LINCS : Using Harm Reduction while
working together with HIV+ patients
in San Francisco Department of
Public Health
November 17, 2012
Harm Reduction Coalition National Conference
Erin Antunez, SFDPH
Overview
• What is San Francisco’s LINCS Program?
• How LINCS works with HIV+ patients and their
partners in SFDPH
• SFDPH’s Harm Reduction Policy
• LINCS Harm Reduction guidelines
• Case studies
Purpose
• Harm Reduction has a place in HIV Linkage to
Care and HIV Services
LINCS Overview
• LINCS: Linkage Integration Navigation
Comprehensive Services
• Program Goal: To provide and coordinate
comprehensive HIV care
– Linkage to Care
– Partner Services
– Navigation
• Patients: People who test HIV+ in SFDPH Medical
and Community testing sites, and their partners
• Time limited: 90 days
LINCS Organization
•
Joint program of SFDPH HIV Prevention and STD Prevention and Control
•
LINCS works collaboratively with:
– SF Community HIV Testing Network
– SFDPH medical clinics
– San Francisco General Hospital, HIV care team
– SFDPH HIV Epidemiology and Surveillance
– Jail Health Services
•
2 LINCS Program Coordinators
•
Partner Services/Linkage Field Staff
– 2 Embedded staff at our high volume HIV test sites
– 1 Mobile field staff for low volume and medical sites
•
Navigation Field Staff
– 1 Navigator for known positives, city wide
LINCS and the HIV Continuum of Care
Surveillance
Confirmation
HIV
Testing
Positive Result
Results
received at
medical or
community
site
Patient
Notification
Linkage to
Care
LINCS Assistance
Previously
Known HIV+
Referred for
navigation
Partner
Services
Continued Care
Treatment
Engagement
Retention
Virologic Suppresion
How it works for patients who just
tested HIV+:
• LINCS staff meet with new HIV+ patients as soon as possible
and offer:
1. Partner Services for sex and needle sharing partners
2. Warm handoffs for Linkage to Care
• Why?
1. Partner Services identifies previously undiagnosed
cases of HIV infection and reduces HIV transmission
2. Status awareness is empowering
3. Early Linkage to Care improves health outcomes
How it works for known HIV+, out of
care patients
• Navigators help out of care patients “navigate the system of
care”
1. Support the HIV+ patient in making, keeping track of, and
attending medical appointments
2. Provide warm referrals to address specific barriers to care
3. Navigators coordinate care with other HIV service
providers
• For these complex, out of care patients, Harm Reduction is
important, even essential to help overcome barriers to care
Harm Reduction (HR) Definition
•
•
•
•
•
Public health philosophy
Reduce harm
Client-centered
Client is active participant in setting goals
Principles:
– Respect
– Non-judgment
– Non-stigmatizing
SFDPH Harm Reduction Policy
• September 2000, the San Francisco Health
Commission passed a resolution adopting a harm
reduction policy for substance abuse, STD and
HIV treatment and prevention services
• In response, the SFDPH developed a policy that
requires programs to:
– Incorporate a set of core Harm Reduction principles
– Address in their design and objectives how they will
provide harm reduction treatment options
– Develop harm reduction guidelines
Resolution: Adopting a Harm Reduction
Policy For Substance Abuse, STD and HIV
LINCS Harm Reduction Guidelines
• LINCS recognizes positive, incremental changes made by patients
• LINCS is client centered:
– Strengths based approach
– Meet HIV+ patients where they are at
– Patients set their own goals
– Patients who fall out of care are not treated as failures
• Services are provided with respect, non-judgment, patience
• Integration of Care is harm reduction: prevent duplication of services and
respect patient and provider time
• HIV Care is non-linear: LINCS is a safety net that helps patients engage
with the system of care
Safety Net for the Continuum of HIV
Care
Putting it all together
Harm reduction
principles
LINCS services
Improved
health
outcomes
Case Study-New Positive
• 35 y/o MSM
• HIV hx: New HIV+ test result at Magnet in April 2012.
Pt interested in care
• LINCS Harm reduction work:
– Client centered
• Overwhelm with new dx, insurance options, social support
– Strengths based
• Pt identified needs and was proactive following through with
partner disclosure, care, social support
Case Study-Known Positive
• 41 y/o female, active substance use, SRO housing
• HIV hx: tested in jail in March 2012, received confirmatory result from
LINCS staff outside of jail in March 2012; no hx of primary medical care
• LINCS Harm reduction work:
– Meet pt where she is at
• Home visits build trust in SFDPH services, build trust in clinician
– Non-judgment
• Substance use
• HIV status
– Incremental steps and patience
• She is not a failure
• Appointments- missing and attending
What people said about LINCS…
• "I really appreciate having someone to talk to,
helping me understand what is happening and the
steps I need to take. I really want to be able to live
the same life I led before this happened, and you've
helped me start out on the right foot.“
• “Thank you for being so patient.”
• “If it wasn’t for you, I probably wouldn’t have made it
to this appointment today.”
Acknowledgments
LINCS team and Leadership:
Matt Sachs
Sam Samuelson
Jennifer Vanaman
Charles Fann
Nyisha Underwood
Trang Nguyen
Frank Strona
Nicholas Moss
Kyle Bernstein
Noah Carraher
Bob Kohn
Susan Philip
Tracey Packer
Ali Marrero
Sandra Torres
Diane Jones
SFDPH Community Testing Network
SFDPH Community Oriented Primary
Care HIV Providers
The HIV+ clients and patients in SFDPH
For More Information
Erin Antunez
LINCS Coordinator,
Navigation Services
AIDS Office, HIV Prevention
Section
San Francisco Department of
Public Health
(415) 437-4670
Erin.Antunez@sfdph.org
Charles Fann
LINCS Coordinator,
Partner Services and Linkage
to Care
San Francisco City Clinic
San Francisco Department of
Public Health
(415) 437-5506
Charles.Fann@sfdph.org