1. LINCS : Using Harm Reduction while working together with HIV+ patients in San Francisco Department of Public Health November 17, 2012 Harm Reduction Coalition National Conference Erin Antunez, SFDPH

2. Overview What is San Francisco’s LINCS Program? How LINCS works with HIV+ patients and their partners in SFDPH SFDPH’s Harm Reduction Policy LINCS Harm Reduction guidelines Case studies

3. Purpose Harm Reduction has a place in HIV Linkage to Care and HIV Services

4. LINCS: Linkage Integration Navigation Comprehensive Services Program Goal: To provide and coordinate comprehensive HIV care – Linkage to Care – Partner Services – Navigation Patients: People who test HIV+ in SFDPH Medical and Community testing sites, and their partners Time limited: 90 days LINCS Overview

5. Joint program of SFDPH HIV Prevention and STD Prevention and Control LINCS works collaboratively with: – SF Community HIV Testing Network – SFDPH medical clinics – San Francisco General Hospital, HIV care team – SFDPH HIV Epidemiology and Surveillance – Jail Health Services 2 LINCS Program Coordinators Partner Services/Linkage Field Staff – 2 Embedded staff at our high volume HIV test sites – 1 Mobile field staff for low volume and medical sites Navigation Field Staff – 1 Navigator for known positives, city wide LINCS Organization

6. Continued Care Treatment Engagement Retention Virologic Suppresion Continued Care Treatment Engagement Retention Virologic Suppresion Results received at medical or community site HIV Testing HIV Testing Positive Result Surveillance Confirmation Patient Notification Partner Services Linkage to Care LINCS and the HIV Continuum of Care LINCS Assistance Previously Known HIV+ Referred for navigation

7. LINCS staff meet with new HIV+ patients as soon as possible and offer: 1.Partner Services for sex and needle sharing partners 2.Warm handoffs for Linkage to Care Why? 1.Partner Services identifies previously undiagnosed cases of HIV infection and reduces HIV transmission 2.Status awareness is empowering 3.Early Linkage to Care improves health outcomes How it works for patients who just tested HIV+:

8. Navigators help out of care patients “navigate the system of care” 1.Support the HIV+ patient in making, keeping track of, and attending medical appointments 2.Provide warm referrals to address specific barriers to care 3.Navigators coordinate care with other HIV service providers For these complex, out of care patients, Harm Reduction is important, even essential to help overcome barriers to care How it works for known HIV+, out of care patients

9. Harm Reduction (HR) Definition Public health philosophy Reduce harm Client-centered Client is active participant in setting goals Principles: – Respect – Non-judgment – Non-stigmatizing

10. SFDPH Harm Reduction Policy September 2000, the San Francisco Health Commission passed a resolution adopting a harm reduction policy for substance abuse, STD and HIV treatment and prevention services In response, the SFDPH developed a policy that requires programs to: – Incorporate a set of core Harm Reduction principles – Address in their design and objectives how they will provide harm reduction treatment options – Develop harm reduction guidelines

11. Resolution: Adopting a Harm Reduction Policy For Substance Abuse, STD and HIV

12. LINCS Harm Reduction Guidelines LINCS recognizes positive, incremental changes made by patients LINCS is client centered: – Strengths based approach – Meet HIV+ patients where they are at – Patients set their own goals – Patients who fall out of care are not treated as failures Services are provided with respect, non-judgment, patience Integration of Care is harm reduction: prevent duplication of services and respect patient and provider time HIV Care is non-linear: LINCS is a safety net that helps patients engage with the system of care

13. Safety Net for the Continuum of HIV Care

14. Putting it all together LINCS services Harm reduction principles Improved health outcomes

15. Case Study-New Positive 35 y/o MSM HIV hx: New HIV+ test result at Magnet in April 2012. Pt interested in care LINCS Harm reduction work: – Client centered Overwhelm with new dx, insurance options, social support – Strengths based Pt identified needs and was proactive following through with partner disclosure, care, social support

16. Case Study-Known Positive 41 y/o female, active substance use, SRO housing HIV hx: tested in jail in March 2012, received confirmatory result from LINCS staff outside of jail in March 2012; no hx of primary medical care LINCS Harm reduction work: – Meet pt where she is at Home visits build trust in SFDPH services, build trust in clinician – Non-judgment Substance use HIV status – Incremental steps and patience She is not a failure Appointments- missing and attending

17. What people said about LINCS… "I really appreciate having someone to talk to, helping me understand what is happening and the steps I need to take. I really want to be able to live the same life I led before this happened, and you've helped me start out on the right foot.“ “Thank you for being so patient.” “If it wasn’t for you, I probably wouldn’t have made it to this appointment today.”

18. Acknowledgments LINCS team and Leadership: Matt Sachs Sam Samuelson Jennifer Vanaman Charles Fann Nyisha Underwood Trang Nguyen Frank Strona Nicholas Moss Kyle Bernstein Noah Carraher Bob Kohn Susan Philip Tracey Packer Ali Marrero Sandra Torres Diane Jones SFDPH Community Testing Network SFDPH Community Oriented Primary Care HIV Providers The HIV+ clients and patients in SFDPH

19. For More Information Erin Antunez LINCS Coordinator, Navigation Services AIDS Office, HIV Prevention Section San Francisco Department of Public Health (415) 437-4670 Erin.Antunez@sfdph.org Charles Fann LINCS Coordinator, Partner Services and Linkage to Care San Francisco City Clinic San Francisco Department of Public Health (415) 437-5506 Charles.Fann@sfdph.org