Disease Intervention Specialists

1. The Expanded Role of Disease Intervention Specialists in a Reformed Health SystemNational ADAP TA MeetingFriday, August 1, 2014 Tonya King , MPA Ryan White Part B Program Director

2. Disease Intervention Specialists Mix of nurses and public health representatives Conduct educational outreach Work with providers in their area to ensure reporting Investigate reports of communicable diseases* Ensure adequate treatment Interview cases and contacts Enter investigational outcomes into HD database (PRISM) * DIS in the rural regions also investigate other cases (TB, food-borne, and general epi) and do work in the immunization & emergency preparedness programs * DIS in the metros investigate STDs only; some metros have case loads that preclude investigating all chlamydia & gonorrhea cases (all HIV & syphilis cases are investigated, but only high priority CT & GC cases).

3. Tennessee Department of Health Regional Map 69 34 82 14 13 74 81 63 83 56 46 76 37 07 66 90 85 48 10 44 67 25 92 40 87 29 42 32 11 80 30 19 95 65 01 86 22 71 23 45 03 43 47 27 09 21 18 15 94 93 73 75 78 17 49 41 08 53 88 05 68 89 39 04 57 38 60 72 84 20 51 02 16 12 59 54 62 31 61 77 64 24 35 91 50 79 55 36 28 33 06 26 58 70 52 Regional Office Upper West Mid-Cumberland South Central Southeast East Northeast Cumberland #County #County #County #County #County #County #County #County 3Benton 12Chester 11Cheatham 2Bedford 4Bledsoe 1Anderson 10Carter 8Cannon 9Carroll 20Decatur 22Dickson 16Coffee 6Bradley 5Blount 30Greene 14Clay 17Crockett 24Fayette 42Houston 28Giles 26Franklin 07Campbell 34Hancock 18Cumberland 23Dyer 35Hardeman 43Humphreys 41Hickman 31Grundy 13Claiborne 37Hawkins 21DeKalb 27Gibson 36Hardin 63Montgomery 50Lawrence 54McMinn 15Cocke 46Johnson 25Fentress 40Henry 38Haywood 74Robertson 51Lewis 58Marion 29Granger 86Unicoi 44Jackson 48Lake 39Henderson 75Rutherford 52Lincoln 61Meigs 32Hamblen 90Washington 56Macon 66Obion 49Lauderdale 81Stewart 59Marshall 70Polk 45Jefferson 67Overton Metros 92Weakley 55McNairy 83Sumner 60Maury 72Rhea 53Loudon 69Pickett 84Tipton 85Trousdale 64Moore 77Sequatchie 62Monroe 71Putnam #County 94Williamson 68Perry 65Morgan 80Smith 19Davidson 95Wilson 91Wayne 73Roane 88VanBuren 33Hamilton 76Scott 89Warren 47Knox 78Sevier 93White 57Madison 87Union 79Shelby 82Sullivan

4. TN’s Network of HIV Centers of Excellence

5. CAPUS in Tennessee • Background • Activities • Surveillance (“Data to Care”) • Identify & re-engage known PLWH out of care > 1yr • Identify known PLWH with sub-optimal response to care • HIV Testing • 4th Generation Ag/Ab Testing in TN State Labs • Social Networking Strategy Among AA MSM • Navigation • Corrections Navigators • Social & Structural Barriers

6. TN CAPUS: Surveillance • Activities • HIV Continuum of Care • 2010 Baseline, 2015 Goals, Annual Progress Reports • Identify & re-engage known PLWH out of care > 1 yr • Identify known PLWH with sub-optimal response to care • Data Quality • 2012: Labs required report all HIV-1 Viral Load & CD4 results • 2013: Accurint software acquired / applied to eHARS database • Staffing • 1 Epidemiologist • 2 Data Clerks • 5 DIS Re-Engagement Specialists • 2 Memphis, 1 Nashville, 1 Middle TN, 1 East TN

7. Re-Engagement in Medical Care • Develop Out-of-Care Lists for 5 DIS Re-Engagement Specialists • 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… • Received care w/in the past 1 year, • Moved out of state, or • Died • Stratify remaining list by geography & distribute monthly to DIS Specialists • Each year fully implemented • > 1000 cases / year (200 cases per DIS/year) • > 70% cases contacted • > 70% contacted cases linked to care < 3 mos (or >49% of total)

8. CAPUS DIS Re-Engagement Specialists • Training • Passport to Partner Services • 106 hours of on-line modules, followed by • 5 days of in-person training • ARTAS (Antiretroviral Treatment and Access to Services) • Located in geographically distinct areas • 2 in Memphis • 1 in Nashville • 1 in Middle TN • 1 in East TN • (Note: These 5 DIS cover the jurisdictions that account for ~80% of all known positives who have been identified as being out of medical care for > 1 year.)

9. Data to Care: Progress • First “list” generated October 2013 • 274 names • 63 (23%) determined to be living out of state or dead • 211 remaining names • 139 (66%) contacted • 99 (71%) in care in 2013 • 40 (29%) not in care • 18 (45%) linked to care < 3 mos • 22 (55%) not linked to care < 3 mos • Goals / Progress • Contacted: Goal > 70%, Actual = 66% (139 of 211) • In Care < 3 mos: • Goal > 49% of total, Actual = 55% (117 of 211)

10. FUTURE ROLE OF DIS • Develop position of DIS Engagement Specialist • Focus on ADAP clients with goal of • Linkage to care • Re-engagement in care • Retention in care (both newly diagnosed & current clients on brink of losing/work with medical case managers to identify) • Treatment adherence • Address barriers to care • Training • Expand Passport to Partner Services to this level • ARTAS • ACA Process • Reimbursement/Credentialing

11. Questions Tonya King, MPA Tennessee Department of Health HIV/STD Program Ryan White Part B Program 710 James Robertson Parkway Andrew Johnson Tower, 4th Floor Nashville, TN 37243 615-741-0237 (ph) tonya.king@tn.gov