Engaging CBOs for Partner Services Beau Gratzer, MPP Director of HIVSTD Prevention Howard Brown Heal

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Engaging CBOs for Partner ServicesBeau
Gratzer, MPPDirector of HIV/STD
PreventionHoward Brown Health Center

• NASTAD TA Meeting Reaching Gay Men Using the
  Internet
• March 30, 2009

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Overview and Goals

• Background of HB DIS Program
• Evaluation of PS Outcomes
• Innovations in IPN (Internet Partner
  Notification)
• Program Development
• Infrastructure and Program Considerations
• Training and Supervision
• Program Integration
• Conclusions and Discussion

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Howard Brown DIS Program

• Howard Brown
• LGBT health center (FQHC)
• 16.5 million budget, 220 employees
• Serve about 30,000 clients/year, 10K for medical
• Initiated in June 2002 as part of comprehensive
  response to syphilis outbreak among MSM
• CDPH staff encountered difficulty interviewing
  MSM diagnosed at PCPs
• HB diagnosed significant syphilis morbidity in
  Chicago (approximately 20 total, 30 among MSM)

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HB DIS Program (cont)

• Hired full-time DIS to interview and manage all
  cases of syphilis diagnosed at HB
• DIS went through standard CDC trainings (EDG
  Modules, ISTDI, ASTDI, etc)
• DIS initially reported to CDPH Field Operations
  Manager for case supervision, but was
  administratively supervised by HB staff
• HB now employs three full-time DIS staff,
  including a manager who now supervises our cases
  internally
• Also contracted by IDPH to manage cases in
  suburban Cook County

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Evaluation of Outcomes
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Reasons for success

• Time from Treatment to Interview
• Cultural Competency
• Use of internet for PN
• Integration of DIS into clinical model (both in
  terms of client and provider)
• Distance ourselves from HD while still
  performing same function main goal is to not
  burn bridge with client (repeats)

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Innovations in IPN

• Worked to organically respond to needs of our
  community and began contacting partners over
  internet in 2003
• Presented data at 2004 STD conference about
  initiating IPN in chat rooms
• Chat rooms fizzled, and sex-seeking websites
  became more common requiring new techniques
• Presented evaluation data of our program at 2008
  STD Conference

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IPN Findings
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Contribution of IPN to Program
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Should this be done where I live?

• Is it legal?
• Funding (both in overall program dollars and as
  competition for DPH)
• Is there a high morbidity clinic/CBO?
• Other programs in the country
• LA County
• DPH DIS based at CBO

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Infrastructure

• Relatively large, stable agency
• CBO must have trustworthy relationship with
  community
• Wide scope of HIV and STI testing services
• Recommend working with agencies with primary
  medical care and broad spectrum of affiliated
  services
• Alternatively, agencies should have VERY strong
  relationship with a medical center/provider

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Infrastructure Considerations

• Physical space
• Where will DIS be located?
• Is there a place to interview cases?
• Storage of PHI
• Case filing at CBO or HD?
• Need system for storing case notes, monthly
  logs, lot assignments, etc.
• Is internet access an issue? Do firewalls or
  security systems prevent access to sexually
  explicit material?

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Staffing/Hiring

• Recommendations
• Strong background in HIV/STI service delivery
• Familiarity with use of internet for sex
• Know structure of agency--reduces bureaucracy and
  decreases lag time of buy-in
• Strong knowledge of referral resources
• What else?
• Extremely driven, self-motivated
• Tedious
• Curious

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Training

• Recommendations
• Require EDG, ISTDI, ASTDI
• Rotation in DPH and shadowing field staff
• Attend chalk talks and DIS all staff meetings
• Cross training in HIV and other STDs, including
  client-centered counseling
• If/when a group of CBO DIS staff exists,
  collaboration is crucial.
• Our individual mistakes are our collective
  failures.

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Expectations of DIS

• Emphasis on field work (vs. phone or internet)?
• Other clinic duties? Will this person be
  expected to perform four jobs?
• Reporting and surveillance responsibility
• Morbidity reports, record searches, determining
  case status/initiation
• Running partners out of jurisdiction?

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Issues to Anticipate

• Self-disclosure
• Appropriate vs. Inappropriate
• When is disclosure beneficial?
• Diplomacy
• Disagreements with medical providers
• Culture of public health programs
• Uncooperative clients
• Interviewing former sex partners
• Interviewing fellow staff at your agency

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Supervision

• When/how will case supervision occur?
• When/how will administrative supervision occur?
• How will case/admin supervisors interact?
• What happens when there is disagreement between
  them?
• Who will DIS go to for case definition/surveillanc
  e issues?

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Conclusions

• Community-based partner services programs can
  work!!! If
• Identify collaborator who is stable, believes in
  public health mission, has high morbidity of
  disease
• Expectations are clear up front
• Training/supervision goals are established
• Continued collaboration between CBO and DPH

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Acknowledgements

• HB DIS Staff Daniel Pohl, Mark Pineda, Richie
  Diesterheft (and former staff)
• CDC/CDPH/IDPH Staff (Especially Laurie Anderson,
  John Creviston, Dr. Carol Ciesielski, Dr. Irina
  Tabidze and Dr. Will Wong)
• HB Nurses and Providers

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Wrap-Up

• Questions/Comments?
• Thanks!
• Contact info
• Beau Gratzer
• 773.388.8864
• beaug_at_howardbrown.org