Exhibit M_HIV Provider Testing Key Resources.pdf

Navy Bloodborne Infection Management Center dha.bethesda.wrnmmc.mbx.nbimc@health.mil

Provider Job Aid: Key Resources All documents below serve as a job aid for providers to understand various tests, testing processes, codes, and results. Descriptions, documents, and links are available below.

A: PrEP Training Resources Site https://info.health.mil/sites/hro/CMT/PC/Pages/HIV-PrEP.aspx

- In 2023, the Defense Health Agency (DHA) launched an initiative to expand access to HIV Pre-exposure Prophylaxis (PrEP) in the DoD. This initiative was in response to the DHA-PI 6025.29 titled “Provision of Human Immunodeficiency Virus (HIV) Pre-Exposure Prophylaxis (PrEP) for Persons at High Risk of Acquiring HIV Infection”, which directs Military Treatment Facilities (MTFs) to provide a pathway to access HIV PrEP for all beneficiaries at increased risk for acquiring HIV infection. This initiative aligns with the National HIV/AIDS strategy 2022-2025, which calls on government agencies to accelerate efforts to end the HIV epidemic in the U.S. by 2030.

- HIV PrEP is a daily oral pill or a bimonthly injection that can lower an individual’s risk of acquiring HIV infection by greater than 90% when taken as directed. Oral PrEP and injectable PrEP are covered benefits under Tricare; however, the latter has limited availability within the Military Health System (MHS) currently. Despite HIV PrEP’s high efficacy, it is estimated that less than 17% of Active-Duty Service members who may benefit from taking this medication were prescribed PrEP. The DHA’s HIV PrEP Working Group developed resources to promote healthcare provider training and patient awareness. These resources include a comprehensive HIV PrEP toolkit for primary care providers and patient education materials.

B: Instructions for SOT G Orders

- The HIV -1/O/2 CDD test designated at BUMED only (previously called the SOTG test in CHCS) is ordered for patients on HIV PrEP. This test includes the 4th generation HIV antibody/antigen screen AND qualitative RNA testing.

C: SOT G Provider Results View mailto:dha.bethesda.wrnmmc.mbx.nbimc@health.mil https://info.health.mil/sites/hro/CMT/PC/Pages/HIV-PrEP.aspx

- This document provides visuals for SOT G testing from the provider’s view. An example of a negative screening and negative

HIV Nucleic Acid Test results in MHS Genesis and JLV Genesis are displayed. Positive screening results, positive differentiation, and positive HIV Nucleic Acid Test results are also displayed from the MHS Genesis and JLV Genesis point of view. Test results for final interpretation by the provider are highlighted in yellow.

- C.1: Algorithm – Technical Exhibit 11

a. Navy Contractor HIV and Hepatitis Testing Algorithm

D: Technical Exhibit 10

- List of test codes from A to Z and each codes definition

Document B: Instructions for SOT G Orders

1. Go to Orders and in the search box, type HIV. When the following window shows, select HIV 1/O/2 CDD Future Order, Blood, Routine, Lab Collect (highlighted in blue).

HIV 1/O/2 CDD Future Order, Blood, Routine, Lab Collect

2. Click on the “Details” tab, go to “Source of Test L.C.” and select BUMED only

Source Test LC= SOT The pop up will have all the SOT options. Click BUMED only, the

3. Click on the Order Comments tab, and type PREP Candidate in the Order comments box.

4. Click on the Diagnosis tab. Click on “Add +”. Type in Z20.2 and press the binoculars to search. Click on “Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission “(highlighted box on the lower right).

5. Sign the order.

Document C: SOT G Provider Results View

MHS Genesis- NEGATIVE screening and NEGATIVE HIV Nucleic Acid Test final interpretation results

JLV View – NEGATIVE screening and NEGATIVE HIV Nucleic Acid Test final interpretation results

MHS Genesis- POSITIVE screening results, POSITIVE Differentiation and POSITIVE HIV Nucleic Acid Test final interpretation results

JLV Genesis- POSITIVE screening results, POSITIVE Differentiation and POSITIVE HIV Nucleic Acid Test final interpretation results

Document C.1: Algorithm – Technical Exhibit 11

NAVY CONTRACTOR HIV AND HEPATITIS TESTING ALGORITHM

Document C.1: Algorithm – Technical Exhibit 11

D: Technical Exhibit 10

TECHNICAL EXHIBIT 10

SOURCE OF TEST CODES

CODE DEFINITION

A Alcohol and Drug Rehabilitation

B Blood Donor

C Referred HIV Contract

D Deceased (whether DOA or dying in ER)

E MEPCOM

F General Force Testing

G BUMED use only.

H Post-Deploy Storage Only (Army/Navy) (Health Assessment)

I Clinically Indicated

J Prisoners or Detained Persons

K Free Text

L Free Text

M Medical Admission (include psychiatric)

N Pre-Deployment (Air Force/Army/Navy) (Health Assessment)

The HIV -1/O/2 CDD test designated at BUMED only (previously called the SOTG test in CHCS) is ordered for patients on HIV PrEP. This test includes the 4th generation

O OB Clinic

P Physical Examination

Q Evaluation Unit Patient

R Requested by Individual

S Surgical Admission (including invasive procedures and trauma patient from ER)

T Post Deployment (Air Force) (Health Assessment)

U Free Text

V Sexually Transmitted Disease (STD) Visit

W Double ELISA Positive In-house Blood Bank

X Any Other Code

Y Free Text

Z Double Elisa Positive In-house Clinical

JLV View – NEGATIVE screening and NEGATIVE HIV Nucleic Acid Test final interpretation results