GFHS BOARD OF DIRECTORS MEETING MAY 25,2016. Gaston Family Health Services

Transcription

1 1 GFHS BOARD OF DIRECTORS MEETING MAY 25,2016 Gaston Family Health Services

2 Board Education HepC/HIV Program Erin Hultgren, HIV Program Manager 2 Caring for Our Community

3 About FOCUS On the... F rontlines Of Communities in the U nited S tates A program by Gilead Sciences Works with partners to develop and share replicable model programs that embody best practices in HIV and HCV screening and linkage to care Diverse range of partners across 30+ cities

4 Human Immunodeficiency Virus (HIV) 4 A virus that is spread through certain body fluids blood, semen, rectal fluids, vaginal fluids and breast milk A virus that attacks the body s immune system, specifically the CD4 cells, often called T cells Untreated, HIV reduces the number of CD4 cells in the body, damaging the immune system & making it harder for the body to fight off infections/diseases Opportunistic infections take advantage of a very weak immune system & can signal the onset of AIDS

5 Human Immunodeficiency Virus (HIV) 5 According to the CDC More than 1.2 million people, ages 13 and older, in the U.S. are living with HIV (2012) Almost 1 in 8 (13%) are unaware of their infection About 50,000 new infections per year Gay, bisexual and MSM are most seriously affected African Americans face the most severe burden The South has the highest # of people living with HIV

6 Hepatitis C (HCV) 6 Blood-borne virus that leads to Hepatitis C infection For some people, HCV is a short-term illness but for 70% 85% of people it becomes a chronic infection Chronic Hepatitis C is a serious disease that can result in long-term health problems, even death Majority of infected persons might not be aware of their infection because they are not clinically ill

7 Hepatitis C (HCV) 7 According to the CDC million people in the U.S. have chronic HCV 15% 25% of persons clear the virus from their bodies without treatment and do not develop chronic infection 75%-85% of HCV infection cases become chronic Chronic HCV infection is the leading indication for liver transplants in the U.S. There is no vaccine for Hepatitis C

8 Hepatitis C (HCV) 8 According to the CDC Of every 100 persons infected with HCV, approximately: will go on to develop chronic infection will go on to develop chronic liver disease 5 20 will go on to develop cirrhosis over a period of yrs 1 5 will die from the consequences of chronic infection (liver cancer or cirrhosis)

9 The FOCUS Approach 9 In partnership with government agencies, health systems and others in 30+ highly impacted cities, FOCUS aims to: Make HIV and HCV screening a standard of care Increase stakeholder dialogue Reduce undiagnosed and latediagnosed infections Change public perceptions, overcome stigma Ensure linkage to care and treatment Keep patients in care

10 Expanding Screening and Linkage to Care 2012 Rate of adults/adolescents living with an HIV diagnosis per 100,000 population West Region Open Positon, Regional Lead *Includes Denver, Seattle, Portland, Las Vegas and Phoenix Central Region Jabari Bruton-Barrett, Regional Lead *Includes Minneapolis, St. Louis, Louisville and Nashville Northeast Region Open Positon, Regional Lead *Includes Boston, Providence, and Hartford Chicago, IL Lora Branch, Regional Lead Midwest Region Monique Rucker, Regional Lead *Includes Cleveland, Columbus, Cincinnati, and Detroit New York, NY Heather Anderson, Regional Lead Newark, NJ Arun Skaria, Regional Lead *Includes Jersey City & Camden Oakland, CA Myra Ozaeta, Regional Lead Philadelphia, PA Carol Vincent, Regional Lead Baltimore, MD Angelique Griffin, Regional Lead Los Angeles, CA René Bennett, Regional Lead Houston, TX Smita Pamar, Regional Lead *Includes Dallas v Atlanta, GA Shauni Williams, Regional Lead *Includes Birmingham Washington, DC Tiffany West, Regional Lead Charlotte, NC Liz Mallas, Regional Lead *Includes Columbia and Raleigh New Orleans, LA Sylvia Andrews, Regional Lead *Includes Baton Rouge & Jackson Miami, FL Daniel Montoya, Regional Lead Kacy Hutchison Vice President Gov t Affairs FOCUS Program Oversight Patrick McGovern Senior Director Gov t Affairs FOCUS Program Lead Lorna Davis-Robinson Regional Director FOCUS Jill Foster Regional Director FOCUS Carine Mathurin Regional Director FOCUS Derek Spencer Regional Director FOCUS

11 Carolinas Partnerships Rates of Persons Living with an HIV Diagnosis by County (2012) UNC/Durham County Department of Public Health HIV and HCV 2. Gaston Family Health Services HIV and HCV 3. Affinity Health Center HIV, HCV, Hepatitis A and B 4. South Carolina HIV/AIDS Council HCV

12 The FOCUS Model HIV Routine HIV Screening in Two Health-Care Settings New York City and New Orleans, HCV Identification and Linkage to Care of HCV-Infected Persons in Five Health Centers Philadelphia, Pennsylvania,

13 Unmet Medical Need in HIV and HCV HIV: 14% undiagnosed and 45% diagnosed, not in care 1 Test and treat requires early diagnosis and access to treatment Engagement of out-of-care, previously known positives is needed HCV: 50% undiagnosed and 23% not RNA-confirmed 2 As previously diagnosed patients are cured, unprecedented levels of screening are needed Need to confirm HCV diagnosis for Ab+ patients 1 Skarbinski, Jacek, et al. (2015) Human Immunodeficiency Virus Transmission at Each Step of the Care Continuum in the United States. JAMA Internal Medicine 175(4): Yehia, Baligh, et al. (2014) The Treatment Cascade for Chronic Hepatitis C Virus Infection in the United States: A Systematic Review and Meta-Analysis. PLoS One 9(7):

14 HIV Screening & Linkage to Care Challenges Challenge: Patients test negative for HIV when they may be in the window period and can unknowingly expose others Need: 4 th generation testing to identify patients with acute HIV infection and treatment at diagnosis Challenge: Known HIV positives who are out of care need to be reengaged, assessed and potentially triaged Need: EHR queries, tracking database, outreach & engagement strategies Challenge: HIV negative persons who are high risk still need to be engaged after being routinely screened Need: Best practice use of EHR post-test algorithms and comprehensive prevention

15 HCV Challenges Challenge: 50% of HCV Ab positive do not receive follow-up to determine if chronically infected Need: Better testing and linkage practices; expanded use of lab based testing with reflex to RNA Challenge: Known Ab positives who are out of care need to be reengaged, assessed and potentially triaged Need: EHR queries, tracking database, outreach & engagement strategies Challenge: HCV screening in clinical settings without cumbersome, exceptionalist or parallel processes Need: Best practice use of EHR algorithms and automated order sets; maximize potential of lab based technologies for scale & efficiency Challenge: Achieving linkage to cure with an experienced HCV treater Need: Identification and development of effective referral networks with minimal loss to follow-up

16 Best Practices in Development Acute HIV Diagnosis Opportunity to treat within days of infection and penetrate sexual networks to prevent onward transmission Positive network members immediate linkage to care Negative network members assessed for comprehensive prevention services EHR Technology Public health screening algorithms to designate patients for HIV, HCV, viral STD testing and prevention assessments Draw upon lab data, previous results, zip codes, key words in assessments and progress notes Assess negative patients deemed eligible for comprehensive prevention services (% of tested) Automatic Reflex to RNA Single blood draw for Antibody with Reflex to RNA if positive Reduces patient loss for confirmatory testing with an additional blood draw

17 FOCUS through the end of M HIV Tests, 17K Positives since K HCV Ab tests, 20K Ab+ since % Median Linkage to Care 0.8% Seropositivity 300K tests 215K tests K tests HCV Ab Tests by Year 113 Partnerships in 21 cities (as of Q4 2015) 200% increase in HCV partnerships in one year Median HCV Ab seropositivity >3% in all settings (2015) Dissemination by FOCUS Partners Hospital (39%) Community /Other* (24%) CHC/FQHC (37%) *Other includes health departments, substance use, training, and corrections. 200% Q Q Partnerships conducting HCV screening 4% Community Health Centers 8% Hospitals 12% Substance Use Treatment 3% est. national Baby Boomer Ab+ 260 Abstracts accepted at major conferences 32 Journal Articles published in peer-reviewed journals

18 FOCUS Dissemination 260 Abstracts accepted at major conferences 32 Journal Articles published in peer-reviewed journals 18

19 GFHS Testing Goals: May 1, 2016 June 30, 2017 HIV # Eligible Patients 12,646 PROPOSED GOAL # HIV Tests Conducted 5,000 (40% of eligible) # HIV Positives Identified 30 (.6% positivity rate based on health department history) # Acute HIV Cases Identified TBC # or % HIV+ LTC 24 (80% LTC) HCV # Eligible Patients 2,947 PROPOSED GOAL # HCV Tests Conducted 2,750 (93% of eligible) # HCV AB+ Identified 275 (10% positivity rate) # HCV RNA + Identified 198 (72% of AB+) # HCV RNA+ LTC 138 (70% LTC)

20 Start Up Activities Assigning Staffing and Resources Program Manager Patient Navigator IT/EMR Consultant Data Manager Orientation/training for providers and clinical staff Update of protocols and processes Update forms and lab orders Modification of EMR Launch

21 Questions