Although Manhattan remains New York’s epicenter of HIV/AIDS ,with the highest incidence, the Bronx has been hard-hit with a higher mortality rate. Here the death rate from AIDS is 37 per 100,000 compared with 21 per 100,000 for Manhattan, say city officials.
A program called The Bronx Knows, the most recent initiative by the New York City Department of Health, aims to decrease the fatal statistics by offering HIV testing to every Bronx adult in the next three years.
Shrinking the Numbers
According to the New York City DOH, in 2006, 214 people living in the Bronx first learned they were HIV positive when the virus had already progressed to AIDS. This translates to being undiagnosed for an average of 10 years. Increasing the numbers of people getting tested for HIV will reduce the risk of those who are positive going undiagnosed and untreated until they are ill with AIDS. Finding out about having HIV early means earlier access to available treatment and prevention services before the disease progresses.
The Bronx Knows promotes HIV testing as voluntary and routine, with the underlying premise that testing carries less stigma when it’s a routine part of medical care, thus decreasing some of the related patient hesitancy to testing. All adults ages 18 through 64 who have never been tested, or who have not been tested in the last 12 months, will be included. Persons who have ongoing risk should be tested at least annually.
“Routine HIV testing means that patients who enter the ED or Urgent Care for an injury or illness are offered HIV oral testing free of charge,” says Mary Jean Roth, RN, assistant head nurse, Urgent Care, Jacobi Medical Center, Bronx.
Jacobi is one of more than 50 partners, including clinics, churches, and community centers, that aim to reach the nearly 250,000 Bronx adults who have never had an HIV test. City officials estimate that 40% of the 830,000 people ages 18 to 64 in the Bronx have been tested for HIV in the past year.
How Testing WorksAssistant Head Nurse Mary Jean Roth (left) and Yvette Calderon, MD, review the mobile Tablet PC that patients use to watch HIV videos and enter information.
Adult Urgent Care Director at Jacobi Medical Center, Yvette Calderon, MD, MS, who has been on the forefront of providing the opportunity for HIV testing in the EDs, says, “Jacobi Medical Center and the North Bronx Healthcare Network were glad to jump on board when asked to join The Bronx Knows.” Since 2005, both hospitals have been providing HIV testing via a program called Project B.R.I.E.F. that uses a model applicable to Urgent Care in their facilities and appropriate to the high patient volume and rapid turnover.
“Each hospital uses a slightly different approach for HIV testing,” says Calderon. “At Jacobi Medical Center, for example, we use counseling techniques that enable a high volume of patients.”
Patients watch a five-minute, pre-test counseling video (in English or Spanish) that conveys the necessary information required by the New York State Department of Health to obtain informed consent. (New York State requires written informed consent from each patient.)
Before the rapid oral swab testing is performed, patients have the opportunity to ask questions of counselors. Results are available in 20 minutes.
While waiting for results, patients watch a 10-minute video that delivers risk reduction messages and HIV education. The video includes information about interpretation of HIV test results, partner notification, domestic violence, condom use demonstrations, and methods of encouraging partners to be tested.
Should a patient test positive, counselors link patients to care by personally escorting them to the HIV service clinic at either hospital.
“The real issue is testing patients and getting out into the community and working with them to get them tested for HIV,” says Calderon.
Changing a Culture
Calderon credits Roth for being instrumental early on, even before The Bronx Knows, in getting staff on board to test patients in the ED and Urgent Care areas. “[She] helped redefine the culture of HIV testing in the acute care area [that was] unfamiliar with performing screenings,” Calderon says. Roth can easily approach any attending physician and report that she has triaged a patient where there may be an HIV concern, she says. Getting people to know their HIV status is crucial to treatment, she says.
“The epidemic is on the rise, with the new CDC numbers showing an incidence rate 40% higher in new infection than what was anticipated. This federal concern has filtered down to a citywide concern,” she says.
In December, Project B.R.I.E.F., considered a key part of The Bronx Knows, quadrupled the number of its HIV tests from 350 in October, 2007, to nearly 1,700 2 months later. It was recognized by Mayor Bloomberg for its lifesaving leadership in the struggle against HIV and AIDS.