New York State Hepatitis C Continuity Program

NYS HCV Continuity Program What is the purpose and why is it needed What is the process What is the role of the HCV Care & Treatment Programs’ Linkage to Care Specialist What lessons have we learned

NYS Dept. of Corrections and Community Supervision (DOCCS) - Inmate Profile Characteristic Category Inmates Under Custody Gender Male 95.5% Female 4.5% Age Average Age 38.3% Race/Ethnicity White 24.4% African American 48.6% Hispanic 24.0% Region NYC 43.7% Rest of State 56.2% Crime Violent Felony 65.0% Drug Offense 12.6% Property/Other 12.8% April 2011, Department of Corrections merged with Division of Parole 51,744 individuals under custody 54 state facilities Data as of January 1, 2016

Survey of Incoming Inmates – HIV, HCV The Prison Study Study began in 1998. Runs every two years. Sample of inmates coming into NYS DOCCS facilities. During the 2012 study, 4,205 inmates included: 79% male; 21% female Black was the larges race/ethnicity group Average age 34 years 20.5% reported IDU 18.9% reported being sex partner of IDU 14.2% reported exchanging sex for money or drugs 1.7% male inmates reported MSM risk

Survey of Incoming Inmates – HIV, HCV (2) HIV seropositivity- 2.6% overall 2.4% male; 3.7% female HCV seropositivity 10.7% overall 9.6% male; 14.6% female HCV seropositivity has remained relatively stable between 2000 and 2012 HIV/HCV coinfection 0.7% (32) inmates were coinfected 0.9% males; 0.3% females

NYSDOH NYSDOCCS Longstanding relationship between both agencies NYSDOH AIDS Institute (AI) meets quarterly with NYSDOCCS Collaborate on a number of initiatives related HIV infected inmates Public Health Law (2009) giving AI oversight to the HIV and HCV care in correctional facilities Correctional facility policies and practices regarding HIV/AIDS and hepatitis C prevention and treatment must be consistent with current, generally accepted standards and procedures used to prevent transmission and provide treatment among the general public. AI reviews DOCCS HIV and HCV policies AI monitors HIV and HCV quality of care within DOCCS facilities CD4, HIV viral load, HCV screening, genotype, etc. DOH will perform an annual review of each facility focusing on whether policies and practices are consistent with current, generally accepted medical standards and procedures in the community -DOH will have access to facilities, records, staff and the prison population -Prior to the review, DOH must inform the public of its schedule and permit public input -After its review, DOH must issue a report either approving the policies and practices or finding deficiencies and mandating DOCS to develop and implement a corrective plan, which DOH will monitor Criminal Justice Initiative This initiative also funds community-based organizations to provide re-entry assistance for formerly incarcerated individuals living with HIV/AIDS. Services include transportation, supportive services, risk reduction counseling, coordination of health and human services, referral to community case management and Project START. This strong collaboration allows for the targeted distribution of Health Resource Portfolios and Work Release Packets containing HIV/STI/HCV prevention information and male and female condoms that are provided to inmates as they leave the facility.

NYS Hepatitis C Continuity Program Established in 2006 First such program in the U.S. Program for DOCCS inmates receiving treatment for HCV Provides a treatment completion opportunity to inmates released from DOCCS on HCV medications Allows treatment to be initiated within DOCCS regardless of length of stay Enables inmates to receive timely referral to appropriate community-based health care providers for continuation of treatment Inmate participation is voluntary Unfunded program; however, DOCCS budget supports purchase of HCV medications for inmates

Key Partners NYS Department of Health (DOH) NYS Department of Corrections and Community Supervision (DOCCS) Community-Based Health Care Providers

Partner Roles DOCCS (Regional Infection Control Nurses – RICNs) NYSDOH Provide patient education Ensure all necessary forms are completed Contact community-based provider for appointment upon release Faxes patient health information to provider NYSDOH Assist RICNs with making inmate initial appointment with community-based provider Follow-up with community-based provider to see if patient attended 1st medical appointment Program evaluation

Partner Roles (2) Community-based providers: Accept inmate’s Continuity Program Forms, medical information, and labs Provide continuity of HCV care and treatment post-release

Challenges Inmates Early releases Shelter placement Lack of resources for shelter referrals HCV is not a single qualifying condition for Health Homes Lack of statewide coverage for referrals Lack of funding Inmates released without medication Lack of/delays in Medicaid activation post-release HCV is now a priority medical condition for inmates’ Medicaid reactivation/enrollment

HCV Continuity Program Data, 2006-2013 # referrals Number of appts. kept % appts. kept ROS inmates 126 85 67% NYC-based inmates 101 46 45.5% Total 227 131 58% * Appointment scheduled within two weeks post release

Continuity Program Linkage Specialist Strong feeling that more could be done to link these inmates to care Small number enrolled/year AI-funded Linkage Specialist selected based on background and skills Protocols developed DOCCS RICN notifies Linkage Specialist of new enrollment and schedules phone intake, sends intake forms to Linkage Specialist Linkage Specialist conducts phone intake; makes pre-release care arrangements; notifies parole officer; appointment reminders; contacts provider to confirm if appointment kept Initiative kicked off- January 2014 Linkage Specialist retired in 2015, duties not redelegated Improving linkage to care

HCV Care & Treatment Programs 15 AI-funded Programs Provide on-site HCV medical care, care coordination, treatment, and supportive services in a primary care setting Providers located Upstate and Downstate HepCAP (patient assistance program) available only to uninsured patients seen by the funded programs Each program has a Linkage to Care Specialist on-staff who works with patients to assess potential barriers to care to ensure they attend their medical appointments Linkage to Care Specialists work with RICN to schedule appointment and link patient to care post-release LCS ensures patient attends HCV medical appointments Conduct barrier assessment, link patient to additional resources as necessary (i.e., transportation assistance) Alert others involved in patient’s care (i.e., Parole Officer, shelter) of the appointment

Program Spotlight: Bronx Transitions Clinic Model Correctional Facility Populations: HCV-positive, mental illness, chronic health conditions Osborne Association: education, linkage to medical care Outreach begins in prison. Linkage to Care Specialist (LCS) is a trained Community Health Worker. LCS provides direct transportation on the day of release Osborne Association CHCC LCS provides patient navigation: Medical appointment within 2 weeks Phone call reminders LCS facilitates continuity of care: Appointment reminders Refill requests Reentry Services Primary Care, HIV care, Mental Health

NYC Check Hep C Patient Navigation Nine HCV Patient Navigation programs in health centers across NYC Goal- link NYC residents living with HCV to medical care Patient Navigators support patients to complete HCV medical evaluation and successful treatment, prevent reinfection, and maintain liver health post-treatment Program services provided to patients at no cost, such as linkage to HCV medical care, escorts, drug and alcohol counseling, treatment readiness and adherence, etc. Patient Navigators collaborate with the AI and RICNs to accept Continuity Program referrals Pat

HCV Continuity Program Data, 2014-Current # referrals # of appointments kept % appointments kept ROS inmates 23 20 86.9% NYC-based inmates 19 11 61.1% Total* 42 31 73.8% * 2 referrals excluded: 1 pending outcome; 1 discharged to rehab post-release

Medicaid Workgroup Workgroup of key stakeholders convened to look at challenges with reactivation of Medicaid post-release AI, OHIP, DOCCS Increased understanding of Medicaid enrollment process Work flow diagram developed and shared internally DOCCS increased medication supply post-release (28-days for oral medications only)

Lessons Learned Inmates leaving prison on HCV treatment can be linked to care Linkage to Care Specialist is key to referral process Inmates require some level of care coordination/case management to be linked post-release Activation of Medicaid is important to continuity of care HCV is now a priority medical condition for inmates’ Medicaid reactivation/enrollment Dedicated staff is key!

Lessons Learned (2) “It takes a village” to link these individuals to care All organizations involved in the patient’s care must be included on health release, such as shelters and other CBOs RICNs encouraged to: Use the HCV Continuity Program patient agreement as a tool/reminder of compliance Use Treatment Action Group (TAG) fact sheets: www.treatmentactiongroup.org/hcv/factsheets

Thank You! Questions? Stephanie McHugh, MPH Bureau of Hepatitis Health Care AIDS Institute, NYSDOH Stephanie.McHugh@health.ny.gov (518) 486-6806