RAPPORTEUR SESSION

HIV/STD/TB/VIRAL HEPATITIS SYMPOSIUM

SEPTEMBER 17-18, 2014

What Is PCSI?

A mechanism for organizing and blending interrelated health issues, activities, and prevention strategies to facilitate comprehensive delivery of services that are based on five principles:

• Appropriateness• Effectiveness• Flexibility• Accountability• Acceptability

2

Documenting Your Service Integration Plan

Target Population Setting Services Offered Training Needs

Notes

 Males and females <24 years old

 Family Planning clinic

GC, CT, syphilis screening; opt out HIV testing; Hep A, B Vac as needed

Front desk staff trained to inform patients of needed screenings

Vaccinations available as funding allows

Men who have sex with men (MSM)

HIV testing centers

Opt-out HIV testing and syphilis testing; referral for GC, CT

Collection of urine

Ensuring provision of results for all tests

Persons exposed to TB

TB clinics TB testing; HIV opt-out testing

Rapid HIV test; providing positive results

Linkage to care plan needed for HIV+ results

Six Steps to Assess Your Program and Create a Plan for Improvement

1. Review your programs, analyze data2. Look for areas where service integration

could benefit programs3. Identify barriers and facilitators to program

collaboration and service integration4. State your findings and share them across

programs5. Develop and refine your goals and

objectives6. Develop and refine your service integration

plan

Coordination Across Payers:Translating Coverage into Care and Treatment

SERVICE QHP MEDICAID RW/ ADAP/CDC

HIV Testing Continue to cover in certain settings

RX Cost-sharing assistance

MEDICAL CASE MANAGEMENT

ORAL HEALTH

LABS Cost-sharing assistance

MENTAL HEALTH SERVICES

Cost-sharing assistance

SUBSTANCE ABUSE TREATMENT

Cost-sharing assistance

HIV PRIMARY CARE Cost-sharing assistance

MEDICAL TRANSPORTATION Limited Coverage

INPATIENT HOSPITAL SERVICES

Adapted from West Virginia Ryan White Part B Program

Leveraging New Resources/Payers: It’s Complicated!

Service covered?

Provider in network and credentialed with payer?

Does reimbursement

cover cost of service?

What is impact on

client/patient?

Translate public health service into language of payers/insurance (e.g., CPT codes)

Assess provider requirements (licensed provider; provider supervision; provider recommendation; setting)

Compare reimbursement rate (within capitation or FFS) with cost of providing service

Are privacy and confidentiality concerns addressed?

Sexual Behavior Questions

Percent of students who . . . 9-12 grade

. . . Ever had sexual intercourse 44.9%

. . . Had sexual intercourse for the first time before age 13 3.8%

. . . Had sexual intercourse with four or more people during their life 12.7%

. . . Have ever given or received oral sex 41.3%

. . . Describe themselves as gay, lesbian, or bisexual. 6.2%

ND YRBS 2013

Sexual Behavior QuestionsPercent of students who . . . 9-12 grade

. . . Have ever been tested for a sexually transmitted disease (STD) including HIV, the virus that causes AIDS. 12.8%

. . . Have ever had the HPV vaccine, a vaccine to prevent human papillomavirus or HPV infection. 35.6%

. . . Whose parents or other adults in their family talked with them about what they expect them to do or not do when it comes to sex.

58.4%

. . . Have ever had sex education in school. 74.0%

ND YRBS 2013

OUTBREAK THEMES

1. Contact Investigation

2. Training

3. Continuing Education

4. Incentives – No Walmart

5. Collaboration & Communication

PARTNERSHIP DEVELOPMENT

North Dakota Department of Agriculture

Youth Services – Police Department

North Dakota Department of Health

Emergency Preparedness and Response Immunization Program

Refugee Health Providers

Schools and Health Educators

North Dakota Department of Health Immunization Program

HPV Vaccine: Cancer prevention

Adolescent Vaccination• The ACIP recommended age for HPV vaccination coincides with the recommended age for

other adolescent vaccines, Tdap (tetanus, diphtheria and acellular pertussis) and MCV4 (meningococcal conjugate vaccine), but the rate of vaccination for HPV is much lower than both Tdap and MCV4.

>= 1 dose Tdap >= 1 dose MCV4 >= 1 dose HPV (female)

>= 3 doses HPV (female)

>= 1 dose HPV (male)

>= 3 doses HPV (male)*

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

86.0%

77.8%

57.3%

37.6%34.6%

13.9%

95.0% 93.7%

57.5%

41.1%36.1%

18.4%

2013 Rates for the United States and North Dakota ±

USND

± Rates are from the 2013 National Immunization Survey (NIS)

North Dakota Department of Health Immunization Program

HPV Vaccine: Cancer prevention

Coming up! New HPV vaccine

o Merck is in the process of licensing a new HPV vaccine.9-valent HPV vaccine (V503) o V503 includes five more HPV types (31, 33, 45, 52, 58) in

addition to the four original HPV types (6, 11, 16, 18) in GARDASIL.

o In clinical trials it prevented approximately 97 percent of cervical, vaginal and vulvar pre-cancers caused by HPV types 31, 33, 45, 52, and 58.

o ACIP may recommend the vaccine in 2015.

North Dakota Department of Health Immunization Program

HPV Vaccine: Cancer prevention

Number of TB Cases inU.S.-born vs. Foreign-born Persons,

United States, 1993–2013*

*Updated as of June 11, 2014.

No.

of C

ases

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20112012

20130

5,000

10,000

15,000

20,000

U.S.-born Foreign-born

National Veterinary Services Laboratories – Suelee Robbe Austerman

MSM Heterosexual Injection Drug Use

Risk • HIV + partner• Recent STI• High # partners• Inconsistent / no

condom use • Commercial sex

worker

• Not monogamous• Behaviorally

bisexual• Infrequent

condoms with partners at risk HIV (MSM/IDU)

• HIV + injecting partner• Sharing paraphernalia• Recent drug tx (but currently injecting)

Eligibility • Documented negative HIV test• No signs of acute HIV infection

• Normal renal functions• Documented HBV infection / vaccination status

Prescription TDF/FTC (Truvada) daily, continuous, < 90 day supply

Services Every 3 months follow up with: • HIV test, medication adherence, risk reduction • No signs / symptoms of acute HIV infection • STI assessment q3 months then q6 months

STI testing Pregnancy test / intent q-3 mos

Access to clean needlesDrug rx services

NDDOH FUTURE ACTIVITIES Educate Providers: Website, Fundamentals Online

ACA – Resources for Building Billing Capacity

Support on how best to integrate services within your facility to leverage new funding source opportunities

Work to overcome issues related to how EOB and insurance utilization information is sent for covered services

Evaluation – Program Improvement and Policy Decision

Data Reporting Resource for Local Epidemiological and Data Needs

Outbreak Response Plans for HIV.STD.TB.Viral Hepatitis

Working with DPI on Opportunities to Provide Resources for Schools and Policy Initiatives

CLOSING REMINDERS CEUs

Turn in on Registration Desk Certificate will be emailed

Our Program Information on the Back of Agenda

Please Turn in Evaluation Form

Parking Validation – Yellow Cards

Lunch N’ Learn – September 24th: HIV (CME Credits)

THANK YOU for Coming and Safe Travels!