HIV CARE COLLABORATIVE

Transcription

1 HIV CARE COLLABORATIVE FOR UNDERSERVED POPULATIONS IN THE U.S. While much has been accomplished, 50,000 new HIV diagnoses are reported each year 1 in the United States, and other statistics suggest that more needs to be done, especially among underserved populations. Thirty years after scientists reported the first cases of HIV/AIDS, significant achievements have been made in researching and developing a range of effective treatments that allow people to live with the disease. 2 The fight against HIV/AIDS has also involved a range of efforts from healthcare providers, government, advocates, academia and the pharmaceutical industry, among others. Combined public/private sector work has raised awareness about the disease, promoted behavior change and improved access to HIV care that has saved lives and improved the health outcomes for many of the estimated 1.2 million Americans living with HIV. 1, 3 hivcarecollaborative.org

2 MERCK FOUNDATION COLLABORATIVE EFFORT TO IMPROVE HIV CARE IN THE U.S. Essential to overall HIV-prevention efforts is the need to address the higher rates of infection among underserved and at-risk populations, and to provide those with HIV the care they need to remain healthy. One in six Americans are unaware of their HIV status, and, among those known to have HIV, one in three receive no care at all 3, 4 African Americans represent approximately 12% to 14% of the U.S. population, but accounted for an estimated 44% of new HIV infections in Latinos/Hispanics represented 16% of the population but accounted for 21% of new HIV infections in One-fourth of Americans living with HIV are women, and the disease disproportionately impacts women of color 7 In 2010, black men who have sex with men (MSM) continued to account for the largest number of new U.S. HIV infections (14,700), followed closely by white MSM (13,200) 8 To help address remaining barriers to HIV care, especially among underserved populations, the Merck Foundation launched a three-year initiative HIV Care Collaborative for Underserved Populations in the United States (the Collaborative ) to connect more people living with HIV to the care they need to stay healthy. The Foundation has committed $3 million to support local health departments in Atlanta, Georgia; Houston, Texas; and Philadelphia, Pennsylvania, which are among the top 10 cities with the highest HIV burden in the U.S. 4, 9 2

3 CONNECTING PEOPLE LIVING WITH HIV TO CARE Research shows that when you are able to connect HIV positive (+) individuals with ongoing care, it not only reduces HIV risk behaviors and reduces viral load from antiretroviral therapy (ART), it also contributes to overall decreases in HIV transmission. This is why the U.S. National HIV/AIDS Strategy (NHAS) calls for the establishment of a seamless system to immediately link people to continuous and coordinated quality care when they are diagnosed with HIV. 1, 2 In alignment with this NHAS goal, the Collaborative tackles this challenge head on, working to improve access to available healthcare for HIV+ people by: Integrating innovative, communitybased approaches with local public health systems to improve timely access to quality HIV care for underserved adult populations Helping to reduce new HIV infections among populations at greatest risk Sharing important findings to further the development of other programs that connect people living with HIV/ AIDS to needed care and treatment FULTON COUNTY DEPARTMENT OF HEALTH AND WELLNESS (ATLANTA) Fulton County s Bridging the Gap Initiative focuses on linking HIV+ individuals to medical care. Trained linkage coordinators connect newly diagnosed HIV+ individuals with care within three months of diagnosis. Linkage coordinators also engage individuals who tested HIV+ in the past but who never entered care, and clients who have fallen out of care. Prospective clients include individuals testing for HIV at Fulton County Department of Health and Wellness clinics, as well as individuals who test HIV+ through programs operated by partnering community agencies. Fulton County Department of Health and Wellness collaborates with faculty at Emory University, also in Atlanta, to evaluate the impact of the Bridging the Gap Initiative on retention in care and clinical outcomes. APPROACH Deploying linkage coordinators to facilitate access to care and assist HIV+ clients in obtaining essential services, as well as support engagement and retention in care Evaluating clients readiness to enter care, identify and help address barriers to care, coordinate clinical and support services with the client s care team, and offer other direct client interventions Learn more at 3

4 DEPARTMENT OF HEALTH AND HUMAN SERVICES (HOUSTON) The Expanded Linkage to Care Initiative (ELCI) is a multisector effort bringing together healthcare providers, community groups and researchers to undertake a data-matching program and service-linkage strategy to identify and re-engage HIV+ Houston residents who have fallen out of care. These providerand system-based programs help improve health outcomes of HIV+ individuals and reduce new infections in the Houston area. The City of Houston collaborates with faculty at the University of Texas to evaluate the impact of the ELCI on retention in care and clinical outcomes. APPROACH Implementing a data-matching protocol designed to identify HIV+ individuals who are out-of-care in the Houston area, using laboratory and Ryan White HIV/AIDS Program data Receiving referrals from sexually transmitted infection (STI) clinics, Harris Health, Houston Area Community Services, Legacy Community Health Services and the St. Hope Foundation Deploying trained service-linkage workers to locate HIV+ individuals who have been lost to care, assess and address barriers to care, coordinate clinical and support services with the client s care team, and offer other direct client interventions Learn more at /health DEPARTMENT OF PUBLIC HEALTH (PHILADELPHIA) The Engaging HIV+ Patients in Care Initiative uses system navigators to help guide HIV+ patients through city health centers and other parts of the local healthcare system to improve regular care, viral suppression and management of HIV-related co-morbidities. The Initiative also promotes regular HIV testing and provides customer-service training to city health center staff to augment HIV care and prevention efforts. The City of Philadelphia collaborates with faculty at Philadelphia University and the City of Philadelphia AIDS Activities Coordinating Office to evaluate the impact of the Initiative on retention in care and clinical outcomes. APPROACH Deploying trained Health System Navigators to advocate for HIV+ patients and identify needed resources to help coordinate the complex healthcare and social services necessary to ensure improved patient outcomes Improving City Health Center services by undertaking qualityimprovement activities and strengthening the capacity of staff to communicate and interact effectively with patients Enhancing existing evaluation and quality-management systems to assess health outcomes and quality of care Learn more at /AboutDPH.html Improving access to timely HIV care and helping reduce new HIV infections 4

5 MEASURING RESULTS George Washington University s (GWU) School of Public Health and Health Services serves as the national program office (NPO) for the Collaborative. GWU provides overall technical assistance to Collaborative partners and helps them foster a peer-learning network. GWU is also conducting a cross-site evaluation of the Collaborative s programs. A cohort of newly identified and previously lost-to-care HIV+ adults will be enrolled in care linkage, engagement and retention interventions that employ linkage workers and patient navigators. The cohort s care will be tracked over time to assess clinical and other outcomes associated with these interventions. INTERVENTIONS The Collaborative interventions offer short-term care linkage and patient navigation services for HIV+ adults. By providing these services, Collaborative staff help engage newly identified HIV+ adults in HIV medical care, or re-engage HIV+ adults who have been out of care for at least six months. These staff are referred to as service linkage workers, linkage coordinators or health system navigators. INTERVENTION POPULATIONS AND COMPARISON GROUP The intervention populations addressed in the multi-site evaluation include HIV+ individuals who are at least 18 years of age at the time of enrollment in the Collaborative intervention, have written confirmation of their HIV+ status, and reside in Fulton County (Georgia), Harris County (Texas) or Philadelphia. They also must be either (1) newly identified as HIV+ and untreated for HIV, or (2) out of HIV care for at least six months prior to the date of enrollment in the Collaborative s intervention. The comparison group includes individuals who meet the same criteria as the intervention population but who will not receive the Collaborative s intervention. EVALUATION DOMAINS Feasibility and effectiveness of linkage-to-care and re-linkage services in public health settings Clinical outcomes associated with individuals receiving linkage/ re-linkage services Organizational characteristics that facilitate or impede retention in medical care and use of ART Direct costs associated with linkage and re-linkage services Impact of turnover among Collaborative workers on continuity of care EVALUATION DURATION The evaluation is being conducted over 24 months, including a pilot period in Year 1 of the project to recruit staff, design interventions and establish data-collection processes. KEY EVALUATION METRICS Patient Participation Measures Newly identified HIV+ adults enrolled in the Collaborative HIV+ adults who were lost to HIV medical care but have been re-engaged in care Patient Process Measures Newly diagnosed HIV+ adults who are identified through HIV screening Newly identified HIV+ adults linked to HIV medical care by Collaborative service linkage workers and patient navigators Months from first HIV+ test to linkage to care for newly diagnosed HIV+ adults Three- and six-month retention rates of HIV+ adults at baseline and after Collaborative service linkage or patient navigation intervention Quality of Care Measures (baseline and annual rates) HIV+ adults who completed two or more medical visits HIV+ adults prescribed ART Patient Outcome Measures Baseline and trends in ART outcomes, as measured by longitudinal changes in CD4 counts and viral suppression 5

6 REFERENCES 1. Centers for Disease Control and Prevention, Vital Signs: HIV Prevention Through Care and Treatment United States, CDC Morbidity and Mortality Weekly Report, December 2, mmwrhtml/mm6047a4.htm?s_ cid=mm6047a4_w 2. The White House Office of National AIDS Policy, National HIV/AIDS Strategy for the United States, July sites/default/files/uploads/nhas.pdf 3. Centers for Disease Control and Prevention, HIV in the United States, December hiv/statistics/basics/ataglance.html 4. Mugavero, M.J., Lin, H.Y., Allison, J. J., Willig, J.H., Chang, P.W., et al. (2007) Failure to Establish HIV Care: Characterizing the No Show Phenomenon, Clinical Infectious Disease, 45, Centers for Disease Control and Prevention, HIV Among African Americans, January racialethnic/aa/facts/index.html 6. Centers for Disease Control and Prevention, HIV Among Latinos, January hiv/risk/racialethnic/hispaniclatinos/ facts/index.html 7. Centers for Disease Control and Prevention, HIV Among Women, April risk/gender/women/index.html 8. Centers for Disease Control and Prevention, HIV Among Men in the United States, January men/index.html 9. Centers for Disease Control and Prevention, Estimates of New HIV Infections in the United States. August topics/surveillance/resources/ factsheets/pdf/incidence.pdf Copyright 2013 Merck & Co., Inc. All rights reserved.