Who are we? Kim Koester, AIDS Policy Research Center at the Center for AIDS Prevention Studies Teri Dowling, SFDPH, HIV Prevention Section Noah Carrah

Transcription

1 Enhancing HIV Testing, Linkage to Care and Partner Services in San Francisco CAPS Conference 2010

2 Who are we? Kim Koester, AIDS Policy Research Center at the Center for AIDS Prevention Studies Teri Dowling, SFDPH, HIV Prevention Section Noah Carraher, SFDPH, HIV Prevention Section Katrina Christopoulos, Positive Health Program, San Francisco General Hospital

3

4 What will you learn from us? Be informed about SF HIV testing trends. Be informed about the need for expanding HIV testing in medical settings. To understand the rationale to expand access to HIV testing, linkage and partner services.

5

6

7 Annual HIV Infections in San Francisco New HIV infections per year: * Men who have sex with men 87% Transfemales 6% Heterosexual injection drug users 5% *courtesy of sfhiv.org

8 HIV Testing Deficit in San Francisco Behavioral Risk Population (BRPs) At risk population size* %NOT tested past 6 months** Testing deficit, 6 months MSM 48,329 54% 26,098 IDU 14,609 58% 8473 Transfemale 1,880 UNK Minimum total add l tests needed UNK Needed 34,571 every 6 months

9 Health Care Reform & HIV Testing The Health Care & Education Affordability Reconciliation Act of 2010 signed into law March 23, Beginning September 23, 2010 insurance companies will cover costs of all rec d screenings, including HIV.

10

11 Kat s Presentation on HIV Testing in Emergency Departments

12 Enhancing HIV Testing, Linkage to Care and Partner Services in San Francisco: A Needs Assessment

13 SFDPH & CAPS Collaboration Janet Myers, Kim Koester & Mi-Suk Kang (CAPS) UCSF Teri Dowling and Noah Carraher (SFDPH)

14 Goals of the Needs Assessment Assess the number of HIV tests conducted in SFDPH-funded clinics Assess the barriers & facilitators to expand clinic-based HIV testing Asses how newly diagnosed patients are linked into care Assess the use of partner services

15 How did we achieve goals? Conducted key informant qualitative interviews Collected existing data on HIV tests conducted in SFDPH-funded clinics Assembled report back sessions to share findings & generate additional suggestions Facilitated a stakeholders meeting to present findings and secure input for next steps

16 Who did we interview? SFDPH representatives SFDPH-funded clinic medical directors and clinicians: (n=10) City Clinic representatives SF General Hospital laboratory representatives Healthy San Francisco representative

17 What did we ask? What s happening with HIV testing in your clinic? Tell me about who gets tested? Do you have policies on who to test? Are you aware of the CDC HIV testing rec ds? How does linkage to care work? How do you manage partner services? Is it feasible to increase HIV testing?

18 Overall Findings Figuring i out how many HIV tests t are conducted d in SFDPH-funded clinics is difficult. No clinic i is uniformly implementing the CDC recommendations.

19 How many patients were tested for HIV in SFDPH-funded clinics? Despite an advanced clinical system of care for HIV infected patients in San Francisco, the overall rate of HIV testing in primary care settings remains low, at about 8% (range 2% to 34%).

20 HIV Testing Practices All clinics provide HIV tests if a patient asks No clinic has a formal HIV testing policy for existing i patients A few clinics routinely screen all new patients Many clinicians i i regularly l offer HIV testing ti to existing at risk patients A few clinics have strategies to increase HIV tests (e.g., one day per month)

21 Linkage to Care Practices Linkage to care reported to occur seamlessly Care is offered on-site or Patient is referred to a sister clinic There seems to be good communication among sites with and without HIV experts

22 Partner Services Practices One clinic offers formal partner services on- site. Two clinics encourage patients to bring in their partners to be tested on-site Two clinics refer patients to DPH partner services

23 Special Thanks Teri Dowling and her staff Lisa Johnson Fred Strauss SF General Lab All the SFDPH-funded primary care medical directors and MDs who participated in this project

24 Implications of the Needs Assessment on HIV Testing, Linkage to Care and Partner Services

25