End the Epidemic Quality Improvement Project 2016

How can PPNC contribute in ETE? 1.What is our role in linking PLWHA to care 2.What QI project can we identify 3.How are we going to implement it

Who we are… PPNC is: – a reproductive health care provider, serves women and men, and those who identify across the spectrum. PPNC provides: – Contraception, STD testing, prenatal care services, cervical and testicular cancer screening, well woman visits and abortion care. In addition, PPNC provides routine HIV testing and linkage to care. PPNC does NOT provide: – HIV primary care

What needs improvement PPNC wants to consistently assess whether individuals living with HIV are in care or need linkage to care Our QI project is to create a process in which every patient is asked about her/his HIV status and about her/his HIV health care PPNC plans to revise all of our visit templates to include questions about HIV status, viral load, date of last health care visit and other support services PPNC wants to meet ETE’s criteria while NOT over- burdening staff

Non-Engager, Sporadic Engager, or Fully Engaged Non-Engager Unaware of HIV status (never tested or received results) Knows HIV status (not referred to care or didn’t keep referral appointment) May be receiving other medical care BUT not HIV care Sporadic User Entered HIV Primary Medical Care but dropped out (lost to follow up) In and Out of HIV care/Infrequent User Fully Engaged Fully engaged in HIV Primary Medical Care (linked to care)

Non-Engager, Sporadic Engager, or Fully Engaged cont’d Does the patient need linkage/re-linkage to HIV primary care? Is the patient in compliance with standard quarterly visits with her/his HIV PCP? Does the patient know her/his viral load or know if s/he is virally suppressed?

A) Linkage to Care Measure 1.Newly diagnosed HIV+ = within 30 days 2.Known HIV+ When was their last visit Within the last 3-4 months If they’re not going to HIV PCP, why not?

OTHER BARRIERS: Transportation Housing Instability Insurance Disclosure Issues Refuses Treatment Died Incarcerated Relocated Childcare Unemployed

B) Clinical Engagement Measure 1.Is the patient taking their ARVs/HAART? 2.What are they taking? 3.Within the last 9 months?

C) VLS Measure 1.Does the patient know her/his Viral Load #? 2.Is the patient’s Viral Load count: Undetectable levels (UD – less than 50/ml) If not, what is the VL # 3.Does the patient know her/his CD4 #? 4.Is the patient’s CD4 count: Above 200 cells/mm3 Below 200 cells/mm3

Further considerations/adjustments PPNC needs to: – revise its Policies and Procedures to include a protocol for when non-engaged patients or sporadically engaged patients need to be referred to the key point Linkage & Navigation person – train all staff in order to integrate the protocol and institutionalize the new system – integrate the new questions into its visit templates in its electronic medical record (eCW) – generate a report from eCW to collect ETE data