Site Scale-Up through EHPSd

Technical assistance and continuing education/in-service training for progressive scale-up [of Level 1-Stage 2 (Continuing) PEHTI sites] is offered to healthcare sites which have already begun implementing screening for HIV and are transitioning towards full implementation of opt-out screening for HIV using Enhanced Health Promotion and Screening (EHPS) protocols and tools.
  • Step 1: GETTING STARTED WITH SITE SCALE-UP: To get started with scale-up, Level 1-Stage 2/continuing existing PEHTI sites transitioning to the new EHPS protocol are advised to start the scale-up process as follows:
    • a) Revisit the designation of a site ‘champion’ and a lead site co-investigator (Co-I), ideally the Co-I  would be  the medical director/clinician responsible for updating clinical practice protocols, quality-of-care improvement or quality assurance at the site, i.e. a clinician who can lead the organization’s self-starter efforts through the next steps outlined below. The designated site champion should be an employee of the healthcare site, ideally a clinical staff member who: a) can serve as the site’s day-to-day liaison (point-of-contact, POC) with PEHTI, and b) has easy access to the site’s lead Co-I. These individuals should be accessible to PEHTI project associates and assume  responsibility for leading the organization’s scale-up efforts in partnership with PEHTI through the next steps.
    • b) As an existing site already registered  on the online PEHTI-CPI system, the above-referenced site Co-I/medical director and point-of-contact/POC information and any other site information must be updated through the online site registration form (letter of interest in continuation), including information on the site’s technical/funding support needs, readiness, and ability to continue working towards opt-out screening and other objectives of PEHTI-designated Level 1-Stage 2 sites, and
    • c) Strongly encourage clinical staff to begin accessing  online PEHTI continuing education/refresher information on opt-out HIV screening which includes introductory information on CDC guidelines on opt-out HIV screening within context of inclusion of patient consent for HIV screening under  general consent for care, amended Pennsylvania Confidentiality Law providing for opt-out HIV screening, comparative review/ reconciliation of PA laws and CDC guidelines, the 2013 update of USPSTF / US preventive services task force recommendation to Grade A for routine opt-out HIV screening in healthcare settings (firmly placing HIV screening as a preventive standard-of-practice eligible for fee-for-service health insurance reimbursement / managed care coverage),  health insurance billing codes guidance, and the public health imperative to include referral-tracking of reactive/positive individuals referred for further investigation or care (as an inherent part of a screening program).
  • Step 2: After receipt of the updated online site registration/re-qualification form referenced in Step 1, PEHTI project associates will facilitate  customization/development and implementation of a site workplan for program improvement by providing draft site workplan templates  (draft step-by-step action guidance and benchmarks),  technical support for site workplan development and implementation, and other resources including:
    • a) Strategies and customization of EHPS brochures for patients for routinely offering opt-out HIV screening, including use of the EHPS brochure form for: i) provider documentation of informed patient opt-out consent  for HIV screening incorporated within a general consent-for-care context in accordance with PA Act 59 (2011) and CDC guideline provisions for opt-out HIV screening, ii) providing PA Act 59(2011)- required pre-test information, and iii) incorporation of routine opt-out HIV screening within a broader EHPS framework for screening for conditions of public health importance;
    • b) Guidance on selection of a site-appropriate ‘Test Offering Plan’;
    • c) Opt-out HIV screening promotion materials, including opt-out test-offering language guidance/scripts for clinician use at the point-of-care;
    • d) Technical support/training on integrating elements of opt-out HIV screening relevant to acceptance rate improvements under items a), b) and c) above, and performance monitoring under item j) below;
    • e) Technical support/training on selection of site-appropriate HIV testing technologies; considerations for and use of point-of-care rapid HIV testing technologies, including rapid HIV diagnostic algorithms for use in HIV screening; and regulatory compliance with requirements for point-of-care rapid testing laboratory licensing and maintenance of clinician rapid testing  proficiency;
    • f) Technical support for health insurance coverage of opt-out HIV screening, incl. managed care documentation of fulfillment of standard-of-care for preventive services, and billing codes for services provided under fee-for-service insurance;
    • g) Resources / funding of laboratory costs for routine opt-out HIV screening for indigent uninsured persons (including where applicable, providing point-of-care rapid HIV testing supplies, and clinician rapid testing proficiency development);
    • h) Training and technical assistance on  PEHTI & Critical Phase Interventions (CPI) point-of-care protocols and tools (incl. installation/utilization of software for secure service data capture / extraction from EMRs and encrypted electronic data submission to PA DOH) in support of HIV screening services documentation; reporting of point-of-care rapid HIV test results that are reactive/positive; and CPI testing & referral tracking (TRT) procedures for facilitation of referrals and tracking/facilitation of linkage to prevention/care (incl. intake unmet needs assessments, UNAs)  for persons with reactive HIV test results/new HIV diagnoses in collaboration with PA DOH/local public health authorities;
    • i) CPI help desk online support to facilitate trackable timely technical assistance with EHPS and CPI system implementation (for sites registered to use CPI resources); and
    • j) Quarterly or semi-annual feedback on site progress towards achievement of performance benchmarks for Level 1-Stage 2 PEHTI collaborating sites (including troubleshooting/identifying factors related to consistent opt-out test offering by clinical staff, patient testing acceptance rates, rapid testing proficiency, tracking of linkage to prevention/care, and instituting remedial steps towards progressive program outcome improvement).
  • PLEASE NOTE: Due to limited resources (and consistent with recently updated US preventive services task force’s Grade A recommendation of opt-out HIV screening as part of routine preventive healthcare which should be covered by fee-for-service, managed care and other health insurances), PEHTI is not in a position to support clinical/admin staff time or other costs of implementation of opt-out HIV screening in healthcare settings, except laboratory costs for routine opt-out HIV screening for indigent uninsured persons (the project may provide point-of-care rapid HIV testing supplies to facilitate start-up or for testing of uninsured persons, where applicable);
  • To facilitate scale-up to PEHTI-recommended Level 1-Stage 2 EHPS protocols & tools for improvement of opt-out HIV screening program in support of achievement of Level 1-Stage 2 performance benchmarks  for systematic routine offering of opt-out HIV screening, and enable the PEHTI team to develop an evidence-based customized capacity development/training program which can lead to full implementation of opt-out HIV screening by participating sites, all continuing/existing PEHTI sites are transitioned to secure/encrypted submission of required de-identified service data directly to PA DOH using the CPI-sFTP web portal, AND also submit quarterly aggregate data on the number of unique individuals who attended the healthcare setting, number of persons who were offered HIV screening, the number of persons who accepted an HIV test;
  • Step 3: Participate in continuous PEHTI program improvement activities/training for site capacity development including technical support and resources listed above under Step 2;
  • PLEASE NOTE: To enable the PEHTI team to: a) document service delivery, facilitate HIV reporting, tracking of referrals and linkage to prevention/care of reactive/newly diagnosed persons, and b) develop an evidence-based customized capacity development/training program which would lead to full implementation of opt-out screening, participating  Level 1-Stage 2 (continuing) are required to continue secure transmission of  PEHTI service data to PA DOH using CPI protocols and tools provided by the PEHTI team.
Level 2 (continuing) PEHTI sites are model healthcare settings which have met/exceeded EHPS performance benchmarks for Level 1-Stage 2 (continuing sites)  and have achieved full implementation of opt-out screening for HIV using EHPS protocols and tools [including the EHPS brochure for incorporating opt-out HIV screening in a broader screening program for conditions of public health importance, using an EHPS tool/form for provider documentation of informed consent in accordance with PA Act 59 (2011) provisions for opt-out HIV screening, technical support for managed care and billing of services provided under fee-for-service insurance, and funding/rapid testing supplies for screening of indigent uninsured persons]. These sites continue to receive technical support and training to maintain their top performance, and serve as model sites and mentors for Level 1 sites.