Retaining New Patients in HIV Care Cooper EIP

1. Retaining New Patients in HIV Care Cooper EIP November 14, 2013 For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#

2. Welcome & Introductions • Welcome & Introductions, 5min • Cooper EIP DiscussesRetainingNew Patients in HIV Care, 30min • Panel Discussion, 20min • Updates, Reminders & Evaluation, 5min In the chat room, Enter your: 1. name, 2. agency, 3. city/state, and 4. professional role at agency Michael Hager, MPH MA NQC Manager, in+care Campaign Manager New York, NY

3. Welcome & Overview • This Partners in+care webinar is offered as part of the in+care Campaign. • The in+care Campaign is a national effort to improve retention in HIV care. • Webinars are one of many Partners in+care activities designed to engage people living with HIV/AIDS and their allies in the in+care Campaign. For more information: www.incarecampaign.org

4. This is a “public event.” If you have confidentiality concerns: Your names appear on-line in the list of webinar registrants -consider just listening to the audio or to viewing the webinar at a later time, after it is posted at www.incarecampaign.org All webinars are recorded - do not use identifying information when asking questions Participation Guidelines For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#

5. Actively participate and write your questions into the chat area during the presentation; we will also have a “pop up” question exercise, and will pause for conversation during the webinar Do not put us on hold Mute your line if you are not speaking (press *6, to unmute your line press #6) The slides and recording of this and other Partners in+care webinars are available for playback and group presentations at www.incarecampaign.org – “Events” tab Participation Guidelines For Audio: Dial-in#: 866.394.2346 Participant Code: 397 154 6368#

6. Retaining New HIV Patients Pop-up Question What share of your total patient population was new to your clinic in the last year? (best estimate is ok!) More than 50% Between 25% and 50% Between 10% and 25% Less than 10% I have no idea I do not work in a setting that provides direct patient care Visit www.incarecampaign.org

7. Retaining New HIV Patients Pop-up Question Do you feel your organization is better or worse at retaining new patients in comparison with all ongoing patients in general? We are better at retaining new patients We are worse at retaining new patients We retain both new and ongoing patients with about the same level of success I have no idea I do not work in a setting that provides direct patient care Visitwww.incarecampaign.org

8. Retaining New Patients in HIV Care Pamela A Gorman, R.N., ACRN • Administrative Director • Early Intervention Program and Infectious Diseases • Cooper University Hospital • gorman-pamela@cooperhealth.edu Lucy Suokhrie, RN-BC; BSN; MSHCA • Clinical Navigator • Early Intervention Program and Infectious Diseases • Cooper University Hospital • 856.968.7261 John-LaSalle A. King • Executive CAB Member • South Jersey Community Advisory Board • jlkmba@aol.com

9. Pamela Gorman, R.N., ACRN Administrative Director, EIP and Infectious Diseases gorman-pamela@cooperhealth.edu

10. Cooper Early Intervention Program:A Community Collaborative Approach for HIV Testing and Linkage to Care

11. Meeting the challenge: • What challenge? • The integration of HIV Care and Treatment Programs with Prevention Programs • How? • Started with an invitation to a meeting including Ryan White programs and Community Based HIV Prevention Programs • The purpose • The formal establishment of a Community Collaborative Committee

12. Collaborative Partners Agree to: Ryan White Medical Care Programs • Primary agencies for linking new and lost to care HIV infected persons with medical care services • Immediate access to care within 24-72 hours • Engage patient in Clinical Navigator services • Confirm HIV infection (if needed) • Perform HIV rapid testing services • Identify new and or lost to care HIV infected persons • Immediately refer person to Ryan White Program or designated HIV Care Provider • Contact Clinical Navigator to assure linkage with medical care Community Based Organizations

13. During the first year • Program Directors commit to the collaboration • Officially name the committee • Develop an aim statement • Started with monthly meetings • Establish a Memorandum of Agreement as a “living” document • Provide a venue and system for identifying and addressing community concerns

14. SAFEPAT Strategic Alignment For Effective Care And Treatment Aim Statement “The collaboration of prevention and treatment services to assure coordinated healthcare practices and a healthy community”.

15. What is the purpose of the SAFEPAT Memorandum of Agreement (MOA)? A formal commitment by Agency Directors to participate and contribute to the collaborative through the establishment and execution of a “living” document

16. The MOA Identifies: Participating Agencies Individual Agency Resource Person Contact Information Agency Services Hours of Operation Agencies are added to the document each year – currently 9 Directors have contributed and signed the MOA

17. General Agreement Each Agency will: • Host SAFEPAT Committee Meetings once per year. • Encourage and support client participation on the Southern New Jersey Community Advisory Board. • Host one CAB meeting per year. • Arrange transportation for clients to attend CAB meetings (per agency’s transportation policy).

18. Committee Successes • Established a community collaboration agreement in the form of an MOA (started with 5 agencies and now have 9) • Committee membership/participants increased, averages 15-20 participants • CAB membership/participants increased • Developed standardized forms and processes for linking patients to care and other services

19. Future Works • Addressing concerns related to the rising numbers of young MSM newly identified infections (18-25 y/o) • Establish a community quality improvement project to improve referral and linkage to prevention education programs that focus on this high risk population

20. John LaSalle King Chair, Southern New Jersey Community Advisory Board jlkmba@aol.com

21. Southern New Jersey Community Advisory Board (SNJCAB) The purpose of CAB is to provide a partnership between the Community & Service Providers regarding HIV related medical care, support services, and research activities.

22. Southern New Jersey Community Advisory Board (SNJCAB) Members are committed to becoming educated about changes and advances in the treatment and prevention of HIV infection. In addition, members contribute to providing feedback that drive those changes that impact those services in prevention and care.

23. Southern New Jersey Community Advisory Board (SNJCAB) • The CAB works to promote the physical and mental health of all ages and cultures affected or infected with HIV. • The ultimate goal is to ensure that HIV related services and research operate to reduce the impact and stigma of the HIV epidemic.

24. What does this mean to the Consumer? • Empowers the consumer to take charge and have a voice. • Provides the venue for consumers to describe their perception of best practice models (prevention & medical care). • Provides a mechanism to give back/pay it forward to the community.

25. Lucy Suokhrie, RN-BC, BSN, MSHCA Clinical Navigator, EIP Suokhrie-lucy@cooperhealth.edu

26. What is Clinical Navigation? • Clinical Navigation is an intervention that helps in linkage to care and retention in care through guidance and support • Clinical Navigation aims to improve outcome by engaging patient’s in their medical care by addressing barriers to care

27. Goals of Navigation Immediate access to Health Care Provider and services Provide information and treatment options Re-engagement of lost to care patients Retention in Care Treatment adherence and prevention Partner testing services

28. Role of the Navigator • The newly diagnosed HIV patient experiences significant anxiety and stress. • For most people this overwhelming experience can become incapacitating • The navigator is able to reduce the anxiety through communication, support, education and identification of service resources and facilitation

29. Research Findings • Newly diagnosed patients who are receiving HIV care, mortality is twice as high for those who miss a clinic visit within the first year of diagnosis. (Mugavero, Lin, Willig, et al., 2002) • Study done on ‘Failure to establish HIV care’ showed that longer waiting time from call to schedule a new patient visit to the appointment date was associated with failure to establish care(Mugavero, Lin, Allison, et al.2007) • Non-adherence with appointments has been associated with failure to reach undetectable levels, clinical disease progression(including AIDS-defining illnesses), and death ( Giordano et al.,2007)

30. Navigation helps patients by • Providing comprehensive and easy-to access services • Decreasing structural barriers at clinics • Creating an environment to decrease anxiety and help patient navigate the system with ease • Providing basic HIV education • Teaching patients the skills that will help them stay in care

31. Use of effective behavioral interventions Clear- Choosing Life Empowerment Action Results ARTAS- Anti Retroviral Treatment and Access to Services

32. Barriers Lack of time Unable to commit to these sessions Other socio-economic issues Mental Illness Lack of Knowledge about the disease

33. Benefits of Navigator • With the Navigator on site, patients are seen within the same day or next business day • Patient has a go to person to assist them • Patients are educated on their care, what to expect and next steps

34. Conclusion • The ultimate goal of navigation is removal of potential barriers such as communication, psycho-social dilemmas, fiscal, and any other logistics which can disrupt the continuum of care. The success of the concept is the provision of support and advocacy from diagnosis to survivorship by means of education, guidance and reassurance

35. References • Farrisi,Daniele; Dietz Natalie,(2013) Patient Navigation is a client-centered approach that helps to engage people in HIV care. HIV Clinician, winter 2013,Vol. 25 No. 1, 1-3 • Giordano,T.P.,Gifford,A.L., White, A.C., Suarez-Almazor, M.E.Rageneck, L., Hartman, C, Morgan, R.O. (2007) Retention in care : A challenge to survival with HIV infection. Clinical Infectious Diseases, 44,1493-1499 • Mugavero,M.J.,Lin,H.Y., Allison,J.J., Giordano, T.P.,Raper,J.L., Saag,M.S.(2009). Racial disparities in HIV virologic failure: Do missed visits matter? Journal of Acquired immune Deficiency Syndrome, 50(1),100-108 Mugavero,M.J.,Lin,H.Y.,Willig, J.H.,Chang,P.W.,Marler,m.,. Saag,M.S.(2009).Failure to establish HIV care: characterizing the “no show” phenomenon. Clinical Infectious Diseases,48, 248-256 • Wilcox, B., & Bruce, S.D. (2010) Patient Navigation: A “win-win” for all involved. Oncology Nursing forum, 37(1),21-25

36. Cooper University Hospital Early Intervention Program (EIP)Contact information: Pamela Gorman, R.N., ACRN Administrative Director, EIP and Infectious Diseases gorman-pamela@cooperhealth.edu Lucy Suokhrie, RN-BC, BSN, MSHCA Clinical Navigator, EIP Suokhrie-lucy@cooperhealth.edu John LaSalle King Chair, Southern New Jersey Community Advisory Board jlkmba@aol.com

37. Retaining New Patients in HIV Care Pamela A Gorman, R.N., ACRN • Administrative Director • Early Intervention Program and Infectious Diseases • Cooper University Hospital • gorman-pamela@cooperhealth.edu Lucy Suokhrie, RN-BC; BSN; MSHCA • Clinical Navigator • Early Intervention Program and Infectious Diseases • Cooper University Hospital • 856.968.7261 John-LaSalle A. King • Executive CAB Member • South Jersey Community Advisory Board • jlkmba@aol.com

38. Retaining New Patients in HIV Care What interventions are used to keep patients in care? What about specific interventions for newly diagnosed? Let us know your experiences in the chat room!

39. Retaining New Patients in HIV Care How does the referral process for linkage to care actually work? Let us know your experiences in the chat room!

40. Retaining New Patients Pop-up Question How likely are you to reevaluate your process of retaining new patients to care as a result of this webinar? More likely than before I watched this program No more or less likely than before I watched this program Less likely than before I watched this program I do not work in a setting that provides direct patient care Visit www.incarecampaign.org

41. Partners in+care Resources Visit Web / Open the Toolkit www.incarecampaign.org - “Partners” tab Sign up for Partners in+care Networkwww.incarecampaign.org – “Partners” tab Join Facebook Send email to incare@NationalQualityCenter.org – “Facebook” in subject line Campaign Headquarters:National Quality Center (NQC)90 Church Street, 13th floor New York, NY 10007Phone 212-417-4730