Public Health Institute Staff Saul Zepada, HIV Testing Manager
Project components and activities—summary of the work plan The current HIV population in Illinois and the Care Treatment Continuum and Surveillance Feed-back loop (Linkage to Care Work Group activities) Share project progress, developments, challenges and successes (where we started, where we’ve come and where we are at) Share highlights to the Routine Testing component and the Youth of Color Initiative (East Side Health District’s ) collaborative of a co-located integrated comprehensive medical, psychosocial, prevention and support services/center for LGBTY--- Kaleidoscope!
1. Expand routine HIV testing in 4 health systems & 7 county jails 2. Build a statewide culturally competent Disease Investigative Services network with local health departments and several “designee” agencies 3. Development of a statewide Patient Navigator program into a peer-led empowerment for HIV+ people of color 4. Statewide retention in care by increasing transportation assistance; start a texting service for appointment/medication reminders 5. Collaborate with CDPH & CDC-direct funded programs; align data systems. 6. Launch a youth of color-initiative in East St Louis to co-locate medical (including LGBT health), and other services in a single setting
Illinois Department of Public Health CAPUS program logic model Priority populations: African American & Latinos Residing in Illinois NHAS Goals: Reduce new HIV infections; Improve access to care and improve health outcomes for people living with HIV; Reduce HIV-related health disparities; Improve Coordination Purpose: Reduce HIV-related morbidity, mortality, and related health disparities among racial and ethnic minorities in Illinois Local needs: Increase number of African Americans/Latinos who know their HIV status ; Address YMSM of color HIV/STI co-infection; Reduce HIV- disease burden among African Americans Inputs= Funding (CDC plus Ryan White and IDPH support), multiple agency partnerships with CBOs and LHDs. Activity Categories Measurable ObjectivesActivitiesOutputsOutcomesImpacts 1. Expand routine HIV testing in 4 health systems & 6 county jails (49,092 tests proposed). 2. Build a statewide culturally competent DIS network. 3. Transform the Patient Navigator program into a statewide Peer-led empowerment for HIV+ people of color. 4. Statewide retention in care: a) Increase transportation assistance; b) start a texting service for appointment /medication reminders. 5. Collaborate with CDPH & CDC-direct funded programs; align data systems. Supplemental: Launch a youth of color-initiative in East St Louis to co- locate medical (including LGBT health), and other services in a single setting. Measure: 1 st opening session held by close of year 1. Testing: # of tests done compared to target set with intended populations; DIS: Designees identified and trained ; first follow up cases by close of year 1; increase # of partners reached/pts linked to care Peers: curriculum enhanced; ARTAS training launched; #of candidates identified/trained; hired with defined duties. Retain in Care: # of people accepting texts; # assisted with transport; reduced no-show rates; suppressed VL CDPH Collaboration: Regular meetings held; signed policy and work plans; data systems aligned. Potential data sources: Process data (activities & outputs)= Program information submitted by grantees to CDC and other federal agencies; Ryan White program data; Outcome data = Self-reported, community survey data collected through existing CDC behavioral surveillance systems Impact data = Annual population-based HIV surveillance data, including Ryan White Unmet Need Data Testing: Conduct Assessment; Training ;Update/develop protocols for HIV ;Implement HIV Testing; Plan to expand HIV Testing; Implement linkage to care; Conduct, TA, Trainings, QA visits, Audits; Develop sustainability plan DIS: Protocols/policies developed with LHDs; conduct site visits; surveys w/clients served Peers: Protocols/policies developed w/Ryan White agencies; ongoing assessment; Care: protocol for voluntary texting; data capturing established; track how transportation assistance is used; negotiate systems with regional transport service; CDPH: analysis of data systems, costs & timeframe. Testing: # of assessments completed;# of clinical teams trained;# of patients tested by month/year; # of written plans to expand HIV testing; # of patients linked to care; # of TA hours delivered, providers trained, QA visits, audits conducted; DIS: LHD follow up on cases monitored by IDPH workgroup ; cultural competency training conducted; Peers: Advanced peer curriculum developed; candidates for advanced training identified; Care: expand texting; transport assistance; CDPH/IDPH written agreements; joint policy implementation/ongoi ng collaboration. Testing: Sites successfully implement and expand HIV testing; a broader mix of populations in IL get tested for HIV; high success rate is achieved in linking persons newly diagnosed with HIV to care/partner services; DIS: # of connections made to medical providers & routine testing partners; Peers: skills developed; retained in program Care: Remove transportation as a barrier to care; CDPH Collaboration One data system for Ryan White Part A&B; improved linkage/ retention in care. Decrease HIV-related morbidity Decrease HIV-related mortality Decrease related health disparities Required by FOA To be developed by grantees based on proposed activities Supplemental/ optional Legend IDPH –Illinois Dept of Public Health CDPH-Chicago Dept of Public Health DIS-Disease Intervention Specialists
1. Expand routine HIV testing in 4 health systems & 6 county jails (34,092 tests proposed). Partnership with Public Health Institute of Metropolitan Chicago (PHIMC) and Midwest AIDS Education Training Center (MATEC) 2. Build a statewide culturally competent DIS network for Speed, Cultural Competency & Quality for Linkage to Care/Partner Services IDPH HIV & STD Sections Collaborate to recruit, train, activate 7-8 Disease Intervention Specialist Designees under IDPH supervision to cover each of the Illinois Regions. Designees proposed will be from local health departments and some well established community based organizations. 3. Transform the Patient Navigator program into a statewide Peer-led empowerment/retention in care program for HIV+ people of color. Partnership with Central Illinois Friends of PWAs & Ryan White Regional Directors to: a) conduct needs assessment in each Ryan White Region; b) review/amend/enhance existing training program; c) establish policies/procedures with Ryan White program leaders; d) establish graduations and other acknowledgment/recognition for completing training/excellent service e) establish continuing education and newsletter for peer leaders
4. Statewide retention in care logistical support: a) Increase transportation assistance; b) start a texting service for appointment /medication reminders. c) case manager assistance with partner services; case finding 5. Collaborate with CDPH & CDC-direct funded programs; align Ryan White Part A&B data systems. Monthly IDPH/CDPH HIV leadership meetings already established; Ongoing mutual representation at both jurisdictional HIV planning meetings; Ongoing collaboration on appropriate use of surveillance data for Illinois cascade development, community VL measurement and facilitation of linkage to care/partner services; Ongoing collaboration to reduce/eliminate perinatal HIV transmission in Illinois, including statewide EPS, statewide perinatal HIV 24/7 hotline 6. Launch a youth of color-initiative in East St Louis to co-locate medical (including LGBT health), and other services in a single setting. Partnership formed with East Side Health District, Project ARK, East Side Empowerment Center for Youth in addition to HIV Prevention and Ryan White Lead Agencies Collaborative effort to address persistent new infections among YMSM /Transgender persons of color in extremely underserved community
HIV Prevention and Ryan White Care Connect Regions are the same in Illinois. Each region has a lead agency and subgrantees (local health departments, CBOs, medical providers, others) delivering a variety of prevention and care services. CAPUS support makes it possible for IDPH to have a DIS designee for each region.
34,712 persons living with HIV/AIDS in Illinois at the close of 2012 - Average # of HIV diagnoses each year = 1,825 4.7% fewer cases diagnosed in 2012 compared to 2008; 9.1% increase in the number of new cases diagnosed between 2011-2012. Men constitute the majority of persons living with HIV/AIDS (79%); females (21%). Current trends indicate a shift in the HIV/AIDS epidemic toward young African American MSM, including cases of co-infection with syphilis. Overall, HIV incidence has declined sharply among IDUs and much less among high-risk heterosexuals. Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit, June 2013
*Based on CDC report that 20% of HIV infected were unaware of their serostatus **HIV diagnoised (age 13 or older) through 12/31/2010 and living with HIV on 12/31/2011 - based on HIV surveillance data reported through 07/29/2013. ***based on the percentage of cased diagnosed in 2011 that were linked to care within 12 month of diagnosis (82%) based on the 2012 Statewide Unmet Needs Analysis that 61% of PLWLA were with needs met ƚƚBased on combined 2010 Chicago and Illinois MMP results: 88% of in care cases were on ART among which 88% with viral suppression
6 month planning and contract delay and hiring processes required a revised work plan, revised testing goals and project timelines Linkage to Care workgroup continues to work through data collection/reporting with the Care Continuum for evaluation/monitoring East Side Health Project youth center providing comprehensive services to the most vulnerable youth in Region 4 HIV Routine Testing component targeted to conduct 75,000 tests in 2014-2015 Peer Navigation training/curricula supports peer leadership development; college credit at 2 universities for the community health worker degree and endorsed by the American Public Health Association
Revised Illinois laws/administrative rules to accomplish: 1 - authority to authorize DIS designees to facilitate quality/culturally competent partner services/linkage to care statewide; 2 - repeal of principal notification law for HIV positive students; 3 - required HIV prevention education in all county jails in Illinois; 4 - opt-out routine HIV screening in IDOC and Cook County Jail; 5 - comprehensive sex education grades 6-12 in IL public schools Medicaid Expansion Passed by IL General Assembly – 2013 State/Federal Marketplace Established for ACA Implementation Collaboration with multiple state agencies: Joint initiatives to implement Affordable Care Act in Illinois in an effort to reduce health disparities/accomplish health equity Collaboration with IL SAMHSA HIV grant director to: Establish routine HIV opt-out screening in behavioral health settings
Illinois proposed as one of its objectives to build a culturally competent Disease Intervention Specialist (DIS)/ Linkage to Care System. Six local health departments and one community based organization have been identified across the state to serve as DIS/Linkage to Care designees outside of the County of Cook/City of Chicago. Each DIS designee will conduct an assessment of current capacity, quality and cultural competency of HIV testing, linkage to care and partner services activities for each county and region of Illinois. Relationships between the designees and the participating agencies have been established within the regions to facilitate data collection for HIV cases surveillance and supplemental surveillance actives. Memorandums of understanding (MOUs) have been sent to all LHDs and selected community based organizations. Each designee will provide training and technical assistance as needed. All participants have attended the HIV/AIDS Section “confidentiality and security training” offered by IDPH. Surveillance-based have been distributed to each region checking to make sure HIV positive individuals are in care.
Region 1-Winnebago County Health Department Region 2-Peoria City/County Health Department Region 3-Sangamon County Health Department Region 4-East Side Health District; St. Clair County Health Department Region 5-Jackson County Health Department Region 6-Champaign-Urbana Public Heath District Region 7-Renz Addiction Center
Administrative rules associated with state statues were approved to include the ability to have “designees” of IDPH for these purposes, as this state has 102 counties, and 95 certified health departments, each with local authority. Having the ability to legally establish designees was key for moving forward with identifying local/regional partners in assuring partner services/linkage to care in real time for all cases throughout the state.
East Side Health District (ESHD) and their collaborative partners; Mallory Mahr Youth Empowerment Center, Project ARK/ The Spot, St. Clair County Health Department(SCHD), and Southern Illinois Healthcare Foundation (SIHF) have collaborated to provide medical, psychosocial, prevention and support services to Lesbian, Gay, Bisexual and Transgender (LGBT)youth between the ages of 13-24 in the East St. Louis, Illinois area.
Obtaining executed grant agreements to officially allow for services to begin and communication to be made with all Designee partners and engaging all health departments about this new development. The infrastructure between eHARS and the Provide Enterprise system has been developed to accommodate this effort, with some experience from its initial pilot launch shortly before CAPUS support began.
State Government lengthy hiring process and CAPUS supported positions are beginning to be filled. There has been improvement in linkage to care for newly identified HIV positive persons. However, we cannot say that those improvements are a direct result of CAPUS supported DIS/LTC activities as yet, due to the fact that cases have began to be distributed in early March, 2014.
East Side Health District established a clinical site – Kaleidoscope Youth Center Each collaborative partner has committed to receive and refer clients meeting the eligibility criteria to Kaleidoscope Mallory Mahr facilitate weekly HIV education and support groups and also offer opportunities for social interaction to Kaleidoscope clients
There is a need to further define division of labor between/among community partners, as some are providing some services to the same target population. Some educational group sessions have had to be placed on hold at Kaleidoscope due to initial low program registration at youth centers
Grant agreements were not executed timely, therefore, program activities were delayed Lengthy process to hire staff position within Illinois Department of Public Health