nc pci progress report, february 2012

18
+ North Carolina Positive Charge Initiative Access to Care Progress Report February 2012

Upload: ncaidsfund

Post on 24-Jun-2015

699 views

Category:

Health & Medicine


1 download

TRANSCRIPT

Page 1: NC PCI Progress Report, February 2012

+

North Carolina Positive Charge Initiative Access to Care

Progress Report February 2012

Page 2: NC PCI Progress Report, February 2012

+Access to Care Study after study outline the importance of consistent HIV care

n  Based on his cumulative research, Edward M. Gardner, et al. estimates only 50% of those who know they are positive are retained in care, and a mere 24% of those who know their positive status have achieved an undetectable viral load. This is crucial to reducing HIV transmission in light of recent research headed by Myron Cohen, M.D. indicating a 96% decrease in HIV transmission between serodiscordant couples when the partner with HIV initiated antiretroviral therapy while their immune system as still stronger (CD4 350 and 550) and builds on years of mounting evidence that a lower viral load reduces the risk of HIV transmission.

Page 3: NC PCI Progress Report, February 2012

+Access to Care

n Engagement in routine HIV care, in addition to the public health benefits of reduced HIV transmission, reduces overall costs of treatment through: delayed disease progression, extension of productive life years, and avoidance of costly emergency care.

Page 4: NC PCI Progress Report, February 2012

+Who is out of Care? In North Carolina generally and the NC Positive Charge Initiative

n  In North Carolina, an estimated 23.4% of those who know they are HIV+ are not receiving HIV medical care.

NC Epidemiologic Profile for HIV/STD Prevention and Care Planning (12/11)

Age of Clients, NC PCI

18-24

25-29

30-39

40-49

50+

Annual Income, NC PCI

<$20,000

$20,000-40,000

$40,000-80,000

Missing

Race, NC PCI American Indian/Alaska Native

Black, non-Hispanic

Hispanic

White, non-Hispanic

Page 5: NC PCI Progress Report, February 2012

+Why are people out of Care? Barriers to Care and Meeting Basic Daily Needs NC Positive Charge Initiative clients

0

10

20

30

40

50

60

70

Drug and alcohol abuse

treatment

Housing or shelter

Food or other subsistence

need

Dental services HIV-related medical services

Non-HIV related medical services

Pharmacy or medication services (for

HIV or non HIV reasons)

Mental health services

Current Needs of NC PCI clients at Enrollment

percentage

Page 6: NC PCI Progress Report, February 2012

+

NC Positive Charge Initiative Key Partners:

North Carolina Community AIDS Fund

Hertford County Public Health Authority

Mecklenburg County Health Department

Partners In Caring

RAIN

Started in July 2010, the NC Positive Charge Initiative is designed to find people who know their positive status but are out of care, connect them to HIV medical care, and support those in care that face barriers to adhering to care.

NC Positive Charge Initiative access to care.

Page 7: NC PCI Progress Report, February 2012

+Program Outline North Carolina Positive Charge Initiative n  Teams of 2-3 part-time Access

Coordinators work to identify people who know they are HIV+ but out of care, bring them into care, and retain people in care who are at risk of disengaging

n  Access Coordinators received PETS (peer education) training and the specially designed Access Coordinator training: n  planning an event, outreach,

identifying resources, public speaking, self care

n  Access Coordinators split their time between their HIV agencies and non-HIV community settings

n  Funding for the Positive Charge Initiative is provided by AIDS United and Bristol-Myers Squibb

The Positive Charge Initiative serves rural, suburban, and urban areas of the state, reaching clients in 18 counties.

Page 8: NC PCI Progress Report, February 2012

+

Hertford County Public Health Authority

n  The HCPHA is the lead agency in the local HIV Network of Care; it is the only agency providing HIV care in the region. The team consists of the Program Manager, 2 RNs, 2 Medical Case Managers, 1 Jail Testing Coordinator and 3 Access Coordinators. Many of the services that can be, are brought to the location of the clients for a one stop shop approach to care.   

n  The work is accomplished with the aid of a mobile unit to hold clinics in different areas to attempt to overcome the huge transportation challenges in the region. HCPHA has 5 mobile clinic sites and 1 fixed site clinic.

n  We see the clients on a quarterly basis; the more constant contact is needed to keep them engaged in care.  Having the Access Coordinators has added another layer in the ability to make that personal connection with clients.  The ACs attend all clinics and lab days to work with clients as needed which has been important as issues with clients have popped up, clients have a chance to meet with them immediately.

Tommy Jones, Access Coordinator

Delton Smith, Access Coordinator

Tracy Bristow, HIV Program Manager

Page 9: NC PCI Progress Report, February 2012

+

Mecklenburg County Health Department

n  Two Access Coordinators work in conjunction with the Access Coordinators at RAIN to provide services to the residents of Mecklenburg County.

n  The Access Coordinators have received referrals from the Disease Intervention Specialist program, case managers, HIV testing programs, local clinics, current clients, and other service providers.

n  The Access Coordinators invited numerous service providers to an evening of food, fellowship, and education in the effort to promote the Positive Charge Initiative in Mecklenburg County. The event allowed providers and Access Coordinators to develop strategies to successfully implement the project.

Lamont Holley, Access Coordinator

DeVondia Roseborough, Access Coordinator

Brian Witt, Supervisor, Health Education

Page 10: NC PCI Progress Report, February 2012

+

Partners In Caring

n  The team of three Access Coordinators serve a six-county region.

n  Many of the counties served lack adequate transportation to medical care and supportive services. Partners in Caring Positive Charge Initiative project offers home visits, linkage to care, medical transport and education activities and events.

n  Access Coordinators work very closely with the New Hanover Regional Medical Center’s HIV Clinic in order to secure continuity of care for clients. ACs along with with their supervisor attend monthly quality improvement meetings with the HIV Care Team in order to update and report changes with an out of care list created by the clinical staff.

Cressie Stokes, Access Coordinator

Hayden Braye, Access Coordinator

Suzette Curry, Senior Clinical Chaplain – Community Educator

Page 11: NC PCI Progress Report, February 2012

+

RAIN Regional AIDS Interfaith Network

n  RAIN has been providing HIV services to the Charlotte community for 20 years. Their team of two Access Coordinators have expanded that work to include access to care.

n  The Access Coordinators are working with medical care providers and case managers to identify people who have missed three medical appointments to bring them back into care.

n  The Access Coordinators continue to focus some of their outreach work on health fairs but are placing more focus on events that offer HIV testing.

n  Through the Positive Charge Initiative, a new partnership has been started to work with the public housing authority to provide education and connect residents to care.

Dee Dee Richardson, Access Coordinator

Richard Mills, Access Coordinator

Cheryl Roberge, Director of CARE Management

Page 12: NC PCI Progress Report, February 2012

+

North Carolina Community AIDS Fund

n  The North Carolina Community AIDS Fund (NCCAF) is a Community Partnership of AIDS United, administering grants statewide and serving as an AmeriCorps Operating Site in the Triangle in addition to our Access to Care work.

n  As the project lead, NCCAF coordinates communication between project partners and conducts the project evaluation.

n  NCCAF provides orientation and annual training for the Access Coordinators.

n  Tools have been developed for Access Coordinators and resources gathered for agencies working with peers and conducting access to care work.

Beth Stringfield, Project Coordinator

Kimberly Walker, Principle Investigator

Sammy Tchwenko, Evaluator

Page 13: NC PCI Progress Report, February 2012

+ Tools for Partners To support program development and staff www.NCcommunityAIDSfund.org/positivecharge.php

Outreach Self Care

Page 14: NC PCI Progress Report, February 2012

+Successes n  Since enrollment began in last 2010, over 100 clients have

entered the project, an additional 40+ people have received PCI services, dozens have received HIV testing, and hundreds have received HIV education.

n  Preliminary data show an increase in the mean CD4 count and decrease in viral load in six months of clients’ active enrollment in the program.

n  Additionally, the percent of clients with an undetectable viral load has grown, based on preliminary data.

n  A skills-based curriculum was developed to prepare Access Coordinators to fill these newly created positions.

n  We have seen improved referrals systems for HIV care and support and reduced no-shows at medical clinics.

Page 15: NC PCI Progress Report, February 2012

+Successes n  Access Coordinators have conducted HIV education and

prevention outreach at public housing complexes, community colleges, churches, and colleges, and have hosted community HIV testing events.

n  New partners in HIV prevention and education have been identified in the three regions.

n  Strong integration of the Access Coordinators onto the staff has increased capacity of agencies and allowed new services to added.

n  Private funding has provided the flexibility needed to serve clients across county lines, regardless of their current engagement in HIV medical care, and to have a single position provide a continuum of services from education and prevention to supportive care.

Page 16: NC PCI Progress Report, February 2012

+Lessons learned n  Training is important. Challenge: Access Coordinators that

don’t receive the initial training have been at a significant disadvantage in their position, however logistics and expenses prevent hosting it for each new person. The 3-day Access Coordinator curriculum is being broken down into individual learning modules for new staff members.

n  Street and community outreach is difficult. Challenge: people have been out of care for a reason, finding then in the broader community is extremely time consuming, leading us to focus more on those who are new to care and tenuously in care.

n  Basic HIV education is still needed. Challenge: Access Coordinators have been faced by significant deficits in general HIV knowledge, as a result they have been doing more HIV education than anticipated.

Page 17: NC PCI Progress Report, February 2012

+Lessons learned n  Transportation costs remain a barrier. Challenge: the

amount of travel for outreach, connecting clients to care, and individual clients’ transportation remain high in spite of PCI funding for transportation, a mobile medical unit in the northeast, and public transportation in Charlotte.

n  Access Coordinators need to be fully integrated in the agency. Challenge: Access Coordinators that are not validated as full staff members have not be as successful in reaching their enrollment numbers, conducting outreach work, and have lower job satisfaction. Some factors that contribute to the success of the program have included providing Access Coordinators adequate work space and tools, introductions to the staff and clear distinct job roles, support from the leadership, incorporating PCI into the referral system, and assuring Access Coordinators participate in agency meetings and trainings.

Page 18: NC PCI Progress Report, February 2012

+

NC Positive Charge Initiative is a project of the North Carolina Community AIDS Fund 2812 Erwin Road, Suite 403 Durham, NC 27705 919.613.5431

www.NCcommunityAIDSfund.org