Engaging CBOs for Partner Services Beau Gratzer, MPP Director of HIV/STD Prevention Howard Brown Health Center

1. Engaging CBOs for Partner ServicesBeau Gratzer, MPPDirector of HIV/STD PreventionHoward Brown Health Center NASTAD TA Meeting: Reaching Gay Men Using the Internet March 30, 2009

2. Overview and Goals • Background of HB DIS Program • Evaluation of PS Outcomes • Innovations in IPN (Internet Partner Notification) • Program Development • Infrastructure and Program Considerations • Training and Supervision • Program Integration • Conclusions and Discussion

3. Howard Brown DIS Program • Howard Brown • LGBT health center (FQHC) • $16.5 million budget, 220 employees • Serve about 30,000 clients/year, 10K for medical • Initiated in June 2002 as part of comprehensive response to syphilis outbreak among MSM • CDPH staff encountered difficulty interviewing MSM diagnosed at PCPs • HB diagnosed significant syphilis morbidity in Chicago (approximately 20% total, 30% among MSM)

4. HB DIS Program (cont) • Hired full-time DIS to interview and manage all cases of syphilis diagnosed at HB • DIS went through standard CDC trainings (EDG Modules, ISTDI, ASTDI, etc) • DIS initially reported to CDPH Field Operations Manager for case supervision, but was administratively supervised by HB staff • HB now employs three full-time DIS staff, including a manager who now supervises our cases internally • Also contracted by IDPH to manage cases in suburban Cook County

5. Evaluation of Outcomes

6. Reasons for success • Time from Treatment to Interview • Cultural Competency • Use of internet for PN • Integration of DIS into clinical model (both in terms of client and provider) • Distance ourselves from “HD” while still performing same function; main goal is to not burn bridge with client (repeats)

7. Innovations in IPN • Worked to organically respond to needs of our community and began contacting partners over internet in 2003 • Presented data at 2004 STD conference about initiating IPN in chat rooms • Chat rooms fizzled, and sex-seeking websites became more common requiring new techniques • Presented evaluation data of our program at 2008 STD Conference

8. IPN Findings

9. Contribution of IPN to Program

10. Should this be done where I live? • Is it legal? • Funding (both in overall program dollars and as competition for DPH) • Is there a high morbidity clinic/CBO? • Other programs in the country • LA County • DPH DIS based at CBO

11. Infrastructure • Relatively large, stable agency • CBO must have trustworthy relationship with community • Wide scope of HIV and STI testing services • Recommend working with agencies with primary medical care and broad spectrum of affiliated services • Alternatively, agencies should have VERY strong relationship with a medical center/provider

12. Infrastructure Considerations • Physical space • Where will DIS be located? • Is there a place to interview cases? • Storage of PHI • Case filing at CBO or HD? • Need system for storing case notes, monthly logs, lot assignments, etc. • Is internet access an issue? Do firewalls or security systems prevent access to sexually explicit material?

13. Staffing/Hiring • Recommendations: • Strong background in HIV/STI service delivery • Familiarity with use of internet for sex • Know structure of agency--reduces bureaucracy and decreases lag time of buy-in • Strong knowledge of referral resources • What else? • Extremely driven, self-motivated • Tedious • Curious

14. Training • Recommendations: • Require EDG, ISTDI, ASTDI • Rotation in DPH and shadowing field staff • Attend “chalk talks” and DIS all staff meetings • Cross training in HIV and other STDs, including client-centered counseling • If/when a group of CBO DIS staff exists, collaboration is crucial. • Our individual mistakes are our collective failures.

15. Expectations of DIS • Emphasis on field work (vs. phone or internet)? • Other clinic duties? Will this person be expected to perform four jobs? • Reporting and surveillance responsibility • Morbidity reports, record searches, determining case status/initiation • Running partners out of jurisdiction?

16. Issues to Anticipate • Self-disclosure • Appropriate vs. Inappropriate • When is disclosure beneficial? • Diplomacy • Disagreements with medical providers • Culture of public health programs • “Uncooperative” clients • Interviewing former sex partners • Interviewing fellow staff at your agency

17. Supervision • When/how will case supervision occur? • When/how will administrative supervision occur? • How will case/admin supervisors interact? • What happens when there is disagreement between them? • Who will DIS go to for case definition/surveillance issues?

18. Conclusions • Community-based partner services programs can work!!! If… • Identify collaborator who is stable, believes in public health mission, has high morbidity of disease • Expectations are clear up front • Training/supervision goals are established • Continued collaboration between CBO and DPH

19. Acknowledgements • HB DIS Staff: Daniel Pohl, Mark Pineda, Richie Diesterheft (and former staff…) • CDC/CDPH/IDPH Staff (Especially: Laurie Anderson, John Creviston, Dr. Carol Ciesielski, Dr. Irina Tabidze and Dr. Will Wong) • HB Nurses and Providers

20. Wrap-Up • Questions/Comments? • Thanks! • Contact info: Beau Gratzer 773.388.8864 beaug@howardbrown.org