lincs : using harm reduction while working together with hiv+ patients in san francisco department...
TRANSCRIPT
LINCS : Using Harm Reduction while working together with HIV+ patients in San
Francisco Department of Public Health
November 17, 2012Harm Reduction Coalition National Conference
Erin Antunez, SFDPH
Overview
• What is San Francisco’s LINCS Program? • How LINCS works with HIV+ patients and their
partners in SFDPH• SFDPH’s Harm Reduction Policy• LINCS Harm Reduction guidelines• Case studies
Purpose
• Harm Reduction has a place in HIV Linkage to Care and HIV Services
• LINCS: Linkage Integration Navigation Comprehensive Services
• Program Goal: To provide and coordinate comprehensive HIV care– Linkage to Care– Partner Services – Navigation
• Patients: People who test HIV+ in SFDPH Medical and Community testing sites, and their partners
• Time limited: 90 days
LINCS Overview
• Joint program of SFDPH HIV Prevention and STD Prevention and Control
• LINCS works collaboratively with:– SF Community HIV Testing Network– SFDPH medical clinics– San Francisco General Hospital, HIV care team– SFDPH HIV Epidemiology and Surveillance– Jail Health Services
• 2 LINCS Program Coordinators
• Partner Services/Linkage Field Staff– 2 Embedded staff at our high volume HIV test sites– 1 Mobile field staff for low volume and medical sites
• Navigation Field Staff– 1 Navigator for known positives, city wide
LINCS Organization
Continued CareTreatment
Engagement Retention
Virologic Suppresion
Results received at medical or community
site
HIVTesting
Positive Result
Surveillance Confirmation
Patient Notification
Partner Services
Linkage to Care
LINCS and the HIV Continuum of Care
LINCS Assistance
Previously Known HIV+ Referred for
navigation
• LINCS staff meet with new HIV+ patients as soon as possible and offer:
1. Partner Services for sex and needle sharing partners2. Warm handoffs for Linkage to Care
• Why?1. Partner Services identifies previously undiagnosed
cases of HIV infection and reduces HIV transmission2. Status awareness is empowering3. Early Linkage to Care improves health outcomes
How it works for patients who just tested HIV+:
• Navigators help out of care patients “navigate the system of care”1. Support the HIV+ patient in making, keeping track of, and
attending medical appointments2. Provide warm referrals to address specific barriers to care3. Navigators coordinate care with other HIV service
providers
• For these complex, out of care patients, Harm Reduction is important, even essential to help overcome barriers to care
How it works for known HIV+, out of care patients
Harm Reduction (HR) Definition
• Public health philosophy• Reduce harm• Client-centered• Client is active participant in setting goals• Principles:
– Respect– Non-judgment– Non-stigmatizing
SFDPH Harm Reduction Policy
• September 2000, the San Francisco Health Commission passed a resolution adopting a harm reduction policy for substance abuse, STD and HIV treatment and prevention services
• In response, the SFDPH developed a policy that requires programs to:– Incorporate a set of core Harm Reduction principles– Address in their design and objectives how they will
provide harm reduction treatment options– Develop harm reduction guidelines
Resolution: Adopting a Harm Reduction Policy For Substance Abuse, STD and HIV
LINCS Harm Reduction Guidelines• LINCS recognizes positive, incremental changes made by patients • LINCS is client centered:
– Strengths based approach– Meet HIV+ patients where they are at– Patients set their own goals – Patients who fall out of care are not treated as failures
• Services are provided with respect, non-judgment, patience• Integration of Care is harm reduction: prevent duplication of services and
respect patient and provider time• HIV Care is non-linear: LINCS is a safety net that helps patients engage
with the system of care
Safety Net for the Continuum of HIV Care
Putting it all together
LINCS servicesHarm reduction principles
Improved health
outcomes
Case Study-New Positive
• 35 y/o MSM • HIV hx: New HIV+ test result at Magnet in April 2012.
Pt interested in care• LINCS Harm reduction work:
– Client centered• Overwhelm with new dx, insurance options, social support
– Strengths based• Pt identified needs and was proactive following through with
partner disclosure, care, social support
Case Study-Known Positive• 41 y/o female, active substance use, SRO housing• HIV hx: tested in jail in March 2012, received confirmatory result from
LINCS staff outside of jail in March 2012; no hx of primary medical care• LINCS Harm reduction work:
– Meet pt where she is at• Home visits build trust in SFDPH services, build trust in clinician
– Non-judgment • Substance use• HIV status
– Incremental steps and patience• She is not a failure• Appointments- missing and attending
What people said about LINCS…
• "I really appreciate having someone to talk to, helping me understand what is happening and the steps I need to take. I really want to be able to live the same life I led before this happened, and you've helped me start out on the right foot.“
• “Thank you for being so patient.”
• “If it wasn’t for you, I probably wouldn’t have made it to this appointment today.”
Acknowledgments
LINCS team and Leadership:
Matt SachsSam SamuelsonJennifer VanamanCharles FannNyisha UnderwoodTrang NguyenFrank StronaNicholas MossKyle BernsteinNoah CarraherBob KohnSusan PhilipTracey Packer
Ali MarreroSandra TorresDiane Jones
SFDPH Community Testing NetworkSFDPH Community Oriented Primary
Care HIV Providers
The HIV+ clients and patients in SFDPH
For More Information
Erin Antunez LINCS Coordinator, Navigation Services
AIDS Office, HIV Prevention Section
San Francisco Department of Public Health
(415) 437-4670 [email protected]
Charles FannLINCS Coordinator,
Partner Services and Linkage to Care
San Francisco City ClinicSan Francisco Department of
Public Health(415) 437-5506