Incorporating HIV test

Counseling, Testing and Referral
into an Adolescent Clinic–
The St. Chris experience
Tahniat Ansari, MD MPH
Assistant Professor of Pediatrics
Drexel University College of Medicine
St. Christopher’s Hospital for Children
Who we are
• Our staff
– 4 front desk, 3 medical assistants, 1
charge nurse, 3 nurse practitioners, 3
health educators, 3 physicians, pediatric
residents, medical students
• 2 clinics
– North Philadelphia -medically underserved
– Central Philadelphia
Family Planning Demographics
• Confidential free reproductive care for
ages 12-21y/o males and females
• Over 10,000 visits per year
• A little over 3,000 individual patients
• African American = Hispanic >>>
Caucasian > Asian
• 99% below poverty
Family Planning Based Clinic
• Annual exams
– complete physical, pelvic/male GU exam, Pap
smear, GC/CT testing, RPR, HIV testing
• Six month checks
– GC/CT testing
• Acute care visits
– vaginal complaints, ECP
• Walk in pregnancy test clinic
• Health educator only visit
– BC start/check, ECP
HIV Test Counseling
• 14 year old female
• Referred from our high school health
resource center for treatment of
• Further questioning: sexually active with
one partner for the past 1 month, didn’t
use a condom “one time”.
HIV Test Counseling
• Who: clinicians, health educator specialists,
…front staff, medical assistants
• When: Incorporated into almost visit as a part of
preventive health topics and risk reduction
• What: ABC’s discussed. Counseling tailored to
patient’s developmental level and understanding.
Written information also provided. Brochures,
Posters, Power point presentation
HIV Testing
• 16 year old female
• Here for routine “gyn” exam, refused blood
work because she “hates needles”
• Complains of itchy vaginal discharge
• Further history: sexual initiation 6 months
ago, history of 2 different partners,
intermittent condom use
• Physical exam: 2 tatoos, normal except green
frothy vaginal discharge
HIV Testing
• Conventional serum: MA draw 2 tubes of blood as
a part of triage. 1 is sent for RPR testing, the other
can be sent by the patients request for HIV testing
• Rapid: 20 minutes
– Oral
– Finger stick

• Follow-up
– Appointments made 2 weeks after testing for results
– Tracking sheet
Follow-Up Tracking Sheet
Post test counselor:
Patient Name/Medical Record #:
Test date:
Result date:
Post-test date:
HIV result: reactive, non reactive, inconclusive
Form kept as first paper in the chart. Can be completed
anytime the patient returns to clinic.
Positive HIV Test Referral
• 19 year old male
• Here for a routine physical exam
• Only complaint: fatigue, sore throat for 3 weeks
• Further questioning:
– Recent rash on palms and soles, now healed. Weight
– Sexually active with history of 3 males partners,
+ condoms
• Physical exam: multiple non tender enlarged lymph
nodes, large shallow healing ulcers in the throat
HIV Test Referral
• Partnership with Immunology/HIV clinic at
St. Chris
– Safety net created: Clinicians and counselors
develop a plan prior to patient arriving.
– St. Chris Immunology: a physician and/or
social worker and/or peer counselor is
available immediately.
– They make immediate arrangements to begin
HIV test Integration-2+ Years
• Every Annual
• Six month check up
• Positive GC/CT/Trich if no test in
previous 3 months
• Pregnancy
• Unprotected sex
• Walk-in rapid testing “WRAP”
Lessons Learned
• Create culture---work as a team, get “buy-
in”, identify “champions”, positive
• Teach confidentiality to staff, ensure patient
• Use every opportunity, be flexible, be
• Make it easy
Lessons Learned
• Partnership
– Outside resources
– Patients
• Patience and persistence
• Don’t be afraid---plan for the worst
• Breathe
The Real Workforce
• Health educators: Jenny Brice, May Lo,
Mark Miller
• Drs. Levine, Acquavella
• NPs- Dale Drucker, Chris Hoyler, Lynn
• MAs-Myteesha, Relonda, Cely
• Front desk- Christy, Lydia, LaTonya,
• Family Planning Council support

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