Project SUCCEED Overview Project Scaling-Up Co-Infection Care to End Ethnic Disparities Brooklyn Hep C Task Force February 6, 2018
2 Goals and Objectives Goal: to eliminate hepatitis C (HCV) amongst people living with HIV (PLWH) in NYC and reduce racial/ethnic disparities in access and treatment Objectives: Promote HCV screening, rescreening, and diagnostic testing according to guidelines Educate HIV patients about the risks of HCV, and the benefits of cure Increase HIV clinical and non-clinical provider HCV knowledge and care management skills Support organizations to identify, return to care, and treat all HCV patients Conduct case investigation and linkage to care for patients who can not be returned to care by an organization
3 HIV/HCV Co-infection Estimate for NYC, 2016 85,890 HIV-Diagnosed Individuals in NYC as of December 2016* 88,710 HCV-Diagnosed Individuals in NYC as of December 2016* 11,536 Individuals co-infected and diagnosed with HIV/HCV 13% of HIV cases 13% of HCV cases *To better account for out-migration and deaths, the number of individuals considered to be diagnosed and living in NYC has been restricted to people who had at least one HCV or HIV lab test reported since 2014 and weren t known to have died prior to 2017.
4 ~4,200 Individuals Currently Still Co-infected 84% in HIV Care 56% established in care at largest HIV care facilities in NYC 24% established in care at other facilities or receiving care at multiple facilities 20% in sporadic care 16% out of HIV care 60% HIV virally suppressed
5 Characteristics of Co-infected Individuals in NYC, 2016 Race/Ethnicity (%) 7 46 41 42 Area-based Poverty Level (%) HIV only Birth Cohort (%) 28 32 32 61 55 20 16 3 HIV/HCV 42 69 3 2 Black Hispanic White Other HIV only HIV/HCV 42 55 Lower poverty (<30% below FPL) Very high poverty (>=30% below FPL) Unknown 3 3 HIV only HIV/HCV <1945 1945-1965 >1965
6 Characteristics of Co-infected Individuals in NYC, 2016 45 HIV Exposure Category (%) 42 History of Incarceration (%) HIV only 9 21 23 24 91 13 17 HIV/HCV 6 6 27 2 73 Men who have sex with men (MSM) Injection drug use history (IDU) MSM-IDU HIV only Heterosexual contact HIV/HCV Other/ Uknown Yes No
HIV and HCV Care Outcomes for Co-infected Individuals in NYC, 2016 7 100% 90% 80% 70% 60% 90% 74% 79% 50% 40% 41% 30% 20% 10% 0% Care in 2016 Virally suppressed Ever RNA+ Initiated treatment HIV Care HCV Care
8 Surveillance Based Dashboard for HIV Care Providers
9 Brooklyn Sites Who Can Request Patient List Brookdale Hospital Coney Island Hospital Housing Works Community Healthcare Interfaith Medical Center Kings County Hospital Center Lutheran Medical Center New York Methodist Hospital SUNY Downstate: STAR Health Center The Brooklyn Hospital Woodhull Medical Center Wyckoff Heights Medical Center
10 Project SUCCEED Approach Education &Training Practice Transformation Case Investigation & Linkage to Care Clinical and non-clinical provider training Patient education Hep C Toolkit Technical assistance Data monitoring Return to care support Community of Practice and Learning Finding lost patients Direct outreach and linkage to care
11 Intervention Site Commitment Clinical Provider Intervention at least one new provider per site Clinical provider training and preceptorship (10 CME) Hep C Medication Coverage Training (2 CME) Non-Clinical Provider Intervention at least 5 HIV Service Providers per site Hep C Patient Navigation Training (7 CASAC) Hep C Medication Coverage Training (2 CME) Both clinical and non-clinical provider intervention Hep C Toolkit Data monitoring EHR or program data query reporting and surveillance based dashboards Technical Assistance - minimum of 3 site visits HepCure tele-education - all will be invited and regularly reminded to attend Hep C Task Force: HIV/HCV Treatment Access Committee all will be invited and regularly reminded to attend
12 Practice Transformation Technical Assistance Data review, site visits, provision of recommendations, development of a mutually agreeable plan, follow up on recommendations, and monitoring. Improve Collection and Utilization of Data Program Implementation Reports eshare indicators Surveillance based HIV/HCV dashboards
13 Get Involved by Joining the HIV/HCV Treatment Access Committee Open Committee of the NYC Hep C Task Force RSVP is required MaNtsetse Mkgama, Project Manager mkgama1@health.nyc.gov Meets Quarterly Next Meeting Thursday March 15 th 10:00 AM 12:00 PM
14 HIV/HCV Treatment Access Committee Provide Guidance on Implementation Plans Offer Recommendations for HIV/HCV Collaborations Review Evaluation Plans and Findings Promote Project SUCCEED Initiatives
15 Get Involved by Participating in a Training Non-Clinical Provider Training Dates Monday, February 26 Monday, March 19 Full-Day Training Outline Hep C Basics Hep C Patient Navigation Steps Navigation Skills Hep C Navigation Models Resources To register for a training visit https://hepfree.nyc/events/ Hep C Clinical Provider Training Dates Thursdays from 4:30 5:30 PM March 22 May 31, 2018 *No Session on April 12, 2018 Curriculum 1. Pre-Treatment Assessment 2. Role of Resistance Testing 3. Overview of Fibrosis 4. Treatment by Genotype 5. Side Effects and Drug-Drug Interactions 6. Treatment of HIV and Hepatitis C Coinfection 7. Treating People with Mental Health Conditions & Substance Use 8. Monitoring Prior, During, and After Treatment 9. Management of Advanced and Complicated Disease 10.Hepatitis C Medication Coverage and Prior Authorization
16 Get Involved by Hosting a Patient or Peer Training at your site Topics covered include: Hep C Basics Hep C Screening Disease Transmission Disease Progression Treatment Prevention To request this ongoing training, contact Alex Brenes at abrenes@health.nyc.gov or 347-396-2683
17 Thank you Keep in touch! Natalie Octave, MPH, CHES noctave@health.nyc.gov Email: Hep@health.nyc.gov Coalition Website & Social Media: www.hepfree.nyc Subscribe to monthly Newsletter: http://eepurl.com/kv5iz