HIV/STD Prevention for HIV Positive Women: Integration of Family Planning Services and HIV Care 2004 National STD Prevention Conference Philadelphia, PA. March 2003

Authors Brian M. Green, MS Manager-Quality Improvement & Planning Circle of Care Erika Aaron, RN, CRNP Director of Women’s Services HIV/AIDS Medicine Section Drexel University School of Medicine Jill Foster, MD Medical Director Special Immunology HIV Family Clinic St. Christopher’s Hospital for Children Jim Witek, MD Medical Director Partnership Comprehensive Care Practice Rashidah Abdul- Khabeer, RN, MHS Deputy Director, Circle of Care Alicia Beatty, MA Director, Circle of Care Marie Ransell Coordinator, Perinatal Services Circel of Care

Learning Objectives Discuss different approaches to integration of HIV/STD prevention and family planning Identify 5 steps that will enhance your clinic’s ability to integrate HIV/STD prevention, family planning, & HIV care

CDC “New” Initiatives Circle’s integration of HIV/STD prevention for PLWH predates CDC’s Advancing HIV Prevention Initiatives: Routine HIV testing in medical settings Rapid HIV testing for diagnosing infection Secondary Prevention for PLWH Further decrease Perinatal transmission of HIV Purpose: increase # who know their HIV status; increase # HIV+ into care

Circle of Care Ryan White Title IV Grantee— Philadelphia, PA Network of HIV clinical and support service providers Served 1400 HIV affected families FY03 Built upon a vision of integrated and family focused services

Integration Settings Family Planning Clinic with integrated HIV prevention services & immediate linkage to care HIV Ambulatory Family Clinic in pediatric hospital. Integrated STD, family planning, and ob/gyn services. HIV Ambulatory Clinic in teaching hospital, integrated STD, family planning, and ob/gyn services (presentation focuses on this last one)

Partnership Comprehensive Care Practice (PCCP) Comprehensive HIV clinic, integrated family planning services in ,400 patients, 40% women Heterosexual transmission of HIV Increase in planned pregnancies among HIV+ women. Uninsured-20%; family planning-33%

PCCP, continued Integration of on-site GYN and colposcopy services Co-management of pregnant women with Dept. of OB/GYN Pre-conceptual counseling HIV Rapid Testing pilot project

PCCP, Planning for Services Needs Assessment Consumer focus groups Service utilization data Ensure practice wide buy-in Internal staff education Presentations by Title X (FP) staff Multi-disciplinary planning meetings Cross-department meetings Service utilization forecasting

PCCP, FP Patients

PCCP, Family Planning Data

Case Study Common Elements Identifying the range of care and prevention issues/challenges/needs for any given client is ongoing and complex Screening services and other prevention services may need to be offered to consumers many times over long periods of time before they accept services Consumers need support for disclosure decisions, critical for effective prevention Peer counselors can have a key role in bridging care and prevention for a client (or reconnecting client to care) Establishing rapport/building trust key

PCCP, Integration Challenges Change from traditional ID control focus to collaborative model of care Staff-additional education & training on family planning/prevention issues Tensions in providing new services that address “sensitive” issues Added clinical responsibilities Increased administrative/reporting functions

Integration Readiness Assessment What services are most needed to address HIV prevention needs of your clients? What services are most needed to address STD prevention needs of your clients? What services are needed to integrate care and prevention? What services are likely to be accepted and used by clients? Is co-location of services feasible? Are staff ready for co-management and coordination challenges? Which staff are affected? Can you provide cross-training of staff? Are prevention services offered continuously to clients (not just at intake or annual visits)? Do providers assist HIV positive clients with disclosure decisions? Is there a role for peer counselors for “hard to reach” clients?

Essential Steps for Integration What are you trying to achieve? Plan your outcomes Know the prevention and care needs of your client populations Integration Readiness Assessment Implement core services 1 st, add additional services incrementally Use CQI process to continually monitor, assess, and modify integration efforts

Team Assessment Process Process for assessing integration ideas Identify potential services to integrate Rating of potential services Why is this item important to our clients? our outcomes? What can it tell us about quality of care? Process helps consolidate, eliminate, or revise items, or identify root causes

Conclusions Prevention Interventions for PLWH must include support for disclosure decisions Need clear protocols for Partner Notification (PCRS) and consent for PCRS Providers considering integrating prevention services for PLWH need to have ability to provide range of support services (ex: domestic violence screening & referral) Prevention for PLWH is not a one-time service, need for ongoing services, and continual assessment and support HIV Rapid testing offers considerable promise for getting HIV+ into care as soon as possible, but provider trust and need for disclosure support and connection to peers only heightened