home
***
CD-ROM
|
disk
|
FTP
|
other
***
search
/
Shareware Overload Trio 2
/
Shareware Overload Trio Volume 2 (Chestnut CD-ROM).ISO
/
dir26
/
cdcguide.zip
/
CDC94041.TXT
< prev
next >
Wrap
Text File
|
1994-08-05
|
21KB
|
449 lines
Document 0041
DOCN CDC94041
TI HIV Counseling, Testing, and Referral: Standards and Guidelines
DT 9408
SO CDC National AIDS Clearinghouse - August 1994
TX TABLE OF CONTENTS
HIV Counseling--Program Standards and Guidelines
Client Eligibility
References
Risk Assessment Development
Referral Service Development
Quality Assurance
Publicly Funded Programs - Data Collection
CLIENT ELIGIBILITY CRITERIA
Public health agencies that receive federal funds from the
National Center for Prevention Services (NCPS) are required to
routinely offer, on a voluntary basis with informed consent, HIV
prevention counseling and HIV laboratory testing services to
persons who are potentially HIV infected, their partners and
others who have high risk behaviors (1). Grantees are encouraged
to offer services to clients at designated counseling and testing
sites, sexually transmitted disease (STD) clinics, drug treatment
centers, tuberculosis clinics, criminal justice and correctional
systems, women's health clinics, youth and adolescent programs,
and other sites which serve persons with risk behaviors for
acquiring HIV. To use resources as efficiently as possible,
grantees are encouraged to integrate HIV counseling and testing
into ongoing operations, especially in STD and substance abuse
treatment clinics. HIV Prevention Community Planning provides
one forum for priority setting, accomplished through a
participatory process, which may guide the targeting of HIV
counseling services.
Unless it is prohibited by state law or regulation, clients
should be offered reasonable opportunities to receive HIV-
antibody counseling and testing services anonymously. The
availability of anonymous services may encourage some persons at
risk to seek services who would otherwise be reluctant to do so.
Grantees who elect to charge for services are strongly encouraged
to use a sliding scale, and to provide services regardless of
ability to pay. That services will not be denied because of the
client's inability to pay should be clearly communicated by the
facility by posting signs or providing written materials.
Program staff who register clients or collect fees should be
familiar with this policy. When a client is identified to be at
risk for HIV infection, the health care facility is responsible
for providing services or ensuring effective referral for
services.
Counseling programs should develop a triage assessment procedure
to identify persons at risk for HIV infection. This procedure
should consider local circumstances that influence the risk of
HIV infection for persons who might not be perceived as being at
risk. Health care providers should take advantage of every
encounter with a client to reinforce HIV prevention messages (2).
STANDARDS
HIV prevention program managers must accomplish the following:
* Establish systems to ensure that strict confidentiality is
maintained for all persons who are assessed for HIV counseling
and testing services.
* Seek to ensure that all persons who seek HIV testing are
offered counseling relevant to their needs.
* Seek to ensure that persons who are determined to be at
risk for HIV infection as a result of sexual or drug
using behaviors are routinely counseled.
* Establish that no facility that receives federal funds
for HIV counseling and testing services may deny a client
services because of that client's inability to pay (3).
SPECIAL CONSIDERATIONS
* Clients who request repeat testing should be managed as
indicated in the "Counseling and Repeat Testing Section."
REFERENCES
(1) CDC. 1992 HIV Prevention Program Guidance.
(2) CDC. Technical Guidance on HIV Counseling, January 1993.
(3) CDC. 1992 HIV Prevention Program Guidance.
RISK ASSESSMENT DEVELOPMENT
Program managers, from sites that provide HIV counseling services
should review available data to identify site-specific HIV
prevention needs. This review and evaluation should include AIDS
case surveillance data, HIV seroprevalence data, STD morbidity,
prevention counseling data, and demographic and risk behavior
profiles of the population and the catchment community served by
each site. Based on analysis of this data, the program should
develop policies for each site that address the appropriate
provision of primary and secondary HIV prevention services
including triage assessment, targeted or universal risk
assessment procedures. For example, if the voluntary HIV testing
seropositivity at a site is higher than the blinded
seroprevalence, this site is successfully targeting prevention
efforts. However, if the voluntary HIV testing seropositivity is
lower than the blinded seroprevalence, this site may not be
appropriately targeting assessments, outreach efforts, prevention
counseling, and/or provision of voluntary testing services. This
information should be used to plan activities and services,
redirect efforts and resources to meet current needs, use
resources more efficiently, and identify unmet service needs.
Each site that offers HIV testing must provide prevention
counseling tailored to individual client needs and should develop
an effective method to involve clients in identifying their risk
behaviors. This approach should also address local and specific
circumstances which might influence the client's perception of
risk. Where available, sites should use triage assessment as one
of the first efforts to direct persons at risk of HIV infection
into prevention counseling. Clinic environment should support
the risk assessment process, another essential method to involve
clients in identifying their risk behaviors. Strategies to
achieve this include group discussions, audiovisual materials,
pamphlets, and/or posters. Community based organizations are
excellent collaborators in the development and provision of
client support services. Educating clients through multiple
methods increases the chance that clients will recognize
behaviors which place them at risk.
STANDARDS
HIV prevention program managers must make certain that the
following are achieved:
* Provision of training and quality assurance to
staff to ensure identification of risk behaviors
of all clients counseled or tested for HIV.
* Establishment of site-specific demographic and
risk profiles, based on analysis of HIV test
data.
* Ongoing collection and review of available site-specific
data, including AIDS case surveillance data, HIV
seroprevalence data, STD morbidity, prevention counseling
data, demographic, and risk behavior profiles for
targeting of resources and quality assurance of service
delivery.
* Determination of appropriate site-specific
strategies for risk assessment of clients, based
on demographic and risk profiles.
* Procedures to maximize targeting of clients for
prevention counseling based on risk profiles.
GUIDELINES
HIV prevention program managers should do the following:
* Ongoing review and analysis of relevant seroprevalence data,
including site specific blinded seroprevalence if available, and
* Analyze by site the extent of HIV prevention counseling coverage
(number of clients seen, blinded seroprevalence, and number of
HIV infected persons identified through prevention counseling).
REFERRAL SERVICE DEVELOPMENT
A thorough client assessment often indicates a need for services
that cannot be provided by the counselor (e.g. drug treatment,
peer support groups, etc.). To ensure that clients receive
appropriate care, the program must establish a procedure for
referring persons to sites that provide services in a timely,
efficient, and professional manner. A collaborative relationship
should have already been established with the appropriate
representative of the referral site.
STANDARDS
HIV prevention program managers must develop a process for
routine referral which include the following:
* A written referral process for identifying, evaluating,
and updating referral sources in the site's operations
manual.
* A mechanism to provide clients with immediate access to
emergency psychological or medical service.
* Appropriate referral resources for
- Any client at-risk for HIV infection who may be in
need of support to maintain safer behaviors,
- HIV negative clients who continue to test but are
without risk,
- HIV negative clients who continue to engage in risk
behavior,
- HIV positive clients who continue to engage in risk
behavior,
- HIV positive or high risk HIV negative clients who
need STD diagnosis and/or treatment, and
- HIV positive persons who need a medical assessment.
* Written standards for the follow-up of confidentially
tested HIV positive clients who don't return for results
and counseling.
GUIDELINES
HIV prevention program managers should develop a process for
routine referral which would accomplish the following:
* Maintains a current list of community and institutional
referral resources such as infectious disease specialists
and clinics, free clinics, social service agencies,
emergency medical services, hospitals, prenatal care
clinics, family planning clinics, mental health centers,
AIDS service organizations, HIV/AIDS community-based
organizations (CBOs), substance abuse treatment
facilities, and religious institutions;
* Establishes a liaison at each of these resources; and
* Provides periodic inservices from referral agencies.
QUALITY ASSURANCE
The objective of quality assurance is to ensure that appropriate,
competent, and sensitive, methods are used for risk assessments,
counseling, and referral of clients. Management staff,
contractors, or collaborative agency staff should be trained and
should be able to perform routine objective quality assurance
site visits. A minimal level of performance should be determined
and agreed upon by the funding agency and the service provider.
Less than minimal performance must be remedied, or the site
should suspend counseling and testing activities until an
acceptable minimal standard of performance can be assured.
Counseling programs should develop written quality assurance
policies and procedures consistent with these standards and
guidelines; these documents should be available to all staff.
Client feedback should be routinely used as a factor in assessing
quality assurance.
STANDARDS
I. Facility
* The site must be geographically accessible to the
population it serves.
* The site must operate during appropriate hours and
minimize any delay in providing services.
* Counseling rooms must be private to ensure
confidentiality of the counseling session.
II. Staff
* Management staff must ensure that necessary resources and
systems are available to ensure acceptable job performance.
* The program director must ensure adequate on-site supervision
for staff.
* Counselors must meet locally established qualification
standards.
* Counselors and other relevant staff must be provided
updates at least annually on the scientific/public health
aspects of HIV.
III. Educational and Risk Reduction Materials
* Culturally competent, linguistically specific, and
developmentally appropriate written HIV information must
be available to clients. The National HIV Clearinghouse
is a useful resource to obtain and review a range of HIV
education and risk reduction materials.
IV. Records/Forms
* Client records (confidential and anonymous) must contain
a copy of the informed consent document, laboratory slip
with test results, documentation of prevention
counseling, result notification, and formulation of risk-
reduction plans.
* Records with patient identifiers must be secured.
* All personal identifying information in connection with
the delivery of services provided to any person must not
be disclosed unless required by law or unless the person
provides written, voluntary informed consent.
* Routine audits of risk assessment questionnaires,
counseling and interview forms, and client risk reduction
plans must be conducted.
GUIDELINES
I. Facility
* The physical facility should display a level of
professionalism and client orientation relevant to the
population served.
II. Staff
* A written job description should be provided for all
counselors.
* Performance tasks and standards should be established and
reviewed with the employee.
* All counselor and supervisory staff should be familiar
with all services connected with the counseling program.
* New counselors should be observed (with client consent)
daily until proficiency is assured and periodically
thereafter to ensure that proficiency is maintained.
* The supervisor should routinely provide constructive
feedback to the employee, based on the observations.
* Case presentations should be conducted routinely, using
techniques such as team problem solving sessions with
medical, supervisory, and counseling staffs.
* Each counselor and supervisor should be provided
additional information through training and/or inservices
about HIV, STD, TB, immunization, family planning,
substance abuse, and early interventions such as
antiviral treatments, etc.
III. Educational and Risk Reduction Materials
* Condoms should be available to the client--directly from
providers and easily accessible without the client having
to ask.
* Current written materials should be prominently displayed
in public areas and made available to clients.
* Current written and audiovisual materials should be
culturally and linguistically appropriate for the client
population. Materials should be sensitive to the reading
levels, gender, and ethnicity of the client population.
PUBLICLY FUNDED PROGRAMS
DATA COLLECTION AND ANALYSIS
Accurate and consistent data collection from HIV prevention
counseling, test results, notification of results, referrals, and
partner notification activities are critical to the
implementation, maintenance, and evaluation of a quality HIV
prevention program. Data collection and quality assurance of
referrals and partner notification are addressed in the
respective guidelines. Analysis of HIV counseling and testing
data in combination with seroprevalence and local demographic and
STD morbidity data are essential components of prevention program
operations. Required by the program, the data should:
* Identify barriers and gaps in service delivery,
* Plan, refine and target program intervention strategies,
* Analyze resource allocation,
* Provide site specific feedback to clinic staff, and
* Provide specific feedback to counselors.
STANDARDS
Publicly funded programs must
* Utilize a standard data collection tool throughout the project
area.
* Collect minimum required variables:
- Unique record/client identifier;
- Unique site identifier;
- Prevention counselor identifier;
- Date of prevention session;
- Client demographics (age, sex, race/ethnicity, state,
county, and zip code),
- Client risk behavior (identified through client self-assessment
and/or counselor discussion with client during prevention
counseling);
- Final laboratory result/report; and
- Date of notification of results and prevention counseling.
* Adhere to the NCPS site numbering system criteria:
- Site number is determined by where the client is tested;
- Each clinic within a facility has a unique site number;
- Satellite clinics require a unique site number;
- Site numbers are not duplicated across counties, districts,
or parishes; and
- Site location, not counselor identification number, determines
the site number.
* Counselor/DIS field services and outreach teams require a
unique group site number for field work.
* Conduct routine and systematic review of data for errors and
inconsistencies and establish formal mechanisms for corrections.
* Report client record data (with client identifiers removed) to
NCPS on a quarterly basis.
* Use the following program indicators to evaluate HIV counseling
at individual sites:
- Number of clinic visits,
- Number of clients eligible for prevention counseling,
- Number of clients who received prevention counseling,
- Number of clients tested for HIV,
- Number of clients testing positive,
- Number of positive clients notified of results and provided
prevention counseling,
- Number of clients testing negative, and
- Number of negative clients notified of results and provided
prevention counseling.
- Other relevant program indicators identified through ongoing
quality assurance and data analysis.
Note: The first three indicators provide important denominator
data for sites that provide a range of health care services.
GUIDELINES
Publicly funded programs should
* Review site-specific data analysis with appropriate staff at
least quarterly.
* Conduct counselor-specific data analysis and provide feedback
to the counselor at least twice a year.
* Conduct personnel resource analysis to establish minimum
workload guidelines.
* Establish a computerized data system to facilitate data
analysis for quality assurance.
DISTRIBUTED BY GENA/aegis (714.248.2836 * 8N1/Full Duplex) SOURCE:
National AIDS Clearinghouse.