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Enhancing Public Health and Health Center Collaboration: TO IMPROVE the HIV Care Continuum

This presentation highlights the collaborative efforts in Massachusetts to improve the HIV care continuum, including training and capacity building, workflow planning, and data system development. Lessons learned and opportunities for sustainability are discussed.

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Enhancing Public Health and Health Center Collaboration: TO IMPROVE the HIV Care Continuum

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  1. Enhancing Public Health and Health Center Collaboration: TO IMPROVE the HIV Care Continuum Liisa Randall, PhD Director, Office of Health Care Planning Bureau of Infectious Disease Massachusetts Department of Public Health Joan Pernice, RNC, MS, Clinical Health Affairs Director Massachusetts League of Community Health Centers National HIV Prevention Conference December 7, 2015

  2. CONTEXT OF HIV SERVICES: Massachusetts • Health Care System • 2006 health care reform = 98% insured • Infrastructure • Community health centers • Primary health care • Academic training and research extensive • MDPH-Funded HIV Prevention and Care Services • Integrated = HIV, STI, HCV • 36 funded providers • 120 sites providing integrated testing ( 11 CBOs, 16 CHCs, 7 hospitals, corrections); Targeted: prevalence, risk, SDH • 36 agencies providing case management and support services (16 CBOs, 9 CHC, 11 other) • Infrastructure • Community health centers (“RW clinics”) • Flexible state funding • Public health laboratory

  3. HIV CARE CONTINUUM: Massachusetts 84% of those with 1 lab are virally suppressed 87% of those with 2 labs at least 3 mos apart are virally suppressed 61% “Engaged in care” = one laboratory test result (CD4 or viral load test) /yr “Retained in care” = 2 lab tests /yr; 3 mos apart “Viral suppression” = HIV viral load less than or equal to 200copies/mL.

  4. MASSACHUSETTS P4C: Redefining Roles and Collaboration • • Codman Square (Dorchester) • • SSTAR (Fall River) • • Lowell CHC • • Mattapan CHC • • North Shore CHC (Salem) • • Whittier Street CHC (Roxbury)

  5. Collaboration to support implementation and practice change • Training and Capacity Building • Learning Sessions • Webinars • Targeted training • Field services for partner notification/out-of-care re-engagement • Coordination with TAC; local training/TA providers (e.g. MDPH, NEAETC) • Technical assistance and quality improvement support • Individualized consultation and TA with practice coaches • CHC work plan development • Work flow planning • Policies and procedures • Identify and prioritize training and TA needs • Data system and CQI report development (DRVS, ESPnet)

  6. Workflow planning: PROCESS MAPPING

  7. MONITORING IMPLEMENTATION

  8. EVALUATION AND CQI: DRVS REPORTS

  9. Evaluation and cqi: Project level Reference and Clinical Labs State PH Lab Community Health Centers Hospitals & Other Clinical Providers EHRs MAVEN: Surveillance and Management System EHRs ESPnet -Case reporting of notifiable diseases (HL7, LOINC, SNOMED) -Query clinical data from EHR “MDPH Net” -Aggregate reporting of screening and preventative services Mass League: DRVS Modules: - Acute HCV surveillance - HIV - Sexually transmitted infections - Tuberculosis - HIV and STI case management and partner services - Other reportable infections -Foodborne illness - Refugee and immigrant health case mgt - HCV medical case mgt -Query capability for CQI reports Health Resources and Services Administration Centers for Disease Control

  10. STATUS: P4C in MASSACHUSETTS • Routine testing • Process mapping • Learning sessions • Targeted training and TA • HIV care integration • Process mapping • Learning sessions • Targeted training and TA • Out-of-Care Re-engagement • Protocol (line list, field services) • Training • Implementation conferences

  11. Lessons learned • Shift from dedicated service model • Clarity in expectations (e.g. “routine” testing, “integrated” care) • Attitudes and perception of staff (all levels) • Aligning resources and historical investments • Implementing public health services • Attitudes toward public health-delivered intervention • Providers • Public health field staff • Understanding of public health roles and authorities • Implement new protocols and practices • Collaboration essential to success • Leverages experience and expertise • Reinforces changing roles of public health and CHCs in service delivery • Allows and encourages application from/to other areas, services

  12. Opportunities for learning and application to other health areas • Strategies for sustainability: • Integrate communicable disease services into primary care • Balance primary and specialty care, relative to patient needs. • Return on investment: • Integrate communicable disease services into primary care • Public health-delivered engagement support services • Improvement in population health

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