HIV, STIs and Viral Hepatitis Routine Screening Emergency Department Toolkit: Post-test education

Step 1: Patient triage | Step 2: Initiating standard screening protocol | Step 3: Testing and diagnosis | 

Step 4: Patient education and post-test counseling | Step 5: Linkage to Care

Educating and engaging patients in their care is a critical consideration for how to implement an effective routine screening program. However, lack of staff training or knowledge on infectious disease control contributes to the uneven division of labor, reduces the likelihood of routine screening and can cause missteps in follow up and linkage to care.

Clinicians or staff members are often left with the burden of calling the patient back to counsel on results in addition to their demanding workload. This is made even more difficult when screening is conducted in the emergency department. Some clinicians or staff members who lack counseling skills may be intimidated by sharing positive results and thus may skip routine screening all together. When rapid testing is performed in the emergency department, both lack of time and lack of space for privacy to provide education or in-person counseling can also be a challenge. Empowering every member of the care team with education and equipping the care team with counseling training can help overcome these concerns.

• Knowledge gaps exist across members of the care team who may not know the steps to take or the latest HIV or STI treatments 
• Access to patient-centric material to distribute is needed
• Patients do not understand the behaviors associated with HIV, STIs or viral hepatitis, especially if they do not identify with the stereotypical population disproportionately affected 
• Additional training on how to provide sensitive counseling of post-test results is needed
• Time for clinicians and staff members to effectively communicate results and counsel with respect to the patient’s privacy needs to be allocated

1. Empower every member of the care team with education and training

   1. Providing in-depth, disease-specific education sessions for every member of the care team on the need for routine screening and how to conduct it, engenders greater empathy for the patient and boosts confidence to answer questions rather than deferring to the lead clinician. 

   2. Related resources

   3. Training and education for the care team on HIV, STIs, viral hepatitis, and TB essentials: The following links are a compilation of education and training resources from the CDC targeted to health care professionals. STD and STI testing 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/ AIDS Training for Public Health Professionals from the National Prevention Information Network
      • HIV Training Resources
      • Hepatitis Training resources from the National Prevention Information Network
      • Viral Hepatitis Training Resources
      • STD Prevention Training from the National Prevention Information Network
      • STD Continuing Online Education
   4. 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.

2. Have patient education materials available at visit completion

   1. Having patient friendly education materials at discharge is an important piece of patient care. Emergency departments can improve discharge communication through educating patients and providing resources about community-based health clinics for routine care.

   2. Related resources

   3. 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
   4. 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.
   5. HIV
   • Human Immunodeficiency Virus
   • Who Should Be Screened for HIV Infection?
   • Can HIV Infection Be Prevented With Medication?
   • HIV Infection: The Basics
   1. 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
   1. STIs
   • Screening for Syphilis in Pregnant Women
   • Screening for Syphilis

3. Equip staff with skills to communicate more effectively with patients

   1. In the absence of patient navigators, investing in training for the care team on counseling and cultural safety or structural competence can help staff develop skills to communicate more effectively with patients, leading to increased comfort with counseling patients on results. Especially in the emergency department, dedicated counseling at the point of discharge can help to emphasize the importance of routine screening, promote health literacy, and link patients to the resources they need to access routine screening in the future.

   2. Related resources

   • 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.
   • 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.

Disclaimer: This page contains resources supplied by third party organizations. Inclusion of these materials on this page does not imply endorsement of these resources or corresponding organization.

The toolkit is organized across the screening continuum and offers helpful resources and best practices for the emergency department care team.

Overview

Step 1: Patient triage

Step 2: Initiating standard screening protocols

Step 3: Testing and diagnosis

Step 4: Patient education and post-test counseling

Step 5: Linkage to care