The Changing Role of DIS - PowerPoint Presentation

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The Changing Role of DIS DIS in HIV Prevention Programs

Romni

Neiman

Jessica

Frasure

-Williams

Wanda Jackson

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What do DIS do?

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HIV Status among Early Syphilis* Cases among MSM

California Project Area & San Francisco†, 2014

Rev. 11/2015

Note: N=2,251; N does not include HIV status unknown or refused to state: 563 cases in 2014.* Includes primary, secondary, and early latent syphilis.† Los Angeles cases have been excluded as the data does not differentiate HIV results as being new or previous.

New HIV PositiveLinkage to HIV careHIV partner servicesCounseling

HIV NegativeHIV testing Education & counselingLinkage to PEPLinkage to PrEP

Previous HIV +Re-engagement in care Prevention counselingHIV partner services

New HIV+

4%

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HIV Continuum of Care – California, 2012

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DIS contribute to many steps of the HIV Care Continuum

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DIS contribute to many steps of the HIV Care Continuum

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DIS contribute to many steps of the HIV Care Continuum

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DIS Certification Project

Goal: Develop a certification model that reflects the full spectrum of DIS knowledge, skills, and abilities across communicable diseases. Certification expected tostandardize and validate the knowledge, skills, and abilities of DISdrive standardization and improvement of trainingincrease quality and consistency of service deliveryincrease recognition of skills and abilities of DIS

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Why this? Why now?

Formally recognize the contribution of this classification Professional growth and developmentPolitical momentum regarding Ebola and other emerging issuesPotential reimbursement for service delivery

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DIS Mentorship Program

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DIS Mentorship Program

The mentor offers the following

Training on identified core competencies

Tracking tools and documentation of progress

Mentorship and coaching for 3 months

Observation of mentee to determine readiness.

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HIV

LINKAGE TO CARE:

ROLE OF DIS

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Primary DIS HIV LTC Functions

Identify patients for linkage

Assign to PS/Linkage DIS

DIS Conduct Linkage Activities

Confirm and Document

L

inkage

Feedback to Surveillance

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Identifying Patients

DIS embedded in testing clinics

Referral from private provider

Surveillance generates NIC list

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Assignment of Patients

Patient is assigned to a PS/Linkage DIS

Prioritizing based on local criteria

Confirm through provider contact or other means that patient is NIC

Assess any specific needs from available information

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Conducting Linkage

Necessary materials and resources organized

Patient contacted

Assure patient of confidentiality and benefit of linkage services

Make warm handoff to further linkage assistance

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Initial HIV Linkage To Care Call Checklist

Name, Role, Purpose of Call

Discuss Confidentiality

Polite Check-In around new diagnosis

Discuss Benefits of Linkage to Medical Care

Minimize transmission to others

Live healthy life

Reduce chance of advancing to AIDS through medical treatment

Increase T-Cell Count

Decrease viral load

Manage other infections

Ongoing

immune system

monitoring

Provide/monitor

treatment to avoid drug

resistance

Test

and/or treat partners to reduce chance of HIV acquisition

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Initial HIV Linkage To Care Call Checklist (cont.)

Discuss programs to support access to care

Ryan White Case Management Services

No-Cost services locally

ADAP

ACA

Medicare

Other services (e.g. drug rehab)

Inquire about patients readiness to link to medical care and/or discuss barriers to link to care

Secure initial medical appointment

Close (Thank patient, address final concerns , extend phone number with your name

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Confirm Initial Visit and Document

Confirm patient has attended first medical appointment

Document linkage as required by program

Disposition case using local Codes

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Provide Feedback to Surveillance

Information learned during linkage activities

Mechanisms for closing loop

Maintaining security of information

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Performance

Indicators and

Outcome Measures

for DIS Conducting HIV

LTC Work

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How DIS Support Recommendationsthrough HIV LTC Activities

Assist patients with starting HIV care within 1 month after diagnosis

Inform persons of benefits of starting HIV care/ART early

Assess facilitators/barriers to linkage

Help persons enroll in health insurance or medical assistance programs

Collaborate with other providers that promote prompt linkage services

Track outcomes of linkage services and provide follow-up assistance

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DIS HIV LTC Performance Indicators, Measures and Standards

Record searches

should be

conducted within 24 hours and immediately

documented

Initiation

of follow-up of HIV positive persons for linkage to care services should begin within 24

hours

Newly

tested HIV positive persons should be interviewed within 7

days

PLWHA

should be referred to care within 30

days

Field

visits should begin within 24 hours if unable to contact by phone, text, or e-mail

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DIS HIV LTC Performance Indicators, Measures and Standards

All partners of newly diagnosed HIV positive persons should be located, tested and possibly treated within 7

days

Case

closure should occur within 30 days or until first medical appointment has been made and verified, whichever comes

first

Case

closures should be submitted to supervisor for review within 24

hours

Once

a case is complete, information should be updated in electronic HIV surveillance system within 1

week

Surveillance

coordinator should follow up on all

congenital

labs and prenatal HIV reports within 48 hours

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QA/QI Methods

Training and continuing education

Regular observation and feedback

Regular case conferences

Review of records

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Training Structure

4

discrete “Tracks” based on Partner Services job function

8 Disease Concepts web modules5-7 Partner Services introduction and skills modules, depending on Partner Services function3-day or 5-day instructor-led course after completion of web modules for Partner Services providers

Those who refer patients to Partner ServicesThose who provide various phases of Partner Services

Web-based training with no instructor-led component

Structure:

Blended curriculum:

Intended audience:

Online only:

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Description of “Tracks”

For medical providers and other referring providers who refer patients to a Partner Services Program.Includes: 1 online module (CME, CNE, CHES credit), other modules are optional

Track A

For those who conduct elicitation and referral primarily for HIV, with limited or no notification.Includes: 13 online modules and a 3-day instructor-led course

Track B

For those who conduct elicitation and/or notification and referral for Gonorrhea, Chlamydia, HIV, and Syphilis (excludes Syphilis case management and VCA). Includes: 13 online modules and a 3-day instructor-led course

Track C

For those who conduct full spectrum of Partner Services- interviewing; elicitation; notification and referral; Syphilis case management; and, Visual Case Analysis (VCA).Includes: 14 online modules, VCA E3 webinar series, Lot System module (optional), and a 5-day instructor-led course

Track D

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Registration Process – Step 1www.LearnPartnerServices.org

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Registration Process – Step 2www.LearnPartnerServices.org

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Registration Process – Step 3www.LearnPartnerServices.org

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Questions/Answers

What do you need to strengthen HIV/STD integration?

How can you build DIS capacity?

What support do you need form CDPH

?

What concern do you have regarding STD/HIV integration and engagement of DIS to fulfill HIV LTC role?