Latino Advisory Board – OA Review

1. Latino Advisory Board – OA Review • LAB-SPECIFIC ITEMS • Roles, communication, OA staff position • COMMUNICATION - Website update • COLLABORATION and COORDINATION – Enhancing Care, Prevention and Testing • Clinical Meeting • Prevention Think Tank • Testing meeting with CDC & OA plans • Rural Think Tank/Shasta, Imperial and Madera visits • Southern CA PAETC visit • SURVEILLANCE • HIV Incidence Surveillance and Surveillance overview • CDC eHARS/web-CMR visit • Second Surveillance Stakeholder meeting

2. Latino Advisory Board Support forCDPH Strategic Plan Goal for HIV Healthy People 2010 • Reduce deaths due to HIV infection • Target = 0.7 per 100,000 population • How? • Improve care impact for people with HIV • Limit new infections, and thus the number of people who are vulnerable to die

4. Latino Advisory Board Support for OA’s Goals and Strategies: Primary Goals • Minimize # of people acquiring HIV infection • Maximize # of people with HIV infection who are accessing appropriate care, treatment, and support

5. My Understanding of the Role of the Latino Advisory Board • OA-initiated • To respond to OA requests for input • Through collaboration with OA managers and staff in follow-up to TA meeting • Through requests at LAB meetings, other OA meetings, and interim OA requests • To disseminate information provided by OA • Help us develop and maintain contact lists (after staff on) • LAB-initiated • To provide input to OA generated by your own experiences and ideas • Facilitated by LAB in-person and telephone meetings

6. My Suggestions for LAB Work Plan Considerations • Prioritize developing an aggressive strategy to recruit OA Latino specialist, with specific recommendations to OA and specific actions on part of LAB members • Review TA presentation/OA organizational chart and assign individuals or groups to liase with OA sections doing work that you are interested in providing input in • Review the following presentation on current OA focus and identify specific areas of interest to provide input • Review LAB report and develop work groups to assist OA in follow-through once staff person hired • Reconsider frequency of in-person meetings and teleconferences taking into account your time and OA’s time and costs (eg meet 2/year; teleconference monthly for 1-2 hr)

7. Communication • Eventually, through Latino Specialist • For now, through Brian • For OA section-specific work, through section manager with Brian copied • OA staff and managers responsible for keeping Kevin and me informed • Recommend following up phone calls with emails outlining understanding and time frames to ensure everyone has the same expectations

8. Website update

9. Top half of Office of AIDS Home Page

10. Bottom half of Office of AIDS Home Page

12. Meetings, Conferences and Events

15. OA Focus: Supporting California's HIV Care Needs An Initial Meeting of Training, Consultation and Professional Organization Partners October 16, 2008

16. Training, Professional Organizations, Care and Public Health Networks • PAETC Pacific AIDS Education and Training Center • PTC California STD/HIV Prevention Training Center • IAS-USA International AIDS Society • AAHIVM The American Academy of HIV Medicine • HIVMA HIV Medicine Association • ANAC Association of Nurses in AIDS Care • CMA California Medical Association • CDCR California Department of Corrections and Rehabilitation • VA Veterans Affairs Administration • KP Kaiser Permanente • CCLAD California Conferenceof Local AIDS Directors Unable to attend: NMA, UCD Telemedicine

17. Discussion Our vision is for every person in California with HIV infection to receive high quality medical care. • How can OA facilitate and support increased coordination and collaboration among partner groups, to maximize the impact of our work to provide high quality care and support to people with HIV throughout the state. • Creating an Emergency Response Network for HIV care and support. • Are there other professional organizations with a focus on HIV care and/or clinical training and consultation in California • e.g., professional organizations representing HIV clinical pharmacists, Family Medicine, Internal Medicine, Physician's Assistants, etc

18. OA Focus: Enhancing HIV PreventionPrevention Think Tank May 13-14, 2008 Purpose: To create an opportunity for prevention and care providers, funders, researchers, and public health officials to review current status of selected HIV prevention strategies and assess possibilities for scale-up in the future

19. Attendees LHDs University-affiliated researchers HIV prevention providers CDC managers and behavioral scientists NIMH scientist Physicians providing direct care to clients State partners: STD, PTC, Lab 25 members of OA management and staff

20. Agenda Topics Day One Post-exposure Prophylaxis (PEP) Prevention with Positives Acute HIV testing Behavioral Interventions Day Two HIV testing in Emergency Depts. and hospitals HIV testing in STD and other clinics Partner Counseling and Referral Services (PCRS)

21. Prevention Think Tank….more “Big picture discussions:” Prioritization, Evaluation and Capacity-building Outcomes/Next Steps: Report on website Focus groups, key informant interviews and additional focused meetings Convene additional stakeholders, including community partners, providers, consumers Discussion with CCLAD, CHPG, LAB, CAHAAC, other community partners

22. OA Focus: Opportunities to increase HIV screening in California CDPH/Office of AIDS Considerations: What role can we play?

23. Reduce Barriers to HIV screening • Expand in new and existing venues • Take full advantage of • CDC guidelines (2006) • Legislation (AB682) eliminating written consent requirement for performing an HIV test (2008) • Legislation (AB1894) requiring reimbursement by private insurers for HIV screening (2009) • Recent incidence and prevalence reports from CDC (2008)

24. Needs that OA could address to facilitate increased HIV screening by venue • Identify appropriate test method(s) and associated training and support needs • Consider reimbursement sources/existing billing infrastructure and associated training and support needs • identify remaining areas in need of financial support • Consider ‘enhanced’ data needs and associated financial, training and support

25. Venue considerations • Outpatient settings • Providing continuity care • Providing as-needed care • Inpatient settings • Corrections (prison, jail, juvenile) • Substance use treatment • Other non-clinical settings (e.g., CBOs, mobile testing programs, health fairs)

26. Outpatient settings • Providing continuity care • TB clinics • Primary care co-located with HIV care clinics • Other primary care (e.g., Family Practice, General Int. Med, Women’s Health) • Providing as-needed care • STD clinics • Emergency Departments • Urgent Care clinics • Family Planning clinics

27. Inpatient settings • Medical wards • Psychiatric wards • Surgical wards, e.g., • Trauma • Services caring for infectious processes

28. Consider venue-specific purpose of HIV screening/testing • Screen only (with minimal education) • Screen + provide expanded education • Test + provide prevention interventions

29. No matter the venue… • All are provided with basic information on the HIV test, voluntary nature of testing, and educational materials on how to remain negative • All HIV-positive clients • receive appropriate results disclosure • are given accurate HIV care/treatment and partner services linkages as well as appropriate assistance in accessing referrals • Minimum data elements

30. OA role in all venues • Consider venue-specific training and technical assistance needs related to: • Specific test technology • Education • Disclosure and other counseling • Care and support linkages • Financial eligibility screening • Data issues • Coordinate or contract with appropriate venue-specific training and TA partners

31. Progress to Date • CDPH/OA has identified preliminary venue types and a process to determine how approach scale-up of HIV screening with well-managed resource assistance from CDPH/OA • Continuing internal process to refine thinking • Initiating discussions with CDPH and external partners • Prioritize and pilot • Identify existing funding sources to support • Fully developing TB approach • Expanding in all areas with training, TA and professional organization collaborators

32. Primary care co-located with HIV clinics

33. TB Clinics

34. Testing meeting with CDC… and next steps

35. Implementation of HIV Screening in Acute Care Settings: A Strategic Planning Workshop for Hospitals October 22-24, 2008 Sponsored by CDC and OA Attendees: 11 California hospitals and clinics - administrators and staff Purpose: To provide hospital teams with an opportunity to hear from “early adopters” of HIV screening and problem-solve on how they can implement HIV screening in their emergency departments, urgent care, and other inpatient and outpatient departments. OA will follow up with PAETC and PTC resources for additional training and TA

36. OA Focus:Rural Think Tank – Part 1March 2 and 3, 2009 Rural LHJs and urban LHJs with rural areas face unique obstacles. Some are common to both groups, such as distance, unique stigma-related issues and unique poverty-related issues. In addition, rural LHJs receive minimal funding, while urban LHJs with rural areas need to make resource allocation decisions taking into account both their urban and rural concerns.

37. First Rural Think Tank Participants: AIDS Directors and one additional health department staff from interested Local Health Jurisdictions (LHJs), including those that are predominantly urban but also have rural areas Training and/or consultation, state and federal partners Content: consider successful programs and strategies as well as barriers and obstacles and brainstorm potential policy and program changes for OA. This meeting will focus on three goals: To identify policy and program changes for OA that are likely to facilitate appropriate and high quality HIV surveillance, education and prevention, and care and treatment activities in rural LHJs and urban LHJs containing rural areas To facilitate access to relevant non-OA training, consultation and other resources To facilitate collaboration within and between LHJs

38. Shasta, Imperial and Madera & surrounding counties site visits How can OA provide flexibility and support to accomplish much with little - education, prevention, care, treatment, support and surveillance

39. Southern CA PAETC visit The Pacific AIDS Education and Training Center, based at UCSF, has 11 local sites throughout California that can provide free training and technical assistance to health care facilities on implementation of the CDC HIV testing recommendations as well as care and treatment issues. Based at medical schools and community-based organizations, the faculty of nurses, physicians and program managers can help you address implementation challenges, train your staff, and develop necessary policies and procedures.

40. OA Focus:Enhancing HIV/AIDS Surveillance Core surveillance: Confidential case registry of demographic and clinical information on all reported California HIV and AIDS cases OA collects data from local health jurisdictions records forwarded to CDC to monitor the epidemic nationally Data are used to: determine federal Ryan White allocations provide current information on HIV/AIDS epidemiology to HIV/AIDS programs and planning councils

42. OA Focus: HIV Incidence Surveillance (HIS)

43. What Is STARHS? • Antibody-based laboratory testing method that allows CDC to identify, with reasonable probability, how many newly reported HIV infections in any given population are recent • i.e., within the previous 6 -12 months

44. Requirements for HIV Incidence Surveillance Remnant HIV+ Serum Supplemental Data STARHS Testing using BED Assay Testing and Treatment History HIV Incidence Estimation

45. Key Non-Health Department Partners • Providers: • Ensure new patient records include testing and treatment history (TTH) • First positive HIV Test • Last negative HIV test • Exposure to antiretroviral medication • Facilitate completion of HIV/AIDS case report form when new case is ascertained • Labs: • Ship remnant serum samples to central facility for STARHS testing

46. Key Health Department Partners • Local Health Departments • Collect core surveillance variables and TTH data through receipt from providers and active surveillance • Office of AIDS • Raise awareness and interest • Guidance, technical support and monitoring • Data management and transfer to CDC • Complete California incidence estimation

47. OA Focus:CDC eHARS/web-CMR visit Implementing now and planning for the future

48. Second Surveillance Stakeholder meeting Web-CMR and eHARS HIV Incidence Surveillance Partner Services

49. Surveillance Stakeholder Meetings 1st: April 9-10, 2008 Purpose: Provide opportunity for consensus-building discussion regarding current and future HIV reporting policies and regulations Attendees: LHDs (incl. CCLAD, CCLHO) Surveillance coordinators Laboratory directors Health care providers Service organizations serving HIV-positive patients Advocates

50. Outcomes and Next Steps Workgroup #1: Data Transmission Issues Workgroup #2: Centralized Laboratory Reporting Workgroup #3: Considerations Regarding Possible Uses of HIV/AIDS Data for Public Health Purposes eg Partner Services, case management Next Meeting December 3, 2008