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The Louisiana Positive Charge Initiative: Enhancing the System of HIV Care in Louisiana

Russell Brewer, DrPH , CHES Director of HIV, STDs, and Reproductive Heal th Louisiana Public Health Institute Strategies on the Ground to Turn the Tide on Improving Access to Care in the U.S. International AIDS Conference Washington, DC July 22, 2012.

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The Louisiana Positive Charge Initiative: Enhancing the System of HIV Care in Louisiana

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  1. Russell Brewer, DrPH, CHES Director of HIV, STDs, and Reproductive Health Louisiana Public Health Institute Strategies on the Ground to Turn the Tide on Improving Access to Care in the U.S. International AIDS Conference Washington, DC July 22, 2012 The Louisiana Positive Charge Initiative: Enhancing the System of HIV Care in Louisiana

  2. LOUISIANA DEMOGRAPHICS Source: US Census and United Health Rankings

  3. Source: LA Office of Public Health, 2010

  4. Source: LA Office of Public Health, 2010

  5. Source: LA Office of Public Health, 2010

  6. UNMET NEED FOR HIV CARE IN LOUISIANA, 2010 Source: LA Office of Public Health, 2010

  7. BACKGROUND ON LOUISIANA POSITIVE CHARGE INITIATIVE • Access to care initiative funded by AIDS United and Bristol-Myers Squibb • LPHI is the lead agency and local evaluator • Goal is to improve linkage to HIV care and supportive services for: - Individuals living with HIV infection that are out of care - Newly diagnosed

  8. BACKGROUND ON LOUISIANA POSITIVE CHARGE INITIATIVE • Implement and evaluate 4 linkage to care interventions in four regions of the state • Linkage Case Management (Baton Rouge) • Health Navigation (New Orleans, Baton Rouge, Lake Charles) • Pre/Post Release Case Manager (New Orleans) • Disease Intervention Specialists (New Orleans, Baton Rouge, Shreveport) • Linkage interventions are 3-6 months in duration

  9. POSITIVE CHARGE SITES BY REGION Region I: New Orleans Region II: Baton Rouge Region V: Lake Charles Region VII: Shreveport

  10. BACKGROUND ON LOUISIANA POSITIVE CHARGE INITIATIVE • Initial 3 month planning phase (April-June 2010) • 3-year implementation phase (July 2010 – June 2013) • Interventionist is housed at multiple locations • Two main data collection points (baseline and follow-up)

  11. POSITIVE CHARGE INTERVENTIONS BY SITE Positive Charge Sites • Capitol Area Reentry Program & Earl K. Long (BR) • N’R Peace & HOP Clinic (NO) • SW Louisiana AIDS Council & Moss Comprehensive Health Clinic (Lake Charles) • NO/AIDS Task Force & Orleans Parish Prison (NO) • Family Service of Greater Baton Rouge (BR) • Office of Public Health, Parish Public Health Units in Regions 1, 2, 7 (NO, BR, Shreveport) Linkage to Care Interventions Health Navigation Pre/Post-Release Case Management Linkage case management intervention Disease Intervention Specialists

  12. LINKAGE TO CARE TOOLS AND RESOURCES • Data collection system - Ryan White CAREWare • Alert system - Louisiana Public Health Information Exchange (LaPHIE) • Surveillance system – CD4 and viral load data from laboratories as required by the Louisiana Public Health Sanitary Code • Reminder system - Out of care lists generated by providers

  13. DEMOGRAPHIC BREAKDOWN OF LA POSITIVE CHARGE PARTICIPANTS

  14. RESULTS

  15. CHALLENGES/LIMITATIONS • Regular Data collection trainings • Multiple IRB modifications • Site specific - Staff turnover - Ensuring confidentiality - Lack of transportation - Loss to follow-up • Retention in care?

  16. LESSONS LEARNED • Positive Charge has raised the visibility of access to care efforts in the state • Provided a platform for other access to care initiatives • Enhanced relationships and coordination among Positive Charge partners • Importance of developing and updating Intervention workflows

  17. CASE STUDY “One client I enrolled took four months to actually link to medical care. The client arrived at the Health Unit for a routine pelvic exam, and left with a positive HIV diagnosis. As a young woman with two children, the client was devastated. She believed this was the end of her life, and that she would not live long enough to see her children grow old. For over two hours, we talked about what her next steps would be. Making an appointment with a doctor was very far down on her list of priorities.”

  18. ACKNOWLEDGEMENTS • PC Participants • PC Partners -LA Office of Public Health, STD/HIV Program - NO/AIDS Taskforce - Orleans Parish Prison - N’R Peace - HIV Outpatient Program (LSU) - Capitol Area Reentry Program - Earl K. Long Medical Center (LSU) - Family Service Greater Baton Rouge - Southwest Louisiana AIDS Council - W.O. Moss Regional Medical Center (LSU) • LPHI Staff (Sarah Chrestman, MPH; Michael Robinson, BA; and Snigdha Mukherjee, PhD) • AIDS United • Bristol-Myers Squibb

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