infants born in County each year from five (5) HIV+ newborns each year to zero (0) HIV+ newborns by 2021. P2.1c Conduct one (1) educational per year with emergency rooms, urgent care centers, and classified high-risk delivery hospitals, to increase provider awareness of their responsibility to utilize the High Risk Pregnancy Notification and Newborn Exposure Notification forms and act on behalf of the HIV infected pregnant women and their HIV infected or exposed babies. The Perinatal HIV Program has met with the Vice President of the Ambulatory and Primary Care Services at Jackson Memorial Hospital to discuss the need to schedule an educational session at their facility which should occur within next quarter. FDOH-MDC 1 P2.2 Create an community process to improve service systems and community resources for women and infants. P2.2a Organize four (4) Fetal Infant Monitoring Review (FIMR-HIV) meetings per year to review all information gathered on perinatal transmission cases, identify system issues, and make recommendations for improvement. The FIMR-HIV is being directed through a contract with the Healthy Start Coalition of County. There has not been a meeting for this quarter. A status report will be provided in July. FDOH-MDC Healthy Start 4 P2.2b Organize four (4) Community Action Team meetings per year to initiate systems change on FIMR-HIV recommendations for improvement. See comment in P2.2a, above. FDOH-MDC Healthy 4 P2.3 Conduct targeted public information campaigns toward pregnant women at risk of HIV, to have access to OB/GYN providers, HIV P2.3a Disseminate a minimum of 1,000 units of educational materials per year, promoting the “Protect Yourself, Protect Your Baby” awareness campaign, encouraging women of childbearing age who are pregnant or considering pregnancy to get tested for HIV (no baseline). Implementation delayed in 2017: annual goal may need to be reviewed in July. FDOH-MDC 1,000 25
prevention materials and information on community services for women with HIV/AIDS. P2.3b Create memorandum of agreement with at five (5) obstetric healthcare providers per year, who agree to show the “Protect Yourself, Protect Your Baby” DVD in patient waiting rooms (no baseline). The Perinatal HIV Program is in the process of creating the form to be used for the memorandum of agreement. The program has had discussions with at least three providers (3) and given them the electronic copy of the PSA for review. FDOH-MDC 5 P2.3c Create linkage services assuring at 85% of HIV-infected post-partum women have access to contraceptive/family planning and preconception care services after delivery (no baseline). Goal met for 2017. FDOH-MDC 65% 91% NHAS 2020 GOAL #1: REDUCE NEW HIV INFECTIONS (2017 IMPLEMENTATION) DIAGNOSIS Objectives Strategies Activities/Measurements Responsible Entities 2017 goal April 2017 July 2017 Oct 2017 Jan 2018 D1. Increase the percentage of people living with HIV/AIDS (PLWHA) who know their serostatus from PROGRESS TOWARD OBJECTIVE: Increase from 85% of PLWHA who know their status in 2016 to 90% in 2021. 86% D1.1 Partner with healthcare settings (e.g. hospitals, health centers, emergency D1.1a By December 31, 2017, create a program to enroll, support and evaluate healthcare providers to implement routinized HIV testing in their facilities. Delay on educational marketing toolbox for routine HIV providers: status report will be provided in July. FDOH-MDC Create
85% in 2014 to at least 90% by 2021. D1.3 Increase the number of HIV tests conducted, effectively identifying and testing individuals at highest risk including but not limited to injection drug users (IDU), Trans-identified persons, gay and bisexual men. D1.3a Provide registered testing sites with a quarterly "report card" identifying areas of success and opportunities for improvement in testing. Challenge: Data Analysis issue, due to the use of old and new 1628 forms during last two quarters of 2016 quarter, first quarter 2017 data is not complete yet to provide a report card. A status report will be provided in July. FDOH-MDC 4 D1.3b Provide technical assistance to registered testing agencies not meeting the standards of the quarterly "report card." See D1.3a comment FDOH-MDC D1.3c Host an annual 501 Update for HIV Testing Counselor's education on testing technologies and emerging testing trends. FDOH-MDC 1 1 NHAS 2020 GOAL #3: REDUCE HIV-RELATED HEALTH DISPARITIES AND HEALTH INEQUITIES (2017 IMPLEMENTATION) DISPARITIES IN PREVENTION Objectives Strategies Activities/Measurements Responsible Entities 2017 goal 2017 July 2017 Oct 2017 Jan 2018
2017-2021 County Integrated HIV/AIDS Prevention and Care Plan 2017 LINKAGE/RETENTION ACTIVITIES NHAS 2020 GOAL #2: INCREASE ACCESS TO CARE AND IMPROVE HEALTH OUTCOMES FOR PEOPLE LIVING WITH HIV OR AIDS (2017 IMPLEMENTATION) LINKAGE TO CARE Objectives Strategies Activities/Measurements Responsible Entities 2017 goal April 2017 July 2017 Oct 2017 Jan 2018 L 1. Increase the percentage of PLWHA linked to medical care [at least one (1) outpatient medical care visit, as documented by a billed OMC encounter, or a CD4 or VL test] within 30 days post-diagnosis from 55% in 2015 to at least 85% by 2021. PROGRESS TOWARD OBJECTIVE: Baseline linkage rate of 55% in 2015 increased to 85% by 2021. FDOH-MDC Part A/MAI 65% L 1.1 Improve existing FDOH-Part A client management process. L 1.1a FDOH-MDC and Ryan Part A/MAI will jointly identify and address at least one (1) Linkage to Care Quality Improvement Opportunity per year (identify, pilot-test, evaluate, implement), for a total of five (5). The newly-configured FDOH/RWP Linkage workgroup is reviewing linkage data, pursuant to looking at barriers to effective linkage and identifying a QI opportunity. A status report will be provided in July. FDOH-MDC Part A/MAI 1 L 1.1b FDOH-MDC and Ryan White Part A/MAI will hold four (4) training events per year with FDOH Disease Intervention Specialists (DIS), Part A outreach workers and FDOH peers to address identified linkage to care gaps and quality improvement initiatives. Four 501 trainings have been scheduled, for April, July, September and October. FDOH-MDC Part A/MAI 4
FDOH-MDC "Data To Care" (DTC) initiative. L 1.3b Through FDOH-MDC and Part A/MAI cooperation, link 25% of DTC clients identified as eligible for linkage in County to care within sixty (60) days of identification. Data will be available in July. FDOH-MDC Part A/MAI 5% NHAS 2020 GOAL #2: INCREASE ACCESS TO CARE AND IMPROVE HEALTH OUTCOMES FOR PEOPLE LIVING WITH HIV OR AIDS (2017 IMPLEMENTATION) RETENTION IN CARE Objectives Strategies Activities/Measurements Responsible Entities 2017 goal April 2017 July 2017 Oct 2017 Jan 2018 R1. Increase the percentage of PLWHA in the RWP who had at least two medical visits [or CD4/VL lab tests, or ARV prescriptions filled, or any combination of PROGRESS TOWARD OBJECTIVES: Baseline retention rate of 60% in 2015 increased to 90% by 2021. Note that RiC rates dropped in 2016 relative to 2015: this is an artifact of VL data problems with RWP clients transferred to ACA in 2016. Strengthened VL reporting requirements in 2017 should remedy this. Part A/MAI QM 66% 56% (2016) R1.1 Identify PLWHA who are at greatest risk for dropping out of care. R1.1a By December 31, 2017 (First Year), identify PLWHA demographic background factors associated with dropping out of Ryan White Program OMC care, and track retention annually thereafter. Report to be provided by Part A based on final FY 2016-17 data: low RiC rates for Black/African Americans is consistent with co-morbidities (see R1.1b, below). Part A/MAI QM
R1.3d Identify at least one (1) program-based Retention In Care Quality Improvement Opportunity per year (identify, pilot-test, evaluate, implement improvement). Part A/MAI QM 1 R1.4 Provide continuous improvements in outpatient medical care that meets the needs and identified vulnerabilities of PLWHA in care. R1.4a Monitor quality and appropriateness of OMC clinical care through client satisfaction surveys, focus groups, targeted reviews of SDIS data and clinical record reviews and improve through various technical assistance methods (on site QM TA, AETC, etc.). Require corrective actions for providers with identified deficiencies. This is an ongoing set of processes. Note that data from the Client Satisfaction Survey will be available in the October meeting. Part A/MAI QM R1.4b Monitor quality and appropriateness of prescription of non-ARV medication, to identify unusual prescription drug patterns reflecting problems in quality of care, through statistical analysis of prescribing frequency and/or desk audits of prescription patterns for particular providers and improve prescribing patterns of these non-ARV medications as needed for appropriateness and cost effectiveness. Require corrective actions for providers with identified deficiencies. This is an ongoing set of processes. Reports will be provided in October. Part A/MAI QM
V1.2d By December 2018 (Year Two), at least 55% of HIV+ persons enrolled in peer navigation programs will receive treatment adherence education, rising to 70% by 2021. (No baseline) FDOH-MDC FDOH Peer Educators V1.2e By December, 2018 (Year Two), 45% of the who fail to pick up medications through ADAP will be contacted and efforts made to diagnose barriers and move them to compliance, rising by 5% per year thereafter. FDOH-MDC ADAP 68% V1.3 Expand role of Part A/MAI MCM and OMC providers in detecting lapses in adherence or persistent viremia, and initiate appropriate responses. V1.3a Hold quarterly meetings between ADAP and Part A/MAI MCM supervisors during MCM supervisor trainings to find ways to increase awareness of detection of lapses in adherence and persistent high viremia. The initiation of this activity depends on the observation of low VL suppression levels among ADAP clients. At present, ADAP clients have high reported VL suppression levels (90% - 95%), consistent with the function of ARVs. This activity will be evaluated for relevance in July, 2017. Part A/MAI ADAP 4 V1.3b Expand implementation of 2016-17 RWP Texting Intervention Project protocols to PLWHA at five (5) MCM sites per year to apply intervention protocols to improve PLWHA viral load suppression. This is the viral load counterpart to R1.2b, above. Part A/MAI 5
V1.3c On a monthly basis, detect PLWHA with persistently high viremia [high VL loads over two consecutive quarterly measurements] and notify OMC and MCM providers to enable targeted response. Monitor improvement in VL levels to ensure efficacy of provider response. The monthly monitoring has begun, although the number of PLWHA who may be identified as having historically high viremia is limited to those whose VL measurements were in place before the current 100% VL measurement enforcement began in March, 2017. Data will be available in July. Part A/MAI V1.3d Beginning January 1, 2018 (Second Year), identify at least one (1) Viral Load (non)Suppression Quality Improvement opportunity per year (identify, pilot-test, evaluate, implement improvement). Part A/MAI NHAS GOAL #3: REDUCE HIV-RELATED HEALTH DISPARITIES AND HEALTH INEQUITIES (2017 IMPLEMENTATION) DISPARITIES IN TREATMENT OUTCOMES (SUPPRESSED / UNDETECTABLE VL LEVELS) Objective Strategies Activities/Measurements Responsible Entities 2017 goal 2017 July 2017 Oct 2017 Jan 2018 DV1. By 2021, increase the percentage of clients in RWP care among three (3) key PROGRESS TOWARD OBJECTIVES: a. Black/African American Males: from 57% suppressed VL in 2015 to 80%. b. Black/African American Females: from 60% suppressed VL in 2015 to 80%. c. Haitians: from 68% suppressed VL in 2015 to 80%. RWP Part A QM a. 60% b. 64% c. 72% a. b. c. a. b. c. a. b. c. a. b. c.