HIV, STIs, Viral Hepatitis and LTBI Routine Screening Toolkit: Resource library

The HIV, STIs, Viral Hepatitis and Routine Screening toolkit was developed with input from health care professionals and was designed for clinicians working in community health centers and emergency departments. Access the library of resources available from the toolkit for use in your practice.

To access interactive maps and charts on number of reported cases by state, race/ethnicity and sex, visit the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention Atlas Plus resource.

HIV

At the end of 2021, an estimated 1.2 million people aged 13 and older had HIV in the United States, including an estimated 153,500 (13%) people whose were not aware of their HIV-positive status (CDC).

For the latest in HIV surveillance from the CDC you can visit the HIV Surveillance Reports webpage.

STIs

Data published by the Centers for Disease Control and Prevention (CDC) show that reported annual cases of STIs in the United States continued to climb in 2021, reaching an all-time high for the sixth consecutive year.

The 2021 STI Surveillance Report found:

• 2.5 million cases of chlamydia, gonorrhea, and syphilis, the three most reported STIs in 2021.
• Congenital syphilis continues to surge, increasing 203 percent in the past five years. In 2021, 38 jurisdictions, including 37 states and the District of Columbia, reported an increase in congenital syphilis cases.

Viral hepatitis

• As of 2016, nearly 3.3 million people in the United States were living with chronic viral hepatitis—an estimated 862,000 with hepatitis B and 2.4 million with hepatitis C.
• Hepatitis B: In 2019, a total of 3,192 acute hepatitis B cases were reported to CDC, resulting in 20,700 estimated infections after adjusting for case under-ascertainment and under-reporting
• Hepatitis C: In 2019, 4,136 acute hepatitis C cases were reported to CDC, resulting in 57,500 estimated infections after adjusting for case under ascertainment and under-reporting. The number of cases reported during 2019 corresponds to a 133% increase from the 1,778 cases reported during 2012.

For the latest in viral hepatitis surveillance from the CDC you can visit the Viral Hepatitis Statistics and Surveillance webpage.

Latent tuberculosis infection (LTBI)    

• During 2019, the United States reported the lowest number of TB cases (8,916) and lowest incidence rate (2.7 cases per 100,000 persons) since individual TB case reporting began in 1953.
• This represents a 1.2% decrease in TB cases and 1.7% decrease in the incidence rate from 2018.
• However, CDC estimated in 2011-2012 up to 13 million people in the United States had LTBI who could benefit from testing and treatment to prevent reactivation to TB disease.

For the latest in Tuberculosis surveillance from the CDC you can visit the Tuberculosis Data and Statistics webpage.

What can you do?

• Couple screenings for HIV, STIs, viral hepatitis and LTBI with screenings for chronic conditions or care for everyday concerns
• Understand what comprehensive care looks like and feels like to the community being served and place routine screening in that context
• Implement patient self-assessment screening in waiting room and address during visit as needed
• Make sure all staff are up to date on screening recommendations
• Identify opportunities for clinical decision support tools that provide reminders or support automatic laboratory orders
• Ensure staff are trained in patient counseling and can deliver news in a clear, culturally sensitive, and effective way
• Have patient education materials available at visit completion
• Have resources to aid patients with disclosing their status to partners
• Have strong linkage to care and follow up protocols for patients in place
• Discuss accessible preventive measures

Resources to help build strong community partnerships

• Tool for Tracking Partners and Partnership Activities: Pages 81-88 from HSA’s Integrating HIV Care, Treatment & Prevention Services into Primary Care–A Toolkit for Health Centers guide includes a Partnership Toolkit that provides a comprehensive list of key considerations, steps, and templates to help guide your organizations’ community relationship building and tracking.
• Partnership Mapping Template (PDF): This template provides a framework to help your organization keep track of relationships with non-clinical services and outpatient clinics that will support both community outreach and a sustainable linkage to care program.

Social and digital marketing material and campaign examples

The CDC’s National Prevention Information Network includes information and links to digital marketing examples and marketing campaigns executed by a variety of organizations.

• CDC’s Let's Stop HIV Together Campaign
• CDC’s National Prevention Information Network Digital Media Tools for HIV
• CDC’s Let’s Stop HIV Together Social Media Toolkit
• CDC’s National Prevention Information Network Digital Media Tools for hepatitis
• CDC’s National Prevention Information Network Digital Media Tools for STDs
• CDC’s Think. Test. Treat TB Campaign 
• CDC’s Latent TB Infection Online Resource Hub

Social Media for Health Centers: This webpage from the National Association of Community Health Centers compiles a series of tips and resources for community health centers to consider when engaging with different audiences through social media platforms as a way to foster relationships, reinforce the organization’s mission and amplify reach.

Social determinants of health resources

• Tools for Putting Social Determinants of Health into Action: This CDC resource compiles a series of tools and resources that health care practitioners can review in order to embed strategies to address social determinants of health in their organization.
• Health-Related Social Needs Screening Tool: This resource from the Centers for Medicare and Medicaid Services can help clinicians find out patients’ needs in 5 core domains including housing instability, food insecurity, transportation problems, utility help needs and interpersonal safety.
• PRAPARE Screening Tool and Implementation Toolkit: Developed in partnership between the National Association of Community Health Centers, the Association of Asian Pacific Community Health Organizations, and the Oregon Primary Care Association the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) is a national standardized patient risk assessment protocol designed to engage patients in assessing and addressing social determinants of health.

Meet patients where they are resources

• HIV Testing in Non-Clinical Settings: This CDC webpage compiles a series of guidelines, recommendations and job aids that supports HIV testing in non-clinical settings.
• Implementing HIV Testing in Nonclinical Settings: A Guide for HIV Testing Providers: The purpose of this guide from the CDC is to familiarize health care professionals with key programmatic issues that impact delivery of HIV testing services in nonclinical settings.

Patient education materials from the CDC

These links compile downloadable patient education materials from the CDC with resources targeted to different patient demographics and available in multiple languages. Patients should be provided with information about the communicable nature of these infections and consider options for notifying others that were potentially exposed. 

• HIV Consumer Info Sheets  
• Viral Hepatitis Patient Education Materials  
• STI Patient Resources from the CDC 
  • CDC Fact Sheets
  • The Facts Brochures
  • Which STD Tests Should I Get?
  • How You Can Prevent Sexually Transmitted Diseases
• LTBI and TB disease resources
  • Find TB Resources: TB Education & Training from the CDC
  • Tuberculosis Patient & General Public Materials

Patient Pages from the JAMA Network™

JAMA Patient Pages are free patient resources designed to distill high-quality evidence and updated guidance from USPSTF into a more accessible patient friendly format to help guide patient decisions. These resources can also be helpful to reference as your clinic or institution develops their own patient-friendly educational resources.

HIV

• Human Immunodeficiency Virus
• Who Should Be Screened for HIV Infection?
• Can HIV Infection Be Prevented With Medication?
• HIV Infection: The Basics

Viral hepatitis

• Screening for Hepatitis B in Nonpregnant Adolescents and Adults
• Screening for Hepatitis B in Pregnant Women
• Screening for Hepatitis C Virus Infection
• Treating Hepatitis C

STIs

• Screening and Prevention of Sexually Transmitted Diseases
• Screening for Syphilis in Pregnant Women
• Screening for Syphilis

LTBI

• Screening for Latent Tuberculosis

Self or risk assessment templates

The following links provide you with examples of self or risk assessment templates that you can leverage in your practice.

• HIV: Learn the HIV risk of different sexual activities when one partner is HIV positive and one partner is HIV negative (a discordant partnership).
• STIs: Link to the CDC’s Prepare Before You’re There STI self-risk assessment quiz.
• Viral hepatitis: Assess your risk with this Hepatitis Risk Assessment Tool from the CDC.
• LTBI
  • This CDC resource is an LTBI guide booklet for primary care clinicians. Appendix A of this resource is a sample risk assessment that can be leveraged when screening for LTBI.

Resources on collecting comprehensive patient demographics and sexual history

• Discussing Sexual Health with Your Patients: The resource from the CDC outlines strategies and tips for facilitating discussions with and asking patients sensitive questions related to sexual health.
• A Guide to Taking a Sexual History (PDF): This CDC resource offers a framework for discussing sexual health issues to help health care professionals complete the overall picture of their patient’s health.
• GOALS Framework for Sexual History Taking in Primary Care: The GOALS Framework resource from the Clinical Guidelines Program of the New York State Department of Health AIDS Institute is designed to streamline sexual history conversations and elicit information most useful for identifying an appropriate clinical course of action.
• Sexual Health and Your Patients: A Provider’s Guide: The resource from the National Coalition for Sexual Health was developed to help health care professionals better integrate sexual health conversations and recommended preventive services into routine visits with adolescents and adults.
• HIV Prevention and Care for the Transgender Population: This CDC resource outlines information and tips for health care professionals to facilitate the disclosure of sexual history information from transgender patients where obtaining this information is particularly sensitive due to potential prior experiences of discrimination in health care.

Screening guidelines from the CDC and USPSTF

• CDC Guidelines and Recommendations
• USPSTF A&B Recommendations
• Clinical algorithm flowcharts for screening: This set of documents translates screening guidance and clinical considerations from the USPSTF into a decision tree format to help outline steps in the testing continuum from beginning to end and allow you to help clarify team member roles at each step of the process.
  • Clinical algorithm flowchart for HIV screening (PDF)
  • Clinical algorithm flowchart for Chlamydia and Gonorrhea screening (PDF)
  • Clinical algorithm flowchart for Syphilis screening (PDF)
  • Clinical algorithm flowchart for HBV screening (PDF)
  • Clinical algorithm flowchart for HCV screening (PDF)

Resources to streamline the testing cascade

• Streamlined testing cascade: This set of infographics outlines the testing cascade for each infectious disease in this toolkit for both community health centers and emergency departments, including opportunities to optimize screening, and can be used to help clarify care team member roles at each step as well as define a clear post-test protocol.
  • Community Health Center: 
    • Routine Screening Toolkit: Streamlined Testing Cascade, HCV (PDF)
    • Routine Screening Toolkit: Streamlined Testing Cascade, HIV (PDF)
    • Routine Screening Toolkit: Streamlined Testing Cascade, LTBI (PDF)
    • Routine Screening Toolkit: Streamlined Testing Cascade, STI (PDF)
  • Emergency Department: 
    • • • Routine Screening Toolkit: Streamlined Testing Cascade, HIV (PDF)
        • Routine Screening Toolkit: Streamlined Testing Cascade, STI (PDF)
        • Routine Screening Toolkit: Streamlined Testing Cascade, HCV (PDF)
• Care team members roles and responsibilities (PDF): This resource outlines potential care team member roles in your organization and the part that they play in the routine screening process. 
• Recommendations for Providing Quality STD Clinical Services: This resource from the CDC highlights the services health care settings can offer to provide the highest-quality STI care to their patients.
• Public Health Department directories: This resource from the CDC outlines who is working to protect the public’s health in your area, including senior health officials, state, local, and territorial health departments, and tribes and Indian organizations. Clinical staff may need to develop relationships with staff in various sections of health departments in order to facilitate reporting, linkage to care or prevention, and other critical services.

Implement the “opt-out” approach 

Training clinicians to implement opt-out language helps normalize routine screening as standard of care. Opt-out screening reduces the subjectivity of the decision on behalf of the patient where consent is not legally required. 

• Explanation of opt-out screening approach for HIV: This resource link from the CDC provides an explanation of an opt-out approach to screening and why it is effective at increasing screening.
• Sample opt out script for providers during HIV screening encounter: Pages 4-5 of the Guidance for Delivering HIV Pre-Test and Post-Test Results resource from the Reproductive Health National Training Centers outlines samples scripts that clinicians can use when conducting an opt-out approach to HIV screening.
• Discussion Guide: Using normalizing and opt-out language for chlamydia and gonorrhea: This resource from the Reproductive Health National Training Centers is designed to build the confidence of clinic staff to use normalizing and opt-out language for chlamydia and gonorrhea screening.
• State Laws that address High-Impact HIV Prevention Efforts: This resource from the CDC is a summary of state specific laws on a minor’s autonomous consent for HIV and/STI services, and laws that address HIV prevention efforts.

Resources to support sex-positive, status-neutral messaging about the benefits of routine screening

• Care team resources to help health care providers educate patients on the importance of sexual health: These tools from the National Coalition for Sexual Health can help health care providers and clinical staff cultivate a clinical environment that delivers inclusive, patient-centered, and accessible sexual health services for all patients.
  • Inclusive Sexual Health Services: Practical Guidelines for Providers & Clinics
  • Sexual Health and Your Patients: A Provider’s Guide
  • Compendium of Sexual & Reproductive Health Resources for Healthcare Providers
• CDC’s status-neutral approach to prevention and care: This webpage from the CDC provides resources about how routine screening benefits your patients as well as outlines the CDC’s status-neutral approach to prevention and care which ensures that all patients can benefit from quality HIV prevention and care, regardless of their HIV status.

Clinical decision support system resources

• Clinical Decision Support System to Increase HIV Screening: The webpage outlines new recommendations and considerations for implementation from the CPSTF that the use of clinical decision support systems increases HIV screening both for the general population as well as those at higher risk for HIV infection.
• Tips to Leverage Your Electronic Health Record to Implement Opt-Out HIV: This resource from Health Information Technology Evaluation and Quality Center outlines best practices and strategies for implementing opt-out HIV screening in your organization using the electronic health record.

Task shifting resources

• Sharing and Shifting Tasks to Maintain Essential Healthcare During COVID-19 in Low Resource, non-US settings resource from the CDC: This resource developed by the CDC specifically for maintaining health care during COVID-19 outlines many of the basics of task shifting and task sharing that can be applied across many health care delivery situations.
• Task Shifting: Global Recommendations and Guidelines from the World Health Organization: This resource from provides recommendation and guidance from the World Health Organization on how to redistribute tasks among the health care team in order to make more efficient use of available human resources, especially in workforce shortages, in order to reach more patients with care.

Resources to create a trusted and welcoming environment

• Tools to Create a Welcoming Environment: Included as a subset of resources in the National Coalition of Sexual Health’s Compendium of Sexual & Reproductive Health Resources for Healthcare Providers, users can find examples and resources on how to create a welcoming and safe environment for both teen and LGBTQ patients.
• Target HIV Cultural Competency Resources: This webpage includes a collection of guidance, tools and trainings that clinicians can use to identify and address bias to improve communication with diverse patients.
• Cultural Competence in Health and Human Services: This resource from the National Prevention Information Network defines what cultural competence is and how it applies to HIV, viral hepatitis, STI and TB prevention.

Cost effectiveness resources

Presenting the cost-benefit analysis of catching diseases early versus treating disease progression can help establish infectious disease control as a strategic imperative in a health setting and gain access to timesaving resources.

• Cost-effectiveness of testing and treatment for Latent Tuberculosis Infection: This original investigation published in JAMA Internal Medicine aimed to estimate health outcomes, costs, and cost-effectiveness of LTBI testing and treatment among non-US born residents with and without medical comorbidities.
• CDC’s HIV Cost-effectiveness resource: This resource from the CDC provides a basic guide to the cost-effectiveness analysis of prevention interventions for HIV infection and AIDS and help prevention program staff and planners become more familiar with potential uses of economic evaluation.

Funding and reimbursement strategy resources

• Routine screening coding quick guide: This coding guide outlines a list of procedural codes related to HIV, STI, viral hepatitis and tuberculosis screening for both private payer insurance and Medicare and helps you ensure that you are coding services correctly for eligible patient populations to cover the cost of the service, with the patient having no cost-sharing responsibility.
  • Routine screening Medicare coding quick guide (PDF)
  • Routine Screening Toolkit: Private payer coding guide (PDF)
  • ICD-10-CM Codes for Tuberculosis (TB)
  • Screening, Diagnosis, and Treatment of Latent Tuberculosis Infection (LTBI) in Primary Care Settings: Tips for Coding and Billing (PDF)

Potential resources to cover direct and indirect costs

The following links are listings of available funding opportunities that could help to cover screening related initiatives and associated costs at your clinic.

• CDC’s National Prevention Information Network–Funding Opportunities
• CDC HIV Funding and Budget resource
• Rural Health Information Hub–HIV and AIDS Funding Opportunities

Resources to help form a strong referral network

• Tool for Tracking Partners and Partnership Activities: Pages 81-88 from HRSA’s Integrating HIV Care, Treatment & Prevention Services into Primary Care–A Toolkit for Health Centers guide includes a Partnership Toolkit that provides a comprehensive list of key considerations, steps, and Partnership-Focused Templates to help guide organizations’ relationship building and tracking.
• Partnership Mapping Template (PDF): This template provides a framework to help your organization keep track of relationships with non-clinical services and outpatient clinics that will support both community outreach and a sustainable linkage to care program.
• Effective Interventions to Treat HIV: This webpage from the CDC outlines resources that are available for the HIV prevention workforce to increase their capacity to link, retain, and re-engage people for HIV care and treatment.
• Learn About PrEP: This CDC webpage provides an overview of clinical practice and prescribing guidelines for PrEP for clinicians.  
• Ready, Set, PrEP: Health care professionals and individuals can use this website to learn more about the the Ready, Set, PrEP program which provides free PrEP HIV-prevention medications to thousands of people living in the United States, including tribal lands and territories, who qualify.
  • Sexually Transmitted Infections Treatment Guidelines: CDC’s Sexually Transmitted Infections (STI) Treatment Guidelines, 2021 provides current evidence-based prevention, diagnostic and treatment recommendations that replace the 2015 guidance.
    • HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C: To provide healthcare professionals with timely guidance, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) developed this website to facilitate the dissemination of evidence-based, expert-developed recommendations for hepatitis C management.
• The Case for Behavioral Health Screenings in HIV Care Settings: This report from Substance Abuse and Mental Health Services Administration (SAHMSA) and HRSA highlights the need for HIV treatment providers to address behavioral health concerns with HIV and offers strategies for providers to implement screening practices for mental health and substance use disorders.
• Behavioral Health Treatment Services Locator: This resource from SAHMSA helps connect persons seeking treatment facilities in the United States for substance use and addiction as well as mental health problems.

Resources related to leveraging patient navigators as members of the care team

• HIV Navigation Services – STEPS to Care: This resource from the CDC provides links to trainings designed to improve navigation skills for those delivering prevention services to persons with HIV and HIV-negative persons at risk.
• STEPS to Care: Staffing and Supervision: This resource from the CDC outlines key roles and responsibilities for the patient navigation team including adaptable job description templates and videos that discuss key skills and strengths needed to be a patient navigator.
• HIV Navigation Services Section of the Rapid Antiretroviral Therapy Toolkit: Section 2 (beginning on page 19) of this toolkit developed in partnership by Primary Care Development Corporation, My Brother’s Keeper, the San Francisco Community Health Center, and the Denver Prevention Training Center provides an overview of the essential role of HIV navigation services in rapid ART services. It also includes a review of staffing needs and considerations for resource-limited settings, suggested protocols, and real-world examples of how to provide services in resource variable settings.

Training on how to assess social determinants of health 

• AMA STEPS Forward® Module: Addressing Social Determinants of Health: This learning module from AMA STEPS Forward® outlines how to identify methods to understand the unique health needs of your community and formulate a plan to help your organization begin to address social determinants of health.
• Social Determinants of Health foundational course: This case-based virtual course from Aquifer provides foundational knowledge and a framework for building skills that minimize the effects of social determinants of health on health outcomes. 
• Training Primary Care Residents on the Social Determinants of Health: This resource from the Greater New York Hospital Association includes foundational content that can be used when teaching social determinants of health concepts to both primary care residents as well as other care team members involved in the routine screening process.  

Care team training on LGBTQ, transgender and gender nonconforming essentials

The AMA Ed Hub offers a series of training modules developed by Howard Brown Health, SAGECare, The Fenway Institute and more that can help provide education to your care team on sex-positive and gender appropriate language and methods to incorporate best practices into your organization.

• Patient Care Education from Howard Brown Health
• SAGECare Education
• LGBTQIA+ Health Education from The Fenway Institute
• AMA Ed Hub CME Course: LGTBQ Health, Diversity & Inclusion

Training to help staff develop skills to communicate with patients more effectively 

• AMA STEPS Forward®: Health Coaching: This learning module from AMA STEPS Forward® outlines steps to help you develop and implement a health coaching model in your practice.
• Self-Study Modules on Tuberculosis: Patient Rights and Confidentiality in Tuberculosis Control (PDF): Patient Rights and Confidentiality in Tuberculosis Control: This resource from the CDC discusses patient rights and general recommendations for developing trust and maintaining confidentiality in the context of TB control.
• Talking with Your Patients about Latent Tuberculosis (TB) Infection: A conversation guide for health care providers about how to talk to patients about latent TB infection.

Long form courses with background education on HIV, STIs, viral hepatitis, and LTBI Essentials

The following links are a compilation of education and training resources from the CDC targeted to health care professionals. These training materials can be leveraged to equip your care team members with the latest information to help boost the confidence of any member of the care team in answering patient questions.

• HIV: 
  • HIV/ AIDS Training For Public Health Professionals from the National Prevention Information Network
  • HIV Training Resources
• Viral hepatitis: 
  • Hepatitis Training resources from the National Prevention Information Network
  • Viral Hepatitis Training Resources
• STIs: 
  • STD Prevention Training from the National Prevention Information Network
  • STD Continuing Online Education
• LTBI and TB:
  • TB 101 for Health Care Workers
  • Core Curriculum on Tuberculosis: What the Clinician Should Know 
  • TB Centers of Excellence for Training, Education, and Medical Consultation
    • LTBI Online Resource Hub
    • Find TB Resources

Training on the PDSA approach to quality improvement initiatives

• AMA STEPS Forward Plan-Do-Study-Act (PDSA): This learning module provides an overview of the PDSA approach to quality improvement in your clinic as well as a process mapping toolkit.

Training on patient portal optimization

• AMA STEPS Forward®: Patient Portal Optimization: This training module from AMA STEPS Forward® outlines how patient portals can help both the care team and patients and how you can encourage your patients to enroll.

Training on collecting comprehensive patient demographics and sexual history

• AMA STEPS Forward®: Collecting Patient Data–Improving Health Equity in Your Practice: This training module from AMA STEPS Forward® highlights why it is important to collect patient race and ethnicity data and how you can establish standards for and train your staff to collect this data.

Building strong community partnerships:

• During this telementoring session focused on building strong community partnerships, Jennifer Brumfield, RN shares how Express Personal Health in Jackson, MS built relationships with other providers to improve patient experiences and outcomes.

Establishing an integrated approach to care:

• During this telementoring session focused on establishing an integrated approach to care, Jacky Bickham describes how the Louisiana Department of Health's STD, HIV, and Hepatitis Program approaches addressing the needs of community members.

Meet patients where they are:

• During this telementoring session focused on meeting patients where they are, Jacky Bickham shares examples and an approach to how the Louisiana Department of Health's STD, HIV, and Hepatitis Program provides testing outside of the clinic.

Registering patients in EHR portals:

• During this telementoring session focused on registering patients into EHR portals, Jennifer Brumfield, RN describes how patients at Express Personal Health in Jackson, MS benefited from being enrolled in their EHR portal.

Collecting comprehensive patient data:

• During this telementoring session focused on collecting comprehensive patient demographics and sexual history, Kara Green, MHA, MSN, APRN, FNP-BC shares how the HOPE Clinic in Houston, TX improved their patient data collection processes and improved their screening procedures.
• During this telementoring session focused on collecting comprehensive patient demographics and sexual history, Jason Zucker, MD, discusses sex-positive strategies for taking a sexual history and the importance of collecting SOGI data.

Sex-positive, status-neutral messaging about the benefits of routine screening:

• During this telementoring session focused on sex-positive, status neutral messaging, Jason Zucker, MD talks about the many benefits of sex-positive, status-neutral messaging in HIV care.

Streamline the testing cascade:

• During this telementoring session focused on approaches to streamline the testing cascade, Lesley Miller, MD describes how the Grady Liver Clinic uses their EHR system to streamline testing and follow-up.

Patient education materials at conclusion of the visit:

• During this telementoring session focused on patient education materials at the conclusion of the visit, Cabell Jonas, PhD shares how the Mid-Atlantic Permanente Medical Group has improved patient education around HCV.

Linkage to care:

• During this telementoring session focused on linkage to care, Katie Conner, MPH discusses key facilitators success for CrescentCare's rapid linkage to care program for HIV.