The Expanded Role of Disease Intervention Specialists in a Reformed Health System

National ADAP TA MeetingFriday, August 1, 2014

Tonya King , MPA Ryan White Part B Program Director

Disease Intervention Specialists

• Mix of nurses and public health representatives

• Conduct educational outreach

• Work with providers in their area to ensure reporting

• Investigate reports of communicable diseases*• Ensure adequate treatment• Interview cases and contacts• Enter investigational outcomes into HD database (PRISM)

* DIS in the rural regions also investigate other cases (TB, food-borne, and general epi) and do work in the immunization & emergency preparedness programs

* DIS in the metros investigate STDs only; some metros have case loads that preclude investigating all chlamydia & gonorrhea cases (all HIV & syphilis cases are investigated, but only high priority CT & GC cases).

#County3Benton9Carroll17Crockett23Dyer27Gibson40Henry48Lake66Obion92Weakley

West

#County12Chester20Decatur24Fayette35Hardeman36Hardin38Haywood39Henderson49Lauderdale55McNairy84Tipton

Mid-Cumberland

#County11Cheatham22Dickson42Houston43Humphreys63Montgomery74Robertson75Rutherford81Stewart83Sumner85Trousdale94Williamson95Wilson

South Central

#County2Bedford16Coffee28Giles41Hickman50Lawrence51Lewis52Lincoln59Marshall60Maury64Moore68Perry91Wayne

Southeast

#County4Bledsoe6Bradley26Franklin31Grundy54McMinn58Marion61Meigs70Polk72Rhea77Sequatchie

#County8Cannon14Clay18Cumberland21DeKalb25Fentress44Jackson56Macon67Overton69Pickett71Putnam 80Smith88VanBuren89Warren93White

East

#County1Anderson5Blount07Campbell13Claiborne15Cocke29Granger32Hamblen45Jefferson53Loudon62Monroe65Morgan73Roane76Scott78Sevier87Union

Northeast

#County10Carter30Greene34Hancock37Hawkins46Johnson86Unicoi90Washington

#County19Davidson33Hamilton47Knox57Madison79Shelby82Sullivan

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Tennessee Department of Health Regional Map

Regional Office

Metros

UpperCumberland

TN’s Network of HIV Centers of Excellence

CAPUS in Tennessee

Background Activities• Surveillance (“Data to Care”)

• Identify & re-engage known PLWH out of care > 1yr• Identify known PLWH with sub-optimal response to care

• HIV Testing• 4th Generation Ag/Ab Testing in TN State Labs• Social Networking Strategy Among AA MSM

• Navigation• Corrections Navigators

• Social & Structural Barriers

TN CAPUS: Surveillance Activities• HIV Continuum of Care

2010 Baseline, 2015 Goals, Annual Progress Reports• Identify & re-engage known PLWH out of care > 1 yr• Identify known PLWH with sub-optimal response to care

Data Quality• 2012: Labs required report all HIV-1 Viral Load & CD4 results• 2013: Accurint software acquired / applied to eHARS

database Staffing• 1 Epidemiologist• 2 Data Clerks• 5 DIS Re-Engagement Specialists

2 Memphis, 1 Nashville, 1 Middle TN, 1 East TN

Re-Engagement in Medical Care Develop Out-of-Care Lists for 5 DIS Re-Engagement Specialists• Identify known diagnosed PLWH who have been out of care for > 1yr• Clients with evidence of any care during prior 3 years (1/1/10 –

12/31/12)• Eliminate anyone who…

Received care w/in the past 1 year,Moved out of state, or Died

• Stratify remaining list by geography & distribute monthly to DIS Specialists

Each year fully implemented• > 1000 cases / year (200 cases per DIS/year)

> 70% cases contacted > 70% contacted cases linked to care < 3 mos (or > 49% of total)

CAPUS DIS Re-Engagement Specialists

Training• Passport to Partner Services

106 hours of on-line modules, followed by5 days of in-person training

• ARTAS (Antiretroviral Treatment and Access to Services)

Located in geographically distinct areas • 2 in Memphis• 1 in Nashville• 1 in Middle TN• 1 in East TN(Note: These 5 DIS cover the jurisdictions that account for ~80% of all known positives who have been identified as being out of medical care for > 1 year.)

Data to Care: ProgressFirst “list” generated October 2013

274 names – 63 (23%) determined to be living out of state or dead

211 remaining names– 139 (66%) contacted

• 99 (71%) in care in 2013• 40 (29%) not in care

– 18 (45%) linked to care < 3 mos– 22 (55%) not linked to care < 3 mos

Goals / Progress– Contacted: Goal > 70%, Actual = 66% (139 of 211)– In Care < 3 mos:

• Goal > 49% of total, Actual = 55% (117 of 211)

FUTURE ROLE OF DIS Develop position of DIS Engagement Specialist• Focus on ADAP clients with goal of

• Linkage to care• Re-engagement in care• Retention in care (both newly diagnosed & current clients on

brink of losing/work with medical case managers to identify) – Treatment adherence – Address barriers to care

• Training– Expand Passport to Partner Services to this level– ARTAS

ACA Process– Reimbursement/Credentialing

Questions

Tonya King, MPA Tennessee Department of Health

HIV/STD Program Ryan White Part B Program

710 James Robertson Parkway Andrew Johnson Tower, 4th Floor

Nashville, TN 37243 615-741-0237 (ph) tonya.king@tn.gov