1. WISCONSIN STATEWIDE ACTION PLANNING GROUP JUNE 25, 2015 MELODY YEE CENTERS FOR DISEASE CONTROL AND PREVENTION PUBLIC HEALTH ASSOCIATE WISCONSIN AIDS/HIV PROGRAM Wisconsin AIDS/HIV Program Statewide Needs Assessment Wisconsin Department of Health Services

2. Overview Purpose of the needs assessment The process and methods Provider key informant demographics Initial findings Client versus provider characteristics Next steps 2 Wisconsin Department of Health Services

3. Purpose Required by Health Resources and Services Administration (HRSA)  Tied to Ryan White planning process Required by the Centers for Disease Control and Prevention (CDC)  Tied to the Jurisdictional HIV Prevention Plan Part of Wisconsin’s HIV/AIDS Strategy Plan 3 Wisconsin Department of Health Services

4. Purpose 4 Wisconsin Department of Health Services

5. Process Literature review not specific to Wisconsin Analysis and synthesis of existing data Collection and synthesis of information regarding client needs and service gaps Internal data collection from staff and Statewide Action Planning Group members Inventory development of HIV-related health and support services 5 Wisconsin Department of Health Services

6. Provider Key Informants: Who? Individuals working in the AIDS/HIV field  Case Managers and Linkage to Care Specialists  Providers (R.N., N.P., P.A., M.D.)  Frontline Prevention Staff  Administrators Wisconsin grantees funded by Ryan White and CDC 6 Wisconsin Department of Health Services

7. Provider Key Informants: Who? 7 Wisconsin Department of Health Services

8. Provider Key Informants: Who? 8 Wisconsin Department of Health Services

9. Provider Key Informants: Who? 9 Wisconsin Department of Health Services

10. Provider Key Informants: Where? 10 Wisconsin Department of Health Services

11. Provider Key Informants: How? They were selected by state staff Individual and group interviews conducted  45-90 minute interviews Most were conducted in-person at the key informant’s agency  Interviewed by 1 to 2 staff members Questions were emailed ahead of time 11 Wisconsin Department of Health Services

12. Interview Tool Tool created by state staff Five Major Sections  HIV Care Continuum – challenges and barriers  Your Role  Services Used / Needed  General – what works well and what can be improved on?  Community Members engagement 12 Wisconsin Department of Health Services

13. HIV Care Continuum in Wisconsin 13 Wisconsin Department of Health Services

14. Barriers to Getting Tested Stigma Misinformation about HIV and personal risk Misconceptions about testing logistics Confidentiality Missed opportunities for testing by health providers 14 Wisconsin Department of Health Services

15. Barriers to Getting Linked/Staying in Care Loss of Linkage to Care program Lack of resources and support at non-funded state sites Navigating the health care system Transportation Competing priorities Relationship with provider 15 Wisconsin Department of Health Services

16. Barriers to Becoming/Staying Virally Suppressed Adherence difficulties  Living situations  Side effects Personal feelings about HIV medication  Feeling burned out  Reminder of HIV  Depression 16 Wisconsin Department of Health Services

17. Providers versus Patients/Clients Providers  Comfortable and open  General consensus about barriers and needs of people living with HIV  Identify big picture barriers Patients/Clients  Comfort level varies  Difficult to reach a consensus about the barriers and needs  Conceptualize barriers as ‘regular way of life’ 17 Wisconsin Department of Health Services

18. “When I first found out I had HIV, I was mad...it’s something I didn’t want to live with. I wanted to kill myself, but that’s the coward’s way out.” Some Statements from Clients 18 Wisconsin Department of Health Services

19. Some Statements from Clients “Someone with diabetes… yeah they have a horrible disease, but nobody tells them it’s a punishment from God and they don’t have to hide it. Nobody thinks anything less of them.” 19 Wisconsin Department of Health Services

20. “There is help out there, you just have to go out and find it… if you want help…. People just got to start taking care of themselves.” Some Statements from Clients 20 Wisconsin Department of Health Services

21. “Yes, HIV is a disease and you can die from it. But my mom has been positive for eleven years…and she’s non-detectable now….you have to break [the stigma]…it’s not a death sentence anymore.” Some Statements from Clients 21 Wisconsin Department of Health Services

22. Next Steps Recruit clients for interviews – Ideas?  Through mid July  $20 gift card incentive to Walmart Continue analyzing data from interviews – including needed services and suggested solutions Solicit input from AIDS/HIV staff and SAPG members Complete report Develop plan for dissemination of findings Recommend changes based on findings 22 Wisconsin Department of Health Services

23. Parting Thought “I like the fact that there are people who sincerely care about [us]. People who work in HIV/AIDS are sincere and actually care.” 23 Wisconsin Department of Health Services

24. Questions? Melody Yee melody.yee@wi.gov Kathleen Krchnavek kathleen.krchnavek@wi.gov kathleen.krchnavek@wi.gov 24 Wisconsin Department of Health Services

25. Questions for Entire Group 25 How do these results related to barriers resonate with your experience? How to reach/recruit clients? Ideas for note-taking that would not inhibit rapport?  Computer vs. hand-writing notes?  Two interviewers? Wisconsin Department of Health Services

26. SAPG Input – Small-Group Discussion 26 What activities should the AIDS/HIV Program be doing that are not currently being done? What should the AIDS/HIV Program change regarding the activities we are currently doing? Include in your response what changes should be made and why. What activities should the AIDS/HIV Program stop doing? Include in your response reasons for your answer. Wisconsin Department of Health Services