Public Health Institute Staff
Saul Zepada, HIV Testing
Manager

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Project components and activities—summary of the work plan
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The current HIV population in Illinois and the Care Treatment
Continuum and Surveillance Feed-back loop (Linkage to Care
Work Group activities)
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Share project progress, developments, challenges and successes (where we started, where we’ve come and where we are at)
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Share highlights to the Routine Testing component and the
Youth of Color Initiative (East Side Health District’s ) collaborative of a co-located integrated comprehensive medical, psychosocial, prevention and support services/center for LGBTY--- Kaleidoscope!

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1. Expand routine HIV testing in 4 health systems & 7 county jails
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2. Build a statewide culturally competent Disease Investigative
Services network with local health departments and several
“designee” agencies
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3. Development of a statewide Patient Navigator program into a peer-led empowerment for HIV+ people of color
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4. Statewide retention in care by increasing transportation assistance; start a texting service for appointment/medication reminders
5. Collaborate with CDPH & CDC-direct funded programs; align data systems.
6. Launch a youth of color-initiative in East St Louis to co-locate medical (including LGBT health), and other services in a single setting

Illinois Department of Public Health CAPUS program logic model
Priority populations: African American & Latinos Residing in Illinois
NHAS Goals: Reduce new HIV infections; Improve access to care and improve health outcomes for people living with HIV;
Reduce HIV-related health disparities; Improve Coordination
Purpose: Reduce HIV-related morbidity, mortality, and related health disparities among racial and ethnic minorities in Illinois
Local needs: Increase number of African Americans/Latinos who know their HIV status ; Address YMSM of color HIV/STI co-infection; Reduce HIVdisease burden among African Americans
Activity
Categories
1 . Expand routine HIV testing in 4 health systems & 6 county jails
(49,092 tests proposed).
2. Build a statewide culturally competent DIS network.
3. Transform the Patient
Navigator program into a statewide Peer-led empowerment for HIV+ people of color.
4. Statewide retention in care: a) Increase transportation assistance; b) start a texting service for appointment
/medication reminders.
5. Collaborate with CDPH
& CDC-direct funded programs; align data youth of color-initiative in East St Louis to colocate medical (including
LGBT health), and other services in a single setting. Measure: 1 st opening session held by close of year 1.
Measurable Objectives Activities Outputs Outcomes Impacts
Testing: # of tests done compared to target set with intended populations;
DIS: Designees identified and trained ; first follow up cases by close of year 1; increase # of partners reached/pts linked to care
Peers: curriculum enhanced;
ARTAS training launched; #of candidates identified/trained; hired with defined duties.
Testing: Conduct Assessment;
Training ;Update/develop protocols for HIV ;Implement
HIV Testing; Plan to expand
HIV Testing; Implement linkage to care; Conduct, TA,
Trainings, QA visits, Audits;
Develop sustainability plan
DIS: Protocols/policies developed with LHDs; conduct site visits; surveys w/clients served
Peers: Protocols/policies developed w/Ryan White agencies; ongoing assessment;
Care: protocol for voluntary texting; data capturing
Testing: # of assessments completed;# of clinical teams trained;# of patients tested by month/year;
# of written plans to expand HIV testing; # of patients linked to care; # of TA hours delivered, providers trained, QA visits, audits conducted;
DIS: LHD follow up on cases monitored by
IDPH workgroup ; cultural competency training conducted;
Retain in Care: # of people accepting texts; # assisted with transport; reduced no-show rates; suppressed VL
CDPH Collaboration: Regular meetings held; signed policy and work plans; data systems aligned.
established; track how transportation assistance is used; negotiate systems with regional transport service;
CDPH: analysis of data systems, costs & timeframe.
Peers: Advanced peer curriculum developed; candidates for advanced training identified;
Care: expand texting; transport assistance;
CDPH/IDPH written agreements; joint policy
Potential data sources: implementation/ongoi ng collaboration.
Impact data = Annual population-based HIV surveillance data , including Ryan White Unmet Need Data
Testing: Sites successfully implement and expand HIV testing; a broader mix of populations in IL get tested for HIV; high success rate is achieved in linking persons newly diagnosed with HIV to care/partner services;
DIS: # of connections made to medical providers & routine testing partners;
Peers: skills developed; retained in program
Care: Remove transportation as a barrier to care;
CDPH Collaboration
One data system for
Ryan White Part A&B; improved linkage/ retention in care.
FOA
• Decrease
HIV-related morbidity
• Decrease
HIV-related mortality
• Decrease related health disparities
Legend
To be developed by grantees based on proposed
Supplemental/ optional
IDPH –Illinois Dept of Public Health
CDPH-Chicago Dept of Public Health
DIS-Disease Intervention Specialists

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1. Expand routine HIV testing in 4 health systems & 6 county jails (34,092 tests proposed).
Partnership with Public Health Institute of Metropolitan Chicago (PHIMC) and Midwest AIDS
Education Training Center (MATEC)
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2. Build a statewide culturally competent DIS network for Speed, Cultural Competency &
Quality for Linkage to Care/Partner Services
IDPH HIV & STD Sections Collaborate to recruit, train, activate 7-8 Disease Intervention
Specialist Designees under IDPH supervision to cover each of the Illinois Regions. Designees proposed will be from local health departments and some well established community based organizations.
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3. Transform the Patient Navigator program into a statewide Peer-led empowerment/retention in care program for HIV+ people of color. Partnership with Central
Illinois Friends of PWAs & Ryan White Regional Directors to: a) conduct needs assessment in each Ryan White Region; b) review/amend/enhance existing training program; c) establish policies/procedures with Ryan White program leaders; d) establish graduations and other acknowledgment/recognition for completing training/excellent service e) establish continuing education and newsletter for peer leaders

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4. Statewide retention in care logistical support:
 a) Increase transportation assistance;
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 b) start a texting service for appointment /medication reminders. c) case manager assistance with partner services; case finding
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5. Collaborate with CDPH & CDC-direct funded programs; align Ryan
White Part A&B data systems.
Monthly IDPH/CDPH HIV leadership meetings already established;
Ongoing mutual representation at both jurisdictional HIV planning meetings;
Ongoing collaboration on appropriate use of surveillance data for Illinois cascade development, community
VL measurement and facilitation of linkage to care/partner services;
Ongoing collaboration to reduce/eliminate perinatal HIV transmission in Illinois, including statewide EPS, statewide perinatal HIV 24/7 hotline
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6. Launch a youth of color-initiative in East St Louis to co-locate medical (including LGBT health), and other services in a single setting.
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Partnership formed with East Side Health District, Project ARK, East Side Empowerment
Center for Youth in addition to HIV Prevention and Ryan White Lead Agencies
Collaborative effort to address persistent new infections among YMSM /Transgender persons of color in extremely underserved community

HIV Prevention and Ryan
White Care Connect
Regions are the same in
Illinois.
Each region has a lead agency and subgrantees
(local health departments,
CBOs, medical providers, others) delivering a variety of prevention and care services.
CAPUS support makes it possible for IDPH to have a
DIS designee for each region.

34,712 persons living with HIV/AIDS in Illinois at the close of 2012 -
Average # of HIV diagnoses each year = 1,825
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4.7% fewer cases diagnosed in 2012 compared to 2008;
9.1% increase in the number of new cases diagnosed between 2011-2012.
2 000
1 800
1 600
1 400
1,945
1,882
1,745
1,700 1,854
2008 2009 2010 2011 2012
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Men constitute the majority of persons living with HIV/AIDS (79%); females (21%).
Current trends indicate a shift in the HIV/AIDS epidemic toward young African American
MSM, including cases of co-infection with syphilis.
Overall, HIV incidence has declined sharply among IDUs and much less among high-risk heterosexuals .
Source: Illinois Department of Public Health, HIV/AIDS Surveillance Unit,
June 2013

Engagement in HIV Care in Illinois for Persons
Diagnosed HIV Infection through 12/31/2010 and
Living with HIV on 12/31/2011
45 000
40 000
35 000
30 000
25 000
20 000
15 000
10 000
5 000
0
39 011
31 209
25 591
19 037
16 753
14 743
HIV-infected* HIV-diagnosed** Linked to HIV care***
Retained in HIV care ƚ
On ART for those in care ƚƚ
Supressed viral load for those on
ART (<=200 copies/mL) ƚƚ
*Based on CDC report that 20% of HIV infected were unaware of their serostatus
**HIV diagnoised (age 13 or older) through 12/31/2010 and living with HIV on 12/31/2011 - based on HIV surveillance data reported through 07/29/2013.
***based on the percentage of cased diagnosed in 2011 that were linked to care within 12 month of diagnosis (82%) based on the 2012 Statewide Unmet Needs Analysis that 61% of PLWLA were with needs met ƚƚBased on combined 2010 Chicago and Illinois MMP results: 88% of in care cases were on ART among which 88% with viral suppression

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6 month planning and contract delay and hiring processes required a revised work plan, revised testing goals and project timelines
Linkage to Care workgroup continues to work through data collection/reporting with the Care Continuum for evaluation/monitoring
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East Side Health Project youth center providing comprehensive services to the most vulnerable youth in Region 4
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HIV Routine Testing component targeted to conduct 75,000 tests in 2014-2015
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Peer Navigation training/curricula supports peer leadership development; college credit at 2 universities for the community health worker degree and endorsed by the American Public
Health Association

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Revised Illinois laws/administrative rules to accomplish:
1 - authority to authorize DIS designees to facilitate quality/culturally competent partner services/linkage to care statewide;
2 - repeal of principal notification law for HIV positive students;
3 - required HIV prevention education in all county jails in Illinois;
4 - opt-out routine HIV screening in IDOC and Cook County Jail;
5 - comprehensive sex education grades 6-12 in IL public schools
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Medicaid Expansion Passed by IL General Assembly – 2013
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State/Federal Marketplace Established for ACA Implementation
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Collaboration with multiple state agencies:
Joint initiatives to implement Affordable Care Act in Illinois in an effort to reduce health disparities/accomplish health equity
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Collaboration with IL SAMHSA HIV grant director to:
Establish routine HIV opt-out screening in behavioral health settings

Illinois proposed as one of its objectives to build a culturally competent Disease
Intervention Specialist (DIS)/ Linkage to Care System. Six local health departments and one community based organization have been identified across the state to serve as
DIS/Linkage to Care designees outside of the County of Cook/City of Chicago.
Each DIS designee will conduct an assessment of current capacity, quality and cultural competency of HIV testing, linkage to care and partner services activities for each county and region of Illinois. Relationships between the designees and the participating agencies have been established within the regions to facilitate data collection for HIV cases surveillance and supplemental surveillance actives.
Memorandums of understanding (MOUs) have been sent to all LHDs and selected community based organizations. Each designee will provide training and technical assistance as needed. All participants have attended the HIV/AIDS Section
“confidentiality and security training” offered by IDPH. Surveillance-based have been distributed to each region checking to make sure HIV positive individuals are in care.

Region 1-Winnebago County Health Department
Region 2-Peoria City/County Health Department
Region 3-Sangamon County Health Department
Region 4-East Side Health District; St. Clair County Health
Department
Region 5-Jackson County Health Department
Region 6-Champaign-Urbana Public Heath District
Region 7-Renz Addiction Center

Administrative rules associated with state statues were approved to include the ability to have “designees” of IDPH for these purposes, as this state has
102 counties, and 95 certified health departments, each with local authority. Having the ability to legally establish designees was key for moving forward with identifying local/regional partners in assuring partner services/linkage to care in real time for all cases throughout the state.

East Side Health District (ESHD) and their collaborative partners; Mallory
Mahr Youth Empowerment Center, Project ARK/ The Spot, St. Clair County
Health Department(SCHD), and Southern Illinois Healthcare Foundation
(SIHF) have collaborated to provide medical, psychosocial, prevention and support services to Lesbian, Gay, Bisexual and Transgender (LGBT)youth between the ages of 13-24 in the East St. Louis, Illinois area.

Obtaining executed grant agreements to officially allow for services to begin and communication to be made with all Designee partners and engaging all health departments about this new development.
The infrastructure between eHARS and the Provide Enterprise system has been developed to accommodate this effort, with some experience from its initial pilot launch shortly before CAPUS support began.

State Government lengthy hiring process and CAPUS supported positions are beginning to be filled.
There has been improvement in linkage to care for newly identified HIV positive persons. However, we cannot say that those improvements are a direct result of CAPUS supported
DIS/LTC activities as yet, due to the fact that cases have began to be distributed in early March, 2014.

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