NJ STATEWIDE MOBILIZATION LINKAGE TO CARE THROUGH THE COLLABORATION AND NAVIGATOR PROGRAM

1. NJ STATEWIDE MOBILIZATION LINKAGE TO CARE THROUGH THECOLLABORATION AND NAVIGATOR PROGRAM Steven Saunders, M.S. 1, Loretta Dutton, M.P.H. 1, Linda Berezny, R.N. 1, Joanne Corbo, MT (ASCP) 2, and Eugene G. Martin, Ph.D. 2 New Jersey Department of Health1, New Jersey HIV Planning Group and UMDNJ – Robert Wood Johnson Medical School2

2. BACKGROUND: • The Division of HIV, STD and TB Services (DHSTS), in collaboration with The New Jersey HIV/AIDS Planning Group’s (HPG) Prevention and Care Collaborative Workgroup developed a best practice model for an integrated approach to HIV/AIDS prevention and care activities for the State of New Jersey.  The model was created in response to the National HIV/AIDS Strategy (NHAS) to address three primary goals: • Reducing the number of people who become infected with HIV; • Increasing access to care and improving health outcomes for people living with HIV; and • Reducing HIV-related health disparities. • To fully address the NHAS, the Prevention and Care Collaborative Workgroup reviewed mandates from the Health Resource Service Administration (HRSA) and the Centers for Disease Control and Prevention (CDC). These programmatic mandates included: • Early Identification of Individuals with HIV/AIDS (EIIHA); • Treatment as Prevention (TasP); and • Program Collaboration Service Integration (PCSI).

3. The HPG Prevention and Care Collaborative Workgroup The Prevention and Care Collaborative Workgroup supports the development of collaborative partnerships between the DHSTS and: Medical Centers, Infectious Disease Clinics, Federally Qualified Health Centers, Local Health Departments, HIV testing sites, Community Based Organizations (CBOs), Addiction Services, Medicaid, and all service providers impacting populations disproportionately affected by HIV are also affected by other infections including TB, Hepatitis C virus (HCV), Hepatitis B virus (HBV) and STDs.

4. Model Outcomes: • There are five types of prevention and care treatment planning outcomes for individuals who go to Clinical and Non Clinical Testing Venues for HIV screening: • those who test HIV positive; • those who test HIV negative; • those who decline HIV testing; • those who already know their status and who are in care; and • those who know their status and are out of care.

5. REGIONAL COLLABORATIONS FORMED • DHSTS formed or assisted in the formation of collaborations in each of the twenty-one New Jersey counties to include both Transitional Grant Areas (TGAs) and Eligible Metropolitan Areas (EMAs). Additionally, collaboration extends to the Federally Qualified Health Care center (FQHCs) and community clinics. • The centerpiece of each regional collaboration is a HIV Specialty Care Clinic or Hospital. A wide range of agencies who experience a single rapid positive test or agencies that discover an out of care HIV+ client will immediately access care (within the same or next business day). Using the Rapid to Rapid (R2R) algorithm, CBOs and non clinical testing sites are able to facilitate immediate linkage to care and actively participating in re-engagement with their partnering medical sites.

6. Eleven New Jersey Collaborations: • Bergen/Passaic TGA • Newark EMA – ERIC (3) • Newark EMA – Morristown • Hudson TGA • Middlesex, Hunterdon, Somerset TGA • Mercer County • Monmouth/Ocean • Camden/Burlington (SAFEPAT) • Cumberland/Salem/Gloucester • Atlantic/Cape May

7. How to Join Your Regional Collaboration • Atlantic, Cape May Counties – Jean Haspel- Jean.Haspel@atlanticare.org • Camden, Burlington – Pam Gorman - Gorman-Pamela@CooperHealth.edu • Cumberland, Salem, Gloucester – Kim McCargo- kcosbymccargo@chcinj.org • Newark EMA – 4 ERICs: • Morristown - J. McEniry – j.mceniry@njas-inc.org • Newark Community Health - Claire Roudette- croudette@nchcfqhc.org • Trinitas - Judy Lacinak - jlacinak@trinitas.org • UMDNJ – Gary Paul Wright – gpwright@aaogc.org • Middlesex, Hunterdon, Somerset - Natalie Aloyets - Artelnaartel@ssw.rutgers.edu • Mercer - Deborah Oliver- Debra.Oliver@henryjaustin.org • Ocean Monmouth – Barbara Benwell- bbenwell@meridianhealth.com • Bergen, Passaic – TGA contact - Pat Virga- pvirga@newsolutionsinc.com • Hudson – TGA contact – Marvin Krieger - hchivcncl@aol.com

8. Navigator Goals • Facilitate a 2nd rapid test for patients initially screened positive, and link to care on the same, or next, business day • Immediately initiate HIV+s into care: (initial work-up including CD4, VL on same day as 2nd rapid test) • Partner Services for new and existing clinic patients using CE and Social Networking • Re-engagement of ‘lost to care’ patients • Treatment adherence and prevention counseling • Collaborative Point Person and MOA Manager

9. HOW? • Provide “concierge service” for initially positive patients identified in the community settings • Direct cell phone line is shared with every agency that has contact with HIV positive individuals. NJAIDS/STD Hotline added Feb 2013; we are also adding prison discharge planners as points of contact. • Provide treatment adherence counseling to new and existing patients. • Re-engage patients lost to care (defined as completing a medical care visit) by flagging EMR, working with community partners and other effective strategies • Provide prevention counseling/strategies such as CLEAR, ARTAS or Partner Testing to new, and existing, patients. • Coordinate local inter-agency collaboration activities. • Ensure immediate, accompanied patient transportation to HIV clinic through collaboration MOUs • Work with collaborators (i.e., CBOs) to assist in re-engagement

10. WHY • 100% Patient centered focus • Leverage resources for patients to experience the collective impact of all local providers • Increase efficiency • Breakdown barriers to complimentary services • Address multiple problems or needs • Provide comprehensive services

11. New Jersey Navigators

12. LOCATIONS: AtlantiCare Medical Center, Atlantic City, Atlantic County Cooper University Hospital, Camden, Camden County Jersey Shore Medical Center, Neptune, Monmouth County Jersey City Medical Center, Jersey City , Hudson County UMDNJ, Newark, Essex County St. Michael’s Medical Center, Newark, Essex County St. Joseph’s Medical Center, Paterson, Passaic County Trinitas, Elizabeth, Union County Raritan Bay Medical Center, Perth Amboy, Middlesex County

13. TESTING INNOVATION: ENHANCING THE LINKAGE TO CARE ELIMINATE WESTERN BLOT: IMPROVING THE RTA Expectation: 100% Notification of Clients Link and Retain in care at least 85% of clients testing positive Reduce Transmission from clients testing positive

14. Rapid Testing Algorithm (RTA) Rapid-Rapid Testing Site and Treatment Site: Rapid-Rapid Testing Site & Non Treatment Site – Client Will Be Transported to Care Category 2: Your testing site is a Rapid-Rapid Testing site, but is NOT an HIV clinical site. You use ClearviewStatPak as the first Rapid HIV test and confirm the positive result by using a second Rapid test (Trinity or OraQuick). Under this category, the client is referred for care to a clinincal site with which your organization has established a Memorandum of Agreement (MOA) permitting linkage to care in the same or next business day. The initial testing site will arrange to have the screen positive client transported to the HIV clinical site. • Category 1: Your testing site is a Rapid-Rapid Testing site and is also an HIV clinical site. You use Clearview StatPak as the first Rapid HIV test and confirm the positive result by using a second Rapid test (Trinity or OraQuick). The client is then linked to care (not intake) in the same or next business day.

15. Client Will Be Transported to Rapid-Rapid Clinical Site for Second Test and Immediate Linkage • Category 3: Rapid Testing Site – Client Will Be Transported to Rapid-Rapid Clinical Site for Second Test and Immediate Linkage • Your testing site is NOT a Rapid-Rapid Testing site. You use ClearviewStatPak as the first Rapid HIV test and confirm the positive test by sending the client to a Rapid-Rapid HIV clinical site (Category 1) which will perform a second Rapid test (Trinity or OraQuick) and immediately link the positive to HIV Care (not intake).

16. MORE SENSITIVE RAPID HIV TESTING TECHNOLOGY IS COMING! • Upon FDA approval, New Jersey intends to offer more sensitive Rapid HIV Tests strategically focusing on urban sites of high prevalence. • Alere Determine p24Ag/Ab Combo tests:

17. HIV Prevention Patient Navigator Outcomes through April 30, 2013 Majority of new patients (543) seen were African American (60%) and male (66%); 21% were Hispanic; 52 2nd rapid HIV tests conducted; 100% positive and enrolled in care 536 other HIV tests conducted, 18% positive and 95% enrolled in care 103 partners tested, 7% positive 337 re-engaged in care; 479 total linked to care