Getting Started / Submit Letter of Interest in Testing Site Start-up

Prospective PEHTI-affiliated sites [Level 1-Stage 1 (Entry-level)] are self-starter healthcare providers interested in incorporation of opt-out HIV screening into routine healthcare/screening for conditions of public health importance. Prospective sites are advised to start the process by following the the steps outlined below.
  • Ground Zero: Starting Point –  Begin by designating 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.
  • Step 1: After designating the POC and site lead Co-I, the prospective site is advised to initiate the process as follows:
    • a) Submit Letter of Interest by completing an online site pre-qualification/registration form which is used for submitting information on the prospective site, including information on the population served by the site, readiness to adopt opt-out screening for HIV in conjuction with routine healthcare/screening for other conditions of public health importance, contact information for the site’s lead Co-I/medical director and point-of-contact/POC;
    • b) Clinical staff undertakes introductory self-paced online continuing education/in-service training by accessing and reviewing educational materials provided in PEHTI’s introductory / refresher information on incorporating routine opt-out HIV screening into the standards-of-care in accordance with the 2013 update of USPSTF / US preventive services task force recommendation to Grade A for routine opt-out HIV screening in healthcare settings (which firmly places HIV screening as a preventive standard-of-practice eligible for fee-for service health insurance reimbursement / managed care coverage),  health insurance billing codes guidance,  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 , etc.
  • Step 2: Get started with Level 1-Stage 1/self-starter activities by utilizing startup recommendations/approaches to initiate  progressive program implementation beginning with recommended entry-level/self-starter activities towards incorporation of opt-out HIV screening into routine healthcare/screening for conditions of public health importance:
  • For example, in healthcare settings such as community health centers, emergency departments with laboratory support which uses ‘analyzer-based’ rapid testing, and correctional settings which already routinely draw blood for other intake screenings (or for all inmates with a clinical presentation/history justifying HIV screening), a good segway to familiarizing  clinical staff with how to begin routinely/systematically implementing protocols for opt-out HIV screening  could entail starting with easily achievable entry level/self-starter activities towards  introducing routine opt-out HIV screening, i.e.
    -a) Begin with routinely/universally offering the site’s existing patient consent for HIV to all persons whose presenting illness/condition, history or intake (in correctional settings) requires a blood draw, and include an HIV test among tests to be performed on the blood drawn for those who consent to HIV testing;
    b) In addition to the above, correctional healthcare settings should also consider updating and routinely/systematically  implementiing clinical protocols for uniformly managing clinical indications for HIV or review of history justifying HIV screening at the intake point-of-care; partnering with jail/prison admin to initiate opt-out referral at discharge for continuity of medical care at Community Health Centers for selected inmates with a history/incarceration reason associcated with HIV risk; and also explore implementing billing of insurance for opt-out HIV screening at intake for inmates whose health insurance is still active at intake. After getting started with routinely/systematically implementing such a start-up protocol and getting pre-qualified for advancement to the next level, entry level sites can advance to true implementation of opt-out HIV screening through accessing PA DOH technical and other support materials as outlined in the next step.
  • Step 3: After getting started with entry level activities outlined above, Level 1-Stage 1 self-starter sites are required to submit site re-qualification information (update of site pre-qualification info) within 3 – 6 months to demonstrate start-up in progress if they need: a) funding/support to cover laboratory costs (including point-of-care rapid testing supplies, if applicable) for indigent uninsured patients; and b) additional in-service training, resources and technical support for advancement to the next PEHTI level (Level 1-Stage 2 of proficiency in initiation of opt-out HIV screening). This step must be initiated by contacting PEHTI to update the previously completed online registration form for re-qualification (updating site pre-qualification information), including update of information on the healthcare provider’s needs and readiness for advancing to full implementation of opt-out HIV screening using Enhanced Health Promotion and Screening (EHPS) protocols and tools: As outlined on the site scale-up web page, EHPS resources and technical support for sites progressing to Level 1-Stage 2 proficiency may include:
    • a) Opt-out HIV screening promotion posters
    • b) Strategies and customization of EHPS patient brochures for routinely offering opt-out HIV screening through use of the EHPS brochure form for provider incorporation/documentation of informed patient consent  for HIV screening within a general consent-for-care context in accordance with PA Act 59 (2011) and CDC guideline provisions for opt-out HIV screening, incl.  incorporation of routine opt-out HIV screening within a broader EHPS framework for screening for conditions of public health importance;
    • c) 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;
    • d) 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);
    • e) Technical support for managed care documentation of fulfillment of standard-of-care for preventive services and billing codes for services provided under fee-for-service insurance;
    • f) 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;
    • g) 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
    • h) 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: To enable the PEHTI team to develop an evidence-based customized capacity development/training program which would lead to full implementation of opt-out screening by participating sites, a monthly aggregate data report is requested from Level 1-Stage 1 entry level sites [i.e. number of persons who attended the healthcare setting, number of persons who were offered HIV screening, the number of persons who accepted an HIV test, and the number of persons who received an HIV test]; this is especially critical for sites requesting/enrolled to begin receiving technical support for advancement to the next level (Level 1-Stage 2) of opt-out HIV screening through use of EHPS-CPI protocols and tools.