
z Where to get other services
z
17
Includes information plus:
z
Benefits/risks of testing
• Physical, social
Implications of test results
How the test results will be
communicated
z Opportunity to ask questions, decline
testing
z
z
18
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
What is the best way to do
the rapid HIV test?????
Buy in from all staff
Confident, well trained staff
| One champion who oversees
| Flexible about the clinic flow
| Feedback loop among staff
| Talk to clients
| Confirmed on the spot
Clinic Flow
|
Questions to ask:
|
|
|
|
|
|
Are you doing counseling or informed
consent only?
How do clients know we offer rapid HIV
testing
What written materials are given to the
client?
Who will get a test?
Who reviews informed consent?
20
Clinic Flow- Counseling
Clinic Flow- Questions
When does the test get done during
the visit?
| Who gives the results?
| Are the same staff counseling,
administering the test and giving
results?
| Where are rapid tests run?
| Can the rapid test be moved once
initiated?
21
|
Personnel
|
|
|
|
|
Who will conduct all the additional tests?
How do staff get training?
How do you address staff resistance to
changes?
Do we cross train staff or have separate
HIV staff?
Who will follow the positive results
through the confirmatory process?
23
How long does it take to get the
rapid results?
| Some clients may still want/need
counseling
| When does counseling happen
and with whom?
| Who documents results on log/in
chart?
|
22
Giving Results
|
Who is trained to give positive
results?
|
Are all staff prepared to give
positive results on the spot?
|
How do you prepare staff for false
test results on RT?
How do you keep staff motivated after
first false or inconclusive results?
|
24
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Documentation
|
How are HIV results documented?
|
How are results shared among staff?
|
Do you know the laws related to sharing of
HIV results?
Costs
More tests doesn’t always mean
more money
| RT: only one visit
| No lab revenues with RT
| Different test, different cost
| More tests lowers the cost
| New system may require less
staff training
|
25
26
State laws & funding
requirements
Case Study
|
| Know
your laws
|
Breaking the Cycle clinic
Began with saliva test
z
| Laws
trump recommendations
z
Behavior based screening
Delay between test & results
Transitioned to rapid test with 2006
CDC recommendations
| HIV Integration Project grant
|
| Funding
may require
counseling
z
Easier to offer to all vs. “Who is at
risk?”
28
Implementation:
Getting Started
Staff Training
Assess staff values and readiness for
change
| Overview of CDC recommendations
| Rapid Testing
|
|
Get buy-in from administration
|
Conduct staff meetings to
discuss HIV testing- where you
are & where you want to be
|
29
Overview
Have rep from company train staff
z How to conduct the test
z Giving results – what do they mean?
z
z
Pilot test before rolling out
30
Roadmap to Integration: HIV Prevention in Reproductive Health
Tab 10: Sample PowerPoint Presentations
Transitioning to Rapid
Testing
Rapid Testing Resources
|
| How
far along are
your staff and clinics
now?
z
|
does your staff
and clinic need to
make this transition?
http://www.cdc.gov/mmwr/preview/m
mwrhtml/rr5514a1.htm
CDC rapid HIV testing:
z
| What
31
2006 CDC HIV testing
recommendations:
http://www.cdc.gov/hiv/topics/testing/
rapid/
32
Rapid Testing Resources
Cont.
|
Arizona AIDS Education and
Training Center (AETC)
z
|
National AIDS Resource Center
z
|
http://www.aids-ed.org/
STD/HIV Prevention Center
z
33
http://www.fcm.arizona.edu/index.cfm/
1,173,0,0,html/Arizona-AIDSEducation-and-Training-Center
http://www.stdhivtraining.org/
Roadmap to Integration: HIV Prevention in Reproductive Health