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Care and Prevention in the United States (CAPUS) Tennessee’s Activities

Care and Prevention in the United States (CAPUS) Tennessee’s Activities. Melissa Morrison, MA HIV Prevention Director, Section HIV/STDs Tennessee Department of Health. CAPUS in Tennessee. Background Proposed Activities Progress Challenges. Demographics (TN, 2010).

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Care and Prevention in the United States (CAPUS) Tennessee’s Activities

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  1. Care and Prevention in the United States (CAPUS) Tennessee’s Activities Melissa Morrison, MA HIV Prevention Director, Section HIV/STDs Tennessee Department of Health

  2. CAPUS in Tennessee • Background • Proposed Activities • Progress • Challenges

  3. Demographics (TN, 2010)

  4. Disproportionately Affected Populations (Case Rates per 100,000 population for Newly Diagnosed HIV in TN, 2010) • Statewide = 14.1 • Gender • Men = 21.3 • Women = 6.1 • Race / Ethnicity • Blacks = 54.5 • Hispanics = 19.7 • Whites = 4.9 • Geography • Memphis = 37% • Nashville = 27%

  5. HIV Test Event, Results, and Outcomes (by facility type)(TN PS10-10138 FY1 APR)

  6. TN: HIV Tests Conducted and New HIV Diagnoses in Tennessee

  7. Tennessee HIV Continuum of Care (2010)

  8. TN HIV Continuum of Care: 2010 Status vs. 2015 Goals

  9. TN’s CAPUS Activities

  10. TN’s CAPUS Activities • HIV Testing • 4th Generation Ag/Ab Testing in TN State Labs • Social Networking Strategy Among AA MSM • Navigation • Corrections Navigators • Surveillance • Identify known PLWH who have been out of care for > 1yr • Identify PLWH with sub-optimal response to care • Social & Structural Barriers • Address issues of cultural mistrust, homophobia and stigma affecting all step in the HIV continuum of care (HDs, CBOs) • Reduce barriers related to employment and housing affecting steps along the HIV continuum of care among AA men

  11. HIV Testing Activities

  12. HIV Testing: Additional Considerations • TN’s three regional state laboratories (and 1 contracted lab) continue to utilize the 3rd generation HIV antibody testing technology • Of all individuals cumulatively diagnosed with HIV in TN through the end of 2010 (11,433 of 23,891), 48% self- identified as being MSM; we believe that new infections are under-attributed to this exposure category

  13. HIV Testing: TN CAPUS Activity #1 • 4th Generation Ag/Ab Testing in TN State Laboratories • Utilize CDC / APHL proposed algorithm • Each year fully implemented • ~ 72,000 HIV tests conducted • Estimate >13 acute infections diagnosed which would otherwise be missed • Resources • 4th generation laboratory assays (Ag/Ab& HIV-1/HIV-2 differentiation assay, HIV-1 NAT)

  14. TN’s 4th Gen HIV Testing: Progress QNS = Quantity not sufficient

  15. HIV Testing: TN CAPUS Activity #2 • Social Networking Strategy for MSM • High-impact prevention strategy • 3 CBOs (2 Memphis, 1 Nashville) • 1 SNS Tester and multiple volunteer SNS Recruiters at each facility • Incentives for testing • $20 to Recruiter for each individual recruited • $20 to each individual tested • Each year fully implemented • Test 900 hard to reach MSM • > 5% seropositivity • > 80% newly diagnosed positives into care < 3 months • Resources • 1.0 FTE Central Project Coordinator • 1.05 FTEs per CBO (through existing contracts) • Incentives and fund testing

  16. TN’s SNS Program: Progress • Contracts with CBOs in place May 2013 • Hiring & training complete June 2013 • Testing began June, 2013 • 9 months of testing • 586 tests conducted; 38 positive • 6.5% positivity (lab confirmation: 23 new, 15 prior) • Linkage to care at or above target

  17. Navigation Services

  18. TN Department of Correction Facility Locations Morgan County Correctional Complex (MCCX) Tennessee Prison for Women (TPW) Wartburg, TN Nashville, TN West Tennessee State Penitentiary (WTSP) Charles Bass Correctional Complex (CBCX) Nashville, TN Henning, TN Riverbend Max Security Institution (RMSI) Nashville, TN Northeast Correctional Complex -Annex (NECX) DeBerrySpecial Needs Facility (DSNF) Northwest Correctional Complex (NWCX) Nashville, TN Tiptonville, TN Pickett n o Macon Hanc. Clay Sullivan s Claiborne Scott n h Campbell Hawkins Jack- o Fentress J Wash- r e Overton g son n i Union a r Carter ington G . b m n Smith a H n o o i Greene s t o Morgan r e c n d Putnam i n e n A U J e B f f e r C s o n u m b e DeKalb r l a Cocke n n d White o Roane n n a Van Sevier C e Loudon Blount o Buren s Warren a d e s h e R g l i B e S M e Monroe Grundy q n n i M c u M a t . y e l Polk TurneyCenter Industrial Southeast TN Reg. Correctional Facility (STSRCF) Complex (TCIX) Pikeville, TN Mark H. Luttrell Correctional Center (MLCC) Only, TN Memphis, TN TurneyCenter Industrial Complex Annex (TCIX) Clifton, TN West Tennessee Middle Tennessee East Tennessee Northeast Correctional Complex – Main (NECX) Mountain City, TN Roan Mountain, TN Mont- Robertson Stewart Sumner gomery e k Trou Obion m a Henry L a Weakley Houston h t a Wilson Dickson e s Davidson y h Davidson e C Dyer r h Gibson Knox Knox p Carroll m u d r o H Williamson e f l r a e C d r o h c r t k e e u t t Hickman d R u r a L Hender- u l t l a a Maury Perry Haywood Madison son c h e s Lewis r Bedford D Tipton a Coffee r e t M s e h C e r L o a n o o w M t Wayne l r Giles i Fayette e d Hardeman Hardin m Shelby McNairy n a a r c Marion Franklin Lincoln e H B

  19. TN’s Network of HIV Centers of Excellence

  20. Linkage to Care: TN CAPUS Activity #3 • Corrections Navigators • Utilize existing contracts / relationships with CBOs in each region providing testing in intake facilities • Provide transitional case management for inmates prior to release • Each year fully implemented • 160 inmates provided navigation upon release • > 70% linked to care in the community < 3 months of release • Utilize incentives for linkage to & retention in care • $25 gift cards (upon release and monthly while in care up to 6 months) • Resources • 1.0 FTE per CBO (3 total) through existing contracts • Incentives

  21. TN’s Corrections Navigators Program: Progress • Contracts with CBOs in place • Hiring & training complete • Navigation packets assembled • Facilities contacted / introductions made • Correctional facilities contacted • All prisons & major metropolitan jails • Reporting forms piloted • Navigation services recently began

  22. Surveillance Activities

  23. Surveillance:TN CAPUS Activity #4 • Re-engagement into care • Resources • Hire / train 5.0 “DIS Re-Engagement Case Managers” across the state • Accurint Software applied to EHARS Note: Viral load & CD4 data in EHARS are the proxies for attendance in med care. • Identify known diagnosed PLWH who have been out of care for >1yr • Clients with evidence of any care during prior 3 years (1/1/10 – 12/31/12) • Eliminate anyone who has: • Received care w/in the past 1 year, moved out of state, or died • Stratify remaining list by geography • Stratified lists sent to CAPUS DIS Surveillance staff monthly • Shelby (x2 DIS), Davidson (x1 DIS), Mid-Cumberland (x1 DIS), East (x1DIS) • Each year fully implemented • > 1500 cases / year (300 cases per DIS/year, or 25 cases per DIS/month) • Contact > 70% cases on list • Link > 70% contacted cases into medical care within 3 months of list

  24. Surveillance:TN CAPUS Activity #4 (cont’d) • Improve Response to Care • Resources • Hire / train 5.0 “DIS Re-Engagement Case Managers” across the state • Accurint Software • Improve clinical outcomes for persons in care • Identify clients who have at least one viral load in EHARS during the prior year • Clients remain on the list only if their last VL in EHARS during the evaluation year was > 200 copies/ml • Stratify remaining list by geography • Stratified lists sent to CAPUS DIS Surveillance staff once a year (April each yr) • DIS Case Managers will provide medical providers in their jurisdictions with a list of their respective clients who are in care but not virally suppressed. • CAPUS DIS Case Managers will report back to CAPUS program details of when / where reports were delivered.

  25. TN’s Surveillance Activities: Progress • Accurint software acquired / applied EHARS • List of known positives who have been OOC > 1 year has been generated (n=2,265) • Reporting forms created • Hiring / training for 4 of 5 DIS • First OOC lists distributed 10/11/13 • List of sub-optimal responders TBD (Mar14)

  26. Identifying Social & Structural Barriers

  27. Identifying Social & Structural Barriers: TN CAPUS Activity #5 • Address issues of cultural mistrust, homophobia, and stigma affecting HIV testing, retention and/or re-engagement into care, and prevention services • Conduct trainings (including pre- and post-assessments) among HD and CBO staff in these areas • To reduce barriers related to employment and housing affective linkage, retention, and/or re-engagement into care among AA men • Identify CAPUS clients for whom housing and/or employment is a barrier to accessing these services • For 100% of CAPUS clients identifying housing and/or unemployment as a barrier to accessing or remaining in care, provide appropriate referral(s)

  28. Challenges: CAPUS Tennessee • Central Hiring & Contract Execution • Establishing robust yet realistic targets • 4th Generation HIV Testing • Ensuring high risk individuals accessing 4th gen testing (even if 2nd or 3rd gen POC testing is negative) • SNS among MSM • Ensure new recruiters are enlisted each month • Corrections Navigators • Maintaining good working relationships with prison case managers despite staff turn-over & wide coverage areas • Augment with additional services (staff training / inmate education)

  29. Thank you!

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