Suchergebnisse

In September 2006, the Centers for Disease Control and Prevention (CDC) released the "Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-care Settings" to improve screening and diagnosis. The CDC now recommends that all patients in all health care settings be offered opt-out HIV screening without separate written consent and prevention counseling. State law on HIV testing is widely assumed to be a barrier to implementing the recommendations. To help policymakers and providers better understand their own legal context and to correct possible misunderstandings about statutory compatibility, a state-by-state review (including Washington, DC) of all statutes pertaining to HIV testing was performed and the consistency of these laws with the new recommendations was systematically assessed. Criteria were developed for classifying state statutory frameworks as consistent, neutral, or inconsistent with the new recommendations, and the implications for implementation of the CDC recommendations in these various legal contexts were examined. The statutory frameworks of 34 states and Washington, DC, were found to be either consistent with or neutral to the new CDC recommendations, which would enable full implementation. Statutory frameworks of 16 states were inconsistent with the new CDC recommendations, which would preclude implementation of 1 or more of the novel provisions without legislative change. In the 2 years since release of the recommendations, 9 states have passed new legislation to move from being inconsistent to consistent with the guidelines. State statutory laws are evolving toward greater compliance with the CDC recommendations. Policymakers, provider groups, consumer advocates, and other stakeholders should ensure that HIV screening practices comply with existing state law and work to amend inconsistent laws if they are interested in implementing the CDC recommendations.

In September 2006, the Centers for Disease Control and Prevention released 'Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Healthcare Settings' to improve screening and diagnosis. The CDC now recommends that all patients in all healthcare settings be offered opt-out HIV screening without separate written consent and prevention counseling. State law on HIV testing is widely assumed to be a barrier to implementing the recommendations. To help policymakers and providers better understand their own legal context and to correct possible misunderstandings about statutory compatibility, we performed a state-by-state review (including District of Columbia) of all statutes pertaining to HIV testing and systematically assessed the consistency of these laws with the new recommendations. We developed criteria for classifying state statutory frameworks as consistent, neutral, or inconsistent with the new recommendations, and we examined the implications for implementation of the CDC Recommendations in these various legal contexts. We found that statutory frameworks of 35 states were either consistent with or neutral to the new CDC Recommendations, enabling full implementation. Statutory frameworks of 16 states were inconsistent with the new CDC Recommendations, precluding implementation of one or more of the novel provisions without legislative change. In the 2 years since release of the recommendations, 9 states have passed new legislation to move from inconsistent to consistent with the guidelines. Indeed, state statutory laws were evolving in only one direction: toward greater compliance with the CDC Recommendations. Policymakers, provider groups, consumer advocates, and other stakeholders should ensure that HIV screening practices comply with existing state law and work to amend inconsistent laws if interested in implementing the CDC Recommendations.

<p class="Pa7"><strong>Objectives: </strong>To understand the health care access issues faced by Los Angeles (LA) County's uninsured and residually unin­sured after implementation of the Afford­able Care Act (ACA) and to identify poten­tial solutions using a community-partnered dialogue.</p><p class="Pa7"><strong>Design: </strong>Qualitative study using a com­munity-partnered participatory research framework.</p><p class="Pa7"><strong>Setting: </strong>Community forum breakout discus­sion.</p><p class="Pa7"><strong>Discussants: </strong>Representatives from LA County health care agencies, community health care provider organizations, local community advocacy and service organiza­tions including uninsured individuals, and the county school district.</p><p class="Pa7"><strong>Main Outcome Measures: </strong>Key structural and overarching value themes identified through community-partnered pile sort, c-coefficients measuring overlap between themes.</p><p class="Pa7"><strong>Results: </strong>Five overarching value themes were identified – knowledge, trust, quality, partnership, and solutions. Lack of knowl­edge and misinformation were identified as barriers to successful enrollment of the eligible uninsured and providing health care to undocumented individuals. Discussants noted dissatisfaction with the quality of tra­ditional sources of health care and a broken cycle of trust and disengagement. They also described inherent trust by the uninsured in "outsider" community-based providers not related to quality.</p><p><strong>Conclusions: </strong>Improving health care for the residually uninsured after ACA implementa­tion will require addressing dissatisfaction in safety-net providers, disseminating knowl­edge and providing health care through trusted nontraditional sources, and using effective and trusted partnerships between community and health care agencies with mutual respect. Community-academic part­nerships can be a trusted conduit to discuss issues related to the health care of vulner­able populations. <em>Ethn Dis. </em>2015; 25(4)487- 494; doi:10.18865/ed.25.4.487</p>