The Expanded Role of Disease Intervention
Specialists in a Reformed Health System
National ADAP TA Meeting
Friday, 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).
Tennessee Department of Health Regional Map
81
74
63
40
11
07
44
19
03
27
21
15
73
89
53
88
72
02
12
05
04
60
51
78
08
68
20
86
18
93
41
57
01
47
75
38
10
32
45
09
39
29
30
65
71
43
17
84
25
95
94
49
90
80
22
23
67
46
37
87
42
82
76
85
92
34
13
56
66
48
69
14
83
16
59
31
54
61
62
77
24
79
35
55
36
91
64
50
28
52
26
58
33
06
70
Regional Office
West
#County
3Benton
9Carroll
17Crockett
23Dyer
27Gibson
40Henry
48Lake
66Obion
92Weakley
#County
12Chester
20Decatur
24Fayette
35Hardeman
36Hardin
38Haywood
39Henderson
49Lauderdale
55McNairy
84Tipton
Mid-Cumberland
#County
11Cheatham
22Dickson
42Houston
43Humphreys
63Montgomery
74Robertson
75Rutherford
81Stewart
83Sumner
85Trousdale
94Williamson
95Wilson
South Central
#County
2Bedford
16Coffee
28Giles
41Hickman
50Lawrence
51Lewis
52Lincoln
59Marshall
60Maury
64Moore
68Perry
91Wayne
Southeast
#County
4Bledsoe
6Bradley
26Franklin
31Grundy
54McMinn
58Marion
61Meigs
70Polk
72Rhea
77Sequatchie
Upper
Cumberland
#County
8Cannon
14Clay
18Cumberland
21DeKalb
25Fentress
44Jackson
56Macon
67Overton
69Pickett
71Putnam
80Smith
88VanBuren
89Warren
93White
East
#County
1Anderson
5Blount
07Campbell
13Claiborne
15Cocke
29Granger
32Hamblen
45Jefferson
53Loudon
62Monroe
65Morgan
73Roane
76Scott
78Sevier
87Union
Northeast
#County
10Carter
30Greene
34Hancock
37Hawkins
46Johnson
86Unicoi
90Washington
Metros
#County
19Davidson
33Hamilton
47Knox
57Madison
79Shelby
82Sullivan
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 by
5 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: Progress
 First “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