Public Health

HIV, STIs, Viral Hepatitis and LTBI Routine Screening Toolkit: Resource library

23 MIN READ

The HIV, STIs, Viral Hepatitis and Routine Screening toolkit was developed with input from health care professionals and was designed for clinicians working in community health centers and emergency departments. Access the library of resources available from the toolkit for use in your practice.

Routinely screen for HIV, STIs, viral hepatitis and latent TB infection

The AMA’s toolkit for community health centers and emergency departments guides you from patient intake to linkage to care.

Impact by the numbers

To access interactive maps and charts on number of reported cases by state, race/ethnicity and sex, visit the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention Atlas Plus resource.

HIV

In 2022, an estimated 1.2 million people aged 13 and older had HIV in the United States, including an estimated 153,500 (13%) people whose were not aware of their HIV-positive status (CDC).

For the latest in HIV surveillance from the CDC you can visit the HIV Data webpage.

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 2021, reaching an all-time high for the sixth consecutive year.

The 2021 STI Surveillance Report found:

  • 2.5 million cases of chlamydia, gonorrhea, and syphilis, the three most reported STIs in 2021.
  • Congenital syphilis continues to surge, increasing 203 percent in the past five years. In 2021, 38 jurisdictions, including 37 states and the District of Columbia, reported an increase in congenital syphilis cases.

For the latest in STI surveillance from the CDC you can visit the About STI Statistics webpage.

Viral hepatitis

  • As of 2016, nearly 3.3 million people in the United States were living with chronic viral hepatitis—an estimated 862,000 with hepatitis B and 2.4 million with hepatitis C.
  • 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.

For the latest in viral hepatitis surveillance from the CDC you can visit the Viral Hepatitis Statistics and Surveillance webpage.

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.

For the latest in Tuberculosis surveillance from the CDC you can visit the Tuberculosis Data and Statistics webpage.

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

Resources to help build strong community partnerships

  • Tool for Tracking Partners and Partnership Activities (PDF): 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.

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 (PDF): This resource from the Centers for Medicare and Medicaid Services can help clinicians 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

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. Patients should be provided with information about the communicable nature of these infections and consider options for notifying others that were potentially exposed. 

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. These resources can also be helpful to reference as your clinic or institution develops their own patient-friendly educational resources.

Self or risk assessment templates

The following links provide you with examples of self or risk assessment templates that you can leverage in your practice.

  • HIV: Learn the HIV risk of different sexual activities when one partner is HIV positive, and one partner is HIV negative (a discordant partnership).
  • STIs: Link to the CDC’s Prepare Before You’re There STI self-risk assessment quiz.
  • Viral hepatitis: Assess your risk with this Hepatitis Risk Assessment Tool from the CDC.
  • LTBI (PDF): This CDC resource is an LTBI guide booklet for primary care clinicians. Appendix A of this resource is a sample risk assessment that can be leveraged when screening for LTBI.

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 (PDF): This CDC resource offers a framework for discussing sexual health issues to help health care professionals complete the overall picture of their patient’s health.
  • GOALS Framework for Sexual History Taking in Primary Care: The GOALS Framework resource from the Clinical Guidelines Program of the New York State Department of Health AIDS Institute is designed to streamline sexual history conversations and elicit information most useful for identifying an appropriate clinical course of action.
  • Sexual Health and Your Patients: A Provider’s Guide: The resource from the National Coalition for Sexual Health was developed to help health care professionals better integrate sexual health conversations and recommended preventive services into routine visits with adolescents and adults.

Screening guidelines from the CDC and USPSTF

Resources to streamline the testing cascade

Implement the “opt-out” approach 

Training clinicians 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. 

Resources to support sex-positive, status-neutral messaging about the benefits of routine screening

Clinical decision support system resources

Task shifting resources

Resources to create a trusted and welcoming environment

  • Tools to Create a Welcoming Environment: Included as a subset of resources in the National Coalition of Sexual Health’s Compendium of Sexual & Reproductive Health Resources for Healthcare Providers, users can find examples and resources on how to create a welcoming and safe environment for both teen and LGBTQ patients.
  • 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.

Cost effectiveness resources

Presenting the cost-benefit analysis of catching diseases early versus treating disease progression can help strengthen infectious disease control as a strategic imperative in a health setting and gain access to timesaving resources.

Funding and reimbursement strategy resources

These coding guides outline 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.

Resources to help form a strong referral network

  • Linkage to care administrative resources:
    • Tool for Tracking Partners and Partnership Activities (PDF): 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.
  • Providing or linking to care treatment and prevention resources:
    • 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.
    • Ready, Set, PrEP: Health care professionals and individuals can use this website to learn more about the the Ready, Set, PrEP program which provides free PrEP HIV-prevention medications to thousands of people living in the United States, including tribal lands and territories, who qualify.
    • Clinical Guidance for PrEP: This resource from the CDC outlines recommendations, treatment options and considerations for managing patients on PrEP.
    • Sexually Transmitted Infections Treatment Guidelines: CDC’s Sexually Transmitted Infections (STI) Treatment Guidelines, 2021 provides current evidence-based prevention, diagnostic and treatment recommendations that replace the 2015 guidance.
    • CDC Guidelines on the use of doxy PEP: This report outlines CDC’s recommendation for the use of doxycycline postexposure prophylaxis (doxy PEP) for bacterial sexually transmitted infection prevention.
    • HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C: To provide healthcare professionals with timely guidance, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) developed this website to facilitate the dissemination of evidence-based, expert-developed recommendations for hepatitis C management.
    • 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.

Resources related to leveraging patient navigators as members of the care team

  • HIV Navigation Services Section of the Rapid Antiretroviral Therapy Toolkit: Section 2 (beginning on page 19) of this toolkit developed in partnership by Primary Care Development Corporation, My Brother’s Keeper, the San Francisco Community Health Center, and the Denver Prevention Training Center provides an overview of the essential role of HIV navigation services in rapid ART services. It also includes a review of staffing needs and considerations for resource-limited settings, suggested protocols, and real-world examples of how to provide services in resource variable settings.
Care team training

Assessing social determinants of health 

LGBTQ, transgender and gender nonconforming essentials

The AMA Ed Hub offers a series of training modules developed by Howard Brown Health, SAGECare, The Fenway Institute and more that can help provide education to your care team on sex-positive and gender appropriate language and methods to incorporate best practices into your organization.

Develop skills to communicate with patients more effectively

HIV, STIs, viral hepatitis, and LTBI Essentials 

The following links are a compilation of education and training resources from the CDC and other institutions targeted to health care professionals. These training materials can be leveraged to equip your care team members with the latest information to help boost the confidence of any member of the care team in answering patient questions.

PDSA approach to quality improvement initiatives

Patient portal optimization

Collecting comprehensive patient demographics and sexual history

Video Clips from Telementoring Session Series for Community Health Centers

Building strong community partnerships:

  • During this telementoring session, Jennifer Brumfield, RN shares how Express Personal Health in Jackson, MS built relationships with other providers to improve patient experiences and outcomes.

Establishing an integrated approach to care:

  • During this telementoring session, Jacky Bickham describes how the Louisiana Department of Health's STD, HIV, and Hepatitis Program approaches addressing the needs of community members.

Meet patients where they are:

  • During this telementoring session, Jacky Bickham shares examples and an approach to how the Louisiana Department of Health's STD, HIV, and Hepatitis Program provides testing outside of the clinic.

Registering patients in EHR portals:

  • During this telementoring session, Jennifer Brumfield, RN describes how patients at Express Personal Health in Jackson, MS benefited from being enrolled in their EHR portal.

Collecting comprehensive patient data:

  • During this telementoring session , Kara Green, MHA, MSN, APRN, FNP-BC shares how the HOPE Clinic in Houston, TX improved their patient data collection processes and improved their screening procedures.
  • During this telementoring session, Jason Zucker, MD, discusses sex-positive strategies for taking a sexual history and the importance of collecting SOGI data.

Sex-positive, status-neutral messaging about the benefits of routine screening:

  • During this telementoring session, Jason Zucker, MD talks about the many benefits of sex-positive, status-neutral messaging in HIV care.

Streamline the testing cascade:

  • During this telementoring session, Lesley Miller, MD describes how the Grady Liver Clinic uses their EHR system to streamline testing and follow-up.

Patient education materials at conclusion of the visit:

  • During this telementoring, Cabell Jonas, PhD shares how the Mid-Atlantic Permanente Medical Group has improved patient education around HCV.

Linkage to care:

  • During this telementoring session, Katie Conner, MPH discusses key facilitators success for CrescentCare's rapid linkage to care program for HIV.
Video Clips from Telementoring Session Series for Emergency Departments

Create a trusted and welcoming environment:

  • During this telementoring session, Fahd Ahmad, MD from the St. Louis Children's Hospital discusses the importance of establishing a trusted and welcoming environment for adolescents in order to increase screening opportunities.

Involve patients in the screening process:

  • During this telementoring session, Fahd Ahmad, MD shares the St. Louis Children’s Hospital's approach to screening asymptomatic adolescent patients for STIs in the emergency department.

Collect comprehensive patient demographics and sexual history:

  • During this telementoring session, Jason Zucker, MD provides some best practices for taking a sexual history by applying the GOALS Framework for Sexual History taking to an emergency department setting.

Implement an opt-out approach:

  • During this telementoring session, Douglas White, MD provides an overview of the history of the opt-out approach for HIV screening and why it is recommended.
  • During this telementoring session, Douglas White, MD from Alameda Health System's Highland Hospital shares tips on implementing opt-out notifications in an emergency department setting.

Stick to sex-positive messaging about the benefits of screening:

  • During this telementoring session, Jason Zucker, MD provides an overview of the importance of using sex-positive messaging to help increase screening for HIV and STIs.

Implement automated EHR reminders, prompts and orders to increase screening

  • During this telementoring session, Carmen Burrell, DO shares West Virginia University's approach to optimizing EHR alerts when implementing opt-out screening in the emergency department.
  • During this telementoring session, Lesley Miller, MD outlines the way that they implemented changes to their EHR in the Grady Hospital emergency department in order to increase routine screening for HCV.

Align infectious disease control with organization’s goals:

  • During this telementoring session, Jason Zucker, MD shares studies that show how universal screening has been shown to be cost effective in numerous settings and models, while also removing stigma associated with HIV testing and contributing to earlier diagnosis and treatment, leading to reduced transmission.

Empower every member of the team with education and training:

  • During this telementoring session, Lesley Miller, MD outlines trends in hepatitis C, why screening is important and the path to achieve elimination.

Form a strong referral network:

  • During this telementoring session, Alex McIntosh-Ogunfolu from CCI Health Services discuss the importance of building strong community partnerships in order to create trusted, warm handoffs for a patient seeking treatment or additional services following a visit in the ED.

Hire or assign current staff as patient navigators:

  • During this telementoring session, Carmen Burrell, DO describes how her institution, University of West Virginia, approaches linking patients to care after a positive diagnosis in the emergency department.
  • During this telementoring session, Lesley Miller, MD reviews the pros and cons of two different approaches to patient navigation that the Grady Liver Clinic has used with patients after a positive diagnosis in the Grady Health System emergency department--bedside navigation and traditional navigation.
Implementing Routine Screening Webinar Series
  • The Importance of Routinely Screening for HIV, STIs, Viral Hepatitis and LTBI: AMA Past President, Jesse Ehrenfeld, MD, MPH, and Jonathan Mermin, MD, MPH, Director of CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention introduce AMA’s toolkit designed for community health centers and emergency departments to integrate routine screening of infectious diseases into patient care. Gain insights on implementing opt-out screening and empowering every member of the care team with training. 
  • Improve Your Screening Process for HIV, STIs, Viral Hepatitis & LTBI: AMA Past President, Jesse Ehrenfeld, MD, MPH, and a panel of experts share real life experiences and effective routine screening strategies for HIV, STIs, viral hepatitis and LTBI, focusing on sticking to sex-positive, status neutral messaging and streamlining the testing cascade.  
  • Connecting Patients to Treatment for HIV, STI, Viral Hepatitis & LTBI: AMA Past President, Jesse Ehrenfeld, MD, MPH, and a panel of experts explore two of the strategies related to connecting patients to treatment: forming a strong referral network and hiring or assigning current staff as patient navigators.

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