LBerezny - Collaboration_Navigators Med Update 7-17-13

Report
NJ STATEWIDE MOBILIZATION
LINKAGE TO CARE THROUGH
THE
COLLABORATION AND NAVIGATOR PROGRAM
Steven Saunders,
1
M.S. ,
Loretta Dutton,
1
M.P.H. ,
Linda Berezny,
and
2
Eugene G. Martin, Ph.D.
New Jersey Department of
1
Health ,
1
R.N. ,
Joanne Corbo, MT
New Jersey HIV Planning Group
and
2
UMDNJ – Robert Wood Johnson Medical School
2
(ASCP) ,
BACKGROUND:
The Division of HIV, STD and TB Services (DHSTS), in collaboration with The New Jersey HIV/AIDS Planning
Group’s (HPG) Prevention and Care Collaborative Workgroup developed a best practice model for an
integrated approach to HIV/AIDS prevention and care activities for the State of New Jersey. The model was
created in response to the National HIV/AIDS Strategy (NHAS) to address three primary goals:

1.
2.
3.
Reducing the number of people who become infected with HIV;
Increasing access to care and improving health outcomes for people living with HIV; and
Reducing HIV-related health disparities.
To fully address the NHAS, the Prevention and Care Collaborative Workgroup reviewed mandates from the
Health Resource Service Administration (HRSA) and the Centers for Disease Control and Prevention (CDC).
These programmatic mandates included:

1.
2.
3.
Early Identification of Individuals with HIV/AIDS (EIIHA);
Treatment as Prevention (TasP); and
Program Collaboration Service Integration (PCSI).
The HPG Prevention and Care Collaborative Workgroup
The Prevention and Care Collaborative Workgroup supports the development of collaborative
partnerships between the DHSTS and: Medical Centers, Infectious Disease Clinics, Federally
Qualified Health Centers, Local Health Departments, HIV testing sites, Community Based
Organizations (CBOs), Addiction Services, Medicaid, and all service providers impacting
populations disproportionately affected by HIV are also affected by other infections including TB,
Hepatitis C virus (HCV), Hepatitis B virus (HBV) and STDs.
Model Outcomes:

There are five types of prevention and care treatment planning outcomes for individuals who go to
Clinical and Non Clinical Testing Venues for HIV screening:
1.
those who test HIV positive;
2.
those who test HIV negative;
3.
those who decline HIV testing;
4.
those who already know their status and who are in care; and
5.
those who know their status and are out of care.
REGIONAL COLLABORATIONS FORMED

DHSTS formed or assisted in the formation of collaborations in each of the
twenty-one New Jersey counties to include both Transitional Grant Areas
(TGAs) and Eligible Metropolitan Areas (EMAs). Additionally, collaboration
extends to the Federally Qualified Health Care center (FQHCs) and
community clinics.

The centerpiece of each regional collaboration is a HIV Specialty Care Clinic
or Hospital. A wide range of agencies who experience a single rapid positive
test or agencies that discover an out of care HIV+ client will immediately
access care (within the same or next business day). Using the Rapid to Rapid
(R2R) algorithm, CBOs and non clinical testing sites are able to facilitate
immediate linkage to care and actively participating in re-engagement with
their partnering medical sites.
Eleven New Jersey Collaborations:










Bergen/Passaic TGA
Newark EMA – ERIC (3)
Newark EMA – Morristown
Hudson TGA
Middlesex, Hunterdon, Somerset
TGA
Mercer County
Monmouth/Ocean
Camden/Burlington (SAFEPAT)
Cumberland/Salem/Gloucester
Atlantic/Cape May
How to Join Your Regional Collaboration
1.
Atlantic, Cape May Counties – Jean Haspel - [email protected]
2.
Camden, Burlington – Pam Gorman - [email protected]
3.
Cumberland, Salem, Gloucester – Kim McCargo - [email protected]
4.
Newark EMA – 4 ERICs:
 Morristown - J. McEniry – [email protected]
 Newark Community Health - Claire Roudette - [email protected]
 Trinitas - Judy Lacinak - [email protected]
 UMDNJ – Gary Paul Wright – [email protected]
5.
Middlesex, Hunterdon, Somerset - Natalie Aloyets - [email protected]
6.
Mercer - Deborah Oliver- [email protected]
7.
Ocean Monmouth – Barbara Benwell- [email protected]
8.
Bergen, Passaic – TGA contact - Pat Virga - [email protected]
9.
Hudson – TGA contact – Marvin Krieger - [email protected]
Navigator Goals
•
Facilitate a 2nd rapid test for patients initially screened positive, and link to care on the
same, or next, business day
•
Immediately initiate HIV+s into care: (initial work-up including CD4, VL on same day as
2nd rapid test)
•
Partner Services for new and existing clinic patients using CE and Social Networking
•
Re-engagement of ‘lost to care’ patients
•
Treatment adherence and prevention counseling
•
Collaborative Point Person and MOA Manager
HOW?
•
Provide “concierge service” for initially positive patients identified in the community settings
•
Direct cell phone line is shared with every agency that has contact with HIV positive individuals. NJAIDS/STD
Hotline added Feb 2013; we are also adding prison discharge planners as points of contact.
•
Provide treatment adherence counseling to new and existing patients.
•
Re-engage patients lost to care (defined as completing a medical care visit) by flagging EMR, working with
community partners and other effective strategies
•
Provide prevention counseling/strategies such as CLEAR, ARTAS or Partner Testing to new, and existing,
patients.
•
Coordinate local inter-agency collaboration activities.
•
Ensure immediate, accompanied patient transportation to HIV clinic through collaboration MOUs
•
Work with collaborators (i.e., CBOs) to assist in re-engagement
WHY
• 100%
Patient centered focus
• Leverage
resources for patients to experience the collective impact of all local
providers
• Increase
efficiency
• Breakdown
• Address
• Provide
barriers to complimentary services
multiple problems or needs
comprehensive services
New Jersey Navigators
LOCATIONS:
1.
AtlantiCare Medical Center, Atlantic City, Atlantic County
2.
Cooper University Hospital, Camden, Camden County
3.
Jersey Shore Medical Center, Neptune, Monmouth County
4.
Jersey City Medical Center, Jersey City , Hudson County
5.
UMDNJ, Newark, Essex County
6.
St. Michael’s Medical Center, Newark, Essex County
7.
St. Joseph’s Medical Center, Paterson, Passaic County
8.
Trinitas, Elizabeth, Union County
9.
Raritan Bay Medical Center, Perth Amboy, Middlesex County
TESTING INNOVATION: ENHANCING THE LINKAGE TO CARE
ELIMINATE WESTERN BLOT:
IMPROVING THE RTA
• Expectation:
100% Notification of Clients
• Link
and Retain in care at least 85% of clients testing
positive
• Reduce
Transmission from clients testing positive
Rapid Testing Algorithm (RTA)
Rapid-Rapid Testing Site and Treatment
Site:

Category 1: Your testing site is a
Rapid-Rapid Testing site and is also an
HIV clinical site. You use Clearview
StatPak as the first Rapid HIV test and
confirm the positive result by using a
second Rapid test (Trinity or OraQuick).
The client is then linked to care (not
intake) in the same or next business
day.
Rapid-Rapid Testing Site & Non Treatment
Site – Client Will Be Transported to Care

Category 2: Your testing site is a RapidRapid Testing site, but is NOT an HIV clinical
site. You use Clearview StatPak as the first
Rapid HIV test and confirm the positive result
by using a second Rapid test (Trinity or
OraQuick). Under this category, the client is
referred for care to a clinincal site with which
your organization has established a
Memorandum of Agreement (MOA)
permitting linkage to care in the same or next
business day. The initial testing site will
arrange to have the screen positive client
transported to the HIV clinical site.
Client Will Be Transported to Rapid-Rapid Clinical Site for
Second Test and Immediate Linkage

Category 3: Rapid Testing Site –
Client Will Be Transported to
Rapid-Rapid Clinical Site for
Second Test and Immediate
Linkage

Your testing site is NOT a Rapid-Rapid
Testing site. You use Clearview StatPak
as the first Rapid HIV test and confirm
the positive test by sending the client to a
Rapid-Rapid HIV clinical site (Category
1) which will perform a second Rapid test
(Trinity or OraQuick) and immediately
link the positive to HIV Care (not intake).
MORE SENSITIVE RAPID HIV
TESTING TECHNOLOGY IS COMING!

Upon FDA approval, New Jersey intends to offer more sensitive Rapid
HIV Tests STRATEGICALLY focusing on urban sites of high prevalence.

Alere Determine p24Ag/Ab Combo tests:
HIV Prevention Patient Navigator Outcomes through
April 30, 2013
Majority of new patients (543) seen were African American (60%) and male
(66%); 21% were Hispanic;
52
nd
2
rapid HIV tests conducted; 100% positive and enrolled in care
536 other HIV tests conducted, 18% positive and 95% enrolled in care
103 partners tested, 7% positive
337 re-engaged in care; 479 total linked to care

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