Expanding Connecticut’s ADAP in a Reformed Health System By Deborah Gosselin Nurse Consultant

 Rebate Model  Eligibility: Connecticut Resident, Documentation of HIV positive status, & Income 400% FPL or less  Connecticut Insurance Premium Assistance Program Connecticut AIDS Drug Assistance Program (CADAP) YearEnrolled ClientsNew ClientsClients with Insurance 6/20141,939161,259 6/20132,155181,117 6/20122,136371,127

HIV continuum of care, Connecticut, 2012 (data reported through 2013) The overall population is overestimated because at time of report cases were only followed up for 11 months after 12/31/2012. CDC suggests that every case should be followed up at least 18 months to collect death certificate information.

 Goal:  Develop & coordinate state & local strategies to identify people who are unaware of their HIV positive status, refer, and link them to medical care and support services  Target Populations:  MSMs: 24% of Connecticut PLWH (2011 data)  Black Heterosexuals: 32% of CT PLWH  Hispanic Heterosexuals: 32% of CT PLWH  Individuals termed “Unaware”  Not been tested in past 12 months  Not informed of HIV test result (+ or -)  Not been informed of their confirmatory test result Early Identification of Individuals with HIV/AIDS (EIIHA)

 Fund 2 Programs  Collaborate services with MAI, OTL, MCMs, PS, Prevention Programs, Medical Providers, Community Based Organizations, etc.  Outreach & Education Soup kitchens, homeless shelters, adult bookstores, know drug trafficking sites, MSM cruising sites, package stores, minority based cafes, housing complexes, youth service centers, faith based organization, etc. Early Intervention Services (EIS)

 Develop “street relationships” to identify potential clients and gate keepers  Develop key points of entry to access sex workers, MSM “party” groups, IDU and homeless individuals not residing in shelters  Provide referrals for HIV C&T, prevention services if HIV negative; medical case management (MCM), medical care, health insurance, CADAP, etc. if HIV positive  Can provide HIV C&T if no other HIV C&T services are available EIS Continued

 MCMs collaborate with EIS to locate and re-engage clients who have fallen out of care and/or MCM  Provide education & counseling for newly diagnosed HIV positive individuals Accompany client to first medical appointment refer client to PS, etc.  Provide HIV information and promote HIV testing at targeted community events  Provide follow-up for 3-6 months to ensure clients remain engaged in care EIS Continued

Outcomes  Individuals referred to C&T: 369 (8 HIV Positive)  Out-of -Care individuals returned to care: 50  New to Care clients: 15  Case Study EIS continued

 One program located in Hartford County  Focus is to identify and facilitate entry or re-entry in to care for minority HIV positive individuals and to connect eligible clients with CADAP  CADAP (Average April-June 2014)  White: 1,392  Hispanic: included in White  Black: 852  Asian: 21  Native American: 11  Pacific Islander: 2  Clients referred to CADAP: 4 Minority AIDS Intervention (MAI)

 Bi-lingual/Bi-cultural staff  Targeted Outreach Education at shelters, soup kitchens, drop-in- centers, City of Hartford Health Van, streets, etc.  Targeted Community Education  Provide HIV Testing when other testing programs are not available  Assist in locating and re-connecting minority PLWH who are lost-to- care  MCMs referred 30 out-of-care clients to CAHEC & all clients were located & re-connected to care (2012)  Collaborate with other Ryan White providers, PS, MCMs, community Organizations Minority AIDS Intervention (MAI)

 8 Statewide programs (Currently 260 active clients)  Eligibility: Connecticut resident, documentation of HIV positive status, income of 300% FPL or less, and contemplating or taking HIV medications  Collaboration with client’s Medical Provider & MCM encouraged  Medical/psychosocial model staffed by Nurses  Services are provided in a medical and/or community based settings Medication Adherence Program (MAP)

 Provide an assessment of client’s motivation, strengths, & weakness for medication adherence and understanding of HIV disease  Assess the clients psychosocial situation, identify any barriers to adherence, and develop strategies with the client to overcome the barriers  Develop an individualized Care Plan  Provide HIV disease & treatment education and Adherence Tools MAP Continued