SEPTEP Work Group - SE AETC

SEPTEP Work GroupSoutheast Practice Transformation Expansion Project Wednesday February 21 2018

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Agenda Welcome and Introductions SEPTEP Updates PrEP Materials Coaching for Culture Change Workshop Questions Next Meeting ndash Wednesday March 21st 400pm

CT500pm ET

2

IntroductionsBrief Introductions Your Name State Health Center Name

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Two Day Training Yes we are still talking about it httpswwwseaetccomSEPTEP All videos are up and ready to view

4

Check your email

Funding Updates All LoAs Received Invoices should be emailed to

tracymartinvanderbiltedu Other Updates and Questions After receiving the funds the health center is expected to

complete the project through June 2018

5

SEPTEP Goals Implement opt-out HIV testing Establish linkages to HIV care Create a stigma free clinical setting Apply culture change leadership Integrate sexual history taking into visits Offer PrEP to patients at risk

6

SEPTEP Goals Opt-out HIV Testing Tests available from Central Office Oral Swab or Finger Stick Email tracymartinVanderbiltedu with number of tests and

shipping address or let Sierra know during individual calls Use central office funds not your SEPTEP funds

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Live Training Dates Remember live training available for your site Thank you to those that have booked ndash we have just a

couple more questions

8

Southeast Practice Transformation Expansion Project Conference Calls

Clinic Name Clinic Location Clinic Champion Individual SEPTEP Call Email 1 Individual SEPTEP Call Date Individual SEPTEP Call Time Training Need(s) Training Date Training Time Individual SEPTEP Call Email 2 Individual SEPTEP Call Email 3 Attendees

Southeast Alabama Rural Health Associates Troy AL Lori Pope 12212017 1222018 130 pm-230 pm Provide training on how to take a routine sexual history adopt an opt-out training policy provide training for all clinical staff to be certified to do HIV testing with pre and post-test counseling interested in increasing HIV testing wants to receive motivational interviewing training Implement PrEP PrEP education and preceptorships LGBTQ training for Providers (Introduction basics and getting comfortable) April 11 2018 1PM-5PM 1152018 Providers and Immediate Managers

IM Sulzbacher Center for the Homeless Inc Jacksonville FL NeTosha Dopson 12212017 1242018 9AM-10AM Sexual history taking Pending April 4 2018 or May 9 2018 1130 am-130 pm 1152018 All Staff

Orange Blossom Family Health Orlando FL Chianta Lindsey 12212017 1152018

Broward Community and Family Health Centers Hollywood FL Andrea Brooks 12212017 1182018 3PM-4PM

Sexual history and motivational interviewing Clearview training

Building PrEP in overall careClinic is very interested in offering LGBTQ and HIV cultural humility training to all clinic staff

Pending April 13 2018 or April 20 2018 12 Morning and 12 Afternoon (All Day) 1152018 All Staff

Care Resource Miami FL Tashara Hodge 12212017 1302018 10AM-11AM

Motivational interviewing in conjunction with taking a sexual history for cliniciansAdditional PrEP training to assist all Providers with being more comfortable prescribing PrEP to eligible patients

Include linkage to care staff in motivational interviewing trainingCultural humility

March 8 2018 or March 22 2018 830 am-1230 am 1152018 All Staff

First Choice Primary Care Macon GA Laura Fussell RN 12212017 1232018 2PM-3PM Sexual history PrEP (wants to start for those at risk) Cultural humility for staff and providers March 23 2018 1PM-5PM 1152018 Providers MAs Front Desk

Southside Medical Center Inc Atlanta GA Rachel See 12212017 122018 9AM-10AM Pending March 10 2018 Half Day 1152018 Providers

HealthPoint Family Care Covington KY Anna Geiman 12212017 1102018 1030 am-1130 am Overview of how to screen patients to determine who is high risk initiating PrEP for those with high risk screening for HIV including prepost testing counseling and discussing positive results with patients March 8 2018 830 am-10AM 1152018

Family Health Centers Inc Louisville KY Katherine Holland 12212017 122018 11AM-Noon Sexual-history-content getting comfortable etc Cultural humilityhellipopt-out testin linage to care PrEP LGBTQ and beginning PrEP April 11 2018 8AM 1152018 All Staff

Jackson-Hinds Comprehensive Health Center Jackson MS 12212017 1152018

Family Health Care Clinic Peal MS Margaret Gray amp Dr Curry 12212017 2142018 3PM-4PM

How to prescribe prepHelp with getting the uninsured available resources

Getting comfortable with LGBTQ topics amongst staff and patients Drrsquos will get them prepared Separate emotional from informational Dr 40 year experience April 1152018

Caswell Family Medical Center Yanceyville NC Lou Ann Reaves 12212017 2142018 2PM-3PM Start with adolescents then move up with older because they do not feel as if they are affected Providers and Nurses are uncomfortable Internal medicinemedical director interested in providing PrEP but not right now because of current Hep C project Suggest discuss Hep C with patients and mention PrEP Have two Transgender patients (cultural humility) 1152018

Rural Health Services Inc Aiken SC Lisa Lewis 12212017 1172018 10AM-11AM Would like to begin treatment for HIV within their clinic 1st PrEP patient in December more screening education=cultural change (sensitivity) and becoming comfortable as far as cultural humility and LGBTQ goes March 1152018

Carolina Health Centers Inc Greenwood SC Shantate Morton amp Brooke Holloway 12212017 1302018 1PM-2PM Support staff training for PrEP March 1152018 Front Desk Nurseshellipetc

Memphis Health Center Inc Memphis TN Rashida Patterson 12212017 1232018 3PM-4PM Linkage to care and retention (referral process and follow-up) PrEP (implement PrEP LGBTQ (Cultural Humility) HIV Testing March 20th-March 21st or March 27th-March 28th Full Day 1152018 ProvidersMAsFront Desk (Possibility due to Avaliability)

TN Dept of Health Upper Cumberland Regional Office Cookeville TN Debbie Hoy 12212017 1102018 930 am-1030 am 1152018

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PrEP Resources Confidentiality Agreement PrEP FAQ For Patients Billing Codes - httpswwwnastadorgresourcebilling-

coding-guide-hiv-prevention How the PrEP Clinic Works Clinical Visit Form Explaining PrEP to Patients Paying for PrEP

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PrEP Resources PrEP Protocols Sexual History PrEP Screening Risk Screening PrEP Prescription Agreement How to Pay httpswwwcopaysorg Negotiate low cost labs

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How to Pay Negotiate low cost labs Establish Sliding Scale

Apply for a grant to cover costs Grant to reimburse cost via gift card Same process as other chronic

disease meds 340B

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Thank You to Care ResourceHIV 4th generation test $4160CMP $149UA $144HBsAg $310HBsAb $618HBcAb $507RPRFTA $131Hep C Ab with Reflex to HCVhellip $507GonorrheaChlamydia $1270

PrEP Clinic Needs Provider Nursing Assistance in communicating with patient Providing labs and other documents to pharmacy Assisting in completing prior authorization

Pharmacy Specialty pharmacy partnership highly recommended

Phlebotomy blood draws Ability to provide treatment and counseling for STIs

Before prescribing Risk Evaluation and Mitigation Strategies (REMS)

httpswwwtruvadaprepremscomtruvadaprep-resources

The First Visit Assess patientrsquos knowledge and attitudes about PrEP Assess patientrsquos HIV risk Medication counseling

The First Visit

httpswwwtruvadaprepremscomtruvadaprep-agreement-form

PrEP Medication Counseling Dosing One tab daily with or without food

Adherence and its relationship to efficacy Time to effectiveness 7-10 days for men 21 days for women Barrier protection especially needed during that time

Adverse effects Nausea vomiting diarrhea loss of appetite weight loss Fatigue headache

Requirements for monitoring Refill process ldquoCall when you have 7-10 days leftrdquo

PrEP resources for patients PrEP welcome packet

1 CDC PrEP medication information sheet for patients2 PatientProvider Agreement3 PrEP Action Plan and Next Steps4 Walgreens Specialty Pharmacy contact information5 Additional PrEP resources

Prescribing ProcessNo Specialty Pharmacy

Send prescription to pharmacy Fax HIV AgAb serum creatinine when available Complete PA if required Information requested last date of screening and sometimes

PrEP Agreement form Copay card Gilead copay card $3600year benefit httpswwwgileadadvancingaccesscomcopay-coupon-card Federal beneficiaries not eligible

Prior Authorization 340B Drug Pricing Program

Federal program that requires manufacturers to provide reduced drug prices for eligible outpatient centers Centers can purchase

and dispense the medication through internal or external (contract) pharmacies

Other Cost Options

httpswwwprojectinformorgpdfPrEP_Flow_Chartpdf

A Year of PrEPEncounter To doMonth 0 bull Screen for HIV

bull Confirm HBV and HCV statusbull Check serum creatininebull Screen for STIsbull Counselingbull Prescribe

Month 3 bull Screen for HIVbull Check serum creatininebull Counselingbull Prescribe

Month 6 bull Screen for HIVbull Screen for STIsbull Counselingbull Prescribe

Month 9 bull Screen for HIVbull Check serum creatininebull Counselingbull Prescribe

Month 12 bull Screen for HIVbull Screen for STIsbull Counselingbull Prescribe

Labs- HIV screen 5- Serum creatinine 3- STI screen 3

PrescriptionsRefill authorizations 5

Discussions 5+

PrEP Thoughts on providing PrEP

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Upcoming ProgrammingCoaching for Culture Change Community of Practice

3rd Friday of every month at 330pm CT430pm ET through June

Available at wwwseaetccomSEPTEP

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Your Form ndash Complete Anonymous Dr Cooper has asked for a volunteer to start the conversationhttpsgooglformsOWlOnPb7FM0Ro8BA3

Additional one-on-one coaching is available for each center

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More Training at seaetccomSEPTEP

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More Resources at seaetccomSEPTEP

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Reminders for Next Month Friday March 16th ndash 330CT430ET Coaching for Culture

Change ndash Community of Practice Wednesday March 21st ndash 400pmCT500pmET -

SEPTEP Workgroup Testing

Live training in your area

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QUESTIONS

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