1. New York State Hepatitis C Continuity Program

2. NYS HCV Continuity Program
What is the purpose and why is it needed
What is the process
What is the role of the HCV Care & Treatment Programs’ Linkage to Care Specialist
What lessons have we learned

3. NYS Dept. of Corrections and Community Supervision (DOCCS) - Inmate Profile
Characteristic
Category
Inmates Under Custody
Gender
Male
95.5%
Female
4.5%
Age
Average Age
38.3%
Race/Ethnicity
White
24.4%
African American
48.6%
Hispanic
24.0%
Region
NYC
43.7%
Rest of State
56.2%
Crime
Violent Felony
65.0%
Drug Offense
12.6%
Property/Other
12.8%
April 2011, Department of Corrections merged with Division of Parole
51,744 individuals under custody
54 state facilities
Data as of January 1, 2016

4. Survey of Incoming Inmates – HIV, HCV
The Prison Study
Study began in Runs every two years.
Sample of inmates coming into NYS DOCCS facilities.
During the 2012 study, 4,205 inmates included:
79% male; 21% female
Black was the larges race/ethnicity group
Average age 34 years
20.5% reported IDU
18.9% reported being sex partner of IDU
14.2% reported exchanging sex for money or drugs
1.7% male inmates reported MSM risk

5. Survey of Incoming Inmates – HIV, HCV (2)
HIV seropositivity- 2.6% overall
2.4% male; 3.7% female
HCV seropositivity
10.7% overall
9.6% male; 14.6% female
HCV seropositivity has remained relatively stable between 2000 and 2012
HIV/HCV coinfection
0.7% (32) inmates were coinfected
0.9% males; 0.3% females

6. NYSDOH NYSDOCCS Longstanding relationship between both agencies
NYSDOH AIDS Institute (AI) meets quarterly with NYSDOCCS
Collaborate on a number of initiatives related HIV infected inmates
Public Health Law (2009) giving AI oversight to the HIV and HCV care in correctional facilities
Correctional facility policies and practices regarding HIV/AIDS and hepatitis C prevention and treatment must be consistent with current, generally accepted standards and procedures used to prevent transmission and provide treatment among the general public.
AI reviews DOCCS HIV and HCV policies
AI monitors HIV and HCV quality of care within DOCCS facilities
CD4, HIV viral load, HCV screening, genotype, etc.
DOH will perform an annual review of each facility focusing on whether policies and practices are consistent with current, generally accepted medical standards and procedures in the community
-DOH will have access to facilities, records, staff and the prison population
-Prior to the review, DOH must inform the public of its schedule and permit public input
-After its review, DOH must issue a report either approving the policies and practices or finding deficiencies and mandating DOCS to develop and implement a corrective plan, which DOH will monitor
Criminal Justice Initiative
This initiative also funds community-based organizations to provide re-entry assistance for formerly incarcerated individuals living with HIV/AIDS. Services include transportation, supportive services, risk reduction counseling, coordination of health and human services, referral to community case management and Project START. This strong collaboration allows for the targeted distribution of Health Resource Portfolios and Work Release Packets containing HIV/STI/HCV prevention information and male and female condoms that are provided to inmates as they leave the facility.

7. NYS Hepatitis C Continuity Program
Established in 2006
First such program in the U.S.
Program for DOCCS inmates receiving treatment for HCV
Provides a treatment completion opportunity to inmates released from DOCCS on HCV medications
Allows treatment to be initiated within DOCCS regardless of length of stay
Enables inmates to receive timely referral to appropriate community-based health care providers for continuation of treatment
Inmate participation is voluntary
Unfunded program; however, DOCCS budget supports purchase of HCV medications for inmates

8. Key Partners NYS Department of Health (DOH)
NYS Department of Corrections and Community Supervision (DOCCS)
Community-Based Health Care Providers

9. Partner Roles DOCCS (Regional Infection Control Nurses – RICNs) NYSDOH
Provide patient education
Ensure all necessary forms are completed
Contact community-based provider for appointment upon release
Faxes patient health information to provider
NYSDOH
Assist RICNs with making inmate initial appointment with community-based provider
Follow-up with community-based provider to see if patient attended 1st medical appointment
Program evaluation

10. Partner Roles (2) Community-based providers:
Accept inmate’s Continuity Program Forms, medical information, and labs
Provide continuity of HCV care and treatment post-release

11. Challenges Inmates Early releases Shelter placement
Lack of resources for shelter referrals
HCV is not a single qualifying condition for Health Homes
Lack of statewide coverage for referrals
Lack of funding
Inmates released without medication
Lack of/delays in Medicaid activation post-release
HCV is now a priority medical condition for inmates’ Medicaid reactivation/enrollment

12. HCV Continuity Program Data, 2006-2013
# referrals
Number of appts. kept
% appts. kept
ROS inmates
126 85
67%
NYC-based inmates
101 46
45.5%
Total
227
131
58%
* Appointment scheduled within two weeks post release

13. Continuity Program Linkage Specialist
Strong feeling that more could be done to link these inmates to care
Small number enrolled/year
AI-funded Linkage Specialist selected based on background and skills
Protocols developed
DOCCS RICN notifies Linkage Specialist of new enrollment and schedules phone intake, sends intake forms to Linkage Specialist
Linkage Specialist conducts phone intake; makes pre-release care arrangements; notifies parole officer; appointment reminders; contacts provider to confirm if appointment kept
Initiative kicked off- January 2014
Linkage Specialist retired in 2015, duties not redelegated
Improving linkage to care

14. HCV Care & Treatment Programs
15 AI-funded Programs
Provide on-site HCV medical care, care coordination, treatment, and supportive services in a primary care setting
Providers located Upstate and Downstate
HepCAP (patient assistance program) available only to uninsured patients seen by the funded programs
Each program has a Linkage to Care Specialist on-staff who works with patients to assess potential barriers to care to ensure they attend their medical appointments
Linkage to Care Specialists work with RICN to schedule appointment and link patient to care post-release
LCS ensures patient attends HCV medical appointments
Conduct barrier assessment, link patient to additional resources as necessary (i.e., transportation assistance)
Alert others involved in patient’s care (i.e., Parole Officer, shelter) of the appointment

15. Program Spotlight: Bronx Transitions Clinic Model
Correctional Facility
Populations: HCV-positive, mental illness, chronic health conditions
Osborne Association: education, linkage to medical care
Outreach begins in prison.
Linkage to Care Specialist (LCS) is a trained Community Health Worker.
LCS provides direct transportation on the day of release
Osborne Association
CHCC
LCS provides patient navigation:
Medical appointment within 2 weeks
Phone call reminders
LCS facilitates continuity of care:
Appointment reminders
Refill requests
Reentry Services
Primary Care, HIV care, Mental Health

16. NYC Check Hep C Patient Navigation
Nine HCV Patient Navigation programs in health centers across NYC
Goal- link NYC residents living with HCV to medical care
Patient Navigators support patients to complete HCV medical evaluation and successful treatment, prevent reinfection, and maintain liver health post-treatment
Program services provided to patients at no cost, such as linkage to HCV medical care, escorts, drug and alcohol counseling, treatment readiness and adherence, etc.
Patient Navigators collaborate with the AI and RICNs to accept Continuity Program referrals
Pat

17. HCV Continuity Program Data, 2014-Current
# referrals
# of appointments kept
% appointments kept
ROS inmates 23 20
86.9%
NYC-based inmates 19 11
61.1%
Total* 42 31
73.8%
* 2 referrals excluded: 1 pending outcome; 1 discharged to rehab post-release

18. Medicaid Workgroup
Workgroup of key stakeholders convened to look at challenges with reactivation of Medicaid post-release
AI, OHIP, DOCCS
Increased understanding of Medicaid enrollment process
Work flow diagram developed and shared internally
DOCCS increased medication supply post-release (28-days for oral medications only)

19. Lessons Learned
Inmates leaving prison on HCV treatment can be linked to care
Linkage to Care Specialist is key to referral process
Inmates require some level of care coordination/case management to be linked post-release
Activation of Medicaid is important to continuity of care
HCV is now a priority medical condition for inmates’ Medicaid reactivation/enrollment
Dedicated staff is key!

20. Lessons Learned (2)
“It takes a village” to link these individuals to care
All organizations involved in the patient’s care must be included on health release, such as shelters and other CBOs
RICNs encouraged to:
Use the HCV Continuity Program patient agreement as a tool/reminder of compliance
Use Treatment Action Group (TAG) fact sheets:

21. Thank You!
Questions?
Stephanie McHugh, MPH Bureau of Hepatitis Health Care AIDS Institute, NYSDOH (518)