Roll-out and Implementation of Rapid Testing from a Field Perspective

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Roll-out and Implementation of Rapid Testing
from a Field Perspective

• Perspectives from San Francisco
• Shelley Facente, MPH
• Rapid HIV Testing Program Coordinator
• San Francisco Department of Public Health
• AIDS Office, HIV Prevention Section

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A bit of background

• Rapid Testing began in San Francisco in May 2003,
  with a pilot at one community-based organization,
  Glide Health Services.
• By the end of 2003, 5 agencies were on board, all
  using the OraQuick rapid HIV-1 antibody test.
• At this time, there are fourteen publicly-funded
  agencies offering rapid HIV testing in San
  Francisco.
• 4 had previous experience with in-house
  laboratory testing
• 4 had previous experience with medical clinic
  services
• 6 had no previous experience with medical or lab
  services.

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The Challenges

• For people whove never done laboratory testing
  before, it is a very new experiencedemanding new
  skills and attention to detail.
• For laboratorians, there is a lot of anxiety
  about lay-people being responsible for providing
  an HIV test result to a client!

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So, how do we work together to ensure that
clients receive the best services possible?
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Ask for the help of lab personnel

• We asked what was needed to increase their
  confidence in our rapid testing programs. Most
  importantly, we took their suggestions.
• They listened to us as well, about what was
  practical in our agencies and would meet the
  needs of our clients.
• This worked, because the goal for all of us was

a program with safe and accurate lab practices.
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Plan quality assurance early

• In San Francisco, we focused on bringing agencies
  on board for the first year or so.
• Every agency had their own CLIA certificate
• Every agency developed their own policies
  procedures
• Every agency had their own specific QA plan
• At the start of the second year, we had the time
  and staff to focus intensely on quality
  assurance, especially of data and lab practices.
• It took awhile to backtrack and fix the problems
  that had occurred in the first year
  .

• and frustrated everyone

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What our QA efforts include

• Our lab slips were set up to collect start and
  end times and temperatures. We check all the
  data.
• We enrolled in the CDC Model Performance
  Evaluation Program, which is used in combination
  with periodic Competency Assessment Tests of test
  technicians, done at each agency.
• We require routine data reports that allow us to
  cross-reference, and find areas where things
  arent lining up, so we know to investigate.

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What we discovered

• There were some test technicians who were not
  recording appropriate start and end times or
  temperatures on the lab slips.
• ?
• There was sometimes confusion over how often to
  run controls, and how long the control fluid was
  good for once opened.

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Why QA is important

• Because we developed systems for quality
  assurance that allowed us to notice problems, we
  were able to take action.
• The Result?
• Clients have been retested when indicated.
• Technical assistance has been provided to clear
  up confusion.
• Protocols have been updated and improved.
• Now, errors are infrequent, and caught early when
  they do occur.

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Plan carefully, train well, and begin slowly

• Rapid testing is a new and exciting technology
  that revolutionizes the services we are able to
  provide to clients around HIV.
• BUT
• It takes awhile to set up a good program. It
  takes months to develop a program with good lab
  practices that works for everyone.

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Lessons Learned

• Laboratorians are correct that there are reasons
  to be concerned about the quality of lab
  practices when conducted by lay people.
• However, it can be done extremely well. Most of
  our agencies have never had an invalid test or
  any other laboratory problem.
• The key is to be paying attention, and taking
  action as needed to ensure that lab practices are
  the best they can be.

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Communication

• The good relationship we have between the program
  coordinators and policymakers at the San
  Francisco AIDS Office and the director and senior
  microbiologist at our city public health lab has
  made all the difference.
• We have worked togetherto ensure that
  individuals testing for HIV in San Francisco are
  receiving accurate results, and that those
  running the rapid test are safe when doing so.

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Thank you!

• Shelley Facente, MPH
• Rapid HIV Testing Program Coordinator
• San Francisco Dept. of Public Health
• AIDS Office, HIV Prevention Section
• Shelley.Facente_at_sfdph.org
• 415-554-9136