1 / 21

Linkage to Care

Linkage to Care. Pursuing the National HIV/AIDS Strategy in Seattle, WA. King County 2015 Linkage to Care Targets:. “ Increase the proportion of newly diagnosed patients linked to clinical care within three months of their HIV diagnosis from 65% to 85% (from 26,824 to 35,078 people). ”

roth-elliott
Download Presentation

Linkage to Care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Linkage to Care Pursuing the National HIV/AIDS Strategy in Seattle, WA

  2. King County 2015 Linkage to Care Targets: • “Increase the proportion of newly diagnosed patients linked to clinical care within three months of their HIV diagnosis from 65% to 85% (from 26,824 to 35,078 people).” • “Increase the proportion of Ryan White HIV/AIDS Program clients who are in care from 73% to 80% (or 237,924 people in continuous care to 260,739 people in continuous care).” • “In care”: at least 2 visits for routine HIV medical care in 12 months at least 3 months apart

  3. We’ve got our work cut out… 19% Gardner, et al, CID 2011 -Slide courtesy of Julie Dombrowski, MD, MPH, SPWG presentation, 11/17/11

  4. Summary: King County Data Relatively frequent testing, high rates of linkage to care Problems: Engagement in continuous care, underuse of ART Estimated population distribution: -Slide courtesy of Julie Dombrowski, MD, MPH, SPWG presentation, 11/17/11

  5. HIV Testing & Care in King County Linkage to initial care visit vs. linkage to sustained care N=657 538 (82%) 467 (71%) National Strategy Target =85% Timely HIV Diagnosis Linkage to HIV Care Retentionin Care -Slide courtesy of Julie Dombrowski, MD, MPH, SPWG presentation, 11/17/11

  6. Collaboration:The overall approach • Identify HIV+ persons. • Increase testing in populations of highest risk. • Remove barriers to routine HIV testing. • Link newly diagnosed HIV+ persons to care. • Retain HIV+ persons in ongoing care. • Reduce community viral load. • Outreach/engage those fallen out of care. • Incorporate HIV+ persons into prevention

  7. Health Department Efforts:Several paths to the same place • Partner Services • One on One Program • Care and ART Promotion Program

  8. Partner Services: • Reach 100% of newly diagnosed patients. • Assistance with confidential or anonymous partner notification services and information on linkage to care. • Cases are not closed until linkage to care is established.

  9. One on One Program: -http://www.kingcounty.gov/healthservices/health/communicable/hiv/resources/OneOnOne.aspx

  10. Care and ART Promotion Program (CAPP): Goal: To increase the proportion of PLWHA on successful ART.

  11. CAPP Program Procedures Eligible persons identified through HIV surveillance Not on ART despite indication (VL >500, CD4<500) [ Soon: no labs in past year] Health Department staff contact medical providers of eligible persons (in batches) Health Department staff contact PLWHA to offer program & arrange meeting Step 3: Identify participant & counselor priorities for discussion Step 2: Defining barriers to care and/or ART use Step 1: Introduction of Program Purpose Step 4: Address identified priority topics Step 5: Summarize & develop action plan Written summary sent to medical provider & case manager (if participant consents) F/u call at 1 month (if participant consents) -Slide courtesy of Julie Dombrowski, MD, MPH, SPWG presentation, 11/17/11

  12. Viral Suppression & CD4 Distribution 6070 PLWHA in King County as of 12/31/09* No laboratory results reported in 2009 1123 (19%) ≥1 Lab result (CD4 or viral load) reported in 2009 4947 (81%) ≥1 VL in 2009 4911 (99%) Missing VL 36 (1%) Dead or moved away In King, not in care Detectable 1719 (35%) Undetectable (≤48 copies/mL) 3192 (65%) In King, in care ≥1 CD4 in 2009 1698 (99%) Missing CD4 21 (1%) 351-500 400 (24%) ≤350 642 (38%) >500 656 (39%) *Cases determined through investigation to have died or relocated were excluded from the total population of PLWHA in King County for this slide. -Slide courtesy of Julie Dombrowski, MD, MPH, SPWG presentation, 11/17/11

  13. Barriers Reported: • Psychosocial: substance abuse, mental illness, socio-economic factors. Women uniquely impacted. • Perceived and actual insurance barriers • Aversion to pills, disbelief in western medicine • Life is complicated!

  14. My own part to play:Health Education & Prevention with Positives • Assist establishing and maintaining access to care • Create rapport and provide support • Patient centered prevention • Normalize risk reduction • Prevention with Positives

  15. Test and treat! Provide rapid tests to partners and other contacts of HIV+ persons. Link to care. http://hiv.aaci.org/files/2011/05/oraquick.jpg

  16. Treatment is Prevention! -http://3.bp.blogspot.com/-Qh9DM-aGhcE/Tc_c-IeB9rI/AAAAAAAAEx8/DPR4ECZAXAA/s1600/untitled.bmp

  17. Keys to success: Address multiple fronts Collaboration Funding Political will Perseverance

  18. Thanks! Kyle W. Davidson Health Educator Harborview Medical Center Madison Clinic, (2WC) Seattle, WA 98104-2499 206-744-6972 pager: 206-540-4864 fax: 206-744-5109 kyledav@u.washington.edu

More Related