Early Identification of   Individuals with HIV/AIDS:A National Ryan White Program Initiative                              ...
HandoutsLogic ModelMatrixHRSA Policy Notice 12-01: OutreachHRSA/CDC letter February 25, 2013March 14, 2013   EIIHA        ...
Background   Individuals who delay testing are likely to have    damaged immune systems because the virus has    had time...
EIIHA Defined                 Identifying, counseling, testing,                 informing, and referring of               ...
National EIIHA Goals  1.  the number of individuals who     are aware of their HIV status  2.  the number of HIV+ indivi...
National HIV/AIDS Strategynew HIV infections access to care and improving health outcomes for PLWH HIV-related health d...
Legislative Language 2009         “… a strategy, coordinated as appropriate with other           community strategies and ...
EIIHA’s Relationship to Funding         “and demonstrated success in identifying individuals with HIV/AIDS         who do ...
Philadelphia EMA EIIHA Strategy    Maintain and expand a diverse and    coordinated portfolio of early intervention    ser...
Philadelphia EIIHA Logic ModelFigure 2.1: Philadelphia EMA EIIHA Strategy Logic Model                      Inputs         ...
Long & Short Term EIIHA Goals                                       EIIHA Service Models                                  ...
HRSA ExpectationsEMA to develop and implement a strategy based on: Estimate of HIV+/unaware (21%)   Assessment of HIV+/u...
Early Intervention Services    Identification of individuals at points of entry    HIV testing and targeted counseling ...
Administering EIIHA           Coordinated with other programs and            Ryan White Program Parts           Incorpor...
EIIHA Matrix         Illustrates how the   P1                                     PHILADELPHIA EMA EARLY IDENTIFICATION O...
System Impacts toSuccessful EIIHA Outputs                                  Need to be able to serve                  More ...
Priority Needs of All Target Groups           HIV/AIDS stigma and discrimination           Poor health literacy        ...
Activities Directed at all Groups           Routine testing in clinical and nonclinical            settings and social ma...
HRSA/HAB Ryan White ProgramPolicy Notice 12-01: Outreach          Outreach is a support service          Outreach is not...
Recent HHS Letter on Testingand Linkage to Care          Issued February 25, 2013 jointly by HRSA           (Cheever) and...
Ways to Confirm Diagnosis          Positive HIV immunoassay and positive           HIV Western blot          Positive HI...
Overall Goal          Diagnose and quickly link persons with           HIV into high quality medical care (RW           l...
Thank you!                   Matthew McClain                 AIDSpolicy@aol.comMarch 14, 2013      EIIHA             23
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Early Identification of Individuals with HIV/AIDS

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Consultant Matthew McClain provided this presentation on EIIHA to the Philadelphia EMA RWPC on 03-14-13

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Early Identification of Individuals with HIV/AIDS

  1. 1. Early Identification of Individuals with HIV/AIDS:A National Ryan White Program Initiative EIIHA Presentation to Philadelphia EMA Ryan White Planning Council Matthew McClain March 14, 2013
  2. 2. HandoutsLogic ModelMatrixHRSA Policy Notice 12-01: OutreachHRSA/CDC letter February 25, 2013March 14, 2013 EIIHA 2
  3. 3. Background Individuals who delay testing are likely to have damaged immune systems because the virus has had time to replicate in their bodies Undiagnosed individuals are more likely to infect others The lower the viral load, the less likely a person is to infect others – and ART can reduce viral load, often to undetectable levels Untreated co-infections can cause spikes in viral loadMarch 14, 2013 EIIHA 3
  4. 4. EIIHA Defined Identifying, counseling, testing, informing, and referring of diagnosed and undiagnosed individuals to appropriate services, as well as linking newly diagnosed HIV positive individuals to medical care.March 14, 2013 EIIHA 4
  5. 5. National EIIHA Goals 1.  the number of individuals who are aware of their HIV status 2.  the number of HIV+ individuals who are in medical care 3.  the number of HIV- individuals referred to services that contribute to keeping them HIV-March 14, 2013 EIIHA 5
  6. 6. National HIV/AIDS Strategynew HIV infections access to care and improving health outcomes for PLWH HIV-related health disparitiesMarch 14, 2013 EIIHA 6
  7. 7. Legislative Language 2009 “… a strategy, coordinated as appropriate with other community strategies and efforts, including discrete goals, a timetable, and appropriate funding, for identifying individuals with HIV/AIDS who do not know their HIV status, making such individuals aware of such status, and enabling such individuals to use the health and support services described section 2604, with particular attention to reducing barriers to routine testing and disparities in access and services among affected subpopulations and historically underserved communities;” Section 2603(b)March 14, 2013 EIIHA 7
  8. 8. EIIHA’s Relationship to Funding “and demonstrated success in identifying individuals with HIV/AIDS who do not know their HIV status and making them aware of such status counting one-third. In making such determination, the Secretary shall consider— (i) the number of individuals who have been tested for HIV/AIDS; (ii) of those individuals described in clause (i), the number of individuals who tested for HIV/AIDS who are made aware of their status, including the number who test positive; and (iii) of those individuals described in clause (ii), the number who have been referred to appropriate treatment and care’’. Section 2617 (b)March 14, 2013 EIIHA 8
  9. 9. Philadelphia EMA EIIHA Strategy Maintain and expand a diverse and coordinated portfolio of early intervention services such that (1) HIV screening is routinely available in clinical settings, and (2) individuals in high risk groups routinely come into contact with HIV screening programs operated in clinical and nonclinical settings.March 14, 2013 EIIHA 9
  10. 10. Philadelphia EIIHA Logic ModelFigure 2.1: Philadelphia EMA EIIHA Strategy Logic Model Inputs Activities Participation Short Term Goals Long Term Goals Ryan White Parts: A, B, C,  HIV screening in clinical  City Health Centers  HIV screening is  Increase in the D, F, and MAI. settings  City STD Clinic routinely available in number of Direct CDC cooperative  HIV screening in  Emergency Departments clinical settings. individuals who agreement funds for HIV nonclinical settings  FQHCs  EMA supports diverse are aware of their prevention.  HIV opt-out screening at  Substance abuse range of community- status. CDC expanded testing, intake in Philadelphia treatment sites based HIV screening enhanced HIV prevention prisons  Family planning sites for targeted high risk  Increase the planning (ECHPP), and a  Social networks testing  Labor and delivery populations (risk- number of HIV test and treat initiative. targeting youth, MSM, and departments based and positive individuals NIH/CDC SMILE (Y/MSM) IDU  Private physicians’ geographically-based). who are in care. initiative.  Social marketing and offices  Opt-out HIV screening PA/NJ state counseling and media campaigns  In-patient settings at medical intake in  Reduce health testing funds.  Rapid testing to increase %  CBO clinics (fixed and Philadelphia prisons. disparities. City of Philadelphia of people who receive test mobile)  100% of individuals counseling and testing results.  Community-based receive their test funds.  Outreach for targeted settings results. Established network of testing  Parole offices  100% of individuals more than 450 testing  Referral to preventive  Syringe exchange sites will receive sites. services  Anonymous testing sites confidential More than 400, active,  Referral to care  Correctional facilities confirmatory tests trained and certified HIV  Partner services  CDC Category C even though initial counselors.  Linkage to care Demonstration grantee test was anonymous. Integrated routine HIV  Training and technical sites  100% of high risk screening in clinical sites assistance for provider  Ryan White SPNS individuals and and targeted HIV screening agencies grantee sites individuals who test in non- clinical settings. positive are referred Directly funded CBOs. for prevention Updated PA State law services and/or care. allowing opt-out HIV  100% of individuals testing. who test positive are Merck Co. Foundation linked to care. linkage to care funds. March 14, 2013 EIIHA 10
  11. 11. Long & Short Term EIIHA Goals EIIHA Service Models  Routine HIV screening in Achievement of the EIIHA goals contributes directly to health care settings the triple aims of the National  Targeted HIV screening in HIV/AIDS Strategy community-based settings  Intake testing at the Represent full realization of Philadelphia Prison Health multiple early intervention System services models and methods  Assure tested individuals implemented in the EMA receive their test results; addressing the needs of referred to care or different populations. prevention; linked to care for preliminary positives March 14, 2013 EIIHA 11
  12. 12. HRSA ExpectationsEMA to develop and implement a strategy based on: Estimate of HIV+/unaware (21%) Assessment of HIV+/unaware to target efforts Close collaboration with counseling and testing and partner services Implementation of outreach, testing, referral, and linkage to care Often use of Early Intervention Services (EIS)Providers and grantee collect and report required data Includes data on those who test negativeMarch 14, 2013 EIIHA 12
  13. 13. Early Intervention Services  Identification of individuals at points of entry  HIV testing and targeted counseling  Referral services  Linkage to care  Health education and literacy training  RWP funds to be used for HIV testing only as necessary to supplement, not supplant, existing funding  Peer EIS models  Enables EMA to address both EIIHA and unmet need March 14, 2013 EIIHA 13
  14. 14. Administering EIIHA  Coordinated with other programs and Ryan White Program Parts  Incorporated into RFPs and contracts  Linked with ADAP and local pharmacy  Takes into account disparities in access  Responds to what is known about challenges to making people aware  Facilitates routine screening March 14, 2013 EIIHA 14
  15. 15. EIIHA Matrix  Illustrates how the P1 PHILADELPHIA EMA EARLY IDENTIFICATION OF INDIVIDUALS WITH HIV/AIDS MATRIX All Individuals in Philadelphia EMA Unaware of their HIV Status (HIV+ & HIV-) overall unaware P2 P4 Not Tested in the Past 12 Months High Risk Individuals P5 Low and P3 P6 Tested in the Past 12 Months Individuals Not Post-test Counseled population is Moderate Risk (HIV+ & HIV-) Individuals P7 P8 Received Preliminary HIV+ Result Only Men Who Substance differentiated by Have Sex with Users/ (No confirmatory test) Men Injection Drug Individuals Tested Confidentially Individuals Tested Anonymously Users Incarcerated Individuals Socio-Economic Status Heterosexuals of Low target population Sex Workers Who Use Drugs MSM of Color White MSM Youth MSM Active IDU Trans IDU  6 “Parent” groups T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11  11 “Target” groups March 14, 2013 EIIHA 15
  16. 16. System Impacts toSuccessful EIIHA Outputs Need to be able to serve More HIV+ newly diagnosed clients individuals immediately Need to estimate what proportion of newly diagnosed are likely to Planning be Ryan White eligible Emphasis on getting people onto Adherent ARV  medications early to reduce transmission as prevention March 14, 2013 EIIHA 16
  17. 17. Priority Needs of All Target Groups  HIV/AIDS stigma and discrimination  Poor health literacy  Lack of understanding of effective HIV treatments March 14, 2013 EIIHA 17
  18. 18. Activities Directed at all Groups  Routine testing in clinical and nonclinical settings and social marketing that lowers stigma  Extensive training of counseling and testing providers on general health and HIV  Extensive training and TA to health care providers on best practices in serving the target populations  Extensive case management system March 14, 2013 EIIHA 18
  19. 19. HRSA/HAB Ryan White ProgramPolicy Notice 12-01: Outreach  Outreach is a support service  Outreach is not a requirement  Outreach may be used to identify individuals with HIV disease at points of access to care  Goal continues: identify and refer individuals into early intervention services (testing, prevention counseling, linkage to care)  Prohibited: activities that exclusively promote HIV prevention educationMarch 14, 2013 EIIHA 19
  20. 20. Recent HHS Letter on Testingand Linkage to Care  Issued February 25, 2013 jointly by HRSA (Cheever) and CDC (Mermin) to clarify questions about eligibility of initially reactive but unconfirmed HIV-positive clients for Ryan White care  Clarifies there is no legislative requirement for a ‘confirmed’ HIV diagnosis prior to linkage to Ryan White care  No requirement related to use of Western blot as only means of confirmatory testingMarch 14, 2013 EIIHA 20
  21. 21. Ways to Confirm Diagnosis  Positive HIV immunoassay and positive HIV Western blot  Positive HIV immunoassay and detectable HIV RNA  Two positive HIV immunoassays (should be different assays based on different antigens or different principles)March 14, 2013 EIIHA 21
  22. 22. Overall Goal  Diagnose and quickly link persons with HIV into high quality medical care (RW legislation)  Establish a seamless system to immediately link people to continuous and coordinated quality care when they are diagnosed with HIV (NHAS)March 14, 2013 EIIHA 22
  23. 23. Thank you! Matthew McClain AIDSpolicy@aol.comMarch 14, 2013 EIIHA 23

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