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Community Embedded Disease Intervention Specialist (CEDIS) Program: The LA Gay & Lesbian Center Experience

Community Embedded Disease Intervention Specialist (CEDIS) Program: The LA Gay & Lesbian Center Experience. Partner Services Community-Embedded Disease Intervention Specialist (CEDIS) Program . Partners…. unaware of their risk. CEDIS:Syphilis /HIV. PCRS and the

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Community Embedded Disease Intervention Specialist (CEDIS) Program: The LA Gay & Lesbian Center Experience

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  1. Community Embedded Disease Intervention Specialist (CEDIS) Program: The LA Gay & Lesbian Center Experience

  2. Partner Services • Community-Embedded Disease Intervention Specialist (CEDIS) Program

  3. Partners….. unaware of their risk

  4. CEDIS:Syphilis/HIV PCRS and the Health Dept CEDIS: GC/CT Past Present Future Low Participation Disease Interruption/ Linkage to Care (LTC) Disease Interruption/ Reduction of HIV Infections

  5. CEDIS Program in Los Angeles Adapted after Howard Brown Clinic, Chicago Employed by and stationed in the Sexual Health Department of LA Gay & Lesbian Center (LAGLC) Unique to LA County CEDIS Program: CEDIS made Health Officer of LAC Dept. Public Health Division of HIV & STD Programs (DHSP) Trained to same standards as LAC DSHP Public Health Investigator (PHI) Review and QA of work by LAC

  6. Benefits of Partner Notification • Notify partners confidentially • Partners may not be aware of their risk • Earlier testing, counseling, and linkage to care (LTC) • Potential to reduce STI rates in community

  7. High STD/HIV morbidity • 14% of Early Syphilis cases in Los Angeles dx out of LAGLC • 55% of these cases also HIV co-infected • Approximately 300+ new HIV cases dx out of LAGLC per year

  8. Traditional PHI/DIS Flow

  9. CEDIS Flow 1

  10. CEDIS Flow 2

  11. Traditional Vs. CEDIS at LAGLC • 20-fold increase in interview w/in 7 days • Lost to Follow-up 4%(CEDIS) vs. 28% (Traditional)

  12. Time to Interview for Early Syphilis Cases CEDIS Started in 2008

  13. PARTNERS NAMED • Partner Index: • 2007 (0.56) • 2009 (1.91) • 3-fold increase

  14. 2010 Early Syphilis Partner Services CEDIS Health Department For every 10 cases interviewed 6 partners are named 2 partners are preventively treated For every • 10 cases interviewed • 12 partners are named • 7 partners are preventively treated.

  15. 2010 CEDIS Disease Interruption Newly Identified Preventively treated 135 Early Syphilis 64 gonorrhea 63 chlamydia • 15 new HIV positives • 75 new ES • 37 new gonorrhea • 41 new chlamydia

  16. Identifying GC/CT Infections • 49 of the 340 partners notified in 2009 for syphilis exposure tested negative for syphilis, but positive for GC,CT, or both. • Identifying and treating GC and CT infections can lead to the prevention of contracting HIV and syphilis.

  17. Performance Measures (PM) • PARTNERS INDEX: Ratio of the number of partners named/Cases interviewed • PARTNERS PREVENTIVELY TREATED: Ratio of the number of partners preventively treated/Cases interviewed

  18. Partner Index for ES cases Partner Index Year

  19. Preventive Index for ES cases Preventive Index Year

  20. Benefits Seen From CEDIS Program • 20 fold improvement in time to interview within 7 days and 4-fold decrease in lost to follow-up • 50% increase in the partners index and 4-fold improvement in partners preventatively treated index

  21. National HIV/AIDS Strategy • Released July 2010 by Obama Administration • By 2015, lower the annual number of new infections by 25% • By 2015 increase the number of new HIV diagnosed patients linked to clinical care within 3 months from 65% to 85%. • Identifying HIV Positive patients and LTC

  22. LAGLC HIV Positivity Rate --7,111 HIV tests performed in 2010. --324 tested HIV Positive --11,111 HIV tests performed in 2011. --365 tested HIV Positive LAGLC HIV Positivity Percentage Year

  23. HIV is a different disease

  24. In 2010 of the 26 new HIV cases interviewed:

  25. Partner Services Acceptance, 2010 Percentage Accepted

  26. HIV Partner Services: A long road….…

  27. When to offer Partner Services • Symptomatic • Over phone when disclosing positive results • Time of Rx • Through DIS – Keep patient in loop • High risk patients/“Frequent Flyers”

  28. How to offer Partner Services • Empowering the individual – take control and responsibility • How many partners during window period • Symptoms • Places met partners • Ask “where” sex occurred • Emergency contacts

  29. How to offer Partner Services • Phone numbers/Phone records • Addresses • Screen names/Emails • Drug usage/IV drugs • Condom usage • Flyers/Educational materials • Self referrals • Inspot.org

  30. Be Knowledgeable • First impressions can make all the difference • Know your patient. Knowledge can help build trust • Understanding and explaining test results • How infections are contracted/spread • Explain Sx and possible long term effects

  31. Challenges…. Mistrust

  32. Indifference

  33. Culturally Sensitive Issues • Sexual Orientation • May not identify as “gay” • Avoid medical jargon • Body Language/Bedside manner

  34. Culturally Sensitive Issues

  35. Terminology • Top/Bottom/Vers • Down-low (DL) • Cruising • Rimming • Blouse • Glory Hole • Bareback

  36. Gonorrhea/Chlamydia 2011 Percent Positive

  37. Safe Space • Safe Space -- www.equal.org/safe-space-program/ • The pink triangle is an internationally recognized symbol of positive gay identity. • The surrounding green circle is an international symbol of acceptance.

  38. Other “Safe Space” Symbols • Human Rights Campaign • Gay Flag

  39. The Interview • Education - How infection is contracted/spread • Symptoms & Window periods • Titers • Advise partners to receive Rx in addition to a test • Anonymous notification • Give referrals and options • Give time frame of when Re-Ixmay occur • Use familiar language • Give business card

  40. The Re-Interview • Check in • LinkageTo Care for HIV positives • Open ended questions • Text messages • Explain titers again • Re-test

  41. Language • Open ended questions • “When was the last time” Vs. “Have you ever” • “What is your experience with…” Vs. “Do you…” • Non-judgmental attitude • Do not lecture. Listen and respond • Do not take all words at face value

  42. Drug Usage • Methamphetamines • Nitrates/Poppers • PNP • Meth users more likely to be HIV positive

  43. Internet/Social Networks • Adam4Adam • ManHunt • Craigslist • BarebackRT.com (BBRT) • Bareback.com • Dudesnude.com • Facebook

  44. Internet Partner Notification Success In 2009 • 67 (36%) ES cases had at least one internet partner • 724 internet partners total • 117 internet partners initiated • 62 internet partners examined • Adam 4 Adam most common website • Smart phones/Text messages/email access lead to rapid return call

  45. Internet/Social Networks Phone Applications • Grindr • Scruff • Jack’d • Recon

  46. Anonymous partners

  47. Texting • Google Voice • Staying current • Quick and easy • VM Full • Book appointments • Messages saved on phone

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