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Clarissa Ospina-Norvell, NP Sandra Torres, SA May 12,2017

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Presentation on theme: "Clarissa Ospina-Norvell, NP Sandra Torres, SA May 12,2017"— Presentation transcript:

1 Clarissa Ospina-Norvell, NP Sandra Torres, SA May 12,2017
RAPID Getting to Zero Clarissa Ospina-Norvell, NP Sandra Torres, SA May 12,2017

2 “RAPID” Rapid ART Program Initiative for New HIV Diagnosis
A pilot project at Ward 86 saw it’s first patient in 2013 Vision is to provide immediate ART to all patients newly diagnosed with HIV In 2013 Providers at SFGH piloted an early treatment program for acute HIV infection. Dr. Hatano saw her first patient in July of 2 013before the formal start of the RAPID program.

3 Three Phases Pilot: newly diagnosed patients in acute infection
Expanded Populations: Include other newly diagnosed patients (low CD4 count, OI, Sero- discordant couples) Clinic Standard for all untreated HIV positive patients

4 Why Immediate Treatment?
Improve linkage and retention in care. Decrease transmission. Improve long term outcomes.

5 New Positives: What do we do?
Disclosure Post-test counseling/support /education Same day ART initiation Partner and family notification Linkage to primary care Referral to research

6 RAPID: What does it take?
Quick/Easy Access Interdisciplinary Team approach Drop-in/next day appointments Eligibilty and Insurance support Tracking/outreach Psychosocial stabilization

7 Challenges Coordination of team members Navigating insurance coverage
Resource intense Psyochsocial factors influencing retention

8 CASE PRESENTATION Gianni 45yo male, immigrant States on “tourist visa”
Presents in ZSFG ED 1/31/17

9 CASE CONTINUED 10 day fever, achiness, malaise
Tobacco smoker 1 ppd, occasional drinker, smokes marijuana, denies HIV risk HIV ab/ag combo presumptive + HIV VL pending ED discloses HIV+ >>> go to W86

10 RAPID VISIT 2/1/17 presents to Ward 86 with friend/ interpreter
HIV Ab/Ag NEGATIVE Insurance fiasco Per patient: in SF 9 months, undocumented last HIV test 3 years ago “Low risk”: condom sex w women, oral sex w/o barrier Alcohol/ substance abuse issues

11 RAPID VISIT HIV VL > 10 million copies/ml (2/4/17)
Medical visit w/ provider Begins ART HIV VL > 10 million copies/ml (2/4/17)

12 Acknowledgements Oliver Bacon, MD Diane Havlir, MD Hiroyu Hatano, MD Diane Jones, RN Chris Pilcher, MD ZSFGH Clinical Laboratory PHAST/RAPID TEAM Christy Camp, SWA Susa Coffey, MD Lizzy Lynch, RN Clarissa Ospina-Norvell, NP Sandra Torres, SWA

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