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    DSHS HIV/STD Program

    Post Office Box 149347, MC 1873
    Austin, Texas 78714

    Phone: (512) 533-3000

    DSHS strives to respond to all email requests in a timely manner. It is important to note, however, that messages that you send to us by email may not be secure and may be intercepted by a third party. Therefore, we recommend that you do not send any confidential health information to us by email.

Quality Assurance Standards

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Targeted Testing and Linkage to Medical Care | Protocol-Based Counseling (PBC) | Comprehensive Risk Counseling and Services (CRCS) | Evidence-Based Interventions | Social Networks Strategy for HIV CTR

Targeted Testing and Linkage to Medical Care

Targeted Testing and Linkage to Medical Care
HIV Testing Chart Review Tool (Word : 26 kb) PDF version (PDF : 186 kb) Revised 4/2013
HIV Testing Observation Tool (Word : 23 kb) PDF version (PDF : 77 kb) Revised 2/2014


Protocol-Based Counseling

The Protocol-Based Counseling Quality Assurance Standards (QA) were created as part of a Centers for Disease Control and Prevention (CDC) funded project to assess what it takes to create quality assured prevention counseling in the real world. The project required the development of tools to help risk reduction specialists (RRS) understand and implement the 2001 CDC Revised Guidelines for HIV Counseling, Testing, and Referral (PDF) [CDC]. As a part of this project, the Texas Department of State Health Services (DSHS) convened a Prevention Counseling Tools Advisory Group. The Advisory Group helped to determine the required core elements for the counseling tools and helped to develop quality assurance plans; these standards are a result of their work.

In early 2005, DSHS staff conducted a series of statewide presentations highlighting the implementation and evaluation of the Protocol-Based Counseling (PBC) project in Texas. The presentation (PowerPoint : 7,901 kb) is available for review. Please contact either  or  if you have questions about the presentation.

The Quality Assurance Standards and related forms support the implementation of protocol-based counseling by DSHS contractors.

As you read this document, please keep in mind the following:

  • Protocol-based counseling (PBC) is an evidence-based intervention.
  • This intervention can be carried out separately from testing and referral.
  • There have been replicated studies that show this intervention reduces clients' risk behaviors and new STD infections.
  • This intervention focuses on plan-based prevention counseling. Plan-based counseling provides a framework for risk reduction specialists to use during the session and makes it more likely for the essential elements of the intervention to be covered. The essential elements of a prevention counseling session include:
    • Introducing and orienting client to the session
    • Enhancing client's self-perceived risk
    • Exploring client's most recent risk
    • Reviewing client's previous risk reduction experiences
    • Summarizing patterns of risks and triggers (putting risk in context)
    • Negotiating a realistic and acceptable risk reduction step
    • Identifying sources of support and providing referrals
    • Summarizing and closing the session
  • In Texas, this intervention also includes:
    • Supporting test decision counseling (when appropriate)
    • Providing results simply and supportively
    • Providing partner elicitation (when appropriate)
  • QA refers to actions taken by supervisors and program managers to ensure that the intervention is consistently implemented across risk reduction specialists and across settings. Quality assurance activities include ensuring risk reduction specialists receive training and other activities to further his/her development; assessment of client satisfaction and client flow; record keeping; and evaluation activities including risk reduction specialist observation, feedback, and documentation review.

Protocol-Based Counseling Quality Assurance Standards

 

Appendix A: Risk Reduction Session Observation Tools
A-1. Risk Reduction Observation: Initial Session (PDF : 33 kb) Revised 3/2007
A-1o. Risk Reduction Observation: Initial Session - Original Version (PDF : 26 kb) Revised 3/2007
A-2. Risk Reduction Observation: Follow-Up Session for Negative HIV and/or HCV Results (PDF : 22 kb) Revised 3/2007
A-3. Risk Reduction Observation: Follow-Up Session for Positive HIV Result (PDF : 22 kb) Revised 3/2007
A-3o. Risk Reduction Observation: Follow-Up Session for Positive HIV Result - Original Version (PDF : 22 kb) Revised 3/2007
A-4. Risk Reduction Observation: Follow-Up Session for Positive HCV Result (PDF : 18 kb) Revised 2/2007
A-5. Risk Reduction Observation: Follow-Up Session for Positive HIV and HCV Results (PDF : 22 kb) Revised 2/2007
A-6. Risk Reduction Observation: Initial Session for Rapid Test (PDF : 22 kb) Revised 3/2007
A-7. Risk Reduction Observation: Follow-Up Session for Negative HIV Rapid Test Result (PDF : 20 kb) Revised 3/2007
A-8. Risk Reduction Observation: Follow-Up Session for Preliminary Positive HIV Rapid Test Result (PDF : 21 kb) Revised 3/2007

 

Appendix B: Risk Reduction Specialist Self-Assessment Tools
B-1. Risk Reduction Self-Assessment: Initial Session (PDF : 33 kb) Revised 3/2007
B-1o. Risk Reduction Self-Assessment: Initial Session - Original Version (PDF : 26 kb) Revised 3/2007
B-2. Risk Reduction Self-Assessment: Follow-Up Session for Negative HIV and/or HCV Results (PDF : 21 kb) Revised 3/2007
B-3. Risk Reduction Self-Assessment: Follow-Up Session for Positive HIV Result (PDF : 22 kb) Revised 3/2007
B-3o. Risk Reduction Self-Assessment: Follow-Up Session for Positive HIV Result - Original Version (PDF : 22 kb) Revised 3/2007
B-4. Risk Reduction Self-Assessment: Follow-Up Session for Positive HCV Result (PDF : 19 kb) Revised 3/2007
B-5. Risk Reduction Self-Assessment: Follow-Up Session for Positive HIV and HCV Results (PDF : 23 kb) Revised 3/2007
B-6. Risk Reduction Self-Assessment: Initial Session for Rapid Test (PDF : 22 kb) Revised 3/2007
B-7. Risk Reduction Self-Assessment: Follow-Up Session for Negative HIV Rapid Test Result (PDF : 20 kb) Revised 3/2007
B-8. Risk Reduction Self-Assessment: Follow-Up Session for Preliminary Positive HIV Rapid Test Result (PDF : 21 kb) Revised 3/2007

 

Appendix C: Risk Reduction Specialist Personal Review Tools
C-1. Risk Reduction Specialist Personal Review: Initial Session (PDF : 53 kb) Revised 3/2007
C-2. Risk Reduction Specialist Personal Review: Follow-Up Session (PDF : 54 kb) Revised 3/2007

 

Appendix D: Risk Reduction Session Documentation
D-1. Chart Review Form (PDF : 70 kb) Revised 2/2007
D-1. Chart Review Form (Word : 80 kb) Revised 2/2007
D-2. Summary of Chart Reviews (PDF : 68 kb) Revised 2/2007
D-2. Summary of Chart Reviews (Word : 49 kb) Revised 2/2007

D-3. Initial Session: Session Documentation Form (PDF : 71 kb) Revised 4/2008

D-3. Initial Session: Session Documentation Form (Word : 46 kb) Revised 4/2008

D-4. Follow-Up Session: Session Documentation Form (PDF : 58 kb) Revised 4/2008
D-4. Follow-Up Session: Session Documentation Form (Word : 43 kb) Revised 4/2008
D-5. Rapid Session: Session Documentation Form (PDF : 74 kb) Revised 4/2008
D-5. Rapid Session: Session Documentation Form (Word : 49 kb) Revised 4/2008

 

Appendix E: Risk Reduction Session Observation Notes
E-1. Risk Reduction Observation Notes: Initial Session (PDF : 66 kb) Revised 3/2007
E-2. Risk Reduction Observation Notes: Follow-Up Session for Negative HIV and/or HCV Result (PDF : 76 kb) Revised 3/2007
E-3. Risk Reduction Observation Notes: Follow-Up Session for Positive HIV Result (PDF : 77 kb) Revised 4/2007
E-4. Risk Reduction Observation Notes: Follow-Up Session for Positive HCV Result (PDF : 76 kb) Revised 3/2007
E-5. Risk Reduction Observation Notes: Follow-Up Session for Positive HIV and HCV Results (PDF : 76 kb) Revised 3/2007

 

Revised Protocols
Initial Session (PDF : 263 kb) Spanish version (PDF : 45 kb) Revised 8/2007
Follow-Up Session: Negative HIV and/or HCV (PDF : 223 kb) Spanish version (PDF : 26 kb) Revised 8/2007
Follow-Up Session: Positive HIV (PDF : 218 kb) Spanish version (PDF : 33 kb) Revised 8/2007
Follow-Up Session: Positive HCV (PDF : 190 kb) Spanish version (PDF : 29 kb) Revised 8/2007
Follow-Up Session: Positive HIV and HCV (PDF : 223 kb) Spanish version (PDF : 40 kb) Revised 8/2007
Rapid Test: Initial Session (PDF : 247 kb) Spanish version (PDF : 39 kb) Revised 8/2007
Rapid Test: Negative HIV (PDF : 225 kb) Spanish version (PDF : 26 kb) Revised 8/2007
Rapid Test: Preliminary Positive (PDF : 209 kb) Spanish version (PDF : 29 kb) Revised 8/2007

 

Other Forms
Risk Reduction Specialist Observation and Sign-Off (PDF : 71 kb) Word version (Word : 24 kb) Revised 4/2008

Comprehensive Risk Counseling and Services

Comprehensive Risk Counseling and Services (CRCS) is an individual-level multi-session HIV prevention intervention focused on persons who have difficulty initiating or maintaining HIV risk reduction behaviors. It is a hybrid of long term HIV risk reduction counseling and case management. CRCS in Texas is based on the national guidelines designated by the Centers for Disease Control and Prevention. Quality Assurance (QA) Standards and tools were created to ensure consistent quality services are provided for persons accessing CRCS.

CRCS
Quality Assurance Forms (Instructions) (PDF : 13 kb) Word version (Word : 32 kb) Revised 1/2009
Session Observation Form (PDF : 94 kb) Word version (Word : 221 kb) Revised 12/2008
Review of Client Record Checklist (PDF : 21 kb) Word version (Word : 170 kb) Revised 12/2008

Evidence-Based Interventions

Evidence-Based Behavioral HIV Prevention Interventions are science-based interventions that work to prevent HIV transmission or acquisition among individuals or within a target population. These interventions have been proven to work with a target population that is at high risk of transmitting or acquiring HIV/STDs. All the interventions had positive results for behavioral or health outcomes in the target populations studied. Each of these interventions has been proven to work through scientific research.

There are two levels of behavioral interventions:

  • Group Level Interventions (GLI) involve one or more facilitators working with a specific group of individuals over a finite period of time. The goal is for members of the groups to change their own knowledge, attitudes, and/or beliefs about HIV transmission or acquisition. The target population, number of sessions, learning objectives, and other specifics of the interventions vary widely based on the original research.
  • Community Level Interventions (CLI) involve training members of a community or target population to talk to others in their own community. The goal is to change the community norm regarding attitudes, knowledge and beliefs about HIV transmission and acquisition among members of that community. Specifics of the interventions also vary widely based on the original research.

Quality Assurance (QA) Standards were created to ensure consistent quality services are provided for persons accessing Group or Community Level Interventions.


Social Networks Strategy for HIV CTR

The Social Networks Strategy (SNS) is a cost-effective, incentive based recruitment strategy for reaching and providing HIV CTR to persons who are unaware of their HIV status by using existing social networks. It includes a targeted and focused approach shown to be very successful in reaching highest risk, hard to reach individuals with undiagnosed HIV infection and getting them connected to CTR services. The SNS for CTR is based on the underlying principle that people in the same social network share the same risks and risk behaviors for HIV.

Agencies using SNS for CTR identify clients or peers who are HIV positive or at high risk for contracting HIV (high risk HIV-negative clients), and enlist them to become recruiters. The recruiters identify their “network associates,” who are basically people in their social networks (e.g, friends, sex or drug partners, family members, etc.) who they believe are at risk for contracting HIV and would benefit t from HIV CTR services. The recruiters then talk with their network associates, and discuss with them the benefit of receiving CTR services. The recruiters also refer/direct the network associates to the CTR services provider to get tested for HIV.

As these individuals come in for CTR services, they can also be approached and enlisted to become recruiters and reach out to their friends and family members. And the process starts over again. Recruiters are intended to be short-term (unlike peers advocates or peer educators) and require some training and minimal supervision. They are not intended to be employees or volunteers of the agency. Their goal is strictly to talk to and refer their friends (network associates) to get tested. Incentives can be used to encourage recruiters to talk to and refer their friends.

Research has clearly shown that a Social Networks approach is successful in reaching people with undiagnosed HIV infection. From 2003 to 2005, a two-year demonstration project funded by the CDC, showed that agencies using a social networks approach for HIV testing had a 6–13% positivity rate for HIV:

  • 9 CBOs in 7 cities participated (Philadelphia, PA (2); Orlando, FL ; San Francisco, CA; New York, NY; Boston, MA; Lafayette, LA and Washington, DC
  • 424 Recruiters enlisted
  • 3,179 Network Associates tested
  • 179 New positives identified

These rates were highest among MSM and transgender individuals. This prevalence is six times higher than the average of most HIV CTR programs. Using the targeted approach of Social Networks, agencies may actually test less people, but, because they will be testing the “right” people, they may have a significantly higher positivity rate.

A more thorough overview of the strategy can be found at: www.cdc.gov/hiv/resources/guidelines/snt/overview.htm [CDC]

 

Documents and Links

SNS Interim Guide (PDF : 643 kb)

SNS Quality Assurance Standards (PDF : 80 kb)

SNS Performance Measure Reporting Form (Excel : 27 kb)

CDC Toolkit: www.cdc.gov/hiv/resources/guidelines/snt/index.htm#Sec5 [CDC]

 

Other Resources
Webcast Link: www2.cdc.gov/phtn/webcast/hiv_042706/default.asp [CDC]
SNS Demonstration Project Article (PDF : 525 kb)

City of Laredo SNS Program QA Forms


Last updated February 26, 2014