Ending the Epidemic in New York State Suffolk, Long Island Sub-Regional Group May 19th, 2017 WELCOME Chat Room Question What improvement ideas to you have to advance linkages and retention across agencies and providers? Ending the Epidemic in New York State 2

Welcome

Ending the Epidemic Defining the “End of AIDS” A 3-Point plan announced by the Governor on June 29, 2014 Identify all persons with HIV who remain undiagnosed and link them to health care. Link and retain those with HIV in health care, to treat them with anti-HIV therapy to maximize virus suppression so they remain healthy and prevent further transmission. Provide Pre-Exposure Prophylaxis (PrEP) for persons who engage in high-risk behaviors to keep them HIV negative Reduce the number of new HIV infections to just 750 [from an estimated 3,000] by 2020

Public Release of the Blueprint April 29, 2015 We must add AIDS to the list of diseases conquered by our society, and today we are saying we can, we must and we will end this epidemic. ~Governor Cuomo

Blueprint Recommendations (BPs) Link and retain persons diagnosed with HIV in care to maximize virus suppression so they remain healthy and prevent further transmission. BP5: Continuously act to monitor and improve rates of viral suppression BP7: Use client-level data to identify & assist patients lost to care or not virally suppressed BP8: Enhance & streamline services to support the non-medical needs of persons with HIV... BP29: Expand & enhance the use of data to track and report progress

New York State Cascade of HIV Care, 2015 Persons Residing in NYS† at End of 2015

The counties that make up the Long Island NY Region

Cascade of HIV Care: NYS excluding NYC, 2015 Persons Residing in NYS, excl. NYC† at End of 2015

Cascade of HIV Care: Nassau-Suffolk Ryan White Region Persons Residing in the Nassau-Suffolk Ryan White Region†, at End of 2014 (excludes prisoner cases)

Introductions 11

Illustrating the difficulty with implementation science Introduction Rules: Everyone stand up Introduce yourself (follow the directions on the next slide) When done please retake your seat (unless you would like to be added to the end of the process so you can introduce yourself a second time. Please pay attention to the process

Introduction Directions Please share the following with the group: Your name and title What you do Where you work One thing you believe would facilitate ending the epidemic here in Suffolk County

Organizational Cascades with Improvement plans 14

Stony Brook Medicine: Organizational HIV Treatment Cascade Quality Manager: Cristina Witzke, MPH SPARC Program Coordinator: Katelin Thomas, MPH MCHES

Number of Active Patients in 2017 Improvement Plan Goal: To maintain a viral load suppression rate of Active SBM patients in 2017 of >90%. Action Steps: Refer patients to SBM’s Linkage Treatment Adherence and Retention (LRTA) Program Refer patients to Chronic Disease Self-Management Program (CDSMP) classes facilitated by SBM HIV staff and/or Peers. Refer patients to Peer Program for individual HIV support from Peers. Measurement: Number of patients with a Viral Load < 200 copies/mL at last viral load in 2017 Number of Active Patients in 2017 Time: January 2017 – December 2017 Evaluation: Analyze 2017 viral load data and compare to 2016.

Number of Active Patients in 2017 Improvement Plan Goal: To increase the viral load suppression rates in: Youth ages 13-24 years receiving HIV primary medical care to 80% Females receiving HIV primary medical care at SBM in 2017 to >90%. Action Steps: SBM’s Part D Program- Suffolk Project for AIDS Resource Coordination (SPARC) received one-time supplemental funding to provide incentives in the form of grocery store gift cards (up to $200) to youth and female SBM HIV patients who are not virally suppressed. Patients must meet one or more of the following to receive an incentive: Patient goes for VL blood work Patient’s viral load decreases Patient’s viral load is suppressed Patient’s viral load is undetectable Patient maintains an undetectable viral load for 2 blood draws at least 3 months apart Patient reaches an undetectable viral load and maintains an undetectable viral load Medical Case Managers, Social Workers, Care Coordinators, and/or Retention Specialist will enroll patients into the incentive program. Measurement: Number of patients with a Viral Load < 200 copies/mL at last viral load in 2017 Number of Active Patients in 2017 Time: January 2017 – July 2017 Evaluation: Analyze 2017 viral load data and compare to 2016.

Number of Active Patients in 2017 Improvement Plan Goal: To increase the viral load suppression rates in: Blacks/African Americans receiving HIV primary medical care to 90%, Males ages 25 to 30 receiving primary medical care at SBM in 2017 to 85% Males ages 31 to 44 receiving primary medical care at SBM in 2017 to 90%. Action Steps: Refer patients to SBM’s Linkage Treatment Adherence and Retention (LRTA) Program Refer patients to Chronic Disease Self-Management Program (CDSMP) classes facilitated by SBM HIV staff and/or Peers. Refer patients to Peer Program for individual HIV support from Peers. Measurement: Number of patients with a Viral Load < 200 copies/mL at last viral load in 2017 Number of Active Patients in 2017 Time: January 2017 – July 2017 Evaluation: Analyze 2017 viral load data and compare to 2016.

Hudson River HealthCare Suffolk HIV Program 2016 Quality Assessment Maria Mezzatesta, R-LCSW Genesis Regional Coordinator 1080 Sunrise Highway Amityville, NY Cell 1-845-260-0429 mmezzatesta@hrhcare.org

Overall Organization Cascade –Established Patients Open: Patients with a known diagnosis of HIV who received services anywhere in the organization during the measurement year Active: Patients with a known diagnosis of HIV who received services in the HIV program of the organization during the measurement year Retained in Care: Patients from the active caseload that had a visit in both the first and second halves of the measurement year On ART: Patients from the active caseload that were prescribed ART during the measurement year Virally Suppressed: patients from the active caseload with a viral load <200 copies/mL at last viral load testing during the measurement year. 85.2%

Viral load <200 at last check in 2015 and 2016

Amityville Cascade Open: Patients with a known diagnosis of HIV who received services anywhere in the organization during the measurement year Active: Patients with a known diagnosis of HIV who received services in the HIV program of the organization during the measurement year On ART: Patients from the active caseload that were prescribed ART during the measurement year Virally Suppressed: patients from the active caseload with a viral load <200 copies/mL at last viral load testing during the measurement year.

Shirley Cascade Open: Patients with a known diagnosis of HIV who received services anywhere in the organization during the measurement year Active: Patients with a known diagnosis of HIV who received services in the HIV program of the organization during the measurement year On ART: Patients from the active caseload that were prescribed ART during the measurement year Virally Suppressed: patients from the active caseload with a viral load <200 copies/mL at last viral load testing during the measurement year.

Patchogue Cascade Open: Patients with a known diagnosis of HIV who received services anywhere in the organization during the measurement year Active: Patients with a known diagnosis of HIV who received services in the HIV program of the organization during the measurement year On ART: Patients from the active caseload that were prescribed ART during the measurement year Virally Suppressed: patients from the active caseload with a viral load <200 copies/mL at last viral load testing during the measurement year.

Brentwood Cascade Open: Patients with a known diagnosis of HIV who received services anywhere in the organization during the measurement year Active: Patients with a known diagnosis of HIV who received services in the HIV program of the organization during the measurement year On ART: Patients from the active caseload that were prescribed ART during the measurement year Virally Suppressed: patients from the active caseload with a viral load <200 copies/mL at last viral load testing during the measurement year.

Riverhead Cascade Open: Patients with a known diagnosis of HIV who received services anywhere in the organization during the measurement year Active: Patients with a known diagnosis of HIV who received services in the HIV program of the organization during the measurement year On ART: Patients from the active caseload that were prescribed ART during the measurement year Virally Suppressed: patients from the active caseload with a viral load <200 copies/mL at last viral load testing during the measurement year.

Coram Cascade Open: Patients with a known diagnosis of HIV who received services anywhere in the organization during the measurement year Active: Patients with a known diagnosis of HIV who received services in the HIV program of the organization during the measurement year On ART: Patients from the active caseload that were prescribed ART during the measurement year Virally Suppressed: patients from the active caseload with a viral load <200 copies/mL at last viral load testing during the measurement year.

MLK/Wyandanch Cascade Open: Patients with a known diagnosis of HIV who received services anywhere in the organization during the measurement year Active: Patients with a known diagnosis of HIV who received services in the HIV program of the organization during the measurement year On ART: Patients from the active caseload that were prescribed ART during the measurement year Virally Suppressed: patients from the active caseload with a viral load <200 copies/mL at last viral load testing during the measurement year.

Hudson River HealthCare Quality Improvement Project Objective: Improve the viral load suppression rate to 90% by 12/31/17.

Identified under performers In reviewing HRHCare’s cascade it was noted that several sites continue to struggle to improve suppression rates. The Martin Luther King Health Center at Wyandanch in particular had a rate of 79% with 81/102 patients suppressed. The population experiences many psychosocial issues such as substance abuse, mental health, homelessness and poverty which impact adherence to health care as well as medication. Coram, a small newly established program with 13 patients and a rate of 77%, is well situated for an intensive intervention. A strong new provider has begun to build the practice and the addition of a shared care manager will afford increased follow up with patients. The additional leadership of an Infectious Disease Specialist as regional clinical director will provide new and enhanced direction for both sites.

PDSA Plan/Do: In order to improve the viral load suppression rate to 90% we will: Conduct a quality management meeting with Suffolk County QI teams by 5/31/17to review and analyze cascade data. Facilitate completion of a driver diagram to help staff understand and prioritize factors that drive desired outcomes and think strategically about what to change within the current viral load suppression project. Develop/revise viral load suppression project inclusive of clear roles for each team member and distribute to all members by 5/31/17. Utilize best practices from the Retention and Adherence Program (RAP). Review plan with a consumer group to ensure plan is consistent with consumer interests by 5/15/17. Review plan during monthly QI meetings. Develop an evaluation process for new strategies by 7/30/17.

Study: Utilize COGNOS reports to review viral load suppression client level and aggregate data. Implement a consumer feedback tool.   Act: Review viral load suppression data, process implementation and consumer feedback and revise plan as needed. Present program outcome at the annual Genesis Quality Conference

Regional Aggregates 41

The Living Cascade 44

QOC/Cascade Building Questions 45

Request from NYLinks 46

NYLinks is asking: Clinical Providers create another cascade for the first 6 months of 2017 (you can exclude open if you wish) Non-Clinical providers to create a cascade for the first 6 months of 2017 ETE committees to support these requests

Webpage

Questions Before the End Next meeting is a joint meeting—Suffolk and Nassau. Timing? July? August? September? Content focus—Improvement work related to cascades, non-clinical cascades, regional focus on improvement? Training or TA needs? One question sticky survey

What’s Coming up? May 19th, Suffolk County Sub-Regional NYLinks meeting (with ETE) May 22nd, (week of) Lower Manhattan Regional Meeting May 25th, McPEtE Collective Meeting May 25th, Upper Manhattan Regional Meeting June 8th, Queens Regional Meeting June 21st, Northeastern New York Regional Meeting July, Aug, Sep ??, LI Regional Meeting October 18th, Queens Regional Meeting

Contact Information Steven Sawicki, NYSDOH, NYLink Lead steven.sawicki@health.ny.gov, 518-474-3813 Karen Bovell, karen.bovell@health.ny.gov Bruce D. Agins, Medical Director, bruce.agins@health.state.ny.us Blog at http://linkandretain.wordpress.com/ Website at http://www.newyorklinks.org