Russell Brewer, DrPH, CHES
Director of HIV, STDs, and Reproductive Health
Louisiana Public Health Institute
Strategies on the Ground to Turn the Tide on Improving
Access to Care in the U.S.
International AIDS Conference
Washington, DC
July 22, 2012
Categories
Estimate
Population, 2011
4.5 million
White/Caucasian
64%
Black/African American
32%
Hispanic/Latino Ethnicity
4.4%
Lack of Health Insurance
17.2%
% Below the Poverty Level, 2006-2010
18.1%
Source: US Census and United Health Rankings
Source: LA Office of Public Health, 2010
Source: LA Office of Public Health, 2010
Source: LA Office of Public Health, 2010
Categories
% in Care
(CD4 or viral load in
the last 12 months)
Overall
64%
Female
70%
Male
61%
Black/African American 64%
White
65%
Region 1 – New Orleans 59%
Region 2 – Baton Rouge 71%
Region 5 – Lake Charles 54%
Region 7 - Shreveport
60%
Source: LA Office of Public Health, 2010
% Not in Care
(Unmet Need)
36%
30%
39%
36%
35%
41%
29%
46%
40%

Access to care initiative funded by AIDS United
and Bristol-Myers Squibb

LPHI is the lead agency and local evaluator

Goal is to improve linkage to HIV care and
supportive services for:
- Individuals living with HIV infection that
are out of care
- Newly diagnosed

Implement and evaluate 4 linkage to care
interventions in four regions of the state
▪ Linkage Case Management (Baton Rouge)
▪ Health Navigation (New Orleans, Baton Rouge,
Lake Charles)
▪ Pre/Post Release Case Manager (New Orleans)
▪ Disease Intervention Specialists (New Orleans,
Baton Rouge, Shreveport)

Linkage interventions are 3-6 months in duration
Region I: New
Orleans
 Region II: Baton
Rouge
 Region V: Lake
Charles
 Region VII:
Shreveport


Initial 3 month planning phase (April-June
2010)

3-year implementation phase (July 2010 –
June 2013)

Interventionist is housed at multiple
locations

Two main data collection points (baseline
and follow-up)
Positive Charge Sites
 Capitol Area Reentry Program &
Earl K. Long (BR)
 N’R Peace & HOP Clinic (NO)
 SW Louisiana AIDS Council &
Moss Comprehensive Health
Clinic (Lake Charles)
Linkage to Care Interventions
Health Navigation

NO/AIDS Task Force & Orleans
Parish Prison (NO)
Pre/Post-Release Case
Management

Family Service of Greater Baton
Rouge (BR)
Linkage case management
intervention

Office of Public Health, Parish
Public Health Units in Regions 1,
2, 7 (NO, BR, Shreveport)
Disease Intervention Specialists




Data collection system - Ryan White
CAREWare
Alert system - Louisiana Public Health
Information Exchange (LaPHIE)
Surveillance system – CD4 and viral load data
from laboratories as required by the
Louisiana Public Health Sanitary Code
Reminder system - Out of care lists generated
by providers
Demographic Profile
(August 2010 – January 2012)
Estimate
(N=684)
African American
Male
Transgender (M-F)
MSM
High School Education or less
20 – 29 years of age
90%
68%
4%
15%
69%
34%
30 – 39 years of age
30%
40 – 49 years of age
22%
Enrollment and Linkage
to Care Profile
Estimate
Reported by Interventionists
(August 2010 – May 31, 2012)
Enrolled in PC since 2010
684 individuals
Linked to HIV Medical Care
493 individuals
% Linked to HIV Medical Care
72%
Regular Data collection trainings
Multiple IRB modifications
Site specific
- Staff turnover
- Ensuring confidentiality
- Lack of transportation
- Loss to follow-up
 Retention in care?




Positive Charge has raised the visibility of
access to care efforts in the state

Provided a platform for other access to care
initiatives

Enhanced relationships and coordination
among Positive Charge partners

Importance of developing and updating
Intervention workflows
“One client I enrolled took four months to
actually link to medical care. The client arrived at
the Health Unit for a routine pelvic exam, and
left with a positive HIV diagnosis. As a young
woman with two children, the client was
devastated. She believed this was the end of her
life, and that she would not live long enough to
see her children grow old. For over two hours,
we talked about what her next steps would be.
Making an appointment with a doctor was very
far down on her list of priorities.”


PC Participants
PC Partners
-LA Office of Public Health, STD/HIV
Program
- NO/AIDS Taskforce
- Orleans Parish Prison
- N’R Peace
- HIV Outpatient Program (LSU)
- Capitol Area Reentry Program
- Earl K. Long Medical Center (LSU)
- Family Service Greater Baton
Rouge
- Southwest Louisiana AIDS Council
- W.O. Moss Regional Medical
Center (LSU)

LPHI Staff (Sarah
Chrestman, MPH;
Michael Robinson, BA;
and Snigdha
Mukherjee, PhD)

AIDS United

Bristol-Myers Squibb