Integrating HIV Prevention and Surveillance:...
Transcript of Integrating HIV Prevention and Surveillance:...
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Integrating HIV Prevention and
Surveillance: Building an Effective Program and
Workforce Moderator: Romni Neiman, Assistant Branch Chief, CDPH STD Control Branch
Panelists: Matthew Millspaugh, Chief, HIV Program Section, CDPH/OA
Kristy Michie, MS, Monterey County Public Health Department
Lauren Brookshire, MPH, MSW, HIV, STD, Hepatitis Branch, Public Health Services, San Diego County
Jessica Osorio, HIV/AIDS and STD Programs, Contra Costa County Public Health Department
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Learning Objectives • Identify existing workforce resources (e.g., personnel,
job roles/titles, staffing structure, outside stakeholders, etc) and possible ways to shift resources to match new priorities.
• Describe how several LHJs have successfully adjusted workforce resources in order to integrate surveillance and prevention activities.
• Identify concrete first and follow up steps towards filling gaps and aligning resources with new priorities under 18-1802 funding.
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Program Expectations • Treatment as Prevention!
• Achieve viral suppression through • HIV testing of those at risk
• Young Gay/Bi/MSM of Color • Trangendered Individuals
• Linkage to PrEP and PEP • Linkage to STD Testing/Treatment
• Linkage to HIV care and treatment
• Use data to inform public health interventions • Data sharing to initiate client-level service integration for
STD, PrEP and HIV care. • Evaluate outcomes of local HIV program interventions (i.e.
number of new positives identified, proportion of new positives linked to care, people linked to PrEP, etc.)
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Program Direction • Do More
• Routine opt-out HIV testing in medical settings
• Client navigation services for health insurance, PrEP & HIV care and treatment
• Client-level integration of STD & HIV services
• Partner services as a pathway to facilitate testing and linkage
• Support Syringe Services Programs (SSP)
• Data driven interventions for those at highest risk for acquiring HIV or falling out of care.
• Do Less • Risk Reduction Activities
(RRA) • Targeted HIV Testing in
sites with no positivity in past three years.
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Program Implications • Is your current program well positioned to meet the new program
expectations? • Can be big challenge to re-align staffing and program emphasis • 3rd Party such as a CBA provider facilitate a capacity building effort to think
through staffing/contractual/program changes. • What opportunities will the PrEP-AP program bring regarding providing STD care
and linkage to PrEP • What policies & procedures do you have to
• Support STD/HIV surveillance informed public health program action • Implement integrated services by
• public health • medical providers
• What program organization & staffing do you have or need to develop/hire for • support client navigation (PrEP. LTC, re-engangement to care) • support partner services • Routine Testing • Intergration of STD/HIV/Hep client level
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Program Implications Cont. • Syringe Exchange/SSP
• Huge Change – Previously no CDC funding has gone to SSP’s in the 20 jurisdictions being funded.
• Understand that certain LHJs directly supporting SSPs is not politically viable – however what other steps can you take to support SSP indirectly? • LTC- Many people having a romance with drugs have a
difficult time remaining in care. Funding LTC within a SSP either directly or via a CBO could be an option.
• Funding other services in support of LTC and whole person health for HIV positive persons, navigating to PrEP, etc. could be a solution
• You are not alone, OA has team of people ready to assist you with TA, consultation and strategy in support of developing SSPs and support services at SSPs
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Program Implications Cont.
• SSP Certification • In 2013 CDPH/OA established the Syringe
Exchange Certification Program • Allows qualified entities to apply directly to
CDPH/OA for authorization to provide syringe exchange services.
• All qualified SEPs are eligible to participate in the CA Syringe Exchange Supply Clearinghouse, which prides a baseline level of supplies to authorized programs.
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Workforce/Strategy Changes at OA • OA staff will need to change our work to reflect 18-
1802 so we can support the LHJs and move forward towards Getting to Zero
• Prevention has utilized a CBA Provider to take a look at our branch structure and is currently evaluating what steps to take to re-align staff towards activities under 18-1802 • PrEP/PEP Navigation • LTC • Routine Testing • Gay Men/Transgender Sexual Health • D2C • PS • Enhanced support of coordinating CBA providers and related
evaulation
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Workforce/Strategy Changes at OA • Build and strengthen programmatic
integration between STDCB and OA • OA currently funds PS training and capacity
building efforts with STDCB – build on this to enhance capacity to support STD/HIV/PrEP/D2C program capacity at LHJ level
• Strengthen collaboration with CARE, Surveillance and ADAP • Support strategies for braiding funding and
resources under Prevention, CARE and PrEP-AP • Bring in CBA to assist with capacity building
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OA, CBA Providers and your fellow LHJs are resources • Utilize OA staff for TA and guidance while you
are developing your transition plans • Utilize CBA providers to assist with capacity
building, provider training, workforce training/development, consumer engagement, etc.
• Engage with other LHJs you have heard from how they have approached challenges regarding LTC, Routine Testing, PrEP/PEP Navigation etc.
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Monterey County Health Department: Testing Strategy • Discontinued OA funded community-based HIV
testing in early 2015 • Low yield of new positives for effort
• 2013: cost ≈ $15,000 for 1 new + (1 + / 490 tests) • 2014: cost ≈ $15,000 for 1 new + (1 + / 125 tests, 2x $)
• Identified priority providers and facility types • Reported >1 case in 2014 (low hanging fruit) • Potential high volume testers • Did not include HIV care clinics
• Initiated routine, opt-out testing outreach • Provider outreach (not detailing) for prioritized facilities • Added to other individual provider-level interactions
(convenience outreach) • Health Updates and articles in other routine provider
communications
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Monterey County Health Department: Testing Strategy
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Num
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f New
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New Positives by Diagnosing Facility Type
2014 2017*
*Through October 2017
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San Diego Data to Care
Lauren Brookshire County of San Diego November 29, 2017
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San Diego – Data to Care
• Organizational structure • Work teams • Training • Roll-out • Working with providers • Lessons learned
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Contra Costa County Workforce Implications of Data-to-Care & RAPID
Interventions
Jessica Osorio Interim Director
HIV/AIDS & STD Program
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Contra Costa Snapshot • Mid-sized LHJ – Part of Bay Area counties • Approximately 100 new infections a year • Roughly 2300 PLWHA • Integrated HIV/STD program • 4 county Positive Health Clinics
• Staffed by our program’s medical case managers
• Staff: • 9 MSWs • 6 DITs/Senior DITs (2 housed with STD, 2 HIV Outreach
Workers, all provide HIV counseling & testing) • 2 Health Educators
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Intervention One: Line List Program • Uses State STD Surveillance data to identify
individuals at increased risk of HIV and link them to services
• Line List Priority Individuals: • Coinfected (HIV & STD) • MSM • Transgender • Women of Color
• Disease Intervention Technicians (DITs) are assigned lists of priority individuals: Spanish language calls also made.
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Line List Calls Process & Outcomes • Use separate scripts & conversation flow charts for HIV+ and
HIV- • HIV+: provide risk reduction education, link / re-link to HIV & STD
care, offer partner services • HIV-: provide risk reduction education, link to HIV testing, link / re-
link to STD care, connect with PrEP Navigator • “Sub lists” forming for additional follow up and support: Already on
PrEP, Linked to PrEP, Repeat STDs (same individual on multiple lists for new STD infections)
• Workforce Outcomes: • DITs with expertise with high-risk negative • Sr DIT developed as PrEP Navigator developing PrEP campaign • Further integration of HIV & STD teams
• Outcomes tracked by Planner/Evaluator & Education & Prevention Manager
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Intervention Two: RAPID Linkage to Care • In Spring 2016, set goal
to decrease linkage time (prescribing meds at first visit as opposed to waiting for lab work)
• Utilized existing staff & policies from HIV/AIDS & STD Program
• Protocol for linking new positives was shared with clinicians more widely
Funding • Nothing new – a little bit
of many peoples’ time • Part A: Medical Case
Management (linkage) / Ambulatory Care (some provider time, labs, etc.)
• Part B: Outreach Services (DITS), MAI
• Part C: Outreach Services (Community-based)
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Linkage to Care Overview
• HIV/AIDS Program outreach workers (DITs) get new positives from testing site to first positive health appointment (warm handoffs)
• Clinicians: Call our program right away with any new positives • Notice in EPIC put in place with instruction to call our program
• All new positives are called within 24 hours by MCM • If no response, assigned to an outreach worker: additional calls, home visits
• Counseling and overview of MCM program, services, and care • Assistance making appointments to get lab work and begin treatment
ASAP • MCMs and outreach workers staff positive health clinics; meet clients
there for first appointment • Enroll in MCM • Provide with urgent referrals and information: food, housing, nurse case
management
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Linkage to Care Workforce Outcomes • All existing staff – no new hires • Increased coordination between clinical & PH
department staff • Clinicians • Outreach Workers • DITs / Sr DITs (PrEP navigation / “prevention with
positives” • Health Educators (New positives class; risk reduction
education) • PH Management • Epidemiologist (Partner Services)