The Wisconsin Counseling, Testing, and Referral (CTR) Program has been an important part of the overall strategy to fight HIV and AIDS in Wisconsin. The program has been instrumental in assisting individuals with HIV in accessing medical treatment, social support, and partner counseling and referral services (formerly known as partner notification). It has also been an important HIV prevention strategy. Every client who is tested is also counseled to reduce their risk of acquiring or transmitting the disease.
CTR Program activities are directed at providing the following services:
- readily accessible counseling, testing and referral services for individuals at risk for HIV;
- testing at low or no cost to individuals who would not otherwise be able to afford testing;
- anonymous testing for persons with confidentiality concerns that might prevent them from seeking services;
- client-centered counseling designed to reduce client risk of acquiring or transmitting HIV;
- appropriate referrals for medical or psychological evaluation and social support;
- referral for or assistance with the notification of sexual and needle sharing partners.
Since its inception, the CTR Program has performed over 175,000 HIV antibody tests of which 2,000 tests were HIV positive. The Program currently consists of 33 agencies providing counseling and testing services in 49 locations throughout the state. All designated AIDS Services Organizations (ASOs) provide counseling and testing services onsite through outreach to individuals at highest risk for infection. The CTR Program was reorganized in 1999 to redirect services to those at higher risk for HIV infection. This was particularly important due to dramatic improvements in HIV drug therapy. People who are infected must be diagnosed and placed on treatment early to receive the greatest benefit from drug therapy.
The process of counseling and testing
Clients either make appointments or access CTR services at agencies that provide walk-in services. Upon arrival, most clients complete a questionnaire on demographic and risk information. The questionnaire has a unique identifier (not the clients name) that eventually links information with the clients test result. Demographic and risk information is used by the Wisconsin AIDS/HIV Program to analyze program utilization and to evaluate services.
Clients discuss their concerns and risk for HIV infection with a counselor who works with the client to develop a realistic plan to reduce risk for HIV infection. The counselor also discusses HIV antibody testing and answers client questions regarding testing. Testing is voluntary and clients provide written informed consent before being tested. A serum or oral fluid specimen is collected and a return appointment is made for two weeks from the initial visit for the client to obtain their test results. Clients are required to return to receive their test results.
For clients who test HIV positive, counselors provide emotional support and link the client to needed medical and social support services. Clients are also offered partner counseling and referrals services at this time. For clients who test negative, counselors discuss the clients risk reduction plan and issues that may have surfaced during the two-week waiting period.
Most sites offer both serum and oral fluid HIV antibody testing. Serum testing requires a phlebotomist to draw blood from the client, whereas oral fluid testing utilizes a device placed in the mouth to absorb a fluid known as "oral mucosal transudate". Both types of specimens are tested on a enzyme immunoassay (EIA) which is a screening test for the HIV antibody. If initially positive on the EIA, the specimens are re-evaluated by repeating the EIA in duplicate. If repeatedly reactive, the Western blot confirmatory test is performed. Specimens are considered positive if the EIA tests are repeatedly reactive and the Western blot assay is reactive.
All sites provide both anonymous testing and confidential HIV testing. Confidential testing requires that the client provide their name to be tested, as with any other medical procedure. Anonymous testing enables the client to be tested without providing their name. Studies indicate that some individuals at high risk for HIV choose not to be tested when anonymous testing is not available.
The majority of counseling and testing services have been established at local health department (LHD) clinics and community health clinics. Current sites include LHD sexually transmitted disease (STD) clinics, other non-STD local health department clinics, gay-affiliated STD clinics, family planning clinics, community health centers, and community-based organizations.
The Division of Public Health AIDS/HIV Program trains new CTR staff on client-centered HIV prevention counseling that promote behavior change rather than providing solely prevention information. The AIDS/HIV Program covers the cost of centralized laboratory testing at the State Laboratory of Hygiene and the City of Milwaukee Health Department. The State Laboratory of Hygiene conducts the majority of testing for the program while the Milwaukee Health Department provides laboratory testing only for the Milwaukee Central Health Clinic, a high volume sexually-transmitted disease clinic.
In addition to the CTR Program, HIV antibody testing is also offered in the Wisconsin AIDS/HIV Partner Counseling and Referral Services (PCRS) Program to sexual or needle-sharing partners of individuals with HIV infection. For additional information on the Wisconsin HIV CTR Program, contact Jacob Dougherty at 608-261-9429.