Strengthening Linkages: why & how to connect our dots
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- Christiana McDaniel
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1 Strengthening Linkages: why & how to connect our dots Sophy S. Wong, MD Medical Director, Bay Area & North Coast AETC Associate Clinical Professor of Medicine, UCSF
2 Workshop objectives Why linkage matters for Prevention What we can do: a case story How we can strengthen linkages as one of our priorities
3 Why does linkage & retention matter?
4 POP QUIZ! Who are the drivers of HIV Transmission among MSM? One-time, Casual, or main partner? Acute or chronic infection? Partner is/are: undiagnosed, not linked, not retained? Chapin-Bardales Abstract CROI 2017 #1024
5 Drivers of HIV Transmission among MSM Casual (50%) or main (40%) partner Chronic infection Partners not retained in care Chapin-Bardales Abstract CROI 2017 #1024
6 What % of HIV transmissions are from PLWHA not in care? 2015 JAMA, Skarbinski et. al.
7 Where do new infections come from? diagnosed & not retained 2015 JAMA, Skarbinski et. al.
8 Treatment reduces transmission by HPTN 052 study: Cohen MS et al, NEJM 2011: 365 and CROI 2015
9 California HIV care continuum 91% 67% 65% 52% % diagnosed % linked to care % retained in care % VL < , 2014 data from CA HIV Integrated Plan 2016
10 California HIV care cliff 91% 67% 65% 52% % diagnosed % linked to care % retained in care % VL < , 2014 data from CA HIV Integrated Plan 2016
11 California HIV linkages 91% 2021 Goal: 85% 2021 Goal: 90% 67% 65% 52% % diagnosed % linked to care % retained in care % VL < , 2014 data from CA HIV Integrated Plan 2016
12 Who in the US is least likely to be retained or VL suppressed? Young people Ages US: 76% vs. 83% retention CA: 45% viral suppression vs. 57% 2012 RSR data; 2014 CA surveillance data from Integrated Plan
13 Who in the US & CA are less likely to be virally suppressed? African Americans in CA: 49% Transgender people in CA: 51% IDU in CA: 45% (vs. 57% overall) 2012 RSR data; 2014 CA surveillance data from Integrated Plan
14 What can we do to strengthen linkages?
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16 Existing Models of Linkage to Care <48 hours to 6 weeks + HIV Test Partner Services Interview Linkage Assistance CENTRAL ELIGIBILITY +/- Case management intake Medical Visit + HIV Test Partner Services Interview Linkage Assistance Medical Visit Eligibility Assessment + HIV Test Linkage Assistance & Partner Services Interview Medical Visit Eligibility Assessment Case Management Intake Slide courtesy of Dr. Julie Dombrowski at UW and Seattle & King County Public Health, 2017
17 Data to Care Strategies 1. Health Department HIV Clinic Patient Madison Clinic Part C clinic in Seattle, 117 pts: 32% contacted, 17% relinked 2. Health Department Patient 3. Health Department Check-in HIV Clinic Patient Public Health Seattle & King County 662 pts: 56% contacted, 10% relinked Slide courtesy of Dr. Julie Dombrowski at UW and Seattle & King County Public Health, 2017
18 Most PLWH that appear to be out of care are not actually out of care Seattle - King County Surveillance Round 1 Surveillance Round 2 HIV Clinic Cases with no CD4 or VL for 12 months % moved or died 55% moved or died 79% moved, died or transferred care Findings replicated in diverse geographic areas throughout the U.S. (6 Northwestern states, MA, MD, NY, TN) : 47-88% of cases with no CD4 or VL for 12 months had an alternate explanation for the gap in lab reports Buskin SB, et al STD 2014; PHSKC Program data; Bove, JAIDS 2015
19 Alameda County HIV Care Continuum
20 East Bay linkage & retention network
21 Online linkage contact list: updated quarterly
22 Online linkage contact list: updated quarterly
23 Warm hand-off protocol
24 Literature review of evidence-based linkage and retention practices
25 Alameda County Linkage-to-care % before warm hand-off protocol
26 Alameda County Linkage-to-care % mid-2013: launched warm hand-off protocol
27 Alameda County HIV ACCESS % after warm hand-off & P4P launch
28 Alameda County HIV ACCESS % after P4P & linkage system strengthening
29 Alameda County HIV ACCESS % Linkage system maturation
30 How can we integrate linkage to care into our priorities?
31 Join the polls via web browser Pollev.com/soa From any browser Pollev.com/soa
32
33 Connecting our Dots 1. Write on post-it note(s): How does linkage to care fit into this priority area? What action step will you take in the next 3 months to strengthen linkage integration in this area? 2. Find your top priority area 3. Place a dot and post-its on the poster paper 4. Find someone to talk to! 1. Why you chose this priority area 2. How linkage fits and what you re going to do to strengthen linkages in this area.
34
35 Thank you! Questions?
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