Data to Care: Improving Health Across the HIV Care Continuum in Colorado NASTAD Technical Assistance Meeting July 31, 2015 Maria Chaidez Statewide Linkage to Care Coordinator
Quick Overview of CO As of December 2012, Colorado s population was estimated to be 5,187,582. The majority of Colorado s population resided in 13 counties. 66% of Coloradans were between the ages of 18 and 65. Colorado s population was 69.6%White, 21.0% Hispanic and 3.8% Black. Asian/Pacific Islander, American Indian, Multiple races, and other races comprise the remaining 5.6%. Colorado ranked 18th in the nation s poverty level rating in 2012. Colorado percent of nonelderly uninsured persons was lower (17%) than reported nationally (18%) in 2012. In 2012, cancer was the leading cause of death in Colorado.
Quick Overview of CO
Quick Overview of CO August 1985, Colorado became the first state to require name-based reporting of HIV. Active surveillance activities were initiated in 1988. In May 1993, Board Of Health (BOH) rules and regulations required that all CD4 counts <500 or 29% be reported. Board of Health Rules and Regulations were amended in June 1997 to include all tests that are indicative of HIV infection, thus requiring Viral Load tests be reported. In 2010, BOH rules and regulations required that undetectable Viral Load test results be reported. January 2014, the BOH rules and regulations were amended again requiring all CD4 counts be reported.
Colorado HIV Care Continuum 6,483
The Process is NOT Linear Linked to Care First Diagnosis with HIV Retained in Care Re-Engaged Achieved Viral Suppression Lapsed in Care
Investigation Protocol
Data Sources used to verify or Update Care Status or Contact Information Health Department Sources External Data Sources ehars PRISM (DIS, STD database) ADAP database State Vital Record databases ARIES database TLO Lexis/Nexis Social Media (e.g. Facebook, whitepages) Post Office Searches Driver Motor Vehicle database State Medicaid databases Hospital Electronic Medical Records Jail databases Shelter searches
Active Referral Case 1- Johnny Bronco Newly identified as HIV infected through rapid HIV test at a community based The DIS is paged to perform the confirmatory test Conducts a partner services interview as part of the interaction at the time of the confirmatory test phlebotomy DIS learns the following from interviewing the client: Client is White, MSM, 28 yo, No permanent address, sofa surfing, screened high on the SBIRT for substance abuse, not connected to a medical home, likely Medicaid eligible.
Linkage to Care Services Provided Assess client needs utilizing the CDPHE acuity tool. Address barriers to care and develop a care plan with the client. Utilize Critical Event Program if necessary to address barriers. Work with Health Care unit staff to establish medical coverage if needed. Assist in making the 1 st medical appointment and follow through 2 nd Medical appointment. Attend the clients first medical appointment. Referrals to Case Management (CBOs/ASOs) to ensure client has adequate support moving forward. The Linkage Staff will make contact with client again, if known to be dropping out of care to offer support and make certain they are maintained in care. The linkage staff will address other medical or mental health concerns to support engagement and retention in care.
How to effectively Engage the Community? Clear Communication Build Strong Relationships Make easy accessible service
Performance Measures
Linkage to Care Outcomes January through December 2014 Identified total of 134 clients needing Linkage to Care of which 70% accepted services and were successfully linked.
Lessons Learned Legalities of sharing data. Integration across the STI/VIH/VH Branch and community partners is essential. Building relationships; clients and providers to show them the benefits of the program. Building understanding of the LTC role both internally and externally. Critical Events program to immediately address clients with highest need to retain or reengage them in care.
Critical Event Initiative What is a critical event? An event that makes it much more likely a client will drop out of medical care or never seek medical care to begin with. A marker for a destabilizing crisis. A severe challenge to a client who wants to achieve and maintain viral suppression.
Current Targets: To be eligible, must be: Newly diagnosed with HIV or (within the prior 90 days) Lapsed in care more than 365 days or Over 100,000 viral load. AND have one of the following:
Critical Events: Homeless Recently unemployed (within prior 90 days) Diagnosed with gonorrhea, syphilis, or chlamydia Worsening health status due to hepatitis C Named as a partner, to a person recently diagnosed with HIV Intimate partner violence or sexual assault Diagnosed with another acute illness requiring complex medical treatment or hospitalization, such as cancer Evidence based screening shows potentially severe addiction or drug dependence. Evidence based screening shows potentially severe mental illness. Pregnancy
Next Steps Expanding Role of DIS SBIRT- Substance Abuse Screening ILI Delivery Health insurance Navigators Linking to medical home PrEP referrals.
Questions maria.chaidez@state.co.us