Russell Brewer, DrPH, CHES Director of HIV, STDs, and Reproductive Health Louisiana Public Health Institute Strategies on the Ground to Turn the Tide on.

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Presentation transcript:

Russell Brewer, DrPH, CHES Director of HIV, STDs, and Reproductive Health Louisiana Public Health Institute Strategies on the Ground to Turn the Tide on Improving Access to Care in the U.S. International AIDS Conference Washington, DC July 22, 2012

Source: US Census and United Health Rankings CategoriesEstimate Population, million White/Caucasian64% Black/African American32% Hispanic/Latino Ethnicity4.4% Lack of Health Insurance17.2% % Below the Poverty Level, %

Source: LA Office of Public Health, 2010

Categories% in Care (CD4 or viral load in the last 12 months) % Not in Care (Unmet Need) Overall64%36% Female70%30% Male61%39% Black/African American64%36% White65%35% Region 1 – New Orleans59%41% Region 2 – Baton Rouge71%29% Region 5 – Lake Charles54%46% Region 7 - Shreveport60%40%

 Access to care initiative funded by AIDS United and Bristol-Myers Squibb  LPHI is the lead agency and local evaluator  Goal is to improve linkage to HIV care and supportive services for: - Individuals living with HIV infection that are out of care - Newly diagnosed

 Implement and evaluate 4 linkage to care interventions in four regions of the state ▪ Linkage Case Management (Baton Rouge) ▪ Health Navigation (New Orleans, Baton Rouge, Lake Charles) ▪ Pre/Post Release Case Manager (New Orleans) ▪ Disease Intervention Specialists (New Orleans, Baton Rouge, Shreveport)  Linkage interventions are 3-6 months in duration

 Region I: New Orleans  Region II: Baton Rouge  Region V: Lake Charles  Region VII: Shreveport

 Initial 3 month planning phase (April-June 2010)  3-year implementation phase (July 2010 – June 2013)  Interventionist is housed at multiple locations  Two main data collection points (baseline and follow-up)

Positive Charge Sites  Capitol Area Reentry Program & Earl K. Long (BR)  N’R Peace & HOP Clinic (NO)  SW Louisiana AIDS Council & Moss Comprehensive Health Clinic (Lake Charles)  NO/AIDS Task Force & Orleans Parish Prison (NO)  Family Service of Greater Baton Rouge (BR)  Office of Public Health, Parish Public Health Units in Regions 1, 2, 7 (NO, BR, Shreveport) Linkage to Care Interventions Health Navigation Pre/Post-Release Case Management Linkage case management intervention Disease Intervention Specialists

 Data collection system - Ryan White CAREWare  Alert system - Louisiana Public Health Information Exchange (LaPHIE)  Surveillance system – CD4 and viral load data from laboratories as required by the Louisiana Public Health Sanitary Code  Reminder system - Out of care lists generated by providers

Demographic Profile (August 2010 – January 2012) Estimate (N=684) African American90% Male68% Transgender (M-F)4% MSM15% High School Education or less69% 20 – 29 years of age34% 30 – 39 years of age30% 40 – 49 years of age22%

Enrollment and Linkage to Care Profile Reported by Interventionists (August 2010 – May 31, 2012) Estimate Enrolled in PC since individuals Linked to HIV Medical Care493 individuals % Linked to HIV Medical Care72%

 Regular Data collection trainings  Multiple IRB modifications  Site specific - Staff turnover - Ensuring confidentiality - Lack of transportation - Loss to follow-up  Retention in care?

 Positive Charge has raised the visibility of access to care efforts in the state  Provided a platform for other access to care initiatives  Enhanced relationships and coordination among Positive Charge partners  Importance of developing and updating Intervention workflows

“One client I enrolled took four months to actually link to medical care. The client arrived at the Health Unit for a routine pelvic exam, and left with a positive HIV diagnosis. As a young woman with two children, the client was devastated. She believed this was the end of her life, and that she would not live long enough to see her children grow old. For over two hours, we talked about what her next steps would be. Making an appointment with a doctor was very far down on her list of priorities.”

 PC Participants  PC Partners - LA Office of Public Health, STD/HIV Program - NO/AIDS Taskforce - Orleans Parish Prison - N’R Peace - HIV Outpatient Program (LSU) - Capitol Area Reentry Program - Earl K. Long Medical Center (LSU) - Family Service Greater Baton Rouge - Southwest Louisiana AIDS Council - W.O. Moss Regional Medical Center (LSU)  LPHI Staff (Sarah Chrestman, MPH; Michael Robinson, BA; and Snigdha Mukherjee, PhD)  AIDS United  Bristol-Myers Squibb