Karla Johnson, MSPH Executive Director Development Systems, Inc. Region VII RTC

1. OPA/OFP HIV Prevention ProjectAnnual Technical Support ConferenceReport from Breakout Sessions – Day 2 Karla Johnson, MSPH Executive Director Development Systems, Inc. Region VII RTC June 14, 2007

2. Internal Challenges & Solutions Challenges • HIV testing viewed as “separate” • Clinic flow for integrating rapid tests Suggested Solutions or Actions • “Relentless” training of staff • Revise clinic flow systems, consent forms to accommodate rapid testing • Use example of open access

3. Internal Challenges & Solutions Challenges • Staff resistance to testing Suggested Solutions or Actions • Train staff on importance of testing and needs of clients • Develop systems that incorporate HIV testing into clinic services

4. Internal Challenges & Solutions Challenge • “Silo” funding - separate staffing, appointment systems, protocols • Sustainability of rapid testing (dependent on OPA funding) Suggested Solutions or Actions • Targeted testing at specific sites • Sliding scale fee for rapid testing

5. Internal Challenges & Solutions Challenges • Burden of paperwork • Writing procedures Suggested Solutions or Actions • Streamline and redefine reporting and documentation requirements • PPFA Clinical Guidelines Manual

6. Internal Challenges & Solutions Challenges • False positive with rapid tests Suggested Solutions or Actions • Training/counseling to prepare staff/clients for false positives • Quality control (i.e. storage issues)

7. Internal Challenges & Solutions Challenges • Staff turnover • Staff burnout Suggested Solutions or Actions • Revisit agency mission statement • Get buy-in from management team • Support professional development • Network with model programs

8. Internal Challenges & Solutions Challenges • Cultural competency Suggested Solutions or Actions • Understand cultural diversity and needs of client population • Provide staff training and follow-up with implementation and support • Counseling supervision & feedback

9. External Challenges & Solutions Challenge • Stigma around HIV Suggested Solutions or Actions • Full implementation of training materials that address stigma • Social marketing and education • Normalize HIV testing

10. External Challenges & Solutions Challenge • Collaboration between HIV/AIDS CPGs and FP agencies Suggested Solutions or Actions • OPA collaborate with CDC to determine how family planning and CPGs can work together

11. External Challenges & Solutions Challenge • State requirements don’t match CDC recommendations (e.g. many require separate HIV consent) Suggested Solutions or Actions • Collaborate with other CBOs, ASOs to advocate for public policy to support best practices

12. External Challenges & Solutions Challenge • Some states require testing sites to run daily controls (huge expense) Suggested Solutions or Actions • Review state laws nationwide to determine extent of this issue • Find models for legislative change

13. External Challenges & Solutions Challenge • Reimbursement (e.g. rapid testing, post-test counseling) Suggested Solutions or Actions • Quantify potential loss of income and consider whether this income could be offset (e.g. sliding scale fees, streamlining)

14. External Challenges & Solutions Challenge • Excessive training requirements Suggested Solutions or Actions • Negotiate less extensive training requirements with authorizing agency for family planning staff

15. External Challenges & Solutions Challenge • Difficulty identifying referral linkages in rural settings Suggested Solutions or Actions • Network with HIV organizations to find out where PLWHA receive care, and seek out those providers for cross-referral