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Expanding Connecticut’s ADAP in a Reformed
Health SystemBy
Deborah GosselinNurse Consultant
Rebate Model Eligibility: Connecticut Resident,
Documentation of HIV positive status, & Income 400% FPL or less
Connecticut Insurance Premium Assistance Program
Connecticut AIDS Drug Assistance Program (CADAP)
Year Enrolled Clients
New Clients Clients with Insurance
6/2014 1,939 16 1,259
6/2013 2,155 18 1,117
6/2012 2,136 37 1,127
0
3,000
6,000
9,000
12,000
15,000
12,563
10,849
7,321
5,605 5,768Nu
mb
er
15.8% unaware
33% not in care(no report of VL or CD4)
currently living in Connecticut
HIV continuum of care, Connecticut, 2012(data reported through 2013)
The overall population is overestimated because at time of report cases were only followed up for 11 months after 12/31/2012. CDC suggests that every case should be followed up at least 18 months to collect death certificate information.
Goal: Develop & coordinate state & local strategies to identify
people who are unaware of their HIV positive status, refer, and link them to medical care and support services
Target Populations: MSMs: 24% of Connecticut PLWH (2011 data) Black Heterosexuals: 32% of CT PLWH Hispanic Heterosexuals: 32% of CT PLWH
Individuals termed “Unaware” Not been tested in past 12 months Not informed of HIV test result (+ or -) Not been informed of their confirmatory test result
Early Identification of Individuals with HIV/AIDS (EIIHA)
Fund 2 ProgramsCollaborate services with MAI, OTL, MCMs,
PS, Prevention Programs, Medical Providers, Community Based Organizations, etc.
Outreach & EducationSoup kitchens, homeless shelters, adult bookstores, know drug trafficking sites, MSM cruising sites, package stores, minority based cafes, housing complexes, youth service centers, faith based organization, etc.
Early Intervention Services (EIS)
Develop “street relationships” to identify potential clients and gate keepers
Develop key points of entry to access sex workers, MSM “party” groups, IDU and homeless individuals not residing in shelters
Provide referrals for HIV C&T, prevention services if HIV negative; medical case management (MCM), medical care, health insurance, CADAP, etc. if HIV positive
Can provide HIV C&T if no other HIV C&T services are available
EIS Continued
MCMs collaborate with EIS to locate and re-engage clients who have fallen out of care and/or MCM
Provide education & counseling for newly diagnosed HIV positive individuals
Accompany client to first medical appointment refer client to PS, etc.
Provide HIV information and promote HIV testing at targeted community events
Provide follow-up for 3-6 months to ensure clients remain engaged in care
EIS Continued
2013-2014 Outcomes Individuals referred to C&T: 369 (8 HIV
Positive)Out-of -Care individuals returned to care: 50New to Care clients: 15
Case Study
EIS continued
One program located in Hartford County
Focus is to identify and facilitate entry or re-entry in to care for minority HIV positive individuals and to connect eligible clients with CADAP
CADAP (Average April-June 2014) White: 1,392 Hispanic: included in White Black: 852 Asian: 21 Native American: 11 Pacific Islander: 2
Clients referred to CADAP: 4
Minority AIDS Intervention (MAI)
Bi-lingual/Bi-cultural staff
Targeted Outreach Education at shelters, soup kitchens, drop-in-centers, City of Hartford Health Van, streets, etc.
Targeted Community Education
Provide HIV Testing when other testing programs are not available
Assist in locating and re-connecting minority PLWH who are lost-to-care
MCMs referred 30 out-of-care clients to CAHEC & all clients were located & re-connected to care (2012)
Collaborate with other Ryan White providers, PS, MCMs, community Organizations
Minority AIDS Intervention (MAI)
8 Statewide programs (Currently 260 active clients)
Eligibility: Connecticut resident, documentation of HIV positive status, income of 300% FPL or less, and contemplating or taking HIV medications
Collaboration with client’s Medical Provider & MCM encouraged
Medical/psychosocial model staffed by Nurses
Services are provided in a medical and/or community based settings
Medication Adherence Program (MAP)
Provide an assessment of client’s motivation, strengths, & weakness for medication adherence and understanding of HIV disease
Assess the clients psychosocial situation, identify any barriers to adherence, and develop strategies with the client to overcome the barriers
Develop an individualized Care Plan
Provide HIV disease & treatment education and Adherence Tools
MAP Continued
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