Unleashing the Power of EIS Workshop B:

August 29, 2017 8:40 – 10:00

Unleashing the Power of EIS

• Marjorie Katz – Facilitator • Brenda Huerta - San Ysidro Health Center • Heidi Aiem and Lauren Brookshire – San

Diego County • Colleen Brody and Tamarra Jones –

Orange County

California’s Integrated Plan

Objectives

1. Increase the estimated percentage of Californians living with HIV who know their serostatus to at least 95%.

2. Reduce the number of new HIV diagnosis in California by at least 50%, to fewer than 2,500 per year.

3. Increase the number of Californians at high risk for HIV infection who are on PrEP to 60,000.

4. Decrease the percentage of persons with new HIV diagnosis in California that are diagnosed with Stage 3 (AIDS) within 12 months of diagnosis (i.e., late diagnosis) to less than 17%

California’s Integrated Plan

Strategies

A. Improve PrEP Utilization B. Increase and Improve HIV Testing C. Expand Partner Services D. Improve Linkage to Care L. Increase General HIV Education & Awareness and Reduce Stigma around HIV, Sexual Orientation, and Gender Identity

California’s Integrated Plan Activities

A4. Promote PrEP and Educate about PrEP in Key Populations with Low Uptake B1. Expand Routine Opt-Out HIV Testing in Health Care Settings B3. Expand HIV Testing Targeted to Key Populations C1. Increase Utilization of Surveillance-based Partner Services Activities C2. Enhance Field-based Programs for Partner Notification and Testing C3. Improve Linkage of Partners to Care (if HIV Positive), or PREP and Other HIV

Prevention Interventions (if HIV Negative) D1. Implement Systems for Rapid Linkage to Care D2. Enhance 'Data to Care' Activities to more Rapidly Identify People Who Have Fallen Out

of Care and Actively Re-engage Them in Care D3. Expand use of Patient/Client Navigation Programs D4. Identify Barriers to Linkage to Care and Develop Strategies to Address Them L2. Work with Service Providers to Develop Clear and Consistent Messaging around HIV

Statewide L3. Continue Widespread Condom Promotion and Distribution

San Ysidro Health Center

• Brenda Huerta, Coordinated Services

Manager, HIV Department

SYHC: Humble Beginnings

• Founded in 1969 - 48 years • Local Women’s Organization

Founding Mothers

• Grant in partnership with The Medical Society of SD and UCSD

• Casita – First Clinic Site

SYHC Today • Federally Qualified Health Center (FQHC) • Comprehensive Primary Care and Support Services • More than 91,000 registered patients • 13 clinics serving the South, Central/Southeast and Eastern

regions of San Diego County • Predominately Latino with high rates of poverty, uninsured,

non-English speaking heads of households. The Mission of San Ysidro Health Center is to improve the

health and wellbeing of our community’s traditionally underserved and culturally diverse people.

San Ysidro/Tijuana Border

SYHC Implementation

• 2012 – First implementation of Routine HIV Testing

• Administration Approval • Provider Buy-in (less work to order) • All Staff Training • Focus Groups - Materials

Delivering Positive Results

• Linkage to Care Staff –At the time of result disclosure –Warm hand-off to HIV care

• Who was positive?

–All unlikely to be tested otherwise

HIV Routine Testing

• Is it worth it?

Funding

• Initial funding provided by Ryan White EIS-Part B

• Expanded Testing in Healthcare Settings • Demonstration Project • Title X – Family Planning

Contact Information

Brenda Huerta Coordinated Services Manager

San Ysidro Health Center / HIV Department bhuerta@syhc.org

(619)662-4161

County of San Diego

• Heidi Aiem, Clinic Services Coordinator • Lauren Brookshire, Asst. Medical Services

Administrator

Data to Care Disease Intervention Activities

• It starts with a list! • The list is matched • The refined list is shared with disease investigation

manager • Cases are assigned, investigations are conducted,

linkages are made • Documentation and evaluation are conducted • Final dispositions are made, looped back to SD EPI,

eHARS updated

Data to Care Line List

• State Office of AIDS provides SD EPI with the HIV Data to Care Line List through a secure electronic method.

• List contains all cases presumed to be alive and still residing in San Diego County.

• Cases are organized into 10 categories. • SD EPI matches the cases with local lab data and

match to priorities for disease investigation. • New lists are provided to the disease investigation

manager on a quarterly basis.

Data to Care Implementation Priorities

Cases diagnosed between 12 months and 60 months prior to list created

• No lab HIV labs other than diagnostic test results reported for this case

• Case has likely never engaged in HIV care Priority 1

• Previous HIV care labs received but no results received within last 12 months

• Case has likely fallen out of HIV care Priority 2

Data to Care Assigning Cases for Investigation

• Prior to assignment • Assignment • Logging cases

Data to Care Investigations, Interviews and Linkage to Care

Pre-Patient Interview Activities

Interview Providing Linkages to Care

Data to Care Helpful tips

• Engage providers before rolling out services • Communicate with last known provider before reaching

out to the patient • Obtain original HIV diagnostic labs, when needed • Provide staff access to all available databases used to

locate clients, even if there is a cost

Data to Care Outcomes

OUTCOMES OF HIV DATA TO CARE INVESTIGATIONS (n=56) March 10, 2017 – June 15, 2017 PHASE 1

In HIV care and treatment at the time of investigation 11 (20%)

Successfully linked to HIV care and treatment 5 (9%) Residing outside of San Diego County at the time of

investigation 22 (39%) Still residing in the U.S. 12 Residing in Mexico 6

Lacked sufficient information to successfully investigation 12 (21%)

Case had passed away 3 (5%)

Case was found to be HIV-negative 2 (3%)

Case closed with the individual refusing linkage assistance 1 (2%)

Data to Care Funding

• Ryan White Part B, Early Intervention Services

Contact Information Heidi Aiem (619) 293-4718 Heidi.Aiem@sdcounty.ca.gov Lauren Brookshire (619) 293-4705 Lauren.Brookshire@sdcounty.ca.gov

Orange County Health Care Agency

• Colleen Brody: Program Supervisor for Disease Intervention Services (DIS)

• Tamarra Jones: Program Manager for HIV

Planning and Coordination

Goal of Orange County Program

• Reduce STD/HIV infection • Staff of at least 11 Public Health

Investigators (currently 6 FTE) to: Investigate STD/HIV disease Elicit partners Provide STD and HIV testing to partners Coordinate linkage to STD treatment, HIV

care, and prevention services (including PrEP)

Background of DIS Program • 2012: Transition of roles from providing

STD/HIV Counseling and Testing to “Disease Intervention Specialists (DIS)” coordinating Syphilis Partner Service (PS) activities

• 2014: Expansion of DIS role to HIV PS utilizing HIV surveillance data for case initiation

• 2016: Reorganization of DIS staff to integrate HIV/AIDS Surveillance and Outreach/Data to Care

Funding

• STD PS: Prevention, STD Core, STD Integration Approximately $180,000 annually

• HIV PS: Ryan White Parts A and B Approximately $290,000 annually

• Outreach/Data to Care: Ryan White Parts A and B Approximately $239,000 annually

Unleashing EIS Activities • Goal: Utilize multiple approaches in EIS HIV Surveillance Newly diagnosed Outreach/Data to Care activities

• Staffing: Public Health Investigators (AKA DIS) Outreach staff Case Managers

DIS Unleashing EIS Activities Newly HIV

Diagnosed / Data to Care

Contact

Partner Elicitation/Linkage to Care Referral

HIV/STD Testing of Partner

Linkage to Prevention and/or

Care Services

Orange County Continuum 100.0%

88.7%82.8%

67.6%60.8% 58.6%

100.0%

91.0%84.6%

68.1%63.1%

60.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

HIV Infected HIV Diagnosed Ever Linked to HIVCare

Retained in HIV Care ART Estimate Viral LoadSuppression

HIV Continuum of Care, Orange County, 2015 vs. 2016

2015 2016

Orange County 2016 Outcomes • 320 newly diagnosed • 264 assigned for Partner Services • 80 partners initiated • 19 partners tested (31.1%) • 3 or 4.9% newly diagnosed of the partners tested and 2

or 66.7% have been linked to care • 26 previously positive

– 3 identified as out-of-care – 1 re-engaged in care

Contact Information

• Colleen Brody: (714) 834-7833 Supervisor of HIV Surveillance and HIV PS

• Pristeen Rickett: (714) 834-8615 Supervisor of STD PS

• Tamarra Jones: (714) 834-8798 HIV Planning and Coordination Manager

Getting to Zero Activities

A4. Promote PrEP and Educate about PrEP in Key Populations with Low Uptake B1. Expand Routine Opt-Out HIV Testing in Health Care Settings B3. Expand HIV Testing Targeted to Key Populations C1. Increase Utilization of Surveillance-based Partner Services Activities C2. Enhance Field-based Programs for Partner Notification and Testing C3. Improve Linkage of Partners to Care (if HIV Positive), or PREP and Other HIV

Prevention Interventions (if HIV Negative) D1. Implement Systems for Rapid Linkage to Care D2. Enhance 'Data to Care' Activities to more Rapidly Identify People Who Have Fallen

Out of Care and Actively Re-engage Them in Care D3. Expand use of Patient/Client Navigation Programs D4. Identify Barriers to Linkage to Care and Develop Strategies to Address Them L2. Work with Service Providers to Develop Clear and Consistent Messaging around HIV

Statewide L3. Continue Widespread Condom Promotion and Distribution

Session Title

Questions??