Russell Brewer, DrPH, CHES Director of HIV, STDs, and Reproductive Health Louisiana Public Health Institute Strategies on the Ground to Turn the Tide on.

The Louisiana Positive Charge Initiative: Enhancing the System of

HIV Care in Louisiana

Russell Brewer, DrPH, CHESDirector of HIV, STDs, and Reproductive

HealthLouisiana Public Health Institute

Strategies on the Ground to Turn the Tide on Improving Access to Care in the U.S.

International AIDS ConferenceWashington, DC

July 22, 2012

LOUISIANA DEMOGRAPHICS

Source: US Census and United Health Rankings

Categories EstimatePopulation, 2011 4.5 million

White/Caucasian 64%

Black/African American 32%

Hispanic/Latino Ethnicity 4.4%

Lack of Health Insurance 17.2%

% Below the Poverty Level, 2006-2010 18.1%

Source: LA Office of Public Health, 2010

Source: LA Office of Public Health, 2010

Source: LA Office of Public Health, 2010

UNMET NEED FOR HIV CARE IN LOUISIANA, 2010

Source: LA Office of Public Health, 2010

Categories % in Care (CD4 or viral

load in the last 12 months)

% Not in Care

(Unmet Need)

Overall 64% 36%Female 70% 30%Male 61% 39%Black/African American 64% 36%White 65% 35%Region 1 – New Orleans 59% 41%Region 2 – Baton Rouge 71% 29%Region 5 – Lake Charles 54% 46%Region 7 - Shreveport 60% 40%

BACKGROUND ON LOUISIANA POSITIVE CHARGE INITIATIVE

Access to care initiative funded by AIDS United and Bristol-Myers Squibb

LPHI is the lead agency and local evaluator

Goal is to improve linkage to HIV care and supportive services for:

- Individuals living with HIV infection that

are out of care- Newly diagnosed

BACKGROUND ON LOUISIANA POSITIVE CHARGE INITIATIVE

Implement and evaluate 4 linkage to care interventions in four regions of the state▪ Linkage Case Management (Baton Rouge)▪ Health Navigation (New Orleans, Baton

Rouge, Lake Charles)▪ Pre/Post Release Case Manager (New Orleans)▪ Disease Intervention Specialists (New

Orleans, Baton Rouge, Shreveport)

Linkage interventions are 3-6 months in duration

POSITIVE CHARGE SITES BY REGION

Region I: New Orleans

Region II: Baton Rouge

Region V: Lake Charles

Region VII: Shreveport

BACKGROUND ON LOUISIANA POSITIVE CHARGE INITIATIVE

Initial 3 month planning phase (April-June 2010)

3-year implementation phase (July 2010 – June 2013)

Interventionist is housed at multiple locations

Two main data collection points (baseline and follow-up)

POSITIVE CHARGE INTERVENTIONS BY SITEPositive Charge Sites

Capitol Area Reentry Program & Earl K. Long (BR)

N’R Peace & HOP Clinic (NO) SW Louisiana AIDS Council &

Moss Comprehensive Health Clinic (Lake Charles)

NO/AIDS Task Force & Orleans Parish Prison (NO)

Family Service of Greater Baton Rouge (BR)

Office of Public Health, Parish Public Health Units in Regions 1, 2, 7 (NO, BR, Shreveport)

Linkage to Care Interventions

Health Navigation

Pre/Post-Release Case Management

Linkage case management intervention

Disease Intervention Specialists

LINKAGE TO CARE TOOLS AND RESOURCES

Data collection system - Ryan White CAREWare

Alert system - Louisiana Public Health Information Exchange (LaPHIE)

Surveillance system – CD4 and viral load data from laboratories as required by the Louisiana Public Health Sanitary Code

Reminder system - Out of care lists generated by providers

DEMOGRAPHIC BREAKDOWN OF LA POSITIVE CHARGE PARTICIPANTS

Demographic Profile (August 2010 – January 2012)

Estimate(N=684)

African American 90%Male 68%Transgender (M-F) 4%MSM 15%High School Education or less 69%20 – 29 years of age 34%

30 – 39 years of age 30%

40 – 49 years of age 22%

RESULTS

Enrollment and Linkage to Care Profile

Reported by Interventionists(August 2010 – May 31, 2012)

Estimate

Enrolled in PC since 2010 684 individuals

Linked to HIV Medical Care 493 individuals

% Linked to HIV Medical Care 72%

CHALLENGES/LIMITATIONS

Regular Data collection trainingsMultiple IRB modificationsSite specific

- Staff turnover- Ensuring confidentiality

- Lack of transportation- Loss to follow-up

Retention in care?

LESSONS LEARNED

Positive Charge has raised the visibility of access to care efforts in the state

Provided a platform for other access to care initiatives

Enhanced relationships and coordination among Positive Charge partners

Importance of developing and updating Intervention workflows

CASE STUDY

“One client I enrolled took four months to actually link to medical care. The client arrived at the Health Unit for a routine pelvic exam, and left with a positive HIV diagnosis. As a young woman with two children, the client was devastated. She believed this was the end of her life, and that she would not live long enough to see her children grow old. For over two hours, we talked about what her next steps would be. Making an appointment with a doctor was very far down on her list of priorities.”

ACKNOWLEDGEMENTS PC Participants PC Partners

-LA Office of Public Health, STD/HIV

Program- NO/AIDS Taskforce- Orleans Parish Prison- N’R Peace

- HIV Outpatient Program (LSU)- Capitol Area Reentry Program- Earl K. Long Medical Center (LSU)- Family Service Greater Baton

Rouge- Southwest Louisiana AIDS Council- W.O. Moss Regional Medical

Center (LSU)

LPHI Staff (Sarah Chrestman, MPH; Michael Robinson, BA; and Snigdha Mukherjee, PhD)

AIDS United

Bristol-Myers Squibb