NY Links LIRG Kick Off Meeting_8-24-15

Transcription

Long Island Regional Group (LIRG)
Kick-Off Meeting
August 24, 2015
August 31, 2015
2
Welcome & Opening Remarks
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Dr. James L. Tomarken, Suffolk County
Nina Scollo, Nassau County
Christine Hunter, HIV Planning Council
Steven Sawicki, NY Links Project Director
Stephen Crowe, LIRG Lead
3
Agenda
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Introductions
What is NY Links?
Break
Ending the Epidemic by 2020
Building a System to Link & Retain Patients –
Regional Service Map Exercise
 Working Lunch – Building Collaborative
Relationships
4
Agenda (Cont.)
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Epidemiology Data & Long Island
AI Initiatives: LRTA & ExPS
Break
Consumers & QI
Wrap-Up:
o Next Steps
o Evaluation
5
Introductions
6
What is NY Links?
Clemens Steinbock
Steven Sawicki
Systems Linkages and Access to Care for
Populations at High Risk for HIV Infection
in New York State
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Overall Objective
• Improve Linkage to Care
• Improve Retention in Care
• Improve Viral Load Suppression
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Background Information
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HRSA ‘SPNS’ grant received 9/1/11
 Special Projects of National Significance
o Part of the Ryan White HIV/AIDS Program
o Supports the development of innovative and sustainable
systemic models to improve linkage to and retention in
quality HIV care through implementation of quality
improvement collaboratives (Regional Groups)
o 4-year funding cycle awarded to six states
o Strong evaluation/research component to assess the
effectiveness of models, and then focus on the
dissemination and replication of successes at a state
and national level
o SPNS ends in 8/15 but NYLinks rolls on
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NY Links Overview
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NY Links Mission
 We identify and spread innovative solutions for
improving linkage and retention in HIV care that support
the delivery of routine, timely, and effective care for
PLWHA in New York State.
 We will bridge systemic gaps between HIV related
services and achieve better outcomes for PLWHA
through improving systems for monitoring, recording,
and accessing information about retention, linkage, and
viral load suppression in NYS.
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Regional Collaboratives
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Existing collaborative locations in New York State
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Upper Manhattan
Regional Group
• Engagement of all medical, non-medical,
and supportive services providers in the
Upper Manhattan geographic area to
improve linkage to and retention in HIV
care. Initiated 10/11.
• Expectations for participation:
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Quarterly face-to-face meetings
Routine data submission of
standardized indicators
Implementation of QI interventions to
address internal and cross-agency
linkage/retention challenges
Blue-Clinical Program Participating in the Upper
Manhattan Regional Group
Yellow-Supportive Service Program Participating in
Upper Manhattan Regional Group
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Western New York Regional Group
•
Red-Programs Participating in the WNYS
Regional Collaborative
• Engagement of all medical, non-medical,
and supportive services providers in the
Western NY geographic area (Rochester and
Buffalo) to improve linkage to and retention
in HIV care. Initiated 6/12.
• Current progress:
– Next Learning session scheduled for
August 2015
– Facilities utilizing data, as a system
and individually, to locate areas
where interventions would have the
most impact
– Some facilities working on
improving tracking systems for
better identification
16
Queens & Staten Island Regional Group
• Engagement of all medical, non-medical, and
supportive services providers in the Queens
and Staten Island geographic area to improve
linkage to and retention in HIV care. Initiated
2/13.
– Breaking Queens and Staten Island
into separate regional groups
– Facilities working on data acquisition
and analysis as well as QI/QM team
building/strengthening
– Generating momentum to work on
linkage and retention interventions
17
Mid and Lower Hudson Regional Group
• Engagement of all medical, nonmedical, and supportive services
providers in the Mid and Lower
Hudson geographic area to improve
linkage to and retention in HIV care.
Initiated 1/14.
– Generating momentum to
jointly work on linkage and
retention improvement
– Collected baseline
information to assess
readiness as well as TA needs
18
Bronx and CNY/Southern Tier
 Working with NYC DOHMH to connect
NYLinks to the current Bronx Knows
initiatives.
 CNY/Southern Tier forming now with first
meeting set for November 19, 2015
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Methods
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NY Links Collaborative Measures
 The following measures will be collected and reported in
aggregate by all NY Links regional groups participating
HIV clinical, general medical, and supportive service
providers and should capture all patients/clients with a
diagnosis of HIV/AIDS, regardless of age or funding
sources.
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Brief Overview of NY Links Measures
Measure
Agency Type
Linkage
All Programs that conduct HIV testing
Retention
HIV Clinical Care
New Patient Retention
HIV Clinical Care
Clinical Engagement
Supportive Services, General Medical &
Dental Programs*
Viral Load Suppression
All Sites
*Including those co-located within HIV clinical care sites
22
NY Links Measures Definitions
Linkage to care among
newly diagnoses
patients
Percentage of newly diagnosed patients in the reporting period who had their first HIV
clinical care visit within 30 days of the date of their confirmatory HIV test
Clinical retention
Percentage of patients with at least one HIV clinical care visit during the first 6 months of
the 24-month measurement period who had at least one HIV clinical care visit in each 6month period of the remaining 18 months of the measurement period with a minimum of 60
days between HIV clinical care visits (in line with HRSA/HAB measure)
New patient retention
Percentage of new patients who have their initial HIV clinical care visit during the first 4
months of the 12-month measurement period who had an HIV clinical care visit in each of
the subsequent 4-month periods in the measurement period
Clinical engagement
Percentage of active HIV clients/patients with a supportive service, general medical, or
dental visit during the reporting period who have a documented or self-reported HIV clinical
care visit within the prior 6 months
Viral load suppression
Percentage of patients, regardless of age, with a diagnosis of HIV with a HIV viral load
less than 200 copies/mL at last HIV viral load test during the measurement year
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Performance Measurement Expectations
 Self-reporting of NY Links measures quarterly
 Submission of performance measurement data to NY
Links online database (www.newyorklinks.org/database)
 Sharing of quality improvement (QI) activities
 Future Webinars, Regional Groups, and Partnership
Meetings will provide more in-depth information
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Strategies
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Stakeholder engagement, including providers of HIV services (medical, service,
consumers, Medicaid, NYC DOHMH, Local County DOHs)
Standardized NY Links-specific retention and linkage measures that are used in
all collaborative activities
Online reporting database to facilitate self-reporting and instantaneous
benchmarking
On-site coaching by state and nationally recognized improvement experts
Program coordination and management by NYSDOH AIDS Institute
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Strategies
 Integration of NYS surveillance teams to effectively
utilize existing data sets and to make them accessible
to frontline providers for QI efforts
 Providers and consumers part of planning and
implementation of regional processes in order to build
an infrastructure for sustainability of peer learning
opportunities
 Consumers are full partners of NYLinks
 Regional approach to improvement
 Utilization of existing structures for support of work
 NYLinks key part of Governor’s Ending the Epidemic
Initiative
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NY Links Website
www.NewYorkLinks.org
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BLOG
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Continuum of Care
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Engagement in Care Continuum
Non-Engager
Sporadic User
Fully Engaged
[1] Health Resources and Services Administration, HAB. August 2006. Outreach: Engaging People in HIV Care Summary of a
HRSA/HAB 2005 Consultation on Linking PLWH Into Care.
[2] Eldred L, Malitz F. Introduction [to the supplemental issue on the HRSA SPNS Outreach Initiative]. AIDS Patient Care STDS
2007; 21(Suppl 1):S1–S2.
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CDC Cascade
MMWR December 2, 2011 / 60(47);1618-1623
BHAE
New York State Cascade of HIV Care, 2013
Persons Residing in NYS† at End of 2013
0
50,000
100,000
150,000
Estimated HIV Infected
Persons
129,000
Persons Living w/ Diagnosed
HIV Infection
Cases w/any HIV Care during
the year*
Cases w/continuous care
during the year**
Virally suppressed ( n.d. or
≤200/ml) at test closest to
end-of-year
112,000
87% of infected
86,000 67% of infected
77% of PLWDHI
74,000
70,000
58% of infected
66% of PLWDHI
55% of infected
63% of PLWDHI
82% of cases w/any care
* Any VL or CD4 test during the year; ** At least 2 tests, at least 3 months apart
†Persons presumed to be residing in NYS based on most recent address, regardless of where diagnosed.
Excludes persons with AIDS with no evidence of care for 5 years and persons with diagnosed HIV (nonAIDS) with no evidence of care for 8 years.
BHAE
0
50,000
100,000
Persons
129,000
Testing
and
112,000
Prevention
87% of infected
HIV Infection
the year*
during the year**
end-of-year
150,000
Linkage
74,000
70,000
77% of PLWDHI
Engagement
58% of infected
66% of PLWDHI
ART Therapy and Adherence
55% of infected
63% of PLWDHI
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The 5 Interventions selected by
NY Links for dissemination
1. ARTAS (Anti-Retroviral Treatment and
Access to Services)
2. Appointment Procedures
3. Consistent Messaging
4. Outreach/Return to Care
5. Peers
BHAE
0
50,000
100,000
1
ARTAS
2
Appointment
Procedures
3
Consistent
Messaging
4
Outreach/Return
to Care
5
Peer support
150,000
Persons
129,000
HIV Infection
the year*
during the year**
end-of-year
112,000
87% of infected
77% of PLWDHI
74,000
70,000
58% of infected
66% of PLWDHI
1,2,3,5
1,2,3,4,5
55% of infected
63% of PLWDHI
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Participant Teams
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Participant Teams
 Identify a leader who will drive change, support quality improvement
activities, direct resources and facilitate communication within the
organization in support of the agency specific NY Links activities
 Form a multidisciplinary team, including expert staff (data and
evaluation, quality improvement, clinical providers, consumer(s)
involved in QI) to participate as a team in the LIRG; and
 Members of the Participant Team attend all learning sessions and
champion linkage, retention, and VLS activities in the agency.
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Roles
 Identify key staff to fill the following potential
roles/responsibilities:
o Senior Leader/Participant Team Lead
o Point of Contact – person who can move QI projects ahead and
coordinate
o Data Manager – to help with data extraction, accuracy and submission
o Clinical Provider – someone to inform the project
o Consumer/PLWHA actively participating in QI
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Partnership Meetings
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Purpose of Partnership Meetings
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Learn more about your agency and your participation in current HIV activities
and coalitions/networks
Meet with your staff who will be involved in the NY Links Initiative; including
representation from agency’s Primary Care, Supportive Service, HIV Testing,
and Quality Management Programs
Strengthen your agency’s understanding of the NY Links Long Island Regional
Group (LIRG)
Components:
o Complete a Regional Group Assessment
o Address any questions regarding LIRG
o Identify team members for LIRG participation
o Discuss pre-work/measures/QI activities for future LIRG meetings
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Partnership Meeting Logistics
 Meeting Duration: 90-120 minutes
 Each visit will be lead by a representative from NYSDOH, Stephen
Crowe, and when possible, Steven Sawicki, NY Links Project
Director, and a representative from Regional DOH
 Partner Participation:
o Executive Leader(s), QI Program Coordinator, Data/IT Coordinator,
and/or any other team members
 Aim to complete meetings by end of September
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Who are the DOH staff
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Abigail Baim-Lance
Barbara Bright-Motelson
Barbara Westad
Ben Katz
Beth Woolston
Bruce Agins
Carol-Ann Swain
Clemens Steinbock
Dalys Febres
Dan Belanger
Dan Tietz
Denis Nash
Diane Addison
February Dauria
Felicia Schady
Howard Lavigne
Jill Dingle
Jim Tesoriero
Johanne Morne
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Joy Williams
Julie Helberg Hirsch
Karen Hagos
Kelly Piersanti
Lauren Suchman
Linda DiCamillo
Lyn Stevens
Mary-Ellen Mancinelli
Meaghan Abrego
Megan Johnson
Nanette Brey-Magnani
Rachel Malloy
Stephen Crowe
Steve Sawicki
Susan Weigl
Yanick Eveillard
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Contact Information
 Clemens Steinbock, MBA, Quality Initiatives Director
[email protected]
 Steven Sawicki, MHSA, NY Links Project Director
 [email protected]
 Bruce Agins, MD, MPH, Medical Director
[email protected]
 Stephen Crowe, MSW, NY Links LIRG Lead, 212-417-4558
[email protected]
 General Information: [email protected]
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BREAK
Ending the Epidemic in New York
State by the end of 2020
Steven Sawicki
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Defining the “End of AIDS”
A 3-Point plan announced by the
Governor on June 29, 2014
1.
Identify all persons with HIV who remain
undiagnosed and link them to health care.
2.
Link and retain those with HIV in health
care, to treat them with anti-HIV therapy to
maximize virus suppression so they remain
healthy and prevent further transmission.
3.
Provide Pre-Exposure Prophylaxis (PrEP)
for persons who engage in high-risk
behaviors to keep them HIV negative
Reduce the number of new HIV
infections to just 750 [from an
estimated 3,000]
by 2020
AGGRESSIVE ACTION
47
Establishment of
the Ending the
Epidemic Task
Force
----------------October 14, 2014
Governor Cuomo
announced the
appointment of an
Ending the Epidemic
Task Force made up of
key stakeholders
representing public and
private industry and
community leaders
expert in the field of
HIV/AIDS.
The Task Force is
responsible for
developing and
issuing a Blueprint for
New York State to
achieve the Governor’s
three stated goals.
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Members met on five occasions between October 2014 and
January 2015.
Each Committee reviewed recommendations as they were
received from the public. Task Force meetings provided an
opportunity for Committees to review, prioritize and discuss the
recommendations.
Committees were charged with providing key
recommendations that build on New York State's existing HIV
prevention, care and supportive service efforts.
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Blueprint Structure and Content
On January 13, 2015 the
NYS Ending the Epidemic (ETE) Task Force completed
its charge and finalized 44 committee
recommendations that address HIV related prevention,
care and supportive services.
Committee Recommendations were informed by 294
community recommendations and 17 statewide
stakeholder meetings.
The final Blueprint will contain
30 Blue Print Recommendations and
7 Getting to Zero Recommendations.
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Key Populations
The Task Force ensured that
prioritizing the needs of key
populations significantly impacted by
HIV and AIDS became a central
component of the final ETE
Blueprint document.
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Public Release of the Blueprint
April 29, 2015
We must add AIDS to the list of diseases conquered by our
society, and today we are saying we can, we must and we will
end this epidemic.
~Governor Cuomo
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Blueprint Alignment with NHAS 2020
https://aids.gov/federal-resources/nationalhiv-aids-strategy/nhas-update.pdf
“Several jurisdictions have, through focused efforts, seen
decreasing trends in HIV, including the States of New York and
Massachusetts and the cities of San Francisco and Los Angeles.
In addition, some States and local areas have put forth their own
plans to “end AIDS,” such as New York State, Washington State,
and San Francisco.” – NHAS 2020 Pg. 17
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Blueprint Recommendations (BPs)
Link and retain persons diagnosed with HIV in care to maximize virus
suppression so they remain healthy and prevent further transmission.
BP5: Continuously act to monitor and improve rates of viral suppression
BP6: Incentivize Performance
BP7: Use client-level data to identify & assist patients lost to care or not virally suppressed
BP8: Enhance & streamline services to support the non-medical needs of persons with HIV.
BP9: Provide enhanced services for patients within correctional and other institutions.
BP10: Maximize opportunities through DSRIP process to support programs.
BP29: Expand & enhance the use of data to track and report progress
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New and Expanded Programs

NY Links, a Special Project of National Significance (SPNS),
is designed to bridge systemic gaps between HIV related
services within New York State in order to achieve better
outcomes for people living with HIV. It improves systems
for linking to and retention in care, as well as for
monitoring, recording, and accessing information about
HIV.

The Linkage, Retention and Treatment Adherence
Initiative is a comprehensive care model that facilitates
patient entry into treatment and uses collaborative
strategies and interventions that engage all program and
clinic services and staff, as well as community partners,
to retain patients in care, promote adherence to
antiretroviral treatment (ART), and achieve viral
suppression.
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Expanded Partner Services Program (ExPS) uses HIV
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surveillance data to identify previously known HIV positive
individuals who appear to be out-of-care in order to reengage them in medical care. The presumed out-of-care
individuals are targeted with the specific objectives of reengaging these individuals in medical care and notifying
and testing/treating partners. Anticipated to re-engage
over 1,000 individuals to care annually by 2016.
Positive Pathways, working with HIV-positive
incarcerated persons to encourage the initiation of
medical care and treatment for HIV during incarceration,
and to ensure linkage to medical care and continued
care and treatment for six months following release.
This initiative also works to reduce HIV-related stigma
through education and training of correctional officers,
medical staff, and inmates.
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The Investment
$10 Million towards Ending the Epidemic
services and expenses in the 2015-2016 Budget
Article VII
2014 - 2015 Amendments
•
•
•
Elimination of written consent for HIV
testing.
Expand data sharing between state and
local health departments and health care
providers for linkage and retention
efforts.
Implementation of a “30% rent cap”
affordable housing protection.
Article VII
2015 - 2016 Amendments
•
•
•
Elimination of written consent for HIV testing
in correctional facilities.
Limiting the admission of condoms in
criminal proceedings for misdemeanor
prostitution offenses.
Addressing the legality of syringes obtained
through syringe exchange programs.
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Ending the Epidemic Marketing Campaign
 Launched on March 16,
2015
 ‘Get Tested. Treat Early.
Stay Safe.’
 The campaign is statewide
and includes a variety of
audio and print media
 health.ny.gov/ete
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Implementation: AAC ETE Subcommittee
AIDS Advisory Council (AAC) Ending the Epidemic (ETE) Subcommittee:
The Subcommittee will ensure on-going formal involvement of the AAC in followup and recommendations on the implementation of the Ending the Epidemic Task
Force (ETE TF) recommendations.
 16 Members: The selection of members to the Subcommittee was conducted
as part of the completion of the work of the ETE TF and is representative of
each ETE TF Committee
 Co-Chairs: Charles King, President and CEO, Housing Works, Inc.
Marjorie Hill, PhD, CEO, Joseph Addabbo Family Health Center
 Ending the Epidemic Website:
https://health.ny.gov/EndingtheEpidemic
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Activities Report Card & Dashboard
Coming
Soon!
The AIDS Institute will develop and post an
annual ETE Activity Report Card to assist in
sharing progress towards our stated goals as well
as on recommendations included in the ending
the epidemic Blueprint document.
Key metrics will be systematically tracked at the
state and local levels, with publicly available
results. The AIDS Institute will develop an ETE
Dashboard which will assist in sharing progress
towards our stated goals and share key metrics
and data relevant to ending the epidemic in NYS.
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NYS Regional Discussions

Receive updated information about HIV/AIDS in your region/borough.

Provide input on identified service gaps in your region/borough.

Participate in regional/borough discussions about ending the epidemic.
NYS Regional Discussion Dates
Syracuse
August 3
Manhattan, Lower
September 21
Buffalo
August 12
Brooklyn
September 24
Rochester
August 13
Queens
October 13
Albany
August 18
Staten Island
October 14
Hudson Valley
August 24
Nassau County
November 12
Bronx
August 31
Suffolk County
November 13
Manhattan, Upper
September 22
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Thank you
Steven Sawicki
[email protected]
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Building a System to Link and Retain
Patients: Small Group Work
Stephen Crowe
Table Facilitators
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Building a System to Link and Retain
Overview:
To visually create a system and its sub systems that depict
organizational relationships that link patients to care within the
Nassau and Suffolk County regions.
The diagrams will illustrate:
• the strength of organizational relationships (none to strong)
• linking and retaining patients in care
Uses: Over time,
• identify strengths, weaknesses, and opportunities for
improvement (system, sub-systems)
• peer exchange
• identifying needs for TA and content and methodology for
regional workshops
63
Part 1: Regional Service Map
30 minutes
1. There are four colors:
Pink = Supportive Service
Yellow = Testing
Blue = Clinical
Green = Other
2. Each agency writes its name on the appropriately colored circle. If there
are several services within an agency, the agency can write its name on
each of the designated color circles.
3. Each agency tapes its circle(s) on the flip chart paper.
4. Draw an arrow connecting your agency to those agencies that you have
a linkage and retention relationship with (i.e. protocols in place, frequent
referrals and follow up, etc.). An arrow in one direction means the
communication is essentially in one direction. An arrow that goes in both
directions means there is flow both ways.
5. Draw a dotted line to those agencies that you have a more informal
relationship with and less frequent referrals.
6. If you work with an agency that is not here, add its name to a circle and
tape it to the diagram.
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Buffalo
(WNY)
Regional
Group
Service
Map
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Part 2: Present to the Group
10 minutes
1. Present your service diagram to the group.
2. The group makes observations, comments,
suggestions.
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Part 3: Brief Discussion
5 minutes
Large group exchange:
1. Share your experience and observations in
creating the diagram. Were there new insights?
To what degree was there agreement?
2. What are some of your system’s strengths? Subsystems strengths?
3. Are there opportunities to strengthen your system?
Sub-system?
4. What can you observe about your strategies for
linking or retaining patients?
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WORKING LUNCH: Building
Collaborative Relationships
Trends in HIV infection
New York State and Long Island
Presentation to: NYLinks Long Island Regional Group
Carol-Ann Swain
Bureau of HIV/AIDS Epidemiology
AIDS Institute
Presentation Outline
 HIV and AIDS in New York State (NYS)
o NYS and Long Island
 Changes to how NYS counts cases of HIV and AIDS
 HIV care outcomes
o NYS and regional
 Summary
Trends in HIV and AIDS*
New York State, 2002-2013
6,000
140,000
New HIV
5,000
People
living
with
HIV
4,000
3,000
120,000
Number of PLWDHI
Number of HIV Diagnoses and
Deaths
7,000
100,000
80,000
Deaths
among
persons
with HIV
& AIDS
People
living
with
AIDS
at end of
year
2,000
1,000
60,000
40,000
20,000
0
0
200220032004200520062007200820092010201120122013
*Data as of April 2015. New HIV diagnoses include those diagnosed concurrently with AIDS.
HIV named reporting began in NYS in 2000.
Newly Diagnosed HIV Cases by County of Residence at Diagnosis
New York State, 2013 (Excludes New York City)
EXCLUDES prison
inmates*
INCLUDES prison inmates*
*Prison inmate refers to persons incarcerated in state correctional facilities at the time of diagnosis (even if they
are no longer in prison). The county of residence at diagnosis reflects the county of incarceration at the time of
diagnosis or first report, which may be different from the individual’s home county and later county of
incarceration.
Number of People Living with Diagnosed HIV/AIDS by County of
Residence at Diagnosis New York State, 2013 (Excludes New York City)
EXCLUDES prison
inmates*
INCLUDES prison inmates*
*Prison inmate refers to persons incarcerated in state correctional facilities at the time of diagnosis (even if they
are no longer in prison). The county of residence at diagnosis reflects the county of incarceration at the time of
diagnosis or first report, which may be different from the individual’s home county and later county of
incarceration.
New HIV Diagnoses, 2013
Nassau-Suffolk Ryan White Region
 Majority male (78%)
 52% have MSM (men who have sex with men) transmission risk
 Highest rates of diagnosis by age
o 20-24 years
20.8/100,000 population
o 25-29 years
 Race/ethnicity
o Non-Hispanic blacks 23.8/100,000 population
o Hispanics
o Non-Hispanic whites
Persons Living with Diagnosed HIV Infection (PLWDHI),
2013
Nassau-Suffolk Ryan White Region
 Majority male (68%)
 52% have MSM transmission risk
 Highest prevalence rates by age
o 40-49 years
380/100,000 population
o 50-59 years
 Race/ethnicity
o Non-Hispanic blacks 717/100,000 population
o Hispanics
o Non-Hispanic whites
New Diagnoses of HIV by Transmission Risk
New York State, 2002-2013
0
IDU
Heterosexual
Fem. Pres. Het.
Pediatric
MSM/IDU
MSM
Unknown
*Data as of April 2015
500
1,000
1,500
2,000
20
02
20
04
20
06
20
08
Counting PLWDHI for HIV Care Measures – A New
Approach
 Until this year, all NYS HIV Surveillance reporting of PLWDHI has
been based on residence at HIV or AIDS diagnosis
 For many NYS-diagnosed cases the surveillance system has no
evidence of NYS residence in recent years
 Accurate reporting of measures of HIV care outcomes requires
counts of persons actually resident in the area (e.g. county)
 The Bureau of HIV/AIDS Epidemiology has developed a method to
report estimated PLWDHI by most recent known address
 This new method is used in the HIV care outcomes that follow
PLWDHI, 2013 – Two Methods
Living cases, NYS,
12/2013
by residence at
diagnosis
n=133,400
Use: Cascades through 2013
Annual Surveillance Reports
Out-of-state
diagnosed cases
with most recent
address in NYS
n=5,800
Use: Cascades 2013+
NYS diagnosed
cases with nonNYS recent
address
n=1,600
Cases with no events
(e.g., laboratory report) for
5 yrs (AIDS) or 8 yrs (HIV
non-AIDS)
n=25,200
Living cases, NYS,
12/2013 by recent
address
New York State Cascade of HIV Care,
2013
0
50,000 100,000 150,000
Estimated HIV Infected Persons
129,000
HIV Infection
112,000
87% of infected
the year*
86,000
77% of PLWDHI
during the year**
74,00066% of PLWDHI
≤200/ml) at test closest to…
67% of infected
58% of infected
55% of infected
70,00063% of PLWDHI
Linkage to Care within 3 Months of HIV Diagnosis by Region
of Diagnosis, New York State, 2013
% Linked
NHAS 2015
Goal 85%
New York State
Rochester
Syracuse
Albany
M. Hudson
Nassau Suffolk
New York City
Buffalo
L. Hudson
Binghamton*
82%
89%
86%
85%
84%
84%
82%
81%
79%
73%
0%
*Based on less than 20 persons.
20%
40%
60%
80%
100%
Cascade of HIV Care: Nassau-Suffolk Ryan
White Region
Persons Residing in the Nassau-Suffolk Ryan White Region†, at End of 2013 (includes
prisoner cases)
0
2,000
4,000
HIV Infection
the year*
during the year**
6,000
6,200
5,400
87% of
infected
62% of infected
3,800
71% of
PLWDHI
46% of infected
53% of
PLWDHI
53% of infected
3,30061% of PLWDHI
86% of cases w/any
†Persons presumed to be residing in the Nassau-Suffolk RWR based on most recent care
2,900
address, regardless of where diagnosed. Excludes persons with AIDS with no evidence of
care for 5 years and persons with diagnosed HIV (non-AIDS) with no evidence of care for 8
Cascade of HIV Care: Nassau-Suffolk Ryan
White Region
Persons Residing in the Nassau-Suffolk Ryan White Region†, at End of 2013 (excludes
prisoner cases)
0
2,000
4,000
6,000
5,900
HIV Infection
the year*
5,200
87% of infected
61% of infected
3,600
70% of PLWDHI
during the year**
2,70053% of PLWDHI
3,100
61% of PLWDHI
46% of infected
53% of infected
†Persons presumed to be residing in the Nassau-Suffolk RWR based on most recent address, regardless of
where diagnosed. Excludes persons with AIDS with no evidence of care for 5 years and persons with
diagnosed HIV (non-AIDS) with no evidence of care for 8 years.
Summary (1): Disease Burden in the Population
 New diagnoses of HIV in NYS are decreasing
o From ~6,000 (2002) to ~3,500 (2013)
 Outside NYC, Nassau and Suffolk are among the counties with the
highest number of new diagnoses of HIV and PLWDHI
 HIV disease burden is greatest among men who have sex with men,
Black and Hispanic individuals
 Persons of younger age (20-29 years) had the highest rate of new
infections in 2013
 Persons of older age (40-59 years) represented the majority of
prevalent cases
Summary (2): HIV Care Outcomes
 NYSDOH new method for reporting care outcomes more accurately
reflects where diagnosed person reside
 Approximately one-third of PLWDHI are not virally suppressed
o NYS (63%) and Long Island (61%)
 Work remains to reduce new infections in certain populations and
ensure that HIV-infected individuals are diagnosed, in care, and
virally suppressed
Nassau and Suffolk Counties
Potential NYLinks Sites
Contact
Carol-Ann Swain
[email protected]
Bureau of HIV/AIDS Epidemiology
AIDS Institute
New York State Department of Health
[email protected]
LRTA
Linkage, Retention & Treatment
Adherence Program
Office of the Medical Director, AIDS
Institute
LRTA CONTRACTORS
Evergreen Health Services
Anthony Jordan
Arnot-Ogden MC
Middletown CHC
SUNY Stony Brook
North Shore
U of R – Data Center
ECMC
Trillium Health
SUNYSyracuse
AMC
NUMC
WMC
BACKGROUND
National HIV/AIDS Strategy
• Reduce new HIV infections
• Increase access to care &
improve health outcomes
• Reduce HIV related health
disparities
Objectives
• Link 85% newly diagnosed
within 3 months
• Retain 80% in continuous care
• Increase proportion of
diagnosed gay & bi men with
undetectable viral load by 20%
• Increase proportion of Blacks
with undetectable viral load by
20%
• Increase proportion of Latinos
with undetectable viral load by
20%
New York’s Three Point
Plan to End the Epidemic
(ETE)
• Identify persons with HIV who remain undiagnosed and
link them to health care.
• Link and retain persons diagnosed with HIV in health
care to maximize virus suppression so they remain
healthy and prevent further transmission.
• Facilitate access to Pre-Exposure Prophylaxis (PrEP) for
high-risk persons to keep them HIV negative.
LRTA Goal
Improve outcomes for PLWHIV/AIDS by:
• Increasing their linkage to care
• Improving their retention in care
• Promoting adherence to ART
Increase access to PrEP
• HIV negative individuals at high risk
• Prescribing PrEP
• Adherence Services
LRTA Strategies
• Collaboration within the facility and community partners
• Evidence based interventions:
Outreach workers, retention specialists, peers, EBIs
such as ARTAS, HEART etc.
• Available to all patients with emphasis on those of
most need
• Systematic measurement of linkage, retention and
adherence supported by a funded data center
LINKAGE STRATEGIES
• Engagement in care through systemic outreach to
individuals scheduled for an initial appointment
because of new diagnosis
• Collaboration with other departments and community
sites
• Identify factors most frequently related to failure to link
to primary care and use info to guide outreach and
engagement
• Identify active outreach and follow-up activities to
engage those who did not keep appointments
• Measure linkage to care of all newly diagnosed
PLWHIV/AIDS receiving primary care
LINKAGE MEASURES
• % of new patients with first primary care visit within
30 days of confirmatory HIV test
• Number of newly diagnosed patients scheduled for
initial appointment
• Same as NYLinks
RETENTION STRATEGIES
• Assessment of non-retention risks for each patient and a plan
to address barriers
• Use of outreach workers, peers, support groups and other EBIs
to promote retention
• Availability of specialty health and supportive services
• Participation in regional NYLinks regional meetings
• EBIs
• Health Home coordination
• Monitoring retention using specific outcome measures
RETENTION MEASURE
Measure retention of all PLWHIV/AIDS receiving PC
using the following:
• New patient retention - % of new pts with initial
visit during first 4 months and subsequent 4
month periods of a 12 month reporting period
• Global retention - % of pts with at least 1 visit in
first 6 months and subsequent 6 month periods
of a 24 month reporting period
• Same as NY Links
LRTA NEW PATIENT RETENTION
LRTA GLOBAL RETENTION
TREATMENT ADHERENCE STRATEGIES
Two tiers:
• Tier 1 – Treatment naïve and new
patients
• Tier 2 – Patients not virally
suppressed for > 3 months
Tier 1
All new and treatment naïve individuals (enrolled up to
a 12 month period)
• Base line assessment within 30 days of initial appt.
• Evidence based education and counseling
• VL monitoring
• Evidence based interventions that support adherence
• Measurement of adherence through self report at 1,
3, 6 & 9 months
Discharge – achieve & maintain VLS > 3
months
Tier 2
Patients not virally suppressed for > than 3 months, those missing
appointments and/or those lost to follow-up
• Assessment of barriers to retention and adherence every 4
months
• Service plan to ensure coordination and steps to address
retention
• Support groups and peer counseling
• Quantitative and qualitative measurement of adherence
Discharge – Achieve and maintain VLS > 3 months
VIRAL SUPPRESSION MEASURES
• The percentage of PLWHIV/AIDS in the HIV primary
care program who were virally suppressed at the last
VL measure in a 12 month period;
• The percentage of PLWHIV/AIDS who are enrolled in
Tier II services and have not have been virally
suppressed for > 3 months;
LRTA CLINIC-WIDE VIRAL LOAD
SUPPRESSION *
* This data represents consistent suppression over 2
VL Tests >3 months apart. Will be changing to last
VL measure in a 12 month period
PrEP
• Serve HIV negative high risk patients
• Follow NYS guidance for Pre-Exposure Prophylaxis
• Provide adherence support
PrEP MEASURES
• Number of patients receiving adherence/retention
services for PrEP
• Reasons for discontinuing PrEP
• Average length of time on PrEP
• Number of patients infected while on PrEP
DATA CENTER
• Web based data base to track and analyze LRTA data
• Baseline information on linkage, retention and VL
suppression
• Develop data protocols and provide training and
technical assistance to funded LRTA providers
• Makes data available in real time for funded programs
and AI
Communication within AIDS Institute
• Collaborative grant coordination
• Linkage and retention workgroup
• NY Links
QUESTIONS?
Contact information
Howard Lavigne, Program Director
[email protected]
315-477-8479
Beth Woolston, LMSW
[email protected]
518-473-8815
Expanded Partner Services
Using HIV/AIDS Surveillance Data to Advance HIV Prevention
Programming in New York State
Megan Johnson, MPH, CHES
New York State Department of Health
AIDS Institute
Division of HIV/STD/HCV Prevention Services
Objectives
 Understanding of ExPS
 Showcase ExPS as a collaborative
model of care
 Discuss the major players on Long
Island
 Reinforce the ultimate goal of ExPS
 Leave everyone with a charge for
improving care and services to
people living with HIV on Long Island
Expanded Partner Services (ExPS)
Collaboration between the Division of HIV/STD/HCV Prevention and
the Division of Epidemiology, Evaluation & Research
o Health Department Data-to-Care Model
Utilized HIV surveillance data to identify previously known positive
individuals who appear to be out-of-care
ExPS Pilot launched in September 2013
o PS Staff in Erie, Monroe, Westchester, & Onondaga LHDs, with
Coordination by AIDS Institute
o One year Pilot Period (Sept 13 – Aug 14)
Statewide expansion January 2015
Background and Context
Collaboration
& Service
Integration
Health
Centers &
Medical
Providers
State & Local
Health
Departments
Community
Based
Organizations
Ending the Epidemic
1.
Three Point Plan
Identify all persons with HIV who remain undiagnosed
and link them to health care.
2.
Link and retain those with HIV in health care, to
treat them with anti-HIV therapy to maximize
virus suppression so they remain healthy and
prevent further transmission.
3.
Provide Pre-Exposure Prophylaxis for high risk persons
to keep them HIV negative.
BP7: Use Client-level data to identify and
assist patient lost to care or not virally
suppressed
Expansion of ExPS
AI Funded Counties
1.
2.
3.
4.
5.
6.
7.
Erie
Monroe
Onondaga
Westchester
Albany
Orange
Dutchess
8. Nassau
9. Suffolk
10.NYC
Bureau of HIV STD Field Services
Western Region
Buffalo - Allegany, Cattaraugus, Chautauqua, Genesee, Niagara,
Orleans, & Wyoming
Rochester - Chemung, Livingston, Ontario, Schuyler County, Steuben,
Wayne, & Yates
Central Region Broome, Cayuga, Chenango, Cortland, Herkimer,
Jefferson, Lewis, Madison, Oneida, Oswego, St. Lawrence, Tioga, &
Tompkins
Capital Region Clinton, Columbia, Delaware, Essex, Franklin, Fulton,
Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga,
Schenectady, Schoharie, Warren, & Washington
Metropolitan Region Putnam, Sullivan, & Ulster
Long Island Region Nassau & Suffolk
1. Linkage to
medical care;
ExPS
LHD
Generate
Case
Assignment
s
≠ CD4 or VL lab
w/in 13-24 Months
Region
al
Office
HIV Tracking
System
State & Local
Health
Departments
Health
Centers &
Medical
Providers
Community
Based
Organizatio
ns
ExPS
Advocat
e
Patient County of
Residence
Linkage to Medical
Care for Vial
Suppression
2. Referrals for
identified
supportive
services;
3. Prevention/
Risk Reduction
Counseling/
Discussion of
Partners; and
4. Safer sex
supplies.
Long Island
ExPS Advocates of Long Island
Suffolk County
Department Of
Health
Karen Kessler
Nassau County
Department Of Health
Nina Scollo
Tehran Harrison
Roger Miller
NYSDOH Long Island
Regional Office
Meaghan Abrego
Dalys Febres
PLWH Presumed to be
Out of Care (OOC)
N=413
Open Cases
N=146 (35%)
Current to Care
N=96 (37%)
Clinical Trial
N=3 (3%)
New Lab Post
Assignment
N=5 (5%)
Patient/Provider
Verified Current Care
N=88 (92%)
Not Located
N=4 (1%)
Expanded Partner Services
Initiative
Confirmed OOC
N=41 (16%)
Other Outcomes
N=126 (48%)
Deceased
N=33 (26%)
Out of Jurisdiction
(NYC) N=12 (13%)
(Other) N=80 (87%)
Other Reason
N=1 (1%)
Long Island Outcomes Data
Located
N=263 (64%)
Refused
Assistance
N=15 (37%)
Successful
Re-linkage
N=26 (63%)
Case outcomes based on information entered into
NYEHMS Tracking System as of 8/14/15. Includes all
Nassau and Suffolk ExPS cases generated and
assigned from March 2015. Data are subject to change
Data are subject to change pending case transfers,
worker revisions, and/or data QA reclassifications.
EXPS CASE DEMOGRAPHICS – LONG ISLAND
(N=413)
GENDER
AGE D ISTRIBUTION
70.7%
Male
140
Number of Cases
120
30%
100
23%
80
17%
60
40
17%
12%
20
0%
0
<20
20-29
30-39
40-49
50-59
>60
29.3%
Female
EXPS CASE DEMOGRAPHICS – LONG ISLAND
RACE/ETHNICITY
(N=413)
33%
White, NonHispanic
RISK FACTORS UPON TRANSMISSION
0
MSM/IDU
50
100
11%
8%
Other / Missing
MSM
40%
Heterosexual
Unknown
150
3%
IDU
Female Presumed
Hetero
45%
Black, NonHispanic
21%
8%
15%
1%
Asian / Pacific
Islander
13%
Hispanic
122
REASONS OUT OF CARE (RELINKED EXPS CASES, BY GENDER)
EXPS PILOT DATA (2013-2014)
50
45
40
35
30
25
20
15
10
5
0
Males (N=97)
Females (N=67)
Transgender (N=2)
Note: Individuals who were identified as OOC and successfully relinked to care (N=166/232)
What does this mean for me or my
agency?
Medical Provider
Community Based Organization
May contact you or your office to inquire
about the status of a presumed out-ofcare individual to confirm identifying and
demographic information
May contact your agency on behalf of
an HIV positive individual and/or his or
her identified partner(s) in order to link
him/her to the services that your agency
provides.
May also contact you or your office to
link a previously known HIV positive
individual and/or an identified partner(s)
into medical care.
o
The Advocate will then contact you or
your office the date of or shortly after
the patients scheduled medical
appointment to confirm attendance.
State & Local
Health
Departments
Health
Centers &
Medical
Providers
Community
Based
Organizations
Thank You.
Megan Johnson, MPH, CHES
Prevention Services Coordinator
Division of HIV/STD/HCV Prevention Services
[email protected]
518.402.6811
125
BREAK
126
Consumers and Quality Improvement
Dan Tietz
127
Expectations
Stephen Crowe
128
To participate agencies should have the
following:







A QI project team with clear roles and responsibilities (includes Senior
Leader/Participant Team Lead, Project Lead, Data Lead, Clinical Lead, and a
Consumer)
A performance measurement system that is used to routinely monitor the rate of
linkage to and on-going retention in HIV primary care for patients
Demonstrated experience in applying quality improvement methods to identify and
test system changes
Capacity to collect and submit quarterly process and outcome measures related to
the initiative and if an intervention is selected
Willingness to participate in regular meetings with the NY Links staff assessing
intervention fidelity
Willingness to share learning and adapt interventions
Commitment to work with the NY Links team
129
Benefits
130
131
132
133
MORE BENEFITS
• Data collection tools, protocols and support to implement
interventions known to improve timely access and/or
retention in HIV primary care
• Training resources specific to each intervention and for
additional recommended strategies that can supplement NY
Links interventions
• Technical assistance and coaching that includes
assessment of key elements for implementation and ongoing fidelity monitoring for site specific refinement
• Expert input, data reports and tools to assure a sound
evaluation plan
134
EVEN MORE BENEFITS
•
Guidance on developing a successful team
• Opportunities to strengthen cross-continuum teams and
potentially bridge learning across diseases
•
On-going peer exchange and a community of support from
colleagues implementing interventions
•
Opportunity to highlight your agency's progress and expertise in
addressing the key issue of access to and on-going retention in
care to funders and key stakeholders
•
Access to all of the resources available to NY Links so you can
be successful in this endeavor
135
STILL EVEN MORE BENEFITS
• Opportunity to be part of a very limited, nationally
recognized process designed to improve linkage and
retention
• Opportunities to be part of any material published related to
the process or the particular interventions selected
• Potential national and international recognition
136
UPCOMING MEETINGS
• LIRG Participant Meetings at your sites (Aug/Sept)
• Nassau/Suffolk HIV Planning Council Meetings (Sept, Nov, Jan…)
• LIRG Webinars (Measures/Drilling Down Data – Sept/Oct?)
• Ending the Epidemic Regional Meetings:
•
Nassau County 11/12 & Suffolk County 11/13
• LIRG Sub-Regional Meetings (Dec?)
• Second LIRG Meeting (Jan/Feb?)
137
Wrap Up: Summation
Stephen Crowe
Steven Sawicki
138
Wrap Up: Next Steps &
Evaluation
Stephen Crowe
139
Contact Information
 Stephen Crowe, MSW, NY Links LIRG Lead, 212-417-4558
[email protected]
 Steven Sawicki, MHSA, NY Links Project Director
[email protected]
 Clemens Steinbock, MBA, Quality Initiatives Director
[email protected]
 Bruce Agins, MD, MPH, Medical Director
[email protected]
 General Information:
[email protected]
140
With Gratitude & Many Thanks









Johanne Morne
Steve Sawicki
Bruce Agins
Angela Rivera
Karen Hagos
Nanette Brey-Magnani
Susan Weigl
Diane Addison
Carol-Ann Swain








Ben Katz
Dan Belanger
Dan Tietz
Clemens Steinböck
Howard Lavigne
Beth Woolston
Meg Johnson
And YOU!!!
141
Adjourn! Thank you!

NY Links LIRG Kick Off Meeting_8-24-15

Transcription

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