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What’s NEW in HIV Testing?. September 2009 AMY M. SITAPATI, MD ASSOCIATE CLINICAL PROFESSOR OF MEDICINE ASSOCIATE DIRECTOR, OWEN CLINIC UNIVERSITY OF CA, SAN DIEGO. The Approach. Instructor Background – why me?

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what s new in hiv testing

What’s NEW in HIV Testing?

September 2009

AMY M. SITAPATI, MD

ASSOCIATE CLINICAL PROFESSOR OF MEDICINE

ASSOCIATE DIRECTOR, OWEN CLINIC

UNIVERSITY OF CA, SAN DIEGO

the approach
The Approach
  • Instructor Background – why me?
    • 1st Hospital wide routine HIV Screen in Nation at Howard University in Washington D.C.
    • UC San Diego Medical Center
key issue is the
Key issue is the
  • NEGOTIATION
key points about decisions in negotiation
Key points about decisions in negotiation
  • Irrational escalation
  • Assuming gain is at another’s expense
  • Anchoring judgment on irrelevant information
  • Being affected by presentation
  • Relying too much on readily available information
the purpose
The Purpose
  • To practice negotiation skills at the HIV Testing Table
  • Practice the process of vocalizing our:
    • Issues (tangible)
    • Positions (our stance)
    • Interests (why we care)
  • By the end of this exercise you should be able to improve Integrative negotiations skills
  • Cooperative…win, win… interest based… mutual gains
get ready to
Get ready to
  • GET INTO CHARACTER
the hiv testing game grupo de clinicas comunitarias1
The HIV Testing Game: Grupo de Clinicas Comunitarias
  • Background:Grupo de Clinicas Comunitarias
  • Large community based federally qualified health center
  • Serving 250,000 people living in the San Joaquin
  • Grupo de Clinicas Comunitarias has sought to provide equitable healthcare to a diverse population
  • special interest in providing care to a large group of agricultural workers and Mexican immigrants.
  • San Joaquin currently has six of the state’s counties with the highest poverty (US Census and American Community Survey, 2007).
slide9

Grupo de Clinicas Comunitarias currently provides primary care and specialty services, obstetrical care, and an on-site Urgent Care.

  • The clinic provides an estimated 10,000 visits monthly and generates $8 m in fiscal revenue in addition to $3 m in grant support and operates with $250,000 in the black.
  • The CEO, Diego Roberto, and Medical Director, Margarita Valenzuela, have aggressively worked to better serve the local community during the last 8 years of their tenure.
slide10

A new physician, Victoria Sanchez, was hired nearly a year ago from UCLA as their on-site Infectious Disease provider.

  • She is passionate about her care and has been concerned about the increasing number of Latinos entering care in the late stages of AIDS.
  • She has become vested in seeing that a program be launched to implement routine HIV testing in the Grupo de Clinicas Comunitarias.
  • She approaches Dr. Valenzuela who says that the clinic does not have the resources or interest at this time to implement such a program.
  • Dr. Sanchez calls the AETC for help.
the hiv testing game grupo de clinicas comunitarias2
The HIV Testing Game: Grupo de Clinicas Comunitarias
  • The Cast:
  • Community Local Farmer Group, John Glenn
  • Local Health Department, Mark Brown
  • State Office of HIV/AIDS, Jim Harrison
  • CEO, Diego Roberto
  • Medical Director, Margarita Valenzuela
  • Risk Management, Roberto Orlando
  • Infectious Disease Provider, Victoria Sanchez
  • AETC Regional Office, Jane Doe
  • Laboratory Supervisor, Susana Splendor
the hiv testing game grupo de clinicas comunitarias3
The HIV Testing Game: Grupo de Clinicas Comunitarias
  • The Game:
  • Negotiate implementation of HIV testing with the resources available.
  • Divide the group into 9 parts and give individual groups their scripts.
  • Do not share information about another member.
  • The best negotiator can share their experience
  • The instructor, Amy Sitapati, is available for free consultation
bibliography partial
Bibliography (Partial):
  • HIV/AIDS Policy: HIV Testing in the United States. The Henry J. Kaiser Family Foundation. Fact Sheet. June 2009.
  • Marks G, et al, J Acquir Immnue Defic Syndr, Vol 20, 2006: 1447-50.
  • Burke RC, Sepkowitz KA, Bernstein KT, et al. Why don’t physicians test for HIV? A review of the US literature. AIDS. Vol 21(12), 31 July 2007: 1617-24.
  • CDC HIV Prevalence, Unrecognized Infection, and HIV Testing Among Men Who Have Sex With Men- Five U.S. Cities, June 2004-April 2005 Patients JAMA Volume 294(6), August 10, 2005, pp 674-676.
  • CDC: Cumulative Mortality for HIV: 1987 to 2000. www.cdc.gov
  • Chou, Roger MD Screening for HIV: A Review of the Evidence for the U.S. Preventive Services Annals of Internal Medicine Volume 143(1), July 5, 2005, pp 55-73.
  • D. Cohen, SY Wu, T. Farley. Health Affairs. August 2005 Volume 24#4.
slide14

Daar, Eric S., et al., Primary HIV Infection Recruitment Network. Ann Intern Med. 2001;134:25-29.

  • Halpern, Scott D. HIV Testing Without Consent in Critically Ill Patients JAMA Volume 294(6), August 10, 2005, pp 734- 735.
  • Kahn, JO, et al., Acute human immunodeficiency virus type 1 infection. New Engl J Med 1998; 339:33-9.
  • Kasten, Mary J. MD Human Immunodeficiency Virus: The Initial Physician-Patient Encounter Mayo Clinic Proceedings Volume 77(9), September 2002, pp 957-963.
  • Little, Susan J. et al., Antiretroviral-Drug Resistance among Patients Infected with HIV New Engl J Med Volume 347(6), 8 Aug 2002, pp 385-394.
  • Lou, Wei, et al. Comparision of Sensitivities between DNA and RNA Nucleic Acid Tests for the Detection of HIV-1 Infection. Abstract from HIV Diagnostics: New Developments and Challenges. February 28 to March 1, 2005. Orlando, Florida.
slide15

Merchant, Roland C. MD et al., Perspectives on New Recommendations for Non-occupational HIV Postexposure Prophylaxis. JAMA Volume 293(19), 18 May 2005, pp 2407-2409.

  • Mindel, Adrian; Tenant-Flowers, Melinda Natural History and Management of Early HIV Infection Bristish Medical Journal 2001 Volume 322(7297), May 26, 2001, pp 1290-1293.
  • MMWR: June 24, 2005. HIV Statistics.
  • Perlmutter, Barbara Lee, et al., How to Recognize and Treat Acute HIV Syndrome. American Family Physician. August 1999.
  • Pilcher, Christopher D., et al., Acute HIV revisited: new opportunities for treatment and prevention. J Clin Invest. 2004 April 1; 113(7):937-945.
  • Smith, Davey M., et al. HIV Drug Resistance Acquired Through SuperinfectionAIDS 2005; 19(2):1251-1256.
  • The HIV Medicine Self-Directed Study Guide 2003 Edition Volume 1. AAHIVM
    • Bernard M Associate Director for Laboratory Diagnostics Division of HIV/AIDS preventionFDA Blood Products Advisory Committee Meeting November 3, 2005