Overview of Illinois CAPUS Project Peer ExChange Meetiing

Public Health Institute Staff
Saul Zepada, HIV Testing
Project components and activities—summary of the work plan
The current HIV population in Illinois and the Care Treatment
Continuum and Surveillance Feed-back loop (Linkage to Care
Work Group activities)
Share project progress, developments, challenges and
successes (where we started, where we’ve come and where we
are at)
Share highlights to the Routine Testing component and the
Youth of Color Initiative (East Side Health District’s )
collaborative of a co-located integrated comprehensive
medical, psychosocial, prevention and support services/center
for LGBTY--- Kaleidoscope!
1. Expand routine HIV testing in 4 health systems & 7 county jails
2. Build a statewide culturally competent Disease Investigative
Services network with local health departments and several
“designee” agencies
3. Development of a statewide Patient Navigator program into a
peer-led empowerment for HIV+ people of color
4. Statewide retention in care by increasing transportation
assistance; start a texting service for appointment/medication
5. Collaborate with CDPH & CDC-direct funded programs; align data
6. Launch a youth of color-initiative in East St Louis to co-locate
medical (including LGBT health), and other services in a single
Illinois Department of Public Health CAPUS program logic model
Priority populations: African American & Latinos Residing in Illinois
NHAS Goals: Reduce new HIV infections; Improve access to care and improve health outcomes for people living with HIV;
Reduce HIV-related health disparities; Improve Coordination
Purpose: Reduce HIV-related morbidity, mortality, and related health disparities among racial and ethnic minorities in Illinois
Local needs: Increase number of African Americans/Latinos who know their HIV status ; Address YMSM of color HIV/STI co-infection; Reduce HIVdisease burden among African Americans
Inputs= Funding (CDC plus Ryan White and IDPH support), multiple
agency partnerships with CBOs and LHDs.
1. Expand routine HIV
testing in 4 health
systems & 6 county jails
(49,092 tests proposed).
2. Build a statewide
culturally competent DIS
3. Transform the Patient
Navigator program into a
statewide Peer-led
empowerment for HIV+
people of color.
4. Statewide retention in
care: a) Increase
transportation assistance;
b) start a texting service
for appointment
/medication reminders.
5. Collaborate with CDPH
& CDC-direct funded
programs; align data
Supplemental: Launch a
youth of color-initiative
in East St Louis to colocate medical (including
LGBT health), and other
services in a single
setting. Measure: 1st
opening session held by
close of year 1.
Measurable Objectives
Testing: Sites
Testing: # of
• Decrease
successfully implement
and expand HIV testing; a
completed;# of
broader mix of
clinical teams
• Decrease
populations in IL get
trained;# of patients
tested for HIV; high
tested by month/year;
success rate is achieved
# of written plans to
in linking persons newly
expand HIV testing; #
diagnosed with HIV to
of patients linked to
care/partner services;
care; # of TA hours
DIS: # of connections
delivered, providers
made to medical
trained, QA visits,
providers & routine
audits conducted;
testing partners;
DIS: LHD follow up on
To be developed
Peers: skills developed;
cases monitored by
by grantees
retained in program
IDPH workgroup ;
based on
Care: Remove
cultural competency
transportation as a
training conducted;
Required by
barrier to care;
Peers: Advanced peer
CDPH Collaboration
curriculum developed;
One data system for
candidates for
Ryan White Part A&B;
advanced training
improved linkage/
retention in care.
Care: expand texting;
transport assistance;
IDPH –Illinois Dept of Public Health
CDPH/IDPH written
CDPH-Chicago Dept of Public Health
agreements; joint
DIS-Disease Intervention Specialists
Potential data sources: Process data (activities & outputs)= Program information
submitted by grantees to CDC and other federal agencies; Ryan
White program data; Outcome data = Self-reported, community survey data
through existing CDC behavioral surveillance systems
Testing: # of tests done
compared to target set
with intended
DIS: Designees identified and
trained ; first follow up
cases by close of year 1;
increase # of partners
reached/pts linked to
Peers: curriculum enhanced;
ARTAS training
launched; #of
identified/trained; hired
with defined duties.
Retain in Care: # of people
accepting texts; #
assisted with transport;
reduced no-show rates;
suppressed VL
CDPH Collaboration: Regular
meetings held; signed
policy and work plans;
data systems aligned.
Testing: Conduct Assessment;
Training ;Update/develop
protocols for HIV ;Implement
HIV Testing; Plan to expand
HIV Testing; Implement
linkage to care; Conduct, TA,
Trainings, QA visits, Audits;
Develop sustainability plan
DIS: Protocols/policies
developed with LHDs;
conduct site visits; surveys
w/clients served
Peers: Protocols/policies
developed w/Ryan White
agencies; ongoing
Care: protocol for voluntary
texting; data capturing
established; track how
transportation assistance is
used; negotiate systems with
regional transport service;
CDPH: analysis of data systems,
costs & timeframe.
Impact data = Annual population-based HIV surveillance data , including Ryan White Unmet Need Data
1. Expand routine HIV testing in 4 health systems & 6 county jails (34,092 tests proposed).
Partnership with Public Health Institute of Metropolitan Chicago (PHIMC) and Midwest AIDS
Education Training Center (MATEC)
2. Build a statewide culturally competent DIS network for Speed, Cultural Competency &
Quality for Linkage to Care/Partner Services
IDPH HIV & STD Sections Collaborate to recruit, train, activate 7-8 Disease Intervention
Specialist Designees under IDPH supervision to cover each of the Illinois Regions. Designees
proposed will be from local health departments and some well established community based
3. Transform the Patient Navigator program into a statewide Peer-led
empowerment/retention in care program for HIV+ people of color. Partnership with Central
Illinois Friends of PWAs & Ryan White Regional Directors to:
a) conduct needs assessment in each Ryan White Region;
b) review/amend/enhance existing training program;
c) establish policies/procedures with Ryan White program leaders;
d) establish graduations and other acknowledgment/recognition for completing
training/excellent service
e) establish continuing education and newsletter for peer leaders
4. Statewide retention in care logistical support:
a) Increase transportation assistance;
b) start a texting service for appointment /medication reminders.
c) case manager assistance with partner services; case finding
5. Collaborate with CDPH & CDC-direct funded programs; align Ryan
White Part A&B data systems.
Monthly IDPH/CDPH HIV leadership meetings already established;
Ongoing mutual representation at both jurisdictional HIV planning meetings;
Ongoing collaboration on appropriate use of surveillance data for Illinois cascade development, community
VL measurement and facilitation of linkage to care/partner services;
Ongoing collaboration to reduce/eliminate perinatal HIV transmission in Illinois, including statewide EPS,
statewide perinatal HIV 24/7 hotline
6. Launch a youth of color-initiative in East St Louis to co-locate
medical (including LGBT health), and other services in a single setting.
Partnership formed with East Side Health District, Project ARK, East Side Empowerment
Center for Youth in addition to HIV Prevention and Ryan White Lead Agencies
Collaborative effort to address persistent new infections among YMSM /Transgender persons
of color in extremely underserved community
HIV Prevention and Ryan
White Care Connect
Regions are the same in
Each region has a lead
agency and subgrantees
(local health departments,
CBOs, medical providers,
others) delivering a variety
of prevention and care
CAPUS support makes it
possible for IDPH to have a
DIS designee for each
34,712 persons living with HIV/AIDS in Illinois at the close of 2012 Average # of HIV diagnoses each year = 1,825
4.7% fewer cases diagnosed in 2012 compared to 2008;
9.1% increase in the number of new cases diagnosed between 2011-2012.
HIV Diagnoses
Men constitute the majority of persons living with HIV/AIDS (79%); females (21%).
Current trends indicate a shift in the HIV/AIDS epidemic toward young African American
MSM, including cases of co-infection with syphilis.
Overall, HIV incidence has declined sharply among IDUs and much less among high-risk
Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit,
June 2013
Engagement in HIV Care in Illinois for Persons
Diagnosed HIV Infection through 12/31/2010 and
Living with HIV on 12/31/2011
Linked to HIV
Retained in HIV On ART for those Supressed viral
load for those on
in careƚƚ
ART (<=200
*Based on CDC report that 20% of HIV infected were unaware of their
**HIV diagnoised (age 13 or older) through 12/31/2010 and living with HIV on 12/31/2011 - based on HIV surveillance data reported through 07/29/2013.
***based on the percentage of cased diagnosed in 2011 that were linked to care within 12 month of diagnosis (82%)
based on the 2012 Statewide Unmet Needs Analysis that 61% of PLWLA were with needs met
ƚƚBased on combined 2010 Chicago and Illinois MMP results: 88% of in care cases were on ART among which 88% with viral suppression
6 month planning and contract delay and hiring processes
required a revised work plan, revised testing goals and project
Linkage to Care workgroup continues to work through data
collection/reporting with the Care Continuum for
East Side Health Project youth center providing comprehensive
services to the most vulnerable youth in Region 4
HIV Routine Testing component targeted to conduct 75,000 tests
in 2014-2015
Peer Navigation training/curricula supports peer leadership
development; college credit at 2 universities for the community
health worker degree and endorsed by the American Public
Health Association
Revised Illinois laws/administrative rules to accomplish:
1 - authority to authorize DIS designees to facilitate quality/culturally
competent partner services/linkage to care statewide;
2 - repeal of principal notification law for HIV positive students;
3 - required HIV prevention education in all county jails in Illinois;
4 - opt-out routine HIV screening in IDOC and Cook County Jail;
5 - comprehensive sex education grades 6-12 in IL public schools
Medicaid Expansion Passed by IL General Assembly – 2013
State/Federal Marketplace Established for ACA Implementation
Collaboration with multiple state agencies:
Joint initiatives to implement Affordable Care Act in Illinois in an effort to
reduce health disparities/accomplish health equity
Collaboration with IL SAMHSA HIV grant director to:
Establish routine HIV opt-out screening in behavioral health settings
Illinois proposed as one of its objectives to build a culturally competent Disease
Intervention Specialist (DIS)/ Linkage to Care System. Six local health departments and
one community based organization have been identified across the state to serve as
DIS/Linkage to Care designees outside of the County of Cook/City of Chicago.
Each DIS designee will conduct an assessment of current capacity, quality and cultural
competency of HIV testing, linkage to care and partner services activities for each
county and region of Illinois. Relationships between the designees and the
participating agencies have been established within the regions to facilitate data
collection for HIV cases surveillance and supplemental surveillance actives.
Memorandums of understanding (MOUs) have been sent to all LHDs and selected
community based organizations. Each designee will provide training and technical
assistance as needed. All participants have attended the HIV/AIDS Section
“confidentiality and security training” offered by IDPH. Surveillance-based have been
distributed to each region checking to make sure HIV positive individuals are in care.
Region 1- Winnebago County Health Department
Region 2- Peoria City/County Health Department
Region 3- Sangamon County Health Department
Region 4- East Side Health District; St. Clair County Health
Region 5- Jackson County Health Department
Region 6- Champaign-Urbana Public Heath District
Region 7- Renz Addiction Center
Administrative rules associated with state statues were approved to include
the ability to have “designees” of IDPH for these purposes, as this state has
102 counties, and 95 certified health departments, each with local
authority. Having the ability to legally establish designees was key for
moving forward with identifying local/regional partners in assuring partner
services/linkage to care in real time for all cases throughout the state.
East Side Health District (ESHD) and their collaborative partners; Mallory
Mahr Youth Empowerment Center, Project ARK/ The Spot, St. Clair County
Health Department(SCHD), and Southern Illinois Healthcare Foundation
(SIHF) have collaborated to provide medical, psychosocial, prevention and
support services to Lesbian, Gay, Bisexual and Transgender (LGBT)youth
between the ages of 13-24 in the East St. Louis, Illinois area.
Obtaining executed grant agreements to officially allow for services
to begin and communication to be made with all Designee partners
and engaging all health departments about this new development.
The infrastructure between eHARS and the Provide Enterprise system
has been developed to accommodate this effort, with some
experience from its initial pilot launch shortly before CAPUS support
State Government lengthy hiring process and CAPUS supported
positions are beginning to be filled.
There has been improvement in linkage to care for newly
identified HIV positive persons. However, we cannot say that
those improvements are a direct result of CAPUS supported
DIS/LTC activities as yet, due to the fact that cases have began
to be distributed in early March, 2014.
 Comprehensive
youth friendly medical
 Youth friendly case management
 Dental services
 Social/educational services
 Recreational activities
 East
Side Health District established a
clinical site – Kaleidoscope Youth Center
 Each collaborative partner has committed to
receive and refer clients meeting the
eligibility criteria to Kaleidoscope
 Mallory Mahr facilitate weekly HIV education
and support groups and also offer
opportunities for social interaction to
Kaleidoscope clients
 There
is a need to further define division of
labor between/among community partners,
as some are providing some services to the
same target population.
 Some educational group sessions have had to
be placed on hold at Kaleidoscope due to
initial low program registration at youth
 Grant
agreements were not executed timely,
therefore, program activities were delayed
 Lengthy process to hire staff position within
Illinois Department of Public Health

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