+ North Carolina Positive Charge Initiative Access to Care

+ Who is out of Care? In North Carolina generally and the NC Positive Charge Initiative In North Carolina, an estimated 23.4% of those who know they are HIV+ are not receiving HIV medical care. NC Epidemiologic Profile for HIV/STD Prevention and Care Planning (12/11)

+ A quick introduction to NC What impacted our program design NC has unique geographies Mountains and sea Urban and rural Resources are concentrated in certain areas I-95 and I-40 corridors run through the state HIV service system is splintered prevention/education/care Stigma is strong throughout the state History of peer training programs but not of agencies hiring peers Gaps in funding often prevent continuum of services Clients must be in medical care to get most services No one is looking for people outside of the HIV system Belief that PLWH can relate to other PLWH in a unique way

+ Program Outline Access to care for those living with HIV Access Coordinators (HIV+ peers) are the core of the program Access Coordinators (ACs) work in teams of 2 or 3 in each agency ACs receive special training when they start and monthly conference calls ACs split their time between their agency and the community Short-term relationship 3-9 months Identifying Community outreach Testing events Referrals Agency in-reach Connecting to Care Medical appointments Support services Thriving in Care Communication skills Empowerment

+ NC PCI Partners Across the State Three areas representative of the state Rural (11 counties) Suburban (6 counties) Urban (1 county) Different types of agencies Health Department Community-based Organization Faith-based Organization

+ Why are people out of Care? Barriers to Care and Meeting Basic Daily Needs NC Positive Charge Initiative clients

+ Program Outcomes Improved health outcomes Increased CD4 Decreased viral load Increased number of undetectable clients Number of self-identified barriers to care decreased Improved referral systems Decreased no-show rates New partners HIV testing, prevention and education Skills-based curriculum for Access Coordinators Tools for thriving in care

+ Challenges and Lessons Learned Street and community outreach is difficult Basic HIV education is still needed Training Access Coordinators has to be done right Transportation remain a barrier Access Coordinators need to be fully integrated in their agency Some of our greatest opposition has come from the HIV service system There’s a reason people have been out of care, but they can thrive in care with the right support and skills

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