Health System Navigators Presentation
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This document introduces a new Health System Navigator program in Philadelphia aimed at improving linkage to and retention in HIV care. It notes challenges with late diagnosis, linkage to care, and patient retention. Health System Navigators will help HIV-positive patients navigate health systems and address barriers to staying engaged in care. Navigators will work with newly diagnosed patients, those lost to care, and those loosely engaged to improve testing, linkage, and retention through individual support and system navigation. The program is a collaboration between ActionAIDS and Philadelphia health centers.
Health System Navigators Presentation
- 1. HEALTH SYSTEM NAVIGATORS: A NEW RESOURCE FOR PHILADEPHIA’S HIV-POSITIVE POPULATION
- 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. HIV/AIDS in Philadelphia at a glance, 2011 29,139 • Cumulative HIV/AIDS cases • 25.7% female, 64.5% black 19,157 • Living with HIV/AIDS • 39.6% 50 years or older 888 • New HIV/AIDS diagnoses • 50% heterosexual
- 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. HIV/AIDS: A view from AHS Rapid Testing • 7,000/yr • 40 positive/yr Conventional Testing • Fam Med Clin • Women’s Health HIV Clinics • 1,054 in 2012 • 120 new pts • 115 lost to care
- 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. Improving efficacy of initial HAART regimens *Values are weighted means 1994 to July 2004 (n=14,264 patients). 90 treatment arms from 53 trials: NNRTI (n=38); PI (n=32), NRTI (n=12), boosted PI (n=8). Unboosted PI + 2 NRTIs Boosted PI + 2 NRTIs NNRTI + 2 NRTIs 3 to 4 NRTIs (qid/tid/bid) Unboosted PI + 2 NRTIs Boosted PI + 2 NRTIs NNRTI + 2 NRTIs (tid/bid) Boosted PI + 2 NRTIs NNRTI + 2 NRTIs (qd/bid) 0 20 40 60 80 100 <1998* 1999-2000* 2001-2002* 2003-2004* Patients(%) Bartlett et al (AIDS. 2006;20:2051-2064) 2006-2010 ACTG 5142, CASTLE, ALERT, KLEAN, GEMINI, ARTEMIS, Study 903 and 934, STARTMRK 41% 50% 56% 64% 65% to 85%HIV RNA <50 Copies/mL
- 8. CDC estimates (1996-2005): life expectancy after HIV diagnosis Life expectancy for HIV patients increased from 10.5 to 22.5 years Women: 23.9 years Men: 22.0 years Average life expectancy decreased with each increasing year of age at HIV diagnosis 0 5 10 15 20 25 30 LifeExpectancy(years) 10.3 White Black Hispanic 20.1 1996 2000 2005 Life Expectancy by Year of HIV Diagnosis Harrison KM, et al. JAIDS. 2010;53:124-130. 25.5 9.5 16.4 19.9 10.1 20.4 22.6
- 9. 0 10 20 30 40 50 NA-ACCORD: temporal changes in life expectancy (1996-2007) Age(years) Life Expectancy at Age 20 Years Year Range 96-99 00-02 03-05 06-07 34.4 47.1 36.9 43.1 North America cohort (n=75,148) On HAART (49.5%) 1799 deaths over 89,521 person-years of follow-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 life expectancy is an ongoing need Hogg R, et a. 19th CROI. Seattle, 2012. Abstract 137.
- 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. Linkage to and retention in care 3.9 – 8.8 years of life lost due to late initiation of ART as a result of Late diagnosis Late linkage to care Approximately 1 additional year of life lost due to early discontinuation of ART Among a cohort in TX with no financial barriers to care, compared to those with visits in all 4 quarters of the first year of care, there was 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 quarter Losine E et al, Clin Infect Dis 2009;49(10):1570-1578; Giordano TP et al, Clin Infect Dis 2007;44:1493-1499
- 12. “. . . underscores the importance of developing interventions that are focused on better linkage to and retention in care, especially for racial/ethnic minorities.” - Elena Losina Losina E et al, Clin Infect Dis 2009;49(10):1570-1578
- 13. CDC: HIV-infected persons engaged in selected stages of the continuum of care (2009) 0 20 40 60 80 100 Incidence(%) Black (n=510,600) Hispanic or Latino (n=220,400) White (n=417,200) CDC and Prevention National HIV Surveillance System Diagnosed Linked to care Retained in care 81% 62% 34% 29% 21% Hall HI, et al. 19th IAC. Washington, DC, 2012. Abstract FrLBX05. Prescribed ART Viral suppression 80% 67% 37% 33% 26% 85% 71% 38% 35% 30%
- 14. Outreach data, AHS November-December 2012 Lost to care patients 293 116 177 0 50 100 150 200 250 300 350 Lost to care Not reached Pts contacted Data on file, AHS
- 15. November-December Outreach findings 40 34 63 21 5 12 2 177 0 50 100 150 200 Relocated Re-engaged Change PCP Deceased M issed appts Incarcerated Other Total #ofpatients Data on file, AHS Disposition of lost-to-care patients, AHS 2012
- 16. #ofvisitsforpatientslostto care in 2012 (n=46) 43% 30% 27% 1visit 2visits >2visits First visits important for retention, AHS 2012 Data on file, AHS
- 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. Introducing EHPIC: a program for linkage to and retention in care for Priority Clinic patients Engaging HIV-positive Patients In Care HIV Clinic accessibility to community providers serving PDPH patients Barriers imposed by system complexity (PDPH and other institutions) and patient needs Increase Decrease
- 19. EHPIC Program Health System Navigators to improve retention by assisting patients with Navigating health center systems Navigating other systems to which they are referred Health System Navigators to improve retention by better engaging existing patients Health center clinicians Improve HIV testing rates to identify and link patients with HIV HIV community engagement by identifying key community partners and improving communication and resource-sharing
- 20. Pt HC AA HF AACO
- 21. Targets for health system navigation Health System Navigators Newly diagnosed patients Patients lost to or loosely engaged in care Patients referred
- 22. Health system navigation flow chart
- 23. Health System Navigator referrals Newly diagnosed Social workers Rapid testers Family Med Pediatrics External sources Previously diagnosed Community testing sites Other care providers Other Lost to care Outreach worker
- 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. Introducing the health system navigators Trevor Dantzler (HC #3, HC #5) Shelise Henneghan (HC #9, HC #12) Richard LaBoy (HC #6, HC #10) Donielle Sturgis (HC #2, HC #4) Supervisor CQI Manager
- 26. And the Health System Navigator supervision • Program • CQI Oumar Gaye Clinical Care Coordinator, AHS • Personnel management • ActionAIDS liaison Raphiatou Noumbissi Case Management Supervisor, ActionAIDS
- 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, and who 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. 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. HEALTH SYSTEM NAVIGATORS: A NEW RESOURCE FOR PHILADELPHIA’S HIV-POSITIVE POPULATION