1 / 37

Project B.R.I.E.F.

Project B.R.I.E.F. Analysis of a High Volume Rapid HIV Testing Multimedia Model. Yvette Calderon, M.D., M.S. Associate Professor of Clinical Emergency Medicine Albert Einstein College of Medicine Jacobi Medical Center, NY Jason Leider, M.D., Ph.D. Associate Professor of Internal Medicine

zahur
Download Presentation

Project B.R.I.E.F.

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. Project B.R.I.E.F. Analysis of a High Volume Rapid HIV Testing Multimedia Model Yvette Calderon, M.D., M.S. Associate Professor of Clinical Emergency Medicine Albert Einstein College of Medicine Jacobi Medical Center, NY Jason Leider, M.D., Ph.D. Associate Professor of Internal Medicine Albert Einstein College of Medicine Jacobi Medical Center, NY

  2. USA Stats • At the end of 2003, an estimated 1.1 million persons in the United States were living with HIV/AIDS • 21% are undiagnosed and unaware of their HIV infection • CDC estimated that approximately 56,300 people were newly infected with HIV in 2006

  3. Bronx Demographics • 3rd most densely populated county in US • >80% Hispanic and African American • 1/3 households headed by a single parent • 2003 Bronx Median income = $27,331 • Manhattan = $47,415, Brooklyn = $35,168) • 1/3 of the population is below the poverty line • 40% of Bronx adults lack a high school diploma • Highest unemployment rate in NYC

  4. HIV/AIDS in New York NYSDOH 2005 Surveillance Report, including cases reported and confirmed through 2006

  5. Adult Literacy in NYC www.casas.org/lit/litcode/search.cfm

  6. Why test in the ED? • A significant percentage of patients presenting to inner-city EDs haveunrecognized HIV-1 infection.(Alpert 1996, Kelen 1995, Schoenbaum 1993, et al.) • Inner city EDs servedisadvantaged patient populations who continue to bear a disproportionate burden of the health disparities in our country. • These patients utilize the ED for their primary care and have limited or no access to ongoing regular health care with a provider. • The CDC recommends that diagnostic HIV testing and HIV screening be a part ofroutine clinical care in all health-care settings(CDC 2006 Revised Recommendations)

  7. Barriers to ED HIV Testing • Responsibility • Time • Cost

  8. Project B.R.I.E.F • Behavior intervention • Rapid HIV test • Innovative video • Efficient cost and health care savings • Facilitated seamless linkage to outpatient HIV care Public Health Advocate Educational Videos Rapid HIV Testing Increase Access to HIV Counseling/Testing in the ED

  9. Exam rm Exam rm Exam rm Bathroom Registration Trauma Work Station Trauma Triage Bathroom Bathroom BRIEF POC LAB Exam rm Exam rm Exam rm

  10. Project BRIEF HIV testing Project BRIEF HIV testing

  11. Protocol for People Testing Positive Daytime Hours: Patient are walked to ACS clinic and seen by a provider Evening Hours: Patients are given an appointment to return on next open visit at the ACS clinic

  12. Project BRIEF Results 10/05-1/09 28,365 patients approached 25,871 (91%) eligible 24,495 pts(95%) tested 1,376 pts (5%) refused 116 (0.47% tested HIV+)

  13. B.R.I.E.F.n=23,894 responded

  14. Age, Gender, Language of Patients Tested via BRIEF

  15. Self-reported Risk Factors

  16. Condom Use Reported by BRIEF ED Patients *of patients who stated they were sexually active in the past 3 months

  17. Patient Satisfaction with BRIEF • 99.3% felt HIV testing in the ED was helpful • 96.0% felt the PHAs made getting tested in the ED easier • 94.3% felt the video answered their question regarding HIV testing

  18. Patient Satisfaction with BRIEF 86.4% learned a moderate to large amount of new information 80.8% felt the video gave them new information to influence their sexual practice

  19. Under 21 Cohort

  20. Under 21 Cohort: Risk Factors • 9.0% of males were MSM

  21. Linkage to Care DataOctober 2005 – August 2008

  22. Building Linkage:Coordination of ED testing with HIV clinical care Pt tests HIV+ in UCA/ED Communication from PHA to HIV care team about pt Pt unstable Pt stable Pt admitted to inpt ACS HIV team Pt escorted to ACS clinic Pt stabilized & d/c’d Open access ACS HIV clinic Pt d/c’d home w/ f/u at ACS clinic Pt d/c’d to NH (etc)

  23. BRIEF (10/05-1/09) HIV dx’d Patient Characteristics * 1 pt is transgender (M -> F)

  24. # of pts linked to care @ NBHN n= 86 # of pts linked to outpt care n= 97 (84%) # of pts dx’d HIV+ n= 116 93 pts are newly dx’d Linkage to Care (10/05 – 1/09)

  25. Pts with with AIDS < 12 months after HIV dx # of Patients

  26. Mean (+SE) Rate of Heterosexual Transmission of HIV-1 among 415 Couples, According to the Sex and the Serum HIV-1 RNA Level of the HIV-1-Positive Partner Quinn T et al. N Engl J Med 2000;342:921-929

  27. Disparities in Receipt of HHART Related to Racial Concordance • HCSUS study • Examined time to HAART for 1241 patients cared for by 287 providers • African American patients with white providers received PIs significantly later than patients with concordant providers (p<.001) • Low percentage of minority HIV providers and variable cultural competence among white HIV providers may contribute to disparities in receipt of HAART and outcome by race King WD et al. J Gen Intern Med. 2004; 19: 1146-1153.

  28. Treatment Outcomes: Pts @ NBHN (n=69)

  29. ED Testing Systems

  30. ED HIV Screening Programs - MMWR June, 2007

  31. Financial view of BRIEFRe-imbursement for testing 10/05 – 1/09 • *Note: • 116 pts tested HIV+, 70% of pt come to care @ NBHN (35 pts join SNP, 1.3 x rate for Medicare • about 25% of ED pts are uninsured • Estimated Operating Cost of BRIEF = $453,000 • 24,495 pts tested in ED • For NY Medicaid*: $108 re-imbursement for pre-/post test HIV counseling, • Approx 25% of pts in JMC ER have Medicaid, 33% have re-imbursable insurance for HIV T&C 24495 pts x 0.68 w/ Medicaid x $108/HIV C&T + 53 SNP> $1,798,913 + $1,060,000*

  32. BRIEF: HIV+ Oct ’07-Oct ’08(all patients except for 1 pt from Philadelphia) H H

More Related