Skip to main content
Menu
  • Delivering Care
      1. Delivering Care
      2. Coronavirus
      3. AMA Guides®
      4. Diabetes
      5. Ethics
      6. Health Equity
      7. Hypertension
      8. Overdose Epidemic
      9. Patient Support & Advocacy
      10. Physician-Patient Relationship
      11. Population Care
      12. Precision Medicine
      13. Public Health
      Young person looking at a smartphone

      How teens’ eating-disorder treatment has changed during pandemic

      The Atlantic Health System’s Pediatric Eating Disorders Center takes a family-based approach to a condition that’s grown more prevalent amid COVID-19.
      Profile of person with eyes closed

      Access to abortion and women’s health: What the research shows

      With half the states set to heavily restrict or ban abortion, a 10-year study shows the impact on women denied access to abortion care. Learn more.
  • Practice Management
      1. Practice Management
      2. AMA STEPS Forward®
      3. CPT®
      4. Practice Transformation
      5. Prior Authorization
      6. Reducing Administrative Burden
      7. Scope of Practice
      8. Sustainability
      9. Physician Health
      10. Claims Processing
      11. Private Practices
      12. Payment & Delivery Models
      13. Medicare & Medicaid
      14. Digital
      15. HIPAA
      16. Career Development
      Person on a couch having a virtual meeting

      4 tips to help resident physicians become telehealth superusers

      Resident physicians are doing more patient interactions over telehealth. These tips can allow them to get the most out of telehealth visits as learners and clinicians.
      Tight shot of health care worker in scrubs pushing a gurney down a hospital hallway

      Why one doctor’s burnout story shows that systemic changes matter

      Emergency physician Reena Patel, MD, shares how the pandemic zapped her joy for medicine. Learn what the AMA is doing to reduce physician burnout.
  • Education
      1. Education
      2. Online Learning & CME
      3. AMA PRA Credit System
      4. Improve GME
      5. GME Funding
      6. Medical School Diversity
      7. Accelerating Change in Medical Education
      8. International Medical Education

      Teaching health systems science

      Understand the evolving field of health systems science and acquire the necessary tools and skills to successfully share this approach with medical students.

      Academic coaching in medical education

      A framework for educators and administrators who create programs for coaching medical students.
  • Residents & Students
      1. Residents & Students
      2. Preparing for Medical School
      3. Career Planning Resource
      4. Match
      5. Medical School Life
      6. Residency
      7. Resident & Student Finance
      8. Resident & Student Health
      9. Specialty Profiles
      10. Transition to Practice
      11. USMLE®

      Kaplan USMLE Step 1: Calculate the frequency of this disease

      Prep with help from Kaplan Medical. An autosomal recessive disease has a carrier frequency of 1/25. What is the frequency of individuals expressing the disease?

      Transitioning to practice

      Transitioning from medical student to resident can be a challenge. Explore how to write a medical CV, negotiate employment contracts and more.
  • Health Care Advocacy
      1. Health Care Advocacy
      2. Access to Care
      3. Administrative Burdens
      4. Advocating for Public Health
      5. Payment Reform
      6. Advocacy Update
      7. Federal Advocacy
      8. State Advocacy
      9. Judicial Advocacy

      AMA Advocacy Insights webinar series

      AMA Advocacy Insights webinar series examines key advocacy issues from the federal and state levels impacting patients and physicians.

      AMA advocacy events

      Collaborating and networking to advocate for patients and the medical profession.
  • Member Benefits
      1. Member Benefits
      2. Personal Member Benefits & Discounts
      3. Practice Benefits & Discounts
      4. Member Eligibility & Dues

      AMA Morning Rounds®: Your daily dose of health care news

      Get your daily dose of health care news with AMA Morning Rounds®. Learn more.

      AMA Medline Buying Program

      Save on 300,000+ medical, surgical and pharmaceutical supplies with the AMA Medline Buying Program.
  • Organization
  • Board of Trustees
  • House of Delegates
      1. House of Delegates
      2. AMA Policies
      3. Special Meeting
      4. Annual Meeting
      5. Interim Meeting
      6. AMA Elections
      7. HOD Organization

      House of Delegates, AMA Board and AMA Councils candidates' election

      Review the list of candidates to serve on the AMA Board of Trustees and councils.

      2022 Annual Meeting of the HOD: June 28 Speakers' Update

      In their June 28, 2022 update, the speakers provide the points of privilege from candidates at the 2022 Annual Meeting of the HOD.
  • Councils
      1. Councils
      2. Council on Constitution & Bylaws
      3. Council on Ethical & Judicial Affairs
      4. Council on Legislation
      5. Council on Long Range Planning & Development
      6. Council on Medical Education
      7. Council on Medical Service
      8. Council on Science & Public Health

      Employee benefits: Council on Medical Service reports

      These Council reports address employee benefits unrelated to health insurance benefits, such as paid sick leave and long-term care.

      Health care coverage & choice: Council on Medical Service reports

      These council reports have proposed strategies establishing the AMA vision for health system reform to cover the uninsured and expand health insurance coverage and choice.
  • Member Groups (Sections)
      1. Member Groups (Sections)
      2. Section Meetings
      3. Academic Physicians
      4. Advisory Committee on LGBTQ Issues
      5. Integrated Physician Practices
      6. International Medical Graduates
      7. Medical Students
      8. Minority Affairs
      9. Organized Medical Staff
      10. Private Practice Physicians
      11. Residents & Fellows
      12. Senior Physicians
      13. Women Physicians
      14. Young Physicians

      RFS June 2022 Meeting agenda & resources

      Find the agenda, documents and more information for the RFS June 2022 Meeting.

      YPS June 2022 Meeting agenda & resources

      Find the agenda, documents and more information for the YPS June 2022 Meeting.
  • About
      1. About
      2. AMA Center for Health Equity
      3. AMA History
      4. Awards
      5. Board of Trustees
      6. CPT® Editorial Panel
      7. Foundation
      8. Leadership
      9. Office of International Relations
      10. Publications & Newsletters
      11. RVS Update Committee (RUC)
      12. Research
      13. AMA Career Opportunities
      14. United States Adopted Names
      15. Masterfile

      Top news stories from AMA Morning Rounds®: Week of June 27, 2022

      In the news: Omicron-targeting boosters roll out this fall, cardiovascular health assessment tool updated, monkeypox vaccination strategy launched, and more.
      Jack Resneck Jr., MD

      Dr. Resneck will be “relentless” on behalf of doctors and patients

      New AMA President Jack Resneck Jr., MD, detailed how he will push the nation to renew its commitment to the physicians who have given so much.
  • Explore Products
  • JAMA Network™
  • FREIDA™
  • AMA Ed Hub™
  • COVID-19 Resources
  • AMA Journal of Ethics®
  • CPT
  • Store
  • COVID-19 CPT® Codes
  • AMA Physician Profiles
American Medical Association
Join Renew
Join / Renew
Member Benefits
Sign In
  • Sign In
  • Create free account
  • Join/Renew
  • Member Benefits
Public Health

HIV, STIs, Viral Hepatitis and LTBI Routine Screening Toolkit: Testing and diagnosis

8 MIN READ

Print Page
Health care workers speaking
HIV, STIs, Viral Hepatitis and LTBI Routine Screening Toolkit
  • Overview and toolkit steps
  • Resource library

Contents

  1. Step 4: Testing and diagnosis
  2. Critical considerations at this stage
  3. What can you do? 
  4. Additional toolkit steps and related materials
Step 4: Testing and diagnosis

Step 4: Testing and diagnosis

A lack of a clear protocol for testing, compounded by an overwhelming demand for care, causes staff roles to blur and leaves the bulk of the workflow on the clinician’s shoulders, including obtaining consent, disclosing results, counseling and coordinating follow-up care. Some clinicians and staff also feel intimidated by interpreting results and next steps for the inconclusive test results. For LTBI, the interpretation of the IGRA can often be difficult for clinicians who do not specialize in infectious disease. For HIV, clinicians are often unaware what the next step is upon a positive diagnosis.

Additionally, many STI clinics have merged into one model with family planning clinics or general community health centers. This has resulted in staff shortages and community health center care team members taking on multiple responsibilities beyond their core roles. Employing task shifting techniques, defining a routine testing plan streamlined by EHR support, outlining a clear post-test protocol and clarifying team member roles can help incorporate routine screening more seamlessly into standard workflows. Additionally, providing health coach training and education on the latest evidence-based guidance for screening, testing and treatment can instill confidence in the care team and provide a more personal approach to address the patient’s needs.  

Clinical infrastructure limitations can also present challenges that hinder efficiencies when it comes to testing and diagnosis such as not having appropriate areas to hold private conversations about sexual and medical history or not having sufficient capacity in on-site labs for test storage at the scale required by conducting routine screening. Additionally, financial constraints can impose limitations on routine screening program such as not having dedicated funds integrate screening related EHR alerts. Breaking down direct and indirect costs for each element of the routine screening and testing continuum can help identify gaps and potential funding sources to cover related testing costs. Further, understanding how to properly code services for eligible patients will help with reimbursement for the cost of services and help limit unexpected out of pocket costs for the patient.

Critical considerations at this stage

Critical considerations at this stage

  • Screening guideline ambiguity and the need for clarity for all test result scenarios and who to notify and when to notify them 
  • Health care professional discomfort with screening and diagnosis for LTBI: fear of transmission (latent vs. active TB); confusion about screening guidelines and what tests to use, how to treat (historically, this used to be the responsibility of the local public health agency)
  • Education on interpreting results and next steps for inconclusive/indeterminate results
  • Staffing shortages due to financial limitations and consolidation of clinics 
  • Lack of space to ensure patient privacy
  • Lack of on-site equipment and reliance on external labs 
  • Desire from patients to know results right away is at odds with testing logistics and can lead to loss of contact with the patient before results are complete 
  • Pressure to meet other funder-driven requirements in addition to patient’s chief reason for visit 
  • Need to constantly evolve to changing CPT codes 
What can you do? 

What can you do? 

  1. Streamline the testing cascade and develop clear post-test protocol

    1. Optimizing the clinical workflow can help to streamline testing, clarify roles and ensure clinic staff know what happens at each step along the way. Also, leveraging testing innovations like Reflex RNA for HCV allows for faster detection through the ability to immediately run another lab test on the same blood draw so that patients do not have to return for additional testing. Clear guidance on testing interpretation and result sharing, in accordance with applicable privacy laws, will help reduce the cognitive load for health care professionals who are juggling a positive diagnosis with other immediate clinical needs. Strong relationships with local health departments (in particular, disease surveillance units) can also enable clinical staff members to rapidly identify which patients are experiencing a diagnosis for the first time, or who need reengagement in medical care.
    2. Related resources

      • Streamlined testing cascade (refer to blue bubbles): 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:
        • 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)
      • 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.
  2. Train care team members to task-shift 

    1. Shifting routine screening duties to nurses and medical assistants can answer the patient’s need for a personal approach and ensure clinical and non-clinical tasks are distributed efficiently and effectively.
    2. Related 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.
  3. Honor the patient’s need for privacy 

    1. Trust is earned through creating an environment and care team that is understanding of the patient’s needs: hire from the community, keep the screening team small and personal and offer options to self-report. Health coach training and training for the care team on cultural competency can also help staff develop skills to communicate more effectively with patients.
    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.
  4. Outline funding and reimbursement strategies

    1. Breaking down direct and indirect costs for each element of routine screening and testing, across the health setting’s payer mix, will help identify gaps in funding and reimbursement and uncover opportunities for negotiation. Budgeting EHR development, equipment, the cost of tests and staff time for routine screenings will eliminate unknowns and inspire confidence. Additionally, ensuring you are coding services properly for eligible patients will ensure you are reimbursed for the cost of the service and that the patient will not have any out-of-pocket costs.
    2. Related 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)
    • 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
      • Grant funding through your state and local health department

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.


Additional toolkit steps and related materials

Additional toolkit steps and related materials

The HIV, STIs, Viral Hepatitis and LTBI Routine Screening Toolkit is organized across the screening continuum and offers helpful resources and best practices for the care team.

 

Hand extended for a handshake

Step 1: Community outreach

Patient checking in at a physician's office with patients and office staff wearing masks

Step 2: Patient intake

Hands holding a clipboard and pen

Step 3: Initiating standard screening protocols

Hand holding a vial

Step 4: Testing and diagnosis

Patient and physician in discussion

Step 5: Patient education and post-test counseling

Physician holding a stethoscope

Step 6: Linkage to care

Table of Contents

  1. Step 4: Testing and diagnosis
  2. Critical considerations at this stage
  3. What can you do? 
  4. Additional toolkit steps and related materials
Active State Undo
12
More about:
  • Improving Public Health
  • Patient Privacy
  • Cultural Humility in Health Care
  • AMA STEPS Forward® Program
  • HIV
  • Rural Population Care

RELATED CONTENT

AMA details plan to stop the public health “infodemic”
What doctors wish patients knew about getting a good night’s sleep
What doctors wish patients knew about living with migraines
Featured Stories
N95 mask
Public Health

What doctors wish patients knew about wearing N95 masks

MRI room
Prior Authorization

Cancer killed Kathleen Valentini, but prior auth shares the blame

Child under 5 receiving vaccine shot
Public Health

Why parents should get kids under 5 vaccinated against COVID-19

American Medical Association

The AMA promotes the art and science of medicine and the betterment of public health.

AMA Contact Us

Download AMA Connect app for iPhone or Android

  • AMA Careers
  • Events
  • Press Center
  • AMA Alliance
  • AMPAC
  • AMA Foundation

The best in medicine, delivered to your mailbox

  • JAMA Network™
  • FREIDA™
  • AMA Ed Hub™
  • COVID-19 Resources
  • COVID-19 CPT® Codes
  • AMA Journal of Ethics®
  • CPT
  • Store
  • AMA Physician Profiles
  • Terms of Use
  • Privacy Policy
  • Code of Conduct
  • Website Accessibility
Copyright 1995 - 2022 American Medical Association. All rights reserved.