AHRQ Innovations Exchange | Counseling and Testing Process Makes HIV Screening a Routine Part of Primary Care, Increasing Testing Rates and Identification of Infected Individuals

Counseling and Testing Process Makes HIV Screening a Routine Part of Primary Care, Increasing Testing Rates and Identification of Infected Individuals

Snapshot
Summary
Montefiore Medical Center's Adolescent AIDS Program developed a four-step protocol designed to make HIV screening a routine part of care in the primary care setting using existing resources; the goal is to boost testing rates so as to identify asymptomatic HIV-positive individuals in need of early treatment. Under this approach (known as Advise, Consent, Test, and Support), clinics briefly advise patients on the need for screening and answer any questions they may have, obtain consent for and provide the test, and offer any necessary follow up support. The program has led to a more than doubling of testing rates and a modest increase in the number of HIV-positive individuals identified at Montefiore clinics, and to significant increases in both testing rates and the number of infected individuals identified at two clinics in South Africa that adopted the Montefiore model. In addition, South African youth receiving Advise, Consent, Test, and Support were more likely to have their CD4 count (a measure of the health of the immune system) documented and to return to the clinic for follow up care.

Evidence Rating
Moderate: The evidence consists of comparisons of trends in testing rates in five Montefiore clinics randomized to the program to those in similar Montefiore clinics providing usual care; pre- and post-implementation comparisons of testing rates and the number of HIV-positive individuals identified in two clinics that adopted the ACTS model in South Africa; and post-implementation comparisons of CD4 documentation and follow up care rates between those receiving ACTS and those participating in 30-minute pretest counseling sessions in the South African clinics.

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AHRQ Innovations Exchange | Counseling and Testing Process Makes HIV Screening a Routine Part of Primary Care, Increasing  Testing Rates and Identification of Infected Individuals