Health System Navigators Presentation

809 views

Published on

Dr. Helena Kwakwa's presentation to the RWPC on Philadelphia Health Centers' health system navigators program, funded through Merck.

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
809
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
9
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Health System Navigators Presentation

  1. 1. HEALTH SYSTEM NAVIGATORS:A NEW RESOURCE FOR PHILADEPHIA’S HIV-POSITIVE POPULATION
  2. 2. Overview HIV epidemic in Philadelphia Snapshot of HIV as seen in the health centers Testing Priority Clinics Tools to manage the HIV epidemic Testing Treatment Importance of linkage to care and retention in care Introducing EHPIC, the System Navigator Program
  3. 3. HIV/AIDS in Philadelphia at a glance,201129,139• Cumulative HIV/AIDS cases• 25.7% female, 64.5% black19,157• Living with HIV/AIDS• 39.6% 50 years or older888• New HIV/AIDS diagnoses• 50% heterosexual
  4. 4. Overview HIV epidemic in Philadelphia Snapshot of HIV as seen in the health centers Testing Priority Clinics Tools to manage the HIV epidemic Testing Treatment Importance of linkage to care and retention in care Introducing EHPIC, the System Navigator Program
  5. 5. HIV/AIDS: A view from AHSRapidTesting• 7,000/yr• 40 positive/yrConventionalTesting• Fam Med Clin• Women’sHealthHIV Clinics• 1,054 in 2012• 120 new pts• 115 lost tocare
  6. 6. Overview HIV epidemic in Philadelphia Snapshot of HIV as seen in the health centers Testing Priority Clinics Tools to manage the HIV epidemic Testing Treatment Importance of linkage to care and retention in care Introducing EHPIC, the System Navigator Program
  7. 7. Improving efficacy of initial HAART regimens*Values are weighted means 1994 to July 2004 (n=14,264 patients). 90 treatmentarms from 53 trials: NNRTI (n=38); PI (n=32), NRTI (n=12), boosted PI (n=8).Unboosted PI + 2 NRTIsBoosted PI + 2 NRTIsNNRTI + 2 NRTIs3 to 4 NRTIs(qid/tid/bid)Unboosted PI + 2 NRTIsBoosted PI + 2 NRTIsNNRTI + 2 NRTIs(tid/bid)Boosted PI + 2 NRTIsNNRTI + 2 NRTIs(qd/bid)020406080100<1998* 1999-2000* 2001-2002* 2003-2004*Patients(%)Bartlett et al(AIDS. 2006;20:2051-2064)2006-2010ACTG 5142, CASTLE,ALERT, KLEAN,GEMINI, ARTEMIS,Study 903 and 934,STARTMRK41%50%56%64%65% to 85%HIV RNA <50 Copies/mL
  8. 8. CDC estimates (1996-2005):life expectancy after HIV diagnosis Life expectancy for HIVpatients increased from 10.5to 22.5 years Women: 23.9 years Men: 22.0 years Average life expectancydecreased with eachincreasing year of age at HIVdiagnosis051015202530LifeExpectancy(years)10.3White Black Hispanic20.1199620002005Life Expectancy byYear of HIV DiagnosisHarrison KM, et al. JAIDS. 2010;53:124-130.25.59.516.419.910.120.422.6
  9. 9. 01020304050NA-ACCORD: temporal changesin life expectancy (1996-2007)Age(years)Life Expectancy at Age 20 YearsYear Range96-99 00-02 03-05 06-0734.447.136.943.1 North America cohort (n=75,148) On HAART (49.5%) 1799 deaths over 89,521 person-years offollow-up Life expectancy at age 20 years Increased Stepwise with each calendar year White and Hispanic versus black Decreased IDU versus MSM and heterosexuals Low baseline CD4 (<100 cells/mm3) The need to address disparities in lifeexpectancy is an ongoing needHogg R, et a. 19th CROI. Seattle, 2012. Abstract 137.
  10. 10. Overview HIV epidemic in Philadelphia Snapshot of HIV as seen in the health centers Testing Priority Clinics Tools to manage the HIV epidemic Testing Treatment Importance of linkage to care and retention in care Introducing EHPIC, the System Navigator Program
  11. 11. Linkage to and retention in care 3.9 – 8.8 years of life lost due to late initiation of ART as a resultof Late diagnosis Late linkage to care Approximately 1 additional year of life lost due to earlydiscontinuation of ART Among a cohort in TX with no financial barriers to care, comparedto those with visits in all 4 quarters of the first year of care, therewas A 42% increase in risk of death with visits in 3 quarters A 67% increase in risk of death with visits in 2 quarters A 95% increase in risk of death with visit(s) in 1 quarterLosine E et al, Clin Infect Dis 2009;49(10):1570-1578; Giordano TP et al, Clin InfectDis 2007;44:1493-1499
  12. 12. “. . . underscores the importance ofdeveloping interventions that are focusedon better linkage to and retention in care,especially for racial/ethnic minorities.”- Elena LosinaLosina E et al, Clin Infect Dis 2009;49(10):1570-1578
  13. 13. CDC: HIV-infected persons engaged inselected stages of the continuum of care (2009)020406080100Incidence(%)Black(n=510,600)Hispanic or Latino(n=220,400)White(n=417,200)CDC and Prevention National HIV Surveillance SystemDiagnosedLinked to careRetained in care81%62%34%29%21%Hall HI, et al. 19th IAC. Washington, DC, 2012. Abstract FrLBX05.Prescribed ARTViral suppression80%67%37%33%26%85%71%38%35%30%
  14. 14. Outreach data, AHS November-December2012Lost to care patients293116177050100150200250300350Lost to care Not reached Pts contactedData on file, AHS
  15. 15. November-December Outreach findings40 3463215 12 2177050100150200RelocatedRe-engagedChangePCPDeceasedMissedapptsIncarceratedOtherTotal#ofpatientsData on file, AHSDisposition of lost-to-care patients, AHS 2012
  16. 16. #ofvisitsforpatientslostto care in 2012 (n=46)43%30%27%1visit2visits>2visitsFirst visits important for retention, AHS 2012Data on file, AHS
  17. 17. Overview HIV epidemic in Philadelphia Snapshot of HIV as seen in the health centers Testing Priority Clinics Tools to manage the HIV epidemic Testing Treatment Importance of linkage to care and retention in care Introducing EHPIC, the System Navigator Program
  18. 18. Introducing EHPIC: a program for linkage toand retention in care for Priority ClinicpatientsEngagingHIV-positivePatientsInCareHIV Clinicaccessibility tocommunityprovidersserving PDPHpatientsBarriers imposedby systemcomplexity(PDPH and otherinstitutions) andpatient needsIncreaseDecrease
  19. 19. EHPIC Program Health System Navigators to improve retention by assistingpatients with Navigating health center systems Navigating other systems to which they are referred Health System Navigators to improve retention by better engagingexisting patients Health center clinicians Improve HIV testing rates to identify and link patients with HIV HIV community engagement by identifying key communitypartners and improving communication and resource-sharing
  20. 20. PtHCAAHFAACO
  21. 21. Targets for health system navigationHealthSystemNavigatorsNewlydiagnosedpatientsPatients lostto or looselyengaged incarePatientsreferred
  22. 22. Health system navigation flow chart
  23. 23. Health System Navigator referralsNewly diagnosedSocial workersRapid testersFamily MedPediatricsExternal sourcesPreviously diagnosedCommunitytesting sitesOther careprovidersOtherLost to careOutreach worker
  24. 24. The loosely engaged patient The patient with non-engaged visits Forms Acute issues Walk-in visits Often precedes loss to care Will be referred by Oumar Gaye Priority Clinic team
  25. 25. Introducing the health systemnavigatorsTrevor Dantzler(HC #3, HC #5)Shelise Henneghan(HC #9, HC #12)Richard LaBoy(HC #6, HC #10)Donielle Sturgis(HC #2, HC #4)SupervisorCQI Manager
  26. 26. And the Health System Navigatorsupervision• Program• CQIOumar GayeClinical Care Coordinator,AHS• Personnelmanagement• ActionAIDS liaisonRaphiatouNoumbissiCase ManagementSupervisor, ActionAIDS
  27. 27. Additional Navigator duties Partner services DIS to meet with patients at health centers Coordinated by Oumar Gaye For patients testing HIV-positive through conventional testing, andwho do not show for follow-up appointments Navigators will assist with re-linking patients Not Navigator duties Adherence counseling Case management Social work Clerical duties
  28. 28. Referring to Navigators Trevor Dantzler (HC #3, HC #5) 267-291-4539; tdantzler@actionaids.org Shelise Henneghan (HC #9, HC #12) 267-713-8974; shenneghan@actionaids.org Richard LaBoy (HC #6, HC #10) 267-908-6040; rlaboy@actionaids.org Donielle Sturgis (HC #2, HC #4) Don’t know which health center? Don’t have time to look it up? Call Oumar Gaye (215-869-0721); oumar.gaye@phila.gov Call Raphia Noumbissi (215-387-7058); rnoumbissie@actionaids.org
  29. 29. HEALTH SYSTEM NAVIGATORS:A NEW RESOURCE FOR PHILADELPHIA’S HIV-POSITIVEPOPULATION

×