11 Campaign Webinar Transgender Experience and Retention in+care November 20, 2013

22 Ground Rules for Webinar Participation Actively participate and write your questions into the chat area during the presentation(s) Do not put us on hold Mute your line if you are not speaking (press *6, to unmute your line press #6) Slides and other resources are available on our website at incareCampaign.org All webinars are being recorded

33 Agenda 1. Welcome & Introductions, 5min 2. Campaign Update, 10min 3. HIPS Presentation, 40min 4. Announcements, 5min In the chat room, Enter your: 1. name, 2. agency, 3. city/state, and 4. professional role at agency Michael Hager, MPH MA NQC Manager, in+care Campaign Manager New York, NY

44 Campaign Update

55 in+care Campaign in 2014 Campaign database running through 2018! Campaign website running through 2018! Partners in+care Facebook maintained indefinitely Campaign Newsletter moves to quarterly Campaign Webinars move to quarterly Partners in+care Webinars move to quarterly Campaign Coaching integrates into NQC Continuous TA Portfolios Local Retention Groups that wish to continue meeting should do so – NQC will support where possible

in+care Campaign Activities ActivitiesJULAUGSEPOCTNOVDECJANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC 1-Campaign Webinar 2-Journal Club Webinar 3-Campaign Data Reporting Cycle by Participants 4-Availability of Database Benchmark Function 5-Improvement Strategy Cycle 6-in+care Website and Posting of Updates 7-Campaign Newsletter 8-Partners Webinar 9-Partners in+care Facebook 10-Campaign Coaching Availability 11-Local Retention Group Availability 12-Case Study Drafting 13-Final Report Drafting 14-Communications with participants around transition

77 Submit Improvement Updates!

88 Disseminating Improvement Work Lightning Rounds! 1 or 2 slides that contain the most salient points of your retention projects Include information on patient target, rationale for target selection and baseline data from your measures (including the date) Include information on each improvement cycle (what was tried, what was the result per the data) – for early cycles short measures of change are not necessary, but add value! What are your conclusions? How are you sustaining improvement Simplicity and clarity are the idea!

99 Disseminating Improvement Work Case Studies Help us tell your story! Campaign coaches are seeking longer, written stories about various groups’ journey through the in+care Campaign Contact your Campaign quality coach if you are interested in sharing your story! We are collecting 12 stories in total for publication

10 Gap Measure Results (12/11 – 10/13)

11 Visit Frequency Measure Results (12/11 – 10/13)

12 New Patients Measure Results (12/11 – 10/13)

13 Viral Load Suppression Measure Results (12/11 – 10/13)

The Transgender Experience and Retention in HIV Care Cyndee Clay, Executive Director HIPS Washington D.C.

International Transgender Day of Remembrance 11/20/13

Improving Retention in Care involves a community. Let’s see who’s on board today… Poll:  Medical Provider  Community Member  Transgender  Cisgender  HIV Prevention worker  Community Health worker  Government  Policy  Advocate  Activist

 Full Service harm reduction organization in Washington DC  HIV Prevention and Crisis Intervention Services to the trans* community since 1993  Other programs include Syringe Access & Education, Diversion Programs, Advocacy, Peer Educator Program  3,000 clients a year, approximately 35% trans*  Implemented Testing, Linkage and Retention in Care Pilot for HIV & HCV in 2012

Percentage of respondents to the DC Transgender Needs Assessment Survey who reported being HIV+  5%  12%  33% Source: DCTC Trans Needs Assessment, 2012

True or False: Discrimination decreases in a medical setting when the client feels comfortable enough to disclose his/her/their transgender status

Percentage of transgender individuals who reported being verbally harassed in a medical setting  28%  57%  81% Source: National Transgender Discrimination Survey, 2011

 High Rates of HIV  Stigma  Access to Care  Retention in Care

 National HIV/AIDS Strategy  High Impact Prevention  New Strategies

What could be some reasons that trans* people have challenges to gaining access and retention in care?

 Stigma  Discrimination  Previous Poor Experience  Actual Discrimination  Perceived Discrimination

Street Harassment Housing Discrimination Poverty Involvement in Underground Economies Lack of Health Knowledge Prioritization of Gender Related Care Provider Knowledge

 Staff  Incentives  Collaboration  Transportation  Hormone Services  Advocacy  Follow-up

 Pro’s  Peer-led  Peer-Support  Community Norms

 Challenges  Stigma  Small Communities  HIV Focused  Prioritization

 Collaboration  Training  Patience  Perseverance

   Amsa.org

Questions?

32 Announcements

33  Upcoming Webinars: ―in+care Campaign Webinar | State-Level Efforts to Retain New Patients in HIV Care Wednesday, December 4, 2013 | 2pm ET. ―Partners in+care Webinar | SPNS Projects Examine Retention in+care for HIV-Infected Transgender Individuals Thursday, December 10, 2013 | 2pm ET  Data Collection Submission Deadline: December 2, 2013  Improvement Update Submission Deadline: December 16, 2013  December, 2013 Campaign Topic Digital Health and Retention in+care Upcoming Events and Deadlines

34 Campaign Headquarters: National Quality Center (NQC) 90 Church Street, 13 th floor New York, NY Phone incareCampaign.org youtube.com/incareCampaign