1Introduction to Introduction to OraQuickOraQuickRapid HIV TestingRapid HIV TestingWilliam F. Ryan Community Health CenterWilliam F. Ryan Community Health CenterSchool Based Health ProgramSchool Based Health ProgramPresentersPresentersJill Gallin, CPNPSupervisor School Based Health ProgramBeth Bitton, CSWSocial WorkerSchool Based Health ProgramSchool Based Health ProgramOur program offers complete primary care services onsite to students at West Side High School and Booker T. Washington Middle SchoolNational HIV StatisticsNational HIV Statisticsz Somewhere between 900,000 and 1,125,000 Americans are now infected with HIVz 50 to 60 percent of those infected with HIV DO NOT KNOW they are infectedz In 2003, between 40,000 and 50,000 Americans were infected with HIVz 25% of all newly infected individuals are teenagersz 50% of all newly infected individuals are age 25 or youngerz The rate of new HIV infections is climbing fastest in teenagers, women and people of colorHIV Testing MethodsHIV Testing Methods• Blood Test• OraSure• OraQuickTaking the TestTaking the Test•Confidential Vs. Anonymous•Patient consent and pre-test counseling• Risk Factors Assessment•Meaning of HIV Test Results•Transmission•Benefits of Testing•Recent Exposure•Reporting requirements•Partner notification2Why Rapid Test?Why Rapid Test?• Up to a third of people who have a sample taken for conventional (two week wait) testing never return to get their results.Why not return?Why not return?• Stigma and Shame Associated with HIV• Denial• Fear• Lack of awareness of treatment optionsRapid Test ProcedureRapid Test Procedure3Insert loop into vial and stirStudents should assume Students should assume everyone they date might everyone they date might be infected with HIVbe infected with HIVThe benefits of testing with The benefits of testing with OraQuickOraQuick• Testing helps stop the spread of HIV • Testing and treatment help stop the progression of AIDS• Rapid results facilitate patient awareness of HIV status•Pregnant women•HIV positive• Health care workersWhat you need to know in What you need to know in addition as nursesaddition as nurses• OraSure, OraQuick and blood test are detecting antibody to HIV• In neonates the presence of antibody could mean exposure to HIV, but not infection with HIV. Maternal antibodies may persist for up to 6 months• Absence of antibodies is not proof of absence of infection or incapability of transmitting HIV. Antibody response to recent exposure may take several months to develop. “seroconversion”What you need to know in What you need to know in addition as nursesaddition as nurses• In the United States we typically test for HIV-1 antibodies. A closely related but distinct type of pathogenic human immunodeficiency retrovirus is HIV-2.• HIV-2 has been isolated in West African patients with AIDS. Get a history!4Questions: 1987Questions: 1987z Should…– persons attending STD clinics have a test for HIV antibody?– persons attending drug treatment programs have a test for HIV antibody?– the sexual partners of people with HIV infection be notified about their potential exposure and tested and counseled?Questions: 1987Questions: 1987z Should…– persons attending family planning services have a test for HIV antibody?– pregnant women have a test for HIV antibody as early in pregnancy as possible?– HIV antibody testing be a routine part of a premarital testing program?– Every patient admitted to a hospital be tested for HIV antibody?Questions: 1987Questions: 1987z How…– Can HIV antibody test results be used for appropriate medical and public health purposes without their being used for discrimination of social ostracism?1989 Recommendation1989 Recommendationz No positive test results should be given to clients/patients until a screening test has been repeatedly reactive (i.e., two or more tests) on the same specimen, and a supplemental, more specific test such as the Western blot has been used to validate those results.Proportion of persons who do not Proportion of persons who do not return for their HIV test resultsreturn for their HIV test results47%42%200048%43%199944%38%199842%33%199733%26%199633%25%1995HIV NegativeHIVPositiveSource: CDC Client Record Database, Publicly-funded HIV testing040,000 02,000,0001,442,847 786,9371,147,25126,46522,51419971,147,25122,5149,84327,947 1,374,7091996708,2201,442,84726,4658,023What if rapid HIV tests wereused in all public testing sites?Additional, Rapid TestHIV PositiveCurrent StrategyHIV NegativeAdditional, Rapid TestCurrent Strategy19981,442,847 856,8761,147,25126,46522,514 1,091,04518,1189,8431,442,847 903,8391,147,25126,46522,514 995,95216,04811,19219991,442,847 913,0571,147,25126,46522,514 1,028,27416,22310,593200051998 Recommendation1998 Recommendationz Health care workers should provide preliminary positive rapid test results before confirmatory results are available in situations where tested persons benefit.Contact InformationContact InformationJill GallinSupervisor School Health ProgramBeth BittonSocial WorkerWilliam F. Ryan Community Health Center110 West 97thStreetNew York, NY 10025Email: [email protected]: (212)678-7379Fax: (212)