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STOP HIV/AIDS Pilot: Program Science and Systems Transformation

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STOP HIV/AIDS Pilot: Program Science and Systems Transformation

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STOP HIV/AIDS Pilot: Program Science and Systems Transformation

  1. 1. 1 STOP HIV/AIDS Pilot: Program Science and Systems Transformation Chris Buchner Regional Director, Prevention Vancouver Coastal Health April 30th , 2015
  2. 2. 22
  3. 3. 3 New Infections in BC BC CfE Q3 2014
  4. 4. 44 A provincial initiative to enhance early diagnosis and treatment of HIV with the goal of changing the course of the epidemic •3 year, $48 million pilot project •Two pilot sites: Vancouver & Prince George •Evaluation: • Was diagnosis improved? • Are more people on treatment? • Did we change the course of the epidemic? Seek & Treat to Optimally Prevent (STOP) HIV/AIDS
  5. 5. 55 STOP HIV/AIDS Project Goals • Reduce HIV/AIDS cases in Prince George & Vancouver Inner City • Improve early detection of HIV • Ensure timely access to high-quality & safe HIV/AIDS care & treatment • Improve client experience in every step of HIV/AIDS journey • Demonstrate system & cost-optimization
  6. 6. 66
  7. 7. 7 “If you always do what you’ve always done, you’ll always get what you’ve always got.” - Henry Ford
  8. 8. 8 Data as a transformative tool • Population-level monitoring • Establish current system / program performance and identify gaps • Set common goals, outcome measures, targets • Program-level evaluation • Establish a common culture and articulate expectations
  9. 9. 10 Percent & proportion of new HIV diagnoses with ≥ 1 prior Outpatient, Lab, ER or Inpatient encounter, by CD4 count * Only 57.5% (291/506) of new HIV Dx had a CD4 count on * Only 57.5% (291/506) of new HIV Dx had a CD4 count on record at time of Dx CD4 Count* ≥ 1 prior encounter < 200 58% (30/52) < 350 60% (64/107) < 500 55% (97/177) 10
  10. 10. 11 Innovation in HIV Prevention • Health Promotion Case Managers for HIV- people • NP for HIV- Gay men
  11. 11. 12 Innovation in HIV Testing • Routine offer of an HIV test in acute and primary care • Routine offer of HIV test in key settings (abortion clinics, MH&A programs) • Peers POC testers • Dental and pharmacy POC • First Nations wellness approach
  12. 12. 13 Innovation in HIV Treatment & Support • Clinical outreach pods • Dear Dr. letters • Monitoring retention in care
  13. 13. 14 Rapid Cycle Monitoring and Adjustment • Quarterly population level reports – Volumes of HIV tests performed by setting – Contacts elicited and tested – % positivity – CD4 count at diagnosis – Sustained viral suppression • 6 month evaluation reports by individual initiative
  14. 14. 15 Mean Monthly HIV Lab Tests per 10,000 Population by LHA
  15. 15. 16 Proportion of Patients’ CD4 Cell Count and Disease Stage at Diagnosis by Year of Diagnosis
  16. 16. 17 Number of Contacts Notified and Tested for HIV and Percent Positivity due to Contact Tracing
  17. 17. Integrated Service Delivery System 19
  18. 18. Combination HIV Prevention SDM 20
  19. 19. HIV Testing Service Delivery Model 21 • Routine testing means offering routinely, diagnostic testing when symptomatic or identified risk • There is an assumption to provide risk based testing across all population and settings
  20. 20. HIV Care & Treatment Service Delivery Model 22
  21. 21. Kania, Kramer: Stanford Social Innovation Review, 2011
  22. 22. 24 Key Lessons in Systems Transformation • Resources, outcomes and accountability must be seen from a population level • Data and performance measurement are critical tools for identifying, motivating and quantifying system transformation • Don’t be afraid to be messy or wrong – everything can be cleaned up later
  23. 23. 25 Questions chris.buchner@vch.ca 25

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