DHSTS HIV TESTING ANNUAL MEETING

April 28, 2014

HIV Prevention Patient Navigators: Linkage to Care on the Same or Next Business Day

Steven Saunders, MS, Director, HIV Prevention DHSTS, NJDOH

First Place Winner 2013 ASTHO Vision Award

HIV Prevention Patient Navigator (HPPN) Program

HIV incidence driven by two distinct PLWH populations:

1. Unaware of their HIV infections2. Aware, but not in HIV care and

on ARVs Targets specific population of HIV+s

not on ARVs, not at-risk, HIV -s or all PLWH, the targets of past HIV prevention efforts.

HPPN Program Target Population

HIV+s not on ARVs account for nearly all remaining HIV transmission.

They are a relatively small, finite number.

Nearly all of whom are potentially reachable by a comprehensive prevention with positives strategy such as the HPPNP.

HPPN Program Target Population (cont’d)

Eight HIV Prevention Patient Navigator Programs in New

Jersey

Rutgers NJ Medical School in NewarkSt. Michael’s Medical Center in NewarkJersey City Medical Center in Jersey CityJersey Shore University Medical Center in

NeptuneAtlanticare Regional Medical Center in

Atlantic CityCooper Health System in CamdenSt. Joseph’s Hospital and Medical Center in

PatersonTrinitas Regional Medical Center in Elizabeth

Provides “concierge service” for initially positive patients identified in other community settings

Testing and linkage to care may be incentivized

Ensure or facilitate immediate, accompanied patient transportation to HIV clinic where seen by RN/PA/MD

Direct cell phone line to Navigator shared among all MOA signatories and NJ AIDS/STD Hotline

Works with CBOs to assist in re-engagement

HIV Prevention Patient Navigator Program is Patient

Centered

Provide 2nd rapid test for patients testing + on their 1st rapid test at CBOs or other non RTA test sites – same or next business day

Immediately enroll confirmed +s into care sees Nurse or Doctor for initial work-up CD4, VL on same day as 2nd rapid test - If p24 Ag+, or symptomatic (AHI or AIDS) MD must see that day too.

Partner Services for new and existing clinic patients using Contact Elicitation and Social Networking

Re-engagement of HIV practice patients lost to care

Treatment adherence and prevention counseling

Local Linkage to Care Collaborative Point Person and MOA Manager

Patient Navigator Core Functions

Conduct RTA walk-in testing and link positives to care

Provide 2nd rapid test to in-patients who test positive on initial screening, and link them to care prior to discharge

Conduct 2nd rapid test for 1st test positive patients identified by DHSTS PS staff and link positives to care

Link HIV positive NJ AIDS/STD Hotline callers to care

Link released inmates to care - prison discharge planners

Advocate for routine (hospital-wide) HIV screening

Patient Navigator Additional Functions

New Jersey AIDS/STD Hotline◦ HIV+ callers linked to Navigator cell phones via 3-

way ◦ 23 out-of-care individuals linked to care Jan-June

2013

RW Part B MAI Pre-release Discharge Planners◦ Six grantees cover 11 of 13 state prisons◦ Collectively provide discharge planning services to

206 pre-release HIV+ inmates annually

DOH Partner Services staff ◦ Linked 20 HIV+ to Navigators in 2013

Additional Linkage Partners

Majority of new patients (1106) seen were African American (61%) and male (64%); 22% were Hispanic; 15% were 18-25 years old; majority were 36-55 (49%), largest single age group was 46-55 (27%)

67 2nd (R2R) rapid HIV tests conducted; 96% positive (4% discordant) and all +s (100%) enrolled in care

821 other HIV tests (RTA) conducted, 44 positive (5%) and 84% enrolled in care and 245 partners/social contacts tested, 10 (4%) positive

521 re-engaged in care; 639 total linked to care

HIV Prevention Patient Navigator Outcomes for 2013

HIV Prevention Patient Navigator Outcomes for 2013 (cont’d)

1690 Treatment Adherence sessions for HIV patients

1592 prevention with positives counseling sessions for HIV patients

17,725 condoms distributed to HIV patients

482 HIV patients were linked back out to community-based prevention services