ConnectHIV

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ConnectHIV The Art of Bridging Prevention and Care
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Jerry C. Dillard Executive Director Coalition on
AIDS in Passaic County, Inc. (C.A.P.C.O.)
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• Strategic Planning for Prevention Integration

• Understanding and managing agency change
• Key consideration for policy and procedures
• Case Scenarios

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• Integrating HIV Prevention
• Into Care

• Strategic plan for prevention integration
• Policy Procedure considerations
• Understanding and managing agency change
• Agency readiness and management tasks

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• Understanding the Changes of Organizational Change

Stage 1 Loss The Change Against
Me Stage 2 Doubt Me Against
Change Stage 3 Discomfort The Change
Me Stage 4 Discovery Me Becoming the
Change Stage 5 Understanding The Change
Becoming Me Stage 6 Integration I am
The Change
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Stage of Readiness and Management Tasks
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Stage of Readiness and Management Tasks cont
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Stage of Readiness and Management Tasks
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Ironically, it may require greater intimacy to
discuss sex than to engage it. The Hidden
Epidemic - Institute of Medicine 1997
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• Stage of Readiness and Management Tasks

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• Policy and Procedures Considerations

• 1. Staff and Agency Orientation Understanding
  the role and importance of HIV prevention in care
• Understanding your staff/agency readiness and
  skills
• Understanding your staff/agency professional and
  personal limitations
• 2. Who What staff will be responsible for
  screening and/or delivering prevention messages
• Usually, all staff are in a position to initiate
  or deliver some level of prevention messages
• A unified approach is most effective (clerical,
  medical and social staff)

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• Policy and Procedures Considerations

• 3. What What will be the content of screening
  and the prevention messages?
• Staff role(s) and skills with the patient will
  determine the types of screening and prevention
  messages delivered
• 4. When At what point during the patient visit
  will screening and prevention messages be
  delivered?
• Patient registration with reception/clerical
  staff
• Initial screening
• Clinicians visits (nurse, physicians, or others)
• Ongoing during follow-up visits periodic
  diagnostic testing for STDs ad verbal inquiry

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• Policy and Procedures Considerations

5. How How will you prompt your staff to screen
and deliver prevention messages? Prompts
physician prompts, nurse prompts, social worker
prompts, patients prompts
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• Policy and Procedures Considerations

• 5b. How How will you target messages?
• Universal prevention messages Statements that
  emphasis safer behaviors for patients and
  partners. They may target all patients or
  segments of your patient population. They address
  some misconceptions
• Sample messages STDs increase transmission of
  HIV, viral undetectable does not equal
  non-infectious
• Individualized patient education/counseling
• Group patient education/counseling
• 6. Where Where will messages be delivered?
• Waiting room or lobby
• Hallways
• Counselors rooms
• Examination rooms

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Patient Barriers and Readiness
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• Strategies to Reduce Barriers

• Patient Orientation Normalizing integration of
  HIV prevention in care
• Establish rapport and a non-judgmental
  stance
• Your care at this facility will be
  comprehensive. We will consider all aspects of
  your life Your T-cells, viral loads, sexual
  activity and drug use
• As part of our services we ask all of our
  patients about history of STDs, STD symptoms,
  substance use and risks for pregnancy because
  they directly impact your health outcomes
• As with all information that is collected
  what you tell us about your sex life and drug
  use is held as confidential information

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• Provider Barriers - Personal

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• Provider Barriers - Professional

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• Two Strategies to Integrate
• Prevention Into Care

• Enhance internal capacity and process within care
  unit
• Partnership with a program that specializes in
  prevention

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• Scenario 1
• Enhance Internal Capacity

• Coalition on AIDS in Passaic County, Inc. (CAPCO)
• In-House Process
• Telephone screening and appointment scheduling
  patients informed during first contact they will
  meet with Case Manager and Prevention Specialist
• Prevention Specialist meets with patient 10 20
  minutes to introduce preventions services
• Case Manager completes biopsychosocial assessment
  inclusive of risk screening questions
• Case Manager refers continued risk patients to
  Project CHANGE for no-going risk reduction
  services

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• Scenario 2
• Partner with External Provider

• Coalition on AIDS in Passaic County, Inc. (CAPCO)
• Prevention Partnership with Clinical Services
  Providers
• CAPCOs Project CHANGE partners with early
  intervention programs, drug treatment and mental
  health clinics servicing PLWHAs
• Universal prevention education is delivered in
  waiting rooms to patients awaiting clinical
  services
• Individual level interventions services are
  delivered in private office space
• Group level interventions are delivered to drug
  treatment and mental health groups

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A man who conceals his disease cannot treat his
disease!
African Proverb

• It is our job to support him in revealing his
  disease!