Lessons Learned: Giving HIV Positive Results

The Door – A Center of AlternativesAdolescent Health Center

Carolyn Glaser, L.C.S.W.Supervisor, Health Educationand Outreach

June 2007

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The Door Adolescent Health Center

1876 HIV Tests given in 2006

4 positive results

7 Health Educators

268 tests per Health Educator

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The Door Adolescent Health Center

A LOW AMOUNT OF POSITIVE RESULTS

A HIGH AMOUNT OFSTAFF ANXIETY

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The Door – A Center of Alternatives

The mission of The Door is to empower young people to reach their potential by providing comprehensive youth development services in a caring, supportive environment, where young people are treated with respect and confidentiality.

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Services Provided at The Door

Health Care

Counseling

Education

Arts and Recreation

Legal

Career

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1876 Young People Tested

79% female 21% male

1% under the age of 15 32% between the ages of 15-17 41% between the ages of 18-19 26% over the age of 20

46% Black 35% Latino 5% Asian 7% White 7% Other

81% Conventional testing 19% Rapid testing (Rapid testing began in May 2006) Currently, 80% of testing is Rapid

HIV Testing Demographics 2006

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Not offered to walk-in patients; only to those with appointments.

Use of venipuncture rather than the finger stick or oral swab.

Having a Social Worker or Senior Counselor “on call” during the hours that testing is offered.

Staff training.

Adjustments Made for Implementing Rapid Testing

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One day training for the entire Adolescent Health Center staff tailored specifically to meet our needs with a focus on delivering a positive result.

Learn appropriate language to use when delivering positive results, what needs to be covered in the post-test counseling session, anticipate patient reactions and needs.

Utilization of role playing.

Forum for staff to discuss their anxieties.

Give staff confidence – they are already comfortable with and skilled at delivering bad news.

The Adolescent Health Center’s HIV Rapid Testing Training

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The Health Educator who performed the pretest counseling informs the Supervisor of Health Education or her designee. Brief planning and supportive supervision takes place.

The Social Worker or Senior Counselor on duty is notified and placed on standby.

The medical provider scheduled to see the patient is notified and placed on standby.

The Health Educator delivers the result.

Immediate Steps following Notification of a Preliminary Positive Result

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The exploration of thoughts and feelings. (Includes screening for suicidal ideation.)

A review of the meaning of the preliminary positive result.

Access the physical and emotional stability of the young person. (Existing support systems, housing, income, mental health needs, employment/education.)

Determine immediate referrals necessary based on the stabilization assessment.

A discussion regarding medical care and the Adolescent Health Center’s linkages to primary care providers.

A review of the ways to prevent the spread of the HIV infection.

The First Post-test Counseling Session Includes the Following:

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The First Post-test Counseling Session Includes the Following (cont.):

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A conversation about the patient’s current and past partners and partner notification.

A screening for domestic violence.

Appointment scheduling for a confirmatory test and a discussion regarding the likelihood of a positive confirmatory test result.

A conversation with the young person about how s/he will immediately cope with the diagnosis. (Example: Who will they tell? What will they do if they get very anxious or upset? What will they do for the rest of that day/week?)

A blood sample is automatically sent out for the confirmatory test.

Supportive supervision of the staff member continues.

The Health Educator remains in contact with the patient as needed while s/he waits for the confirmatory result.

The Health Educator presents the experience at a team meeting so the rest of the staff can learn from his/her experience.

The patient returns for the confirmatory result and a second post-test counseling session occurs. This session will include linkages to care and the completion of partner notification.

Following the Post-test Counseling Session

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