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Do 1 Thing - Dr. Stacey Trooskin
The document details a community-engaged research project addressing racial and geographic disparities in HIV and HCV infections, particularly highlighting issues in Southwest Philadelphia, a medically underserved area. It discusses the 'Do One Thing' campaign aimed at increasing testing and linkage to care through outreach, partnerships, and innovative marketing strategies. The summary includes insights into demographic trends and challenges faced in testing and retaining patients in care, proposing future strategies to enhance health outcomes in the region.
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Do 1 Thing - Dr. Stacey Trooskin
- 1. Stacey B. Trooskin,MD PhD Assistant Professor Drexel University College of Medicine Using Community-Engaged Research toUsing Community-Engaged Research to Address Racial and GeographicAddress Racial and Geographic Disparities in HIV and HCV InfectionDisparities in HIV and HCV Infection
- 2. Racial Disparities inHIV InfectionRacial Disparities in HIV Infection • African Americans represent 14% of the population and 45% of HIV infections • African Americans are more likely to present later in the course of their infection and have higher rates of AIDS-related mortality • Traditional behavioral risk factors don’t explain disparities – More limited access to HIV testing, lower insurance rates – Structural and social factors – Complex sexual networks
- 3. Geographic DisparitiesGeographic Disparities •In many urban areas, a few neighborhoods account for a large share of HIV infections • HIV infections cluster • Some neighborhoods have HIV infection rates similar to sub-Saharan Africa • Maps tell us where to focus intensive prevention and treatment efforts Source: AIDSVu
- 4. • Philadelphia hasinfection rates 5 times the national average • Heterosexual epidemic • Zipcode 19143 (in Southwest Philadelphia) is the second most populous zipcode in the city (60,000 people) – 86% African American, 30% people < poverty line • Zipcode 19143 has the 2nd highest number of people living with HIV/AIDS (1,014 individuals in 2010) – Approximately 1.8% seropositivity • Rates of Hepatitis C (HCV) in 19143 unknown, but likely high • 19143 has few medical and health resources HIV & HCV in SouthwestHIV & HCV in Southwest PhiladelphiaPhiladelphia
- 5. Rates of PersonsLiving with HIV/AIDS by Zip Code and Census Tract, 2009 Source: AIDSVu
- 6. Do One ThingOverviewDo One Thing Overview • Southwest Philadelphia, PA is a medically underserved area with high rates of HIV and HCV infection & few HIV and HCV testing & treatment services • Do One Thing is a testing, linkage to care and treatment campaign that stimulates demand for and provides HIV and HCV testing and treatment across an entire zipcode • Do One Thing includes: • A large-scale social marketing and media campaign • Community outreach and mobilization • Partnerships with business, community organizations, and faith institutions • A partnership with a federally qualified health center in Southwest Philadelphia to routinely offer HIV testing to all patients over age 13 • Rapid HIV and HCV testing in a mobile unit, door-to-door testing in 4 census tracts • Community service and volunteerism • Monitoring and evaluation
- 7. Location, location, location!Location,location, location! Do One Thing in Southwest PhiladelphiaDo One Thing in Southwest Philadelphia
- 8. Social Marketing CampaignSocialMarketing Campaign
- 9. Social Marketing CampaignSocialMarketing Campaign • Website: 1nething.com • Texting service • Yard signs, door knockers, door to door outreach • Palm cards • Street outreach • Twitter feed with map of mobile unit of of mobile unit locations
- 10.
- 11. Community Mobilization:Community Mobilization: BusinessesBusinesses CommunityPharmacy Corner Market Cafe
- 12. Routine HIV Testingat theRoutine HIV Testing at the Health Annex, a FQHCHealth Annex, a FQHC
- 13. Victories and ChallengeswithVictories and Challenges with Routine Testing in Clinical SettingRoutine Testing in Clinical Setting Clinical Challenges and Lessons learned • Policy Change: Leadership is most important factor • Integrated Model: Know your patient flow and model – NP clinical model with MAs testing model • EMR Enhancement • Staff and Provider Training • Financial incentives
- 14. Victories and ChallengeswithVictories and Challenges with Routine Testing in Clinical SettingRoutine Testing in Clinical Setting Clinical Challenges and Lessons learned • Offer rate has plateaued at 70% – Next step: incentivize acceptance rate improvements • High decline rate: most commonly cited reasons are “recently tested” and “wasn’t expecting an HIV test” • Behavioral risk profiles: most new positives have “no identified risk;” most are young, African American women • Lower seropositivity than expected: 0.4% • 95% linkage and retention in care rate; has been sustained over time
- 15. Community Service: OurVolunteersCommunity Service: Our Volunteers
- 16. Do One ThingDoor To DoorDo One Thing Door To Door HIV/HCV Testing CampaignHIV/HCV Testing Campaign
- 17. Non-Clinical Testing onMobileNon-Clinical Testing on Mobile Medical UnitMedical Unit
- 18. Demographic Percentage Gender Female45% Male 54.4% Transgender .6% Race African American 90% African 3% Other 7% Education Less than high school 20% High School 50% Some college/AA 21% 4 year college 8% Household Income <$10,000/yr 43% $10,000-15,000/yr 15% $15,000-20,000/yr 12% >$20,000/yr 30% Employment Unemployed 37% Part-time 15% Disabled 11% Full-time 31% Other 6% Demographi c Percentage Health Insurance Status None 37% Medicaid 36% Private 18% Other (Medicare, Veterans, etc) 9% Sexual Orientation (self-report) Heterosexual 89% Gay/Lesbian 6% Bisexual 5%
- 19. Risk Behavior Percentage Multiplesexual partners 22% Believe partner has multiple sexual partners 24% Ever injected drugs 6.7% Ever used crack or cocaine Cocaine 15% Crack 14% Tattoos 49% If tattooed, received tattoo at tattoo party 24% Ever tested for HIV? 85% Ever tested for HCV? 36% Reported venue for testing for HCV Doctor’s Office 56% Reported reason for testing for HCV Participant asked for the test 41% Doctor Recommended 33% Other 26%
- 20. Clinical and Non-ClinicalClinicaland Non-Clinical HIV Testing TrendsHIV Testing Trends • Clinical Settings – Tested 2,100 people for HIV in clinical settings – Health Annex (FQHC) seropositivity: 0.4% – Greatest challenge: 55% decline rate • Non Clinical Settings – Tested 900 people for HIV in non-clinical settings • 1.3% HIV seropositivity – Tested 350 people for HCV in non-clinical settings since December 2012 • 4.8% HCV seropositivity
- 21. Linkage to CareProtocol OraQuick® rapid HCV antibody test reactive OraQuick® rapid HCV antibody test reactive Confirmatory test is positive Confirmatory test is negative x 2 D1T staff notifies patient and provides counseling D1T staff notifies patient : counseling + insurance status Insured with a primary care provider Referral Insured with no known primary care provider PCP visit followed by referral Uninsured with no primary care provider Social worker works w/ clients to gain insurance + then refers OraQuick® rapid HIV antibody test reactive D1T staff immediately links patient to HIV care within 24-48 hrs If uninsur- able, refer to health center Repeat test Blood draw for confirmatory Western blot Repeat test Blood draw for confirmatory HCV PCR quant Repeat test Blood draw for confirmatory HCV PCR quant
- 22. Preliminary linkage toHIV carePreliminary linkage to HIV care trends: Non-clinical Testingtrends: Non-clinical Testing 12 People Tested Preliminary Positive 10 confirmed positives 2 discordant confirmatory results 8 known positives 2 new diagnoses 4 currently in care 1 LTFU 6 being linked to care 1 awaiting viral load results
- 23. Demographic characteristics ofHIV-positiveDemographic characteristics of HIV-positive patients in non-clinical settingpatients in non-clinical setting • Average age HIV+ = 44 years old • African American • Transmission risk factors: MSM (2), Heterosexual (5), no identified risks (5) • 2 co-infected with HCV
- 24. Preliminary Linkage toCare Trends forPreliminary Linkage to Care Trends for Non-clinical Testing: HCVNon-clinical Testing: HCV 17 People Tested Preliminary Positive 13 chronically infected 2 cleared virus 10 previously known 3 new diagnoses 1 currently in care 2 in process of linkage 10 linked to care outreach services 2 uninsured 10 have insurance 2 with insurance pending 6 referrals pending 4 awaiting referrals 2 awaiting results
- 25. • Average ageis 52 • One third are NOT in baby boomer birth cohort • Mode of transmission: no identified risk (7), IDU/cocaine use (7), Heterosexual (1) • 2 co-infected with HIV • Tattooing in unregulated environments Demographic Trends of HCV positiveDemographic Trends of HCV positive Patients in non-clinical SettingPatients in non-clinical Setting
- 26. • Continuing QualityImprovement (CQI) is critical • Many are known HIV and HCV positive and not in care • Comprehensive campaign is a way to raise awareness, fight stigma and re-engage patients in care • Biggest challenge in non-clinical setting: retaining HIV patients in care • Biggest HCV challenge: payment and linkage – insurance and referrals for HCV care Lessons Learned and ImplicationsLessons Learned and Implications
- 27. • Biggest challengein clinical setting: high decline rate • 74% of patients testing for HIV at clinic were women; men more frequently decline HIV testing in clinical setting • More new diagnoses in clinical settings than non-clinical settings • Offering HIV and HCV testing together may enhance testing rates • Street and door to door outreach is effective, especially for reaching youth and men • High HCV seropositivity rate; few clients are in care • Volunteers reduce staff costs and enhance sustainability Surprising FindingsSurprising Findings
- 28. WhatWhat is next?isnext? • Enhancing routine testing at FQHC – Boost our offer rate and reduce our decline rate • Develop a complete neighborhood-based diagnosis, treatment and care cascade • GIS mapping of hotspots for HIV and HCV • Trial comparing control and treatment neighborhoods • Cost-effectiveness study • Complete program evaluation, including improvements from baseline • Mapping transmission using HIV sequences at neighborhood level
- 29. • Principal Investigator AmyNunn, ScD Brown University • Gladys Thomas, Project Director • Gilead Sciences • Health Annex partners • 80 Volunteers • The Southwest Philadelphia community AcknowledgementsAcknowledgements