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The Missing Link in Test-and- Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist and HIV specialist, Asian Health Services Assistant Clinical Professor of test treat
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The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

Dec 14, 2015

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Page 1: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

The Missing Link in Test-and-Treatidentifying and improving gaps in care

Sophy Wong, MDMedical Director, East Bay AETC

Medical Director, HIV ACCESSInternist and HIV specialist, Asian Health Services

Assistant Clinical Professor of Medicine, UCSF

testtreat

Page 2: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

disclosures

None!

I have no financial arrangements or affiliations with commercial interests.

Commercial support was not received for this activity.

I will not discuss off-label uses of drugs or products in my presentation.

Page 3: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

objectives

1. Describe the impact of using clinical data, especially linkage rates, retention rates and viral loads on test-and-treat outcomes.

2. Identify and analyze gaps in linkage to and retention in care.

3. Propose a work plan to implement at least one strategy for identifying and/or improving linkage and retention rates.

Page 4: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

workshop format

• Gardner & CDC test-link-treat cascades• Case• Definitions of linkage, retention, and

viral load suppression• The Alameda County experience• How to use this data to improve care• Your experience and way forward!

Page 5: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

80%

62%

41% 36%28%

2011-11-29 MMWR 60

Page 6: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

New HIV infections

Access to care: test & treat!

HIV health disparities

Page 7: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

treatment reduces transmission by

96%

Page 8: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

65%

85%

79%

90%

73%

80%

28%

48%

NHAS Goals

Page 9: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

case

A 28 year old African American bisexual man tests positive at a community-based rapid testing project…

Page 10: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

2011-11-29 MMWR 60

Page 11: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

% diagnosed % engaged % ART % VL <200

79%

41%36%

28%

79%

37%33%

28%

Test - Link - TreatNational HIV ACCESS

Page 12: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

Definitions

• Linkage: how does the CDC define linkage to care?

• Retention: how does HRSA define retention in care?

Page 13: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

% diagnosed % engaged % ART % VL <200

79%

41%36%

28%

79%

37%33%

28%

Test - Link - TreatNational HIV ACCESS

Page 14: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

% diagnosed % engaged % ART % VL <200

79%

41%36%

28%

79%

37%33%

28%

Test - Link - TreatNational HIV ACCESS

Page 15: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

Definitions

Viral load suppression: how does the CDC define viral load suppression?

Page 16: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

% diagnosed % engaged % ART % VL <200

79%

41%36%

28%

79%

37%33%

28%

Test - Link - TreatNational HIV ACCESS

Page 17: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

The Missing Link in Test-and-Treat

testtreat

link

Page 18: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

The Missing Link: Linkage & retention is our weakest point.

Page 19: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

So what?

Page 20: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

What will it take to substantially reduce HIV transmission in an entire population?

Gardner, CID 2011

Answer: Treatment AND Prevention

Page 21: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.
Page 22: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

Questions?

Page 23: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

CME / CE credits

If you would like to receive continuing education credit for this activity, visit:

http://www.pesgce.com/RyanWhite2012

Page 24: The Missing Link in Test-and-Treat identifying and improving gaps in care Sophy Wong, MD Medical Director, East Bay AETC Medical Director, HIV ACCESS Internist.

thanks!AETC:Kathleen ClanonEast Bay AETC team

OAA/DPH HIV data team:Lorenzo HinojosaNeena MurgaiKate BuchaczElaine BautistaAlex Marr

Kaiser: Leo HurleyHighland: Doug WhiteAHS: Koji SakakibaraEBAC Downtown Youth Clinic

HIV ACCESS:Lois LindseyDan ClanonJose ReyesBrianna Rogan

Alameda County DPH:Damon Francis

Office of AIDS:Kabir Hypolite

CA State:Mark DamesynMatt Facer