HIV, STIs, Viral Hepatitis and LTBI Routine Screening Toolkit
Contents
The Routine Screening toolkit was developed with input from health care professionals and was designed for clinicians working in community health centers. Access the library of resources available from the toolkit for use in your practice.
Impact by the numbers
Impact by the numbers
HIV
At the end of 2019, an estimated 1.2 million people aged 13 and older had HIV in the United States, including an estimated 158,509 (13%) people whose were not aware of their HIV-positive status (CDC).
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 2019, reaching an all-time high for the sixth consecutive year.
The 2019 STI Surveillance Report found:
- 2.5 million cases of chlamydia, gonorrhea, and syphilis, the three most reported STIs in 2019.
- A nearly 30% increase in these reportable STIs between 2015 and 2019.
- The sharpest increase was in cases of syphilis among newborns (i.e., congenital syphilis), which nearly quadrupled between 2015 and 2019 which can be prevented by appropriate and adequate maternal treatment before or during pregnancy.
Viral hepatitis
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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.
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.
Summary of action items
Summary of action items
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
Implementation materials
Implementation materials
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 National Prevention Information Network Digital Media Tools for TB infection
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 providers 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 providers with key programmatic issues that impact delivery of HIV testing services in nonclinical settings.
Patient education materials
Patient education materials
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.
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.
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
Self-assessment templates
The following links provide you with examples of self-assessment templates that you can leverage in your practice.
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: This CDC resource offers a framework for discussing sexual health issues to help health care providers complete the overall picture of their patient’s health.
- HIV Prevention and Care for the Transgender Population: This CDC resource outlines information and tips for health care providers 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.
Resources to streamline the testing cascade and identify a clear post-test protocol
- Streamlined testing cascade: This set of infographics outlines the testing cascade for each infectious disease in this toolkit, including opportunities to optimize, and can be used as a tool to help clarify care team member roles at each step as well as define a clear post-test protocol.
- 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 providers 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.
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.
Cultural competency resources
- 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.
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.
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
Linkage to care resources
- 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.
- 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.
Care team training
Care team training
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
This series of three training modules on the AMA Ed Hub offered by Howard Brown Health can help provide education to your care team on sex-positive and gender appropriate language and methods to incorporate best practices into your organization.
- Transgender and Gender Nonconforming Essentials
- LGBTQ Essentials: Foundations of Care
- Creating Trans Affirming Spaces – Using Gender Appropriate Language
Health coach 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.
Long form courses with background education on HIV, STDs, 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 ensure that your care team members are equipped with the latest information to help boost the confidence of any member of the care team in answering patient questions.
- HIV:
- Viral hepatitis:
- STIs:
- TB:
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.
