Data Driven Targeting and Recruitment

Transcription

1 Data Driven Targeting and Recruitment Part Two: Baltimore City Department of Health Jacky Jennings, PhD, MPH Johns Hopkins University School of Medicine Patrick Chaulk, MD Baltimore City Department of Health April 27, 2016 Jillian Casey NASTAD Joe Caldwell NASTAD

2 Webinar Participant Considerations Phone lines Lines will be muted until dedicated question time. Please do not put your call on hold. Verbal Questions There will be dedicated time for questions. Please wait until the Q & A section to ask questions on the phone. Please identify yourself when asking a question or providing a comment. Written Questions Participants have the ability to submit written questions during the webinar using the Chat function Evaluation Following the webinar, participants will be taken to a website to complete a brief survey to provide feedback on the webinar. 2

3 Webinar Outline 1. NASTAD s Data Driven Targeting and Recruitment Toolkit 2. Baltimore City s Demonstration Project From Routine Testing to Targeting HIV Control Dr. Jacky Jennings, Johns Hopkins University School of Medicine Dr. Patrick Chaulk, Baltimore City Department of Health 3. Audience Q&A and Discussion 3

4 Introducing NASTAD s new HIV Testing Toolkit Data Driven Targeting and Recruitment Previously featured: 1) Selecting a Strategy 2) Productivity & Yield Analysis 4

5 Data Driven Targeting and Recruitment Part One Virginia Department of Health Targeting and Recruitment In-Home Testing Program Partnership with Walgreens 5

6 Reducing HIV in Baltimore City: Results from an Innovative Demonstration Project Jacky M Jennings, PhD, MPH, Patrick Chaulk, MD The Baltimore City Health Department, Johns Hopkins Center for Child & Community Health Research, Maryland Department of Health and Mental Hygiene, Center for Design Practice/MICA, NYC Department of Health, AIDS Education Training Centers (UMD, JHU), JACQUES Initiative, STI/HIV Prevention Training Center Funding Centers for Disease Control and Prevention, Gilead Sciences, T32 AI

7 Setting Baltimore has the 6 th highest rate of HIV diagnoses in the US. 1 in 5 HIV positive persons in Baltimore do not know they are infected. Treatment can reduce the transmission of HIV by 96%.

8 Vision Baltimore City will become a place where new HIV infections are rare, and when they do occur, every person regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socioeconomic circumstances, will have unfettered access to high quality, life-extending care, free from stigma and discrimination. National HIV/AIDS Strategy for the United States Updated to 2020

9 Specific Goals for Baltimore City Reduce HIV transmission Reduce HIV-related health disparities Reduce stigma related to HIV

10 Activity One: Increase routine HIV screening among primary care providers located in > high HIV transmission areas in Baltimore. Objectives To determine the feasibility of public health detailing for routine HIV screening (i.e. relationship and network building) To determine the impact on knowledge, attitudes and practices regarding routine HIV screening

11 What is routine HIV screening? Practice of making HIV screening part of routine, preventive care Screen all patients between 15 and 65 at least once, regardless of risk Screen patients younger than 15 and older than 65 if risk factors present Change from risk based testing that targets people based on demographics or behaviors

12 The time is now April 2013, the US Preventive Services Task Force (USPSTF) upgraded to a grade A the benefit of routine HIV screening. Under the ACA, all marketplace plans and many others are required or incentivized to cover routine HIV screening. The CDC, State of Maryland and BCHD all recommend routine HIV screening. Opt Out legislation passed July

13 The role of primary care providers Primary care providers play an essential role in reducing the spread of HIV and improving the outcomes for those with HIV. 44% of current diagnoses take place in private MD offices and HMOs. Risk-based assessments are stigmatizing and often miss patients with HIV infection. Routine HIV screening is quick: Extensive pre-test counseling is no longer required.

14 HIV Transmission Areas ( ) & Primary Care Provider Locations, Baltimore City Primary care providers

15 HIV Testing Action Kit Provider Guide importance of routine screening Maryland law neighborhood statistics on HIV transmission and new diagnoses types of HIV tests screening guidelines pretest counseling consent coding delivering test results linkage to care, and reporting

16 Quick reference pocket card Screening algorithm Script for pretest counseling Coding/ ordering Steps to connecting HIV+ patients to care

17 Providers interviewed (n=153) 84% Physicians 11% Nurses 4% Physician s Assistants 1% Other

18 Patients served Clinic manager surveys (n=69) 55% Medicare or Medicaid 70% African American 83% > 24 years of age 40% male 6% gay male

19 Baseline Results: Feasibility 100% (85) eligible practices visited 74% (150/202) providers engaged and interviewed Among those agreeing to participate, 96% (76) practices received at least 1 HIV testing action kit with over 300 kits total delivered

20 Impact of Public Health Detailing 73% stated as a result of campaign that HIV screening increased Of the 24% that stated no change in HIV screening, 1/3 intend to change in the next 6 mos 2/3 report that routine screening is already in place ~25 new HIV diagnoses by 16 different providers at 12 practice sites

21 Impact of Public Health Detailing 96% > satisfied with the campaign 41% of providers report using kit at follow-up 58% of providers reported as a result of the campaign that activities associated with screening increased (training, change to EMRs, shared materials with patients)

22 HIV Routine Screening Practices in One Primary Care Site from Pre- (blue) to Post-intervention (red, green)

23 Primary Care Provider quotes... Before our conversation, I only screened patients symptomatically or diagnosed with other STDs but when you said we needed to screen everyone from ages 13-65, I offered HIV screens more towards those age ranges. Thank God all of them are negative, but, yeah, I have been screening more often, even for the elderly patients in monogamous relationship too. Even though I presumed they wouldn t be in the high risk population, I offered them HIV tests anyways during a checkup. I ll say Hey since you re here to get a physical checkup, why not test for HIV too? Many of them take one. Just this week I had a patient with a new diagnosis of HIV on routine screening and made use of the binder you gave me, specifically for guidance on partner notification and notifying DHMH.

24 Next Steps Public health detailing campaign to inform PCPs about new opt out legislation and provide resources for PrEP, npep and PEP Testing reliability and validity of community viral load measures (2016 CROI abstract)

25 Goals Decrease HIV transmission in Baltimore City Increase the efficiency of HIV outreach testing in Baltimore City by utilizing surveillance data (community viral load (CVL) data) and geographic information systems 25

26 Targeted HIV Control Activity two: Increase the efficiency of HIV outreach testing by utilizing surveillance data (community viral load (CVL) data) and geographic information systems Objective: To determine whether a new initiative to increase HIV outreach testing in high community viral load (CVL) areas increases: 1. # of HIV diagnoses, 2. # of new HIV diagnoses and 3. proportion of high viral load cases identified (i.e. incident infections) Compared to a similar time period. 26

27 Study Design CVL maps including low and high viral load areas Two GIS units placed on two mobile outreach testing van Three time points of three months each Baseline (2013), post-intervention (2014) and follow-up (2015) For each of the three time points, calculation of time spent in CVL areas calculation of HIV outcomes 27

28 Initiative Mapped 1) CVL areas and 2) mapped mobile outreach data for 2013 (baseline) Series of meetings decided 2014 focus on night shifts, later decided 2015 focus on night and day shifts Identified high priority areas High viral load areas not touched at all Worked with outreach leaders to identify the areas Developed hard copy maps of high viral load areas for outreach team to utilize to set monthly schedule for outreach 28

29 HIV Transmission Areas ( ), Baltimore City

30 Night Team Outreach Testing, April August 2013, Baltimore City

31 Outreach Testing, 2013, 2014 & 2015, Baltimore City = 2013 = 2014 =

32 Total hours spent testing by CVL transmission areas by year Total Hours Spent Testing No Transmission Areas N = 14 Low Transmission Areas N = 76 High Transmission Areas N = % 30% 69% % 28% 73% % 15% 84% 32

33 Hours spent testing in high transmission areas - Day Team? Total Hours Tested No Transmission Areas N = 14 Low Transmission Areas N = 76 High Transmission Areas N = % 33% 66% % 28% 72% % 10% 88% 33

34 Hours spent testing in high transmission areas - Night Team? Total Hours Tested No Transmission Areas N = 14 Low Transmission Areas N = 76 High Transmission Areas N = % 26% 72% % 27% 73% % 27% 72% 34

35 HIV testing outcomes by year Encounters HIV positives New Positives High Viral Load (3%) 3 (0.1%) 5 (0.2%) (4%) 5 (0.4%) 6 (0.5%) (6%) 6 (0.2%) 9 (0.4%) *Excludes Festivals, Gay Pride, Latino Festival, African American Festival, White Party, Callow Hill Aquatics Center 35

36 HIV testing outcomes by year Day Team % of Time Testing Encounters HIV positives New Positives High Viral Load % (1%) 0 (0%) 0 (0%) % 43 2 (5%) 0 (0%) 0 (0%) % (10%) 2 (0.8%) 3 (1%) *Excludes Festivals, Gay Pride, Latino Festival, African American Festival, White Party, Callow Hill Aquatics Center 36

37 Top Five Venues Time Spent Testing Franciscan Center Turning Point Cherry Hill Shopping Center Laurens St/Pennsylvania Ave Greenmount Ave/25 th St Number of High Viral Load Cases Beans and Bread Reginald F Lewis Museum Cherry Hill Shopping Center Maryland Ave/21 st St Greenmount/25 th St 37

38 Which venues are most important for outreach testing? Affiliation network of newly diagnosed MSM (n=143) and sex partner meeting places (n=132) VENUE Viral Loads Blue= high (>1500 copies/ml) Grey= low ( 1500 copies/ml) White= unknown 38

39 Connectivity across venues: co-occurrence network of sex partner meeting places (n=26) reported by >1 MSM 39

40 Next Steps Continuing public health detailing to maintain relationship with PCPs, inform about new opt out legislation and provide resources for PrEP, npep and PEP Testing reliability and validity of community viral load measures (2016 CROI abstract) Routinizing outreach testing protocols based on targeting areas and venues with high community viral load measures

41 House/Ball Outreach Program Program History Leveraging Community for HIV Testing Engagement Program update and next steps NASTAD Webinar 41

42 Contact Details Jacky Jennings, PhD, MPH Associate Professor and Director of the Center for Child and Community Health Research (CCHR) at Johns Hopkins University School of Medicine Patrick Chaulk, MD Assistant Commissioner of the Bureau of HIV/STD Services at the Baltimore City Health Department 42

43 Questions Verbal Questions Press *7 to unmute Press *6 to re-mute Please identify yourself Written Questions Submit using chat If you have questions regarding this webinar, please contact Joe Caldwell 43

44 Thank you! 44