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Objectives

Ryan White Conference-Wishard ED Early Intervention Guidance Two Unique Models, Two Success Stories Nancy J. Miles, MSW, LSW: Emergency Department HIV Program Manager. Objectives. Participants will learn two unique programming styles for implementing EIS.

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Objectives

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  1. Ryan White Conference-Wishard EDEarly Intervention Guidance Two Unique Models, Two Success StoriesNancy J. Miles, MSW, LSW: Emergency Department HIV Program Manager

  2. Objectives Participants will learn two unique programming styles for implementing EIS. Participant will explore resources that contribute to successful programming and barriers to anticipate. Participants will learn about practical, in the field experience from using this method as well as stumbling blocks and successes. 2

  3. Wishard Hospital • Opened in 1859-City Hospital • One of the largest 5 safety net hospitals • Indiana’s first hospital • First Community Mental Health Center • First hospital to serve communities of color • Offered the first Palliative Care Program dedicated to serving the indigent in Indiana • Hosts the only Center of Excellence in Women’s Health in Indiana • 10 community health centers • Home to the region’s only adult burn center • 45.2% patients are uninsured 3

  4. Wishard’s Emergency Department • Level 1 trauma center • 1st in Indiana • Only 2 in Indiana • One of the busiest EDs in the state of Indiana • Over 100K yearly • Over 2000 traumas per year • Highest penetrating trauma percentage • 93 total beds 4

  5. The New Wishard Emergency Department, Eskenazi Health Opening December 2013 90 individual treatment rooms Over 200 exam rooms 20 bed clinical decision unit HIV testing office 5

  6. Purpose of Testing in an Emergency Department To comply with the CDC’s 2006 Revised Recommendations for HIV testing in Health Care Settings Early detection, intervention, and prevention Increase in screening Decrease stigma Linkage-to-care High-risk area 6

  7. Emergency Department HIV Testing Program • Piloted in 2008 • 4 week pilot • No interruption to the ED flow • Staff buy-in • Funding • Marion County Public Health Department • Ryan White Part A-HRSA • Indiana State Department of Health • Expansion-CDC funding • Indirect Funding • Staff • HIV Testers/Counselors • Interns • AmeriCorps • Manager • Medical Director • Operation • Hours • Patient Identification • Protocol

  8. Identifying Patients • Pre-programmed to identify: • Patients ages 13-64 • Patients without a known HIV positive diagnosis • Patients not tested in the past year • Eligible patients populate a “greaseboard” once registered • Room/bed location and reason for service is available • Specific patients are not eligible for testing

  9. Patient Eligibility Physicians are able to order a rapid test from the lab. 9

  10. Rapid HIV Test • OraQuick Advance Test by OraSure Technologies, Inc. • Detects antibodies for HIV 1 and HIV 2 • Takes 20 minutes • Method • Orally • Fingerstick • Venipuncture • 99% accurate 10

  11. Testing Process Verbal consent will be replacing written consent 11

  12. Reactive Patient Flow Appointment is scheduled before patient leaves

  13. After a Reactive • Confirmatory test results appointment • Indiana State Department of Health Adult HIV/AIDS Confidential Case Report • Duty-to-Warn • Partner Notification Form • Hand-off to Infectious Disease Care • Monitor ID attendance • Patients that do not complete appointments are contacted and assessed 13

  14. ResultsThrough 9/30/2012 1-Addition reactive patient refused Western Blot 2-19 Total identified with prior confirmed diagnosis at earlier dates, but reported did not know status 3-Three patients passed away before linked-to-care, one additional patient referred to care 14

  15. Barriers • Funding • Operations based on a 12 hour cycle • Volume • Testing minors • Patients’ perceived risk • Routine vs. Targeted Testing • Follow-up counseling • Staffing • Certifications 15

  16. Questions

  17. Contact Information Nancy J. Miles MSW, LSW HIV Program Manager Emergency Department Wishard Hospital 1001 W. 10th St. Indianapolis, IN 46202 317-287-3013 (phone) 317-656-4216 (fax) miles.nj@gmail.com nancy.miles@wishard.edu

  18. Early Intervention Services- Two Unique Models, Two Success Stories Ryan Nix Prevention Coordinator Step-Up, Inc.

  19. Overview Agency/Population Overview Rethinking Prevention as a Tool to Testing Collaboration New Ideas Ideas to steal Testing in New Venues Lessons Learned

  20. Step-Up, Inc • Services • Training • Education • Prevention Step-Up’s mission is to promote health and well-being among underserved and hard to reach populations by providing services, education, training and advocacy.

  21. Community Action Group (CAG) Indianapolis Men Advancing Prevention (IMAP) Women Taking Charge Youth At Risk (YAR) Youth And Diversity (YAD) Case Management IN-Shape Consultant Services Thresholds & Transitions (T&T) The Programs

  22. Men in Marion County 3485 compared to 822 women. *Indiana State Department of Health as of June 2012 The overwhelming majority of risk categories were Men Having Sex with Men (MSM). Its rate of 155.0 per 100,000 people of the population is between 6 to 10 times higher than the other risk categories for all diagnosed people. INDIANA EPI DATA FOR MSM Population (Marion Co.)

  23. YOU MUST BE CREATIVE “If we give them a good product they’ll come back for more. So we know who the market is and what they want to buy, you know, and then we sell it to them…. We’re selling self esteem, we’re selling activism, we’re selling hope for the future…We are selling HIV prevention” • Taken from: Learning from the Community. September 2000, CDC

  24. A Model That Works • Establish relationships • Community/HD/Other Non-profits • Look at community needs and wants Consumers Providers (bars etc) • Look outside the box be creative to find new outlets • Reframe topic • Use current resources

  25. Relationships • Establish relationships – Collaborators • Start with who you know is out there • Make sure you know agencies reputation within community • When starting partnerships be clear on roles/expectations • Establish relationships – Owners AND staff • Throw out the “I NEED” ideas • Connect from current contacts • Personal meetings • Go to them • On their schedules

  26. Relationships Continued • Establish relationships – Community • Meetings (community, CPG, bars, etc.) • Focus groups and interviews • Continue ongoing communication and get feedback

  27. Look at community needs and wants • Providers • What events are they hosting • Day to day events • Supplies • Advertising • Consumers • What are they doing? • What are they using? • Likes/Dislikes

  28. Don’t Limit Yourself Look outside the box be creative to find new outlets • ADVERTISE! PROMOTE! VISIBILITY! • Humor – (kits, costumes, and presentation) • Add new venues- (learning from community) • Add to current programming • CTR (lifesaver, travel, prizes) • Other incentives • Providers Needs • Karaoke • Events AD Cards • Trick cards • Bathhouses • Unicorn Club

  29. Karaoke Cards Unicorn Club Cards

  30. Reframing FUNdational Keys • Holidays • Special kits • Bar referral prizes • Numerous locations targeted differently • Events • Safer Sex Summer Socials • BINGO • Fundraisers • Midwest Pride Events • Special Condom kits • Advertising • Resources

  31. Use Current Resources • Collaborate (establishments/health dept/groups) • Focus on ways that HIV prevention doesn’t have to be expensive

  32. Who goes to bathhouses • Men who have sex with men • Survey results on website show • 43% report being single • 35% report being married with a wife • 22% report being in a male relationship

  33. A Model That Works • When Step-Up started the I-MAP program, The Works was our first partner • Provide resources • Free HIV testing/ syphilis screening • Safer sex kits • A lot of community members want to blame bathhouses for the spread of disease, when for many men it is many other things. • Recreation-working out or relaxing • Use for a sense of community

  34. What are we doing to stay on target?

  35. What are we doing to stay on target?

  36. What are we doing to stay on target?

  37. Rapid Testing in a baror bathhouse?!?!

  38. Where do we even start? Assessment How do we do this in the field Working with venues Supplies QA

  39. Assessment • Internal Agency • Supportive top to bottom • Policy/Procedures changed to match new venues • Look at your Sites/Venues • Location • Safety • Security • Support from staff • Lighting

  40. Assessment • Equipment • What all will you need to get, to make this work? • Community • Garner support where possible

  41. How do we do this in the field? Location (our examples) Consent - intoxication Equipment Safety of our clients Transportation of records Partnerships Referrals

  42. So what do you need? Everything that you use for rapid testing in the office (traveling office) Min/Max thermometer Special considerations for lighting Confirmatory method Step-Up tub example

  43. Working with Venues • Some may take time • Work with them on their schedule • Education of bar owner/manager/staff • ONGOING! • Community Partner Letter • Considerations • Lighting (Do controls)… Magnifiers • Space

  44. QA • Back up your buddy! • Min/Max thermometer • Logs- Temp/Controls/Tests • Record keeping • Tubs • Centralized • Point person

  45. DOES IT EVEN WORK?

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