National HIV/AIDS Clinicians' Consultation Center (NCCC)

National HIV/AIDS Clinicians' Consultation Center (NCCC)

National HIV/AIDS Clinicians' Consultation Center (NCCC) is a free expert clinical consultation service for healthcare providers seeking consultation on HIV/AIDS and management of potential exposures to HIV, hepatitis, and other blood-borne pathogens. Using distance-based consultation, the NCCC provides immediate information and case-specific recommendations to clinicians about HIV/AIDS treatment (Warmline); post-exposure prophylaxis and management for health care workers exposed to blood-borne pathogens (PEPline)[1]; and treatment of HIV-infected pregnant women and their infants (Perinatal HIV Hotline). These services give clinicians of any experience level access to current information that can help them prevent HIV transmission, improve the quality of life of persons with HIV, and support life-saving and life-extending HIV care.[2]

The Department of Family and Community Medicine at the University of California, San Francisco currently operates the NCCC. The NCCC works in collaboration with the regional AIDS Education and Training Centers (RAETCs), the National Minority AETC (NMAETC), the AETC National Resource Center (NRC), and the Centers for Disease Control and Prevention (CDC) in providing nationally available, readily accessible expert consultation on HIV treatment and prevention to facilitate improved HIV and post-exposure care throughout the United States.[3] The NCCC is part of the Health Resources and Services Administration's (HRSA) HIV/AIDS Bureau. To date, the NCCC has provided more than 135,000 clinical consultations nationwide.

Contents

Background

Because HIV/AIDS clinical management as well as interventions to prevent HIV transmission can present critical and often complex clinical dilemmas, timely consultation is often needed. NCCC clinical consultation helps improve medical services by supporting both HIV expert clinicians and clinicians without extensive HIV experience.[4] These clinicians have key roles in preventing HIV transmission (including mother-to-child transmission[5]) and managing the care of persons with HIV. Effective antiretroviral (ARV) therapy has dramatically improved the health care status of HIV patients, yet lack of access to care, antiretroviral resistance, and incomplete prevention of HIV transmission continue to present important challenges in the AIDS epidemic.[6] Healthcare professionals who frequently use the Warmline, PEPline, and Perinatal HIV Hotline include physicians, nurses, physician assistants, pharmacists, dentists, and other allied health professionals seeking expert consultation. The NCCC particularly focuses on aiding minority and minority-serving clinicians[7] and clinicians in rural and underserved areas.

Consultation Lines

The Warmline (National HIV Telephone Consultation Service) 1-800-933-3413 is a clinicial consultation service that provides free advice from HIV expert clinicians on HIV/AIDS management and prevention of transmission. The service takes telephone queries from a range of clinicians including infectious disease doctors, primary care doctors, nurses, physician assistants, and HIV specialists. Some of these callers have no HIV treatment experience and limited access to expert consultation while some call with questions about complex ARV resistance dilemmas. Prevalent Warmline consultation topics include HIV testing and counseling questions, drug treatment strategies, management of HIV-related conditions, clinical and laboratory abnormalities, transmission and prevention, primary care and epidemiology. The Warmline is available Monday through Friday, 8am to 8pm EST. The Warmline has answered more than 46,000 calls since its inception in 1993. The Warmline averages 200 calls per month.

The PEPline (National Clinicians’ Post-Exposure Prophylaxis Hotline) 1-888-448-4911 provides around-the-clock expert guidance on managing healthcare worker exposures to HIV and hepatitis B and C (through needlestick injury, splashes, etc.). Since its launch in 1997, the PEPline has played a key role in the dramatic reduction of occupational HIV transmission, as there have been no documented HIV transmissions to healthcare personnel in the U.S. since 2001.[8] The PEPline has received more than 87,000 calls and currently averages more than 700 occupational exposure calls/month. The majority of calls are from MDs, nurses, nurse practitioners, and physician assistants treating potential exposures sustained by other healthcare workers; however, the PEPline receives a substantial number of calls from healthcare workers requiring consultation about an exposure they sustained themselves.

The Perinatal HIV Hotline (National Perinatal HIV Consultation & Referral Service) 1-888-448-8765 The Perinatal HIV Consultation and Referral Service includes the Perinatal HIV Hotline and the Perinatal HIV Clinicians’ Network. The Perinatal HIV Hotline provides around-the-clock advice on rapid and standard HIV testing and care in pregnancy, prevention of transmission (pre-conception and contraception), intrapartum HIV care, HIV-exposed infant care, and consultation on antiretroviral use in pregnancy[9], labor and delivery, and the postpartum period. The Perinatal HIV Clinicians’ Network helps callers link HIV-infected pregnant women with local perinatal HIV experts for consultation, co-management, or transfer of care. These services are key in reducing HIV transmission from HIV-infected mothers to their infants.[10] The Perinatal HIV Hotline has received more than 1,550 calls.

State HIV Testing Laws Compendium

The State HIV Testing Laws Compendium describes each state’s laws and policies on HIV testing in clinical settings. Since the release of the CDC’s Revised Recommendations for HIV Testing in Adults, Adolescents, and Pregnant Women in Health Care Settings in September 2006, many states have revised their HIV testing laws. Understanding individual states’ HIV testing laws is essential when providing testing and counseling for patients and in implementing HIV testing programs.[11] The State HIV Testing Laws Compendium contains easily downloadable PDF documents on each individual state, a Quick Reference Guide for all 50 states and Puerto Rico, and definitions of key HIV testing terms. The Compendium also guides clinicians toward helpful links on HIV testing and state laws, including a link to the 2006 CDC testing recommendations.[12]

References

  1. ^ N Engl J Med. 2009 Oct 29;361(18):1768-75. Clinical practice. Postexposure prophylaxis for HIV infection. Landovitz RJ, Currier JS.
  2. ^ HIV Clin. 2004 Summer;16(3):6, National Warmline and PEPline provide clinicians with assistance in managing HIV and occupational exposures.
  3. ^ J Assoc Nurses AIDS Care. 2004 Mar-Apr;15(2):38-50, HIV care: continuing medical education and consultation needs of nurses, physicians, and pharmacists. Liljestrand P.
  4. ^ http://hab.hrsa.gov/treatmentmodernization/educating.htm
  5. ^ http://www.aidsetc.org/aidsetc?page=et-25-77
  6. ^ http://www.cdc.gov/hiv/topics/basic/index.htm#history
  7. ^ 1: J Natl Med Assoc. 2008 Jul;100(7):779-82.African-American clinicians providing HIV care: the experience of the National HIV/AIDS Clinicians' Consultation Center. Mahoney MR, Sterkenburg C, Thom DH, Goldschmidt RH.
  8. ^ HIV Clin. 2004 Summer;16(3):6
  9. ^ J Int Assoc Physicians AIDS Care (Chic Ill). 2009 Jul-Aug;8(4):249-52. Epub 2009 Jun 8. Clinicians' knowledge of 2007 food and drug administration recommendation to discontinue nelfinavir use during pregnancy. Fogler J, Weber S, Mahoney MR, Goldschmidt RH.
  10. ^ Am J Obstet Gynecol. 2007 Sep;197(3 Suppl):S137-41, Consultation needs in perinatal HIV care: experience of the National Perinatal HIV Consultation Service. Fogler JA, Weber S, Goldschmidt RH, Mahoney MR, Cohan D.
  11. ^ Wolf LE, Donoghoe A, Lane T, 2007 Implementing Routine HIV Testing: The Role of State Law. PLoS ONE 2(10): e1005. doi:10.1371/journal.pone.0001005, Implementing Routine HIV Testing: The Role of State Law.
  12. ^ http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm

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