HIV Partner Services in HIV Care Programs

Transcription

1 Welcome HIV Partner Services in HIV Care Programs Building the Care Continuum: Comprehensive Approaches to HIV Care in California Manny Rios HIV Partner Services Specialist CDPH: Office of AIDS Brett AugsJoost Program Advisor CDPH: STD Control Branch

2 Presentation Objectives Overview of Partner Services Why Offer HIV Partner Services Policy Review (Memorandum# 15-06) Improving your HIV PS Program by creating a HIV PS Plan Training and Technical Assistance Where Prevention Starts

3 What Is HIV Partner Services: Overview

4 HIV Partner Services is an Intervention that: Prevent Disease Complications Intervene in the Spread of Disease Improve the Health of Your Community Partner Services is Public Health

5 Public Health conducts Contact Tracing for communicable diseases Ebola: patient in Texas Measles outbreak in Disneyland Public Health Interventions Work!

6 HIV PS: Guiding Principles Voluntary Non-Coercive Confidential Nonjudgmental Client Centered Universal Access

7 HIV PS Disclosure Options Client wants to remain anonymous. Client wants to disclose their status with a Health Educator/Advisor present. Client wants to inform partner on their own.

8 How does HIV PS work? Local Health Dept. Clients Exposure Cluster Client elects: Anonymous 3 rd Party Notification

9 How does HIV PS work? Clients Exposure Cluster Client elects: Dual Disclosure

10 How does HIV PS work? Clients Exposure Cluster Client elects: Self Disclosure

11 How does HIV PS work? Local Health Dept. Clients Exposure Cluster Client elects: Anonymous 3 rd Party Notification Dual Disclosure Self Disclosure

12 HIV Partner Services Benefits Individuals Communities Disclosure Counseling Linkage to Care (LTC) Support Services PEP & PrEP Information Identifying New Positives Re-linkage to Care Reducing New Transmissions in the Community PEP & PrEP Information

13 Why Offer HIV Partner Services?

14 Where Prevention Starts

15 HIV Transmission Trends By Subpopulations Gay, bisexual, MSM continue to be the group most severely affected by HIV CDC fact sheet: HIV Among Gay and Bisexual MSM; 2015:

16 SOURCE: CA State Office of AIDS, The Continuum of HIV Care in California (Dec 2014 ) and HIV in the US: At A Glance (CDC) HIV by the Numbers New infections each year 50,000 United States New infections each year 5,000 California Percentage of HIVpositive people who don t know they are positive 16% California

17 100% 90% 80% 70% 60% 50% 40% HIV Care Continuum California, % N=138,879 HIV PS can help identify those unaware of status. 91% HIV PS staff, LTC Coordinators, Peer Navigators, & Health Educators: help ensure clients are offered PS and linked into HIV medical care. 64 % 52% 30% 20% 10% 0% Infected (Estimated) Diagnosed In HIV Care Achieved Viral Suppression HIV Partner Services in California

18 Helping People Know Their HIV Status Makes Sense Nationally, those with undiagnosed HIV (18%) Are associated with.. 30% of new infections Informing people of their status can reduce HIV transmission. Skarbinski, J., Rosenberg, E., Paz-Bailey, G., et. al (2015). Human Immunodeficiency Virus Transmission at Each Step. JAMA Intern Med. 175(4):

19 Measuring the Success of HIV Partner Services

20 56% Not Notified 44% Notified 400 Partners Elicited Data courtesy CDPH Office of AIDS

21 78% HIV- 22% HIV+ 24% HIV+ 33% Not Tested 44% Agreed to Test 44% Notified Elicited Data courtesy CDPH Office of AIDS HIV Partner Services in California

22 Documentation is Key to Demonstrating Success In California documentation of PS consist of the following LEO: Local Evaluation Online* Partner Services Activities HIV Counseling and Testing RRA (Risk Reduction Activities) ARIES: AIDS Regional Information and Evaluation System* HIV Care Minority AIDS Initiative HOPWA CalREDIE: California Reportable Disease Information Exchange Co-infected Syphilis Co-infected Gonorrhea HIV Surveillance-Based Partner Services*: in development *OA Funded

23 National HIV/AIDS Strategy $ PS Federal Programs / Funding Sources $ $ County LHD / LHJ CBO s, Clinics, Non-Profits, etc. PS Provider YOU

24 How Partner Services Works

25 Is HIV PS right for everyone, all the time?

26 Partner Services Prioritization HIV Partner Services should be prioritized for HIV+ Clients who meet at least one of the following criteria: Acute or recent HIV infection (within 6 months) New diagnosis of HIV infection, regardless of stage Uncontrolled HIV viral load Concurrent syphilis or gonorrhea diagnosis

27 Context for HIV PS Who Interfaces with the Client? HIV Test Provider Linkage to Care Provider HIV Care Provider Prevention Provider HIV or STD Surveillance Staff STD Testing/Treatment Provider Housing Assistance Provider HIV Case Manager

28 Important Points to Consider Being successful at implementing PS involves of a complex set of skills that you will develop over time. PS isn t right for every client at every encounter. Over offering PS can dilute the message and cause burnout. The PS process involves more than simply asking Do you need Partner Services? or Are their any partners you need to notify?

29 Partner Services Prioritization OA HIV Care Program Memorandum #15-06

30 HIV Partner Services Counseling Possible Roles Information & Education Conduct Assessment Provide Information Motivate Obtain Buy-In Refer for Intervention Conduct PEI Conduct Assessment Disclosure counseling Elicited partners Forward partner information to county

31 What does offering HIV PS look like? - Comprehensive HIV PS Counseling Sessions - Partner Elicitation Interview (PEI)

32 Venue-Based HIV PS EXTERNAL REFERRAL PS Assessment (Education & Information) Client Info Local Health Department

33 Venue-Based HIV PS INTERNAL REFERRAL PS Assessment (Information & Education) Partner Elicitation Interview Conducted by a trained HIV PS Champion/Navigator PIF Local Health Department

34 REPORT Surveillance-Based HIV PS HEALTH DEPARTMENT INITIATED Health Department Surveillance Staff / DIS Partner Elicitation Interview Conducted by Health Department DIS Follows up with care provider prior to contacting client

35 Office of AIDS HIV Care Programs Policy Review Memorandum # 15-06

36 OA HIV Care Program Memorandum #15-06 (July 28, 2015) Where Prevention Starts

37 III. Policy OA HIV Care Program Memorandum #15-06 (July 28, 2015) OA has expanded the PS requirement for contractors and service providers to work collaboratively with the Partner Services Coordinator (PSC) in their local health department and develop procedures to ensure that PS is available for the appropriate HIV Care Program (HCP) clients.

38 OA HIV Care Program Memorandum #15-06 Effective Nov. 1, 2015, HCP providers who are funded for the following service categories are required to establish a process for PS referral and counseling: Outpatient/Ambulatory Medical Care (OAMC) Early Intervention Services (EIS) Mental Health Substance Abuse Treatment (outpatient or residential) Health Education/Risk Reduction and Outreach

39 OA HIV Care Program Memorandum #15-06 HCP providers should prioritize PS for HIV-positive HCP clients when clinical and behavioral factors indicate a higher risk of transmission. Acute or recent HIV infection (infection acquired within the last 6 months) Any new diagnosis of HIV infection, regardless of duration of infections Uncontrolled HIV viral load Concurrent syphilis or gonorrhea diagnosis

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41 OA HIV Care Program Memorandum #15-06 In order to facilitate timely intervention in disease transmission, HCP providers should offer PS to clients with HIV during: Disclosure of initial HIV positive result Initial HIV care visit Re-engagement to care encounters Syphilis or gonorrhea diagnoses in an HIV care setting, or any STI diagnosis in the setting of an uncontrolled HIV viral load

42 OA HIV Care Program Memorandum #15-06 Service provider should inform appropriate clients about the availability of PS and then complete one of the following steps: Actively refer the client to the local PSC for health department follow up, or Conduct a comprehensive PS counseling session, discuss different options for PS notification and eliciting sexual and/or needle sharing partner(s) names and locating information for their local PSC to follow up, or Document refusal of PS

43 Improving your HIV Partner Service Program Enhancement Tools HIV PS Plan HIV PS Agency Policy Where Prevention Starts

44 Improving HIV Partner Services: Where do you start? HIV PS Plan Road map to identifying HIV PS stakeholders, resources and areas of opportunities throughout your agency and community. HIV PS CARE Policy Helps establish structure and procedures to guide the actions of all individuals involved in the service/intervention. Where Prevention Starts

45 Basic Outline: HIV PS Plan 1. What locations provide HIV PS? 2. Who are the individuals that are currently trained to provide HV PS? 3. How is HIV PS being conducted? 4. Who at the County Health Dept. level is responsible for HIV PS and partner notification? 5. Who should be offering HIV PS?

46 Basic HIV PS Plan Outline 1. What locations provide HIV PS? - Agencies, hospitals, CBO s, private doctors. 2. Who are the individuals that are currently trained to provide HV PS? - First and last names with contact information of each individual providing HIV PS. 3. How is HIV PS being conducted? - In what capacity is HIV PS being provided (medical setting, eligibility, intake appointments, counseling, support groups, annually, etc )

47 Basic Outline: HIV PS Plan 4. Who at the County Health Dept. is responsible for HIV PS and *HIV partner notifications (field notifications). - Identify county staff or team responsible for HIV PS and HIV partner notifications. Local Health Dept. *HIV partner notification should only be done by designated county staff such as DIS, CDI, PHN or individuals working under the protection of the local county health officer for the purpose of HIV PS.

48 Basic HIV PS Plan Outline 5. Who should be offering HIV PS who is not currently? - Identify individuals or agencies that provide services or care for induvial living with HIV or conduct HIV/STD testing and treatment.

49 Funded Health Department Local Health Dept. County Health Department RW Care funded Agency CBO, hospital, care provider

50 Care Funded Provider Local Health Dept. County Health Department RW Care funded Agency CBO, hospital, care provider

51 HIV Partner Services Training and Technical Assistance Where Prevention Starts

52 Training or Staff Conducting HIV PS Activities CDPH: Office of AIDS and the STD Control Branch recommend that staff conducting HIV PS are trained in discussing sex and needle-sharing partners, offering HIV PS, and gathering partner information. County staff conducting field notification should receive training in field safety and notification techniques. Where Prevention Starts

53 HIV Partner Services Trainings Curriculum have a target audience with these four most common classification: National State Local Agency Where Prevention Starts

54 Introduction to HIV Partner Services in California National State Local Agency Required for OA Prevention Funded LHJs Focused on PS coordination and implementation between state, county health dept. and local care providers. Where Prevention Starts

55 Disclosure Counseling New training concepts to approach disclosure with patients.

56 Types of Relationships & Disclosure FAMILY Smart ROMANTIC + SEXUAL SELF SOCIAL

57 Ryan White Service Categories Funding Activity C1. - Increase Utilization of Surveillance-based Partner Services Activities can be funded under the following service category: Early Intervention Services (EIS) Where Prevention Starts

58 Ryan White Service Categories Activity C2. Enhance Field-based Programs for Partner Notification and Testing is conducted under the following RW service categories: Outpatient/Ambulatory Health Services Early Intervention Services (EIS Mental Health Services Medical Case Management, including Treatment Adherence Services Substance Abuse Outpatient Care Non-medical Case Management Services Outreach Services Substance Abuse Services (residential)

59 Any Questions?

60 For Office of AIDS, HIV Partner Services program questions please contact: Manny Rios HIV Partner Services Specialist Where Prevention Starts Thank You! HIV Partner Services in California