1. The Expanded Role of Disease Intervention Specialists in a Reformed Health System National ADAP TA Meeting Friday, August 1, 2014 Tonya King, MPA Ryan White Part B Program Director

2. Disease Intervention Specialists Mix of nurses and public health representatives Conduct educational outreach Work with providers in their area to ensure reporting Investigate reports of communicable diseases* Ensure adequate treatment Interview cases and contacts Enter investigational outcomes into HD database (PRISM) * DIS in the rural regions also investigate other cases (TB, food-borne, and general epi) and do work in the immunization & emergency preparedness programs * DIS in the metros investigate STDs only; some metros have case loads that preclude investigating all chlamydia & gonorrhea cases (all HIV & syphilis cases are investigated, but only high priority CT & GC cases).

4. TN’s Network of HIV Centers of Excellence

5. CAPUS in Tennessee  Background  Activities Surveillance (“Data to Care”) Identify & re-engage known PLWH out of care > 1yr Identify known PLWH with sub-optimal response to care HIV Testing 4 th Generation Ag/Ab Testing in TN State Labs Social Networking Strategy Among AA MSM Navigation Corrections Navigators Social & Structural Barriers

6. TN CAPUS: Surveillance  Activities HIV Continuum of Care 2010 Baseline, 2015 Goals, Annual Progress Reports Identify & re-engage known PLWH out of care > 1 yr Identify known PLWH with sub-optimal response to care  Data Quality 2012: Labs required report all HIV-1 Viral Load & CD4 results 2013: Accurint software acquired / applied to eHARS database  Staffing 1 Epidemiologist 2 Data Clerks 5 DIS Re-Engagement Specialists 2 Memphis, 1 Nashville, 1 Middle TN, 1 East TN

7. Re-Engagement in Medical Care  Develop Out-of-Care Lists for 5 DIS Re-Engagement Specialists Identify known diagnosed PLWH who have been out of care for > 1yr Clients with evidence of any care during prior 3 years (1/1/10 – 12/31/12) Eliminate anyone who… Received care w/in the past 1 year, Moved out of state, or Died Stratify remaining list by geography & distribute monthly to DIS Specialists  Each year fully implemented > 1000 cases / year (200 cases per DIS/year) > 70% cases contacted > 70% contacted cases linked to care 49% of total)

8. CAPUS DIS Re-Engagement Specialists  Training Passport to Partner Services 106 hours of on-line modules, followed by 5 days of in-person training ARTAS (Antiretroviral Treatment and Access to Services)  Located in geographically distinct areas 2 in Memphis 1 in Nashville 1 in Middle TN 1 in East TN (Note: These 5 DIS cover the jurisdictions that account for ~80% of all known positives who have been identified as being out of medical care for > 1 year.)

9. Data to Care: Progress  First “list” generated October 2013  274 names – 63 (23%) determined to be living out of state or dead  211 remaining names – 139 (66%) contacted 99 (71%) in care in 2013 40 (29%) not in care – 18 (45%) linked to care < 3 mos – 22 (55%) not linked to care < 3 mos  Goals / Progress – Contacted: Goal > 70%, Actual = 66% (139 of 211) – In Care < 3 mos: Goal > 49% of total, Actual = 55% (117 of 211)

10. FUTURE ROLE OF DIS  Develop position of DIS Engagement Specialist Focus on ADAP clients with goal of Linkage to care Re-engagement in care Retention in care (both newly diagnosed & current clients on brink of losing/work with medical case managers to identify) – Treatment adherence – Address barriers to care Training – Expand Passport to Partner Services to this level – ARTAS  ACA Process – Reimbursement/Credentialing

11. Questions Tonya King, MPA Tennessee Department of Health HIV/STD Program Ryan White Part B Program 710 James Robertson Parkway Andrew Johnson Tower, 4 th Floor Nashville, TN 37243 615-741-0237 (ph) tonya.king@tn.gov