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Key Players: Technical Assistance
Health departments can provide nonfinancial support through technical assistance and capacity-building efforts; this includes:
- Free or low-cost rapid test kits
- Laboratory services for confirmatory tests and other tests such as CD4 and viral loads
- Assistance in interpreting public health codes in such areas as consent and counseling requirements
- HIV counseling training for ED staff
- Training for ED staff in administering HIV tests
- Training in and use of information systems to collect and track data from the program
- Placing HIV counselors in the ED to provide testing and counseling
- Equipment, such as mobile carts
- Partner notification and referral services
- Referral resources
- Disease intervention services, such as patient follow-up and tracking
- Providing data to inform decision making about whether it is sensible to implement programs and, if so, which model might be most productive
- Assistance and support in linking with other community resources
- Identifying models and approaches to operationalize HIV testing
Health Department
State and local HIV/AIDS directors and their staffs are key partners in the planning, development and ongoing support of ED-based HIV testing. They are interested in how to best allocate scarce HIV testing resources and must balance competing interests and politics.
top of this pageInitiator
In many places, the health department has initiated the discussion with hospital leaders. They present the opportunity for HIV testing and its potential impact on identifying patients with unknown HIV, improving care for that patient at that ED visit, and presenting the opportunity for earlier care outside the ED for HIV-infected patients. They can also provide data to help inform decision making regarding implementation of HIV testing efforts, including the specific models or approaches that might be most appropriate to the population and/or prevalence.
An important part of this early discussion is cueing in to the ED's concerns that may present barriers. Questions to drive this discussion may include:
- What are the ED's specific concerns about introducing routine HIV testing? These concerns may include consent and counseling requirements, burden of ED staff, interruptions in patient flow, and costs.
- What needs to happen to address those concerns? Sometimes the answer is as simple as clarifying any consent and counseling requirements or presenting the evidence on feasibility and cost. Or you may need a pilot test to demonstrate impact.
- What is essential to the program design if it is going to work in this ED?
- Who in the hospital would support this program? Who in the hospital would oppose it? Why?
Funding
Funding is the most direct way a health department can help launch HIV testing in an ED. While funding can open the door, though its not always available or sustainable. In addition to direct funding, health departments can help incubate a program by:
- Funding a pilot program in the ED, which may demonstrate to other potential funders the feasability and possible results of HIV testing in that ED
- Funding the incremental cost of developing the program, such as salary support for hospital staff to develop a program and find alternative funding
- Working with the hospital to identify other sources of funding and resources, including local and private, that may be more sustainable over time
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