+North Carolina PositiveCharge InitiativeAccess to Care Progress Report February 2012
+ Access to Care Study after study outline the importance of consistent HIV care n Based on his cumulative research, Edward M. Gardner, et al. estimates only 50% of those who know they are positive are retained in care, and a mere 24% of those who know their positive status have achieved an undetectable viral load. This is crucial to reducing HIV transmission in light of recent research headed by Myron Cohen, M.D. indicating a 96% decrease in HIV transmission between serodiscordant couples when the partner with HIV initiated antiretroviral therapy while their immune system as still stronger (CD4 350 and 550) and builds on years of mounting evidence that a lower viral load reduces the risk of HIV transmission.
+ Access to Care n Engagement in routine HIV care, in addition to the public health benefits of reduced HIV transmission, reduces overall costs of treatment through: delayed disease progression, extension of productive life years, and avoidance of costly emergency care.
+ Who is out of Care? In North Carolina generally and the NC Positive Charge Initiative n In North Carolina, an Age of Clients, NC PCI estimated 23.4% of those 18-24 who know they are HIV+ are not receiving HIV medical 25-29 care. 30-39 40-49 NC Epidemiologic Profile for HIV/STD Prevention 50+ and Care Planning (12/11) Annual Income, NC PCI Race, NC PCI American Indian/ Alaska Native <$20,000 Black, non- $20,000-40,000 Hispanic $40,000-80,000 Hispanic Missing White, non- Hispanic
+ Why are people out of Care? Barriers to Care and Meeting Basic Daily Needs NC Positive Charge Initiative clients Current Needs of NC PCI clients at Enrollment70 percentage605040302010 0 Drug and Housing or Food or other Dental services HIV-related Non-HIV Pharmacy or Mental health alcohol abuse shelter subsistence medical related medication services treatment need services medical services (for services HIV or non HIV reasons)
+NC Positive ChargeInitiativeKey Partners:North Carolina Community AIDS FundHertford County Public Health AuthorityMecklenburg County Health DepartmentPartners In CaringRAIN Started in July 2010, the NC Positive Charge Initiative is designed to find people who know their positive status but are out of care, connect them to HIV medical care, and support those in care that face barriers to adhering to care. NC Positive Charge Initiative access to care.
+ Program Outline North Carolina Positive Charge Initiative n Teams of 2-3 part-time Access Coordinators work to identify The Positive Charge Initiative serves rural, suburban, and people who know they are HIV+ urban areas of the state, reaching clients in 18 counties. but out of care, bring them into care, and retain people in care who are at risk of disengaging n Access Coordinators received PETS (peer education) training and the specially designed Access Coordinator training: n planning an event, outreach, identifying resources, public speaking, self care n Funding for the Positive Charge Initiative is provided by AIDS n Access Coordinators split their United and Bristol-Myers Squibb time between their HIV agencies and non-HIV community settings
+ n The HCPHA is the lead agency in the local HIV Network of Care; it is the only agency providing HIV care in the region. The team consists of the Program Manager, 2 RNs, 2 Medical Case Managers, 1 Jail Testing Coordinator and 3 Access Coordinators. Many of the services that can be, are brought to the location of the clients for a one stop shop approach to care. n The work is accomplished with the aid of a mobile unit to hold clinics in different areas toHertford County Public attempt to overcome the huge transportationHealth Authority challenges in the region. HCPHA has 5 mobile clinic sites and 1 fixed site clinic.Tommy Jones, Access CoordinatorDelton Smith, Access Coordinator n We see the clients on a quarterly basis; theTracy Bristow, HIV Program more constant contact is needed to keepManager them engaged in care. Having the Access Coordinators has added another layer in the ability to make that personal connection with clients. The ACs attend all clinics and lab days to work with clients as needed which has been important as issues with clients have popped up, clients have a chance to meet with them immediately.
+ n Two Access Coordinators work in conjunction with the Access Coordinators at RAIN to provide services to the residents of Mecklenburg County. n The Access Coordinators have received referrals from the Disease Intervention Specialist program, case managers, HIV testing programs,Mecklenburg County local clinics, current clients, and otherHealth Department service providers.Lamont Holley, Access Coordinator n The Access Coordinators invitedDeVondia Roseborough, AccessCoordinator numerous service providers to an evening of food, fellowship, andBrian Witt, Supervisor, HealthEducation education in the effort to promote the Positive Charge Initiative in Mecklenburg County. The event allowed providers and Access Coordinators to develop strategies to successfully implement the project.
+ n The team of three Access Coordinators serve a six-county region. n Many of the counties served lack adequate transportation to medical care and supportive services. Partners in Caring Positive Charge Initiative project offers home visits, linkage to care, medical transport and education activities and events.Partners In Caring n Access Coordinators work veryCressie Stokes, Access Coordinator closely with the New HanoverHayden Braye, Access Coordinator Regional Medical Center’s HIV ClinicSuzette Curry, Senior Clinical in order to secure continuity of careChaplain – Community Educator for clients. ACs along with with their supervisor attend monthly quality improvement meetings with the HIV Care Team in order to update and report changes with an out of care list created by the clinical staff.
+ n RAIN has been providing HIV services to the Charlotte community for 20 years. Their team of two Access Coordinators have expanded that work to include access to care. n The Access Coordinators are working with medical care providers and case managers to identify people who have missed three medicalRAIN appointments to bring them backRegional AIDS Interfaith Network into care.Dee Dee Richardson, AccessCoordinator n The Access Coordinators continue toRichard Mills, Access Coordinator focus some of their outreach work on health fairs but are placing moreCheryl Roberge, Director of CAREManagement focus on events that offer HIV testing. n Through the Positive Charge Initiative, a new partnership has been started to work with the public housing authority to provide education and connect residents to care.
+ n The North Carolina Community AIDS Fund (NCCAF) is a Community Partnership of AIDS United, administering grants statewide and serving as an AmeriCorps Operating Site in the Triangle in addition to our Access to Care work. n As the project lead, NCCAF coordinates communicationNorth Carolina between project partners andCommunity AIDS Fund conducts the project evaluation.Beth Stringfield, Project Coordinator n NCCAF provides orientation andKimberly Walker, PrincipleInvestigator annual training for the Access Coordinators.Sammy Tchwenko, Evaluator n Tools have been developed for Access Coordinators and resources gathered for agencies working with peers and conducting access to care work.
+ Tools for Partners To support program development and staff www.NCcommunityAIDSfund.org/positivecharge.php Outreach Self Care
+ Successes n Since enrollment began in last 2010, over 100 clients have entered the project, an additional 40+ people have received PCI services, dozens have received HIV testing, and hundreds have received HIV education. n Preliminary data show an increase in the mean CD4 count and decrease in viral load in six months of clients’ active enrollment in the program. n Additionally, the percent of clients with an undetectable viral load has grown, based on preliminary data. n A skills-based curriculum was developed to prepare Access Coordinators to fill these newly created positions. n We have seen improved referrals systems for HIV care and support and reduced no-shows at medical clinics.
+ Successes n Access Coordinators have conducted HIV education and prevention outreach at public housing complexes, community colleges, churches, and colleges, and have hosted community HIV testing events. n New partners in HIV prevention and education have been identified in the three regions. n Strong integration of the Access Coordinators onto the staff has increased capacity of agencies and allowed new services to added. n Private funding has provided the flexibility needed to serve clients across county lines, regardless of their current engagement in HIV medical care, and to have a single position provide a continuum of services from education and prevention to supportive care.
+ Lessons learned n Training is important. Challenge: Access Coordinators that don’t receive the initial training have been at a significant disadvantage in their position, however logistics and expenses prevent hosting it for each new person. The 3- day Access Coordinator curriculum is being broken down into individual learning modules for new staff members. n Street and community outreach is difficult. Challenge: people have been out of care for a reason, finding then in the broader community is extremely time consuming, leading us to focus more on those who are new to care and tenuously in care. n Basic HIV education is still needed. Challenge: Access Coordinators have been faced by significant deficits in general HIV knowledge, as a result they have been doing more HIV education than anticipated.
+ Lessons learned n Transportation costs remain a barrier. Challenge: the amount of travel for outreach, connecting clients to care, and individual clients’ transportation remain high in spite of PCI funding for transportation, a mobile medical unit in the northeast, and public transportation in Charlotte. n Access Coordinators need to be fully integrated in the agency. Challenge: Access Coordinators that are not validated as full staff members have not be as successful in reaching their enrollment numbers, conducting outreach work, and have lower job satisfaction. Some factors that contribute to the success of the program have included providing Access Coordinators adequate work space and tools, introductions to the staff and clear distinct job roles, support from the leadership, incorporating PCI into the referral system, and assuring Access Coordinators participate in agency meetings and trainings.
+ NC Positive Charge Initiative is a project of the North Carolina Community AIDS Fund 2812 Erwin Road, Suite 403 Durham, NC 27705 919.613.5431 www.NCcommunityAIDSfund.org