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LoginFlorida Department of Health in Broward County
Decreasing Community Viral Load Through Innovative Test and Treat Program
Sonya McQueen
Disease Intervention Program Administrator
caroline.bartha@flhealth.gov
954-847-8087
Fort Lauderdale
Florida
33315
Your summary must address all the questions below:
Overview: Provide a brief summary of the practice in this section
Broward County is the second most populous county in Florida, 17th most populous in the United States with over 1.9 million people and 10% of Florida's residents. Broward County is home to an international airport that is ranked 19th in the U.S. in total passenger traffic and a sea port which is the cruise ship capital of the world. 15.4 million tourists visit our beaches each year. We are a majority/minority community with a population of 37% White, 28% Black, and 30% Hispanic of any race (U.S. Census) with one-third residents being foreign born. Nearly 15% of the residents are living below the poverty level and 20 % of children under age 18 are living in poverty. South Florida continues to be the most cost-burdened metro region in the nation with over half of Broward residents spending more than 30% of their monthly income on housing expenses. Fort Lauderdale ranks 10th nationwide as one of the most cost-burden communities. Broward County Public Schools is the sixth largest public-school system in the United States. Students are from 204 different countries and speak 191 languages.
According to the Centers for Disease Control and Prevention (CDC), the Fort Lauderdale Division of the Miami Metropolitan Statistical Area (MSA) has the highest rate of new HIV infections (40.1/100,000 persons) and the third highest AIDS case rates in the United States (18.9/100,000 persons). In 2018 Broward County had an estimated 21,048 people living with HIV/AIDS. Prior to April 30, 2017, individuals newly diagnosed with HIV in Broward County needed to wait for laboratory results, eligibility and medical appointments before starting anti-retroviral (ART) medication. This practice resulted in clients lost in the process and not engaging in care.
To improve linkage to care and decrease the rate of new HIV infections, the Florida Department of Health in Broward County (DOH-Broward) implemented a Test and Treat (T&T) program. The goals and objectives of the program are aligned with measures/indicators and targets set forth by the CDC and include:
DOH Broward’s T&T program was implemented in partnership with the Broward County Ryan White Part A Grantee Office. The evidence base for the program was the successful projects in San Diego, New York, and San Francisco. The Broward Test and Treat Program is unique because it strives to provide HIV same day primary care appointments and ART initiation and provides 30 days of ART. Additionally, the program was implemented in partnership with all 5 Ryan White Part A HIV primary care providers, and accepts clients regardless of how long they have been non-adherent to ART. In addition, Test and Treat Linkage and Re-engagement Specialists (LRS) help clients overcome barriers to retention in care and medication adherence. They ensure clients make and attend eligibility determination, medical and case management appointments, provide transportation, and make referrals to other services.
DOH-Broward developed a T&T Action Plan to address the high rates of HIV in Broward County and utilized an Incident Command System to provide organizational structure, meeting formats and After Action and Improvement Planning to manage a non-emergency response across multiple internal and external programs.
Key Processes that were monitored on a weekly basis include 1.) Training/Outreach, 2.) Social Marketing, 3.) Data Monitoring and Evaluation, 4.) Ryan White Part A Provider Engagement, 5.) T&T Implementation and 6.) Pharmacy
DOH-Broward has the largest T&T program in Florida. Since May 1, 2017 through April 30, 2019, 1,696 clients have enrolled in the program, 39% being newly diagnosed and 61% previously diagnosed who were lost to care. The one-year evaluation showed a viral suppression rate at 12 months of 87%, compared to 64% for the continuum of care in Broward County. 93% of newly diagnosed clients are virally suppressed, whereas, 79% of clients who have fallen out of care and enrolled are virally suppressed.
The specific factors that led to the success of T&T were the following: 1.) utilization of incident command system, 2.) ongoing engagement in training of stakeholders, 3.) intensive linkage and client engagement.
By increasing the percentage of persons linked to care and on ART medications, percentage retained in care and percentage with suppressed viral load, the long-term outcome will be a reduction in community viral load; therefore, decreasing transmission of the virus and rates of new HIV infection in Broward County.
Website www.broward.floridahealth.gov
A Model Practice must be responsive to a particular local public health problem or concern. An innovative practice must be -
Responsiveness and Innovation
Statement of the problem/public health issue
According to the Centers for Disease Control and Prevention (CDC), the Fort Lauderdale Division of the Miami Metropolitan Statistical Area (MSA) has the highest rate of new HIV infections (40.1/100,000 persons) and the third highest AIDS case rates in the United States (18.9/100,000 persons). In 2017, Broward County had an estimated 20,871 people living with HIV/AIDS. In 2018, the number of people living with HIV/AIDS was 21,048. Prior to April 30, 2017, individuals newly diagnosed with HIV in Broward County needed to wait for laboratory results, eligibility and medical appointments before starting anti-retroviral (ART) medication. This resulted in clients lost in the process and not engaging in care as many did not return for their follow up appointments.
In 2016, Broward County met the National HIV/AIDS Strategy target for the metrics associated with the percentage linked to Continuum of Care. Specifically, the percentage of HIV Diagnoses linked to care was 85.7% (target is 85%), the percentage of HIV Diagnoses retained in care was 76.9% (target is 90%), percentage of HIV Diagnoses with suppressed viral load was 66.1% (target is 80%).The percentages of HIV Diagnoses linked to the Continuum of Care for 2017 shows an increase, specifically in the percentage linked to care and retained in care. The percentage of HIV Diagnoses linked to care increased to 89.4%, the percentage of HIV Diagnoses retained in care increased to 81.1%, the percentage of HIV Diagnoses with suppressed viral load also increased to 73.8%. According to the Continuum of Care for 2018, 91.1% were linked to care. The percentage of HIV Diagnoses for those retained in care is at 78.5%. HIV Diagnoses with a suppressed viral load for 2018 is at 70.8%.
US Department of Health and Human Services (DHHS) guidelines currently recommend universal Antiretroviral Therapy (ART) for all people living with HIV regardless of CD4 count immediately after HIV diagnosis. There are few documented programs in the US that support this recommendation. Even with the current recommendations, only three US cities have published on immediate ART after HIV diagnosis; they include San Francisco, San Diego, and New York.
What target population is affected by problem (please include relevant demographics)
The top priority populations based on persons living with HIV disease (HIV prevalence surveillance data) are the following:
What is the target population size? What percentage did you reach?
Per the Florida Department of Health (DOH) 2017 Broward County surveillance data, there were an estimated 20,871 individuals living with HIV/AIDS, accounting for 3,100 (15%) who are unaware of their HIV status. Of the 20,871 people living with HIV/AIDS who were aware of their diagnosis, the percentage linked to care was 94.2%, the percentage retained in care was 70.3%, and the percentage with a suppressed viral load was 64.4%. 2018 surveillance data indicates 94.1% were linked to care, the percentage of those retained in care increased to 70.9%, and the percentage of those with a suppressed viral load also increased to 66%.
DOH-Broward has the largest Test and Treat program in Florida. Since the program’s inception on May 1st, 2017 through April 30th, 2019, a total of 2,016 individuals diagnosed with HIV and currently not on ART medication were referred to the T&T program. Of the total referred, 1,696 (84%) were eligible for the program, meaning they were confirmed HIV positive and 320 were ineligible. Of the total eligible for the program, 1,696 (84%) were successfully enrolled in the T&T Program which is determined by receipt of ART medications and 72 refused participation. Of the 1,696 enrolled, 665 (39%) were newly diagnosed and 1031 (61%) lost to care.
The one-year evaluation showed a viral suppression rate of those retained at 12 months of 87%, compared to an estimated 64% for the continuum of care in Broward County. Of those clients enrolled in Broward's Test & Treat program for the first two years, 50.8% were virally suppressed within 90 days of enrollment, whereas, 36.8% of enrolled clients acquired viral suppression in more than 90 days. 93% of newly diagnosed clients enrolled in the program are virally suppressed, whereas, 79% of clients who have fallen out of care and enrolled are virally suppressed. Continually decreasing viral load will reduce the number of new infections in the County.
T&T enrollment is the best measure of linkage to care because it ensures clients receipt of ART medications. The specific factors that led to the success of T&T were the following: 1.) utilization of incident command system, 2.) ongoing engagement in training of stakeholders, 3.) intensive linkage and client engagement.
What has been done in the past to address the problem?
In the past, the standards for initiation of ART after HIV diagnosis have varied and often were determined by CD4 count levels and physician discretion.
https://hab.hrsa.gov/sites/default/files/hab/clinical-quality-management/2014guide.pdf
Why is the current/proposed practice better?
DOH-Broward’s strategy is unique because it addresses both newly diagnosed HIV positive and previous HIV positive individuals who are re-engaged in care. In addition, DOH-Broward’s T&T program is designed to focus on re-engagement in HIV care and the delivery of comprehensive essential support services through partnerships with community providers that therefore ensure people living with HIV/AIDS continue to receive ART medications.
Is it a creative use of existing tool and practice?
The HIV care continuum is a tool supported by the DHHS and consists of several steps required to achieve viral suppression. This tool measures the effectiveness of the practice of linkage and retention to HIV care and will be used to measure improvements in these measures as a result of T&T program implementation.
Specifically, CDC tracks:
Using both incidence and prevalence-based HIV continuum of care methodologies, we can evaluate and monitor T&T Implementation.
Source: https://www.cdc.gov/hiv/pdf/library/factsheets/cdc-hiv-care-continuum.pdf
Is the current practice evidence-based?
Recently, there has been increased evidence that demonstrates better health outcomes and reduction of infectiousness, the sooner an individual initiates ART after HIV diagnosis. The latest updated National Institute of Health (NIH) Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents living with HIV, recommends ART for all individuals with HIV regardless of CD4 cell counts. This is determined to reduce morbidity and mortality associated with HIV infection.
Source: https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/10/initiation-of-antiretroviral-therapy
The LHD should have a role in the practice’s development and/or implementation. Additionally, the practice should demonstrate broadbased involvement and participation of community partners (e.g., government, local residents, business, healthcare, and academia). If the practice is internal to the LHD, it should demonstrate cooperation and participation within the agency (i.e., other LHD staff) and other outside entities, if relevant. An effective implementation strategy includes outlined, actionable steps that are taken to complete the goals and objectives and put the practice into action within the community.
LHD and Community Collaboration
Goal(s) and objectives of practice
The goals and objectives of DOH-Broward’s Test and Treat (T&T) Program are aligned with measures/indicators and targets set forth by the CDC. The CDC’s most recent PS-18-1802 Integrated HIV Surveillance and Prevention Programs for Health Departments Evaluation and Performance Measurement Plan is to:
The long-term outcome will be a reduction in community viral load; therefore, decreasing transmission of the virus and rates of new HIV infection in Broward County.
What did you do to achieve the goals and objectives?
DOH-Broward utilized an Incident Command System (ICS) to provide organizational structure, meeting formats and After Action and Improvement Planning to manage a non-emergency response across multiple internal and external programs. The Federal Emergency Management Agency defines ICS as “a management system designed to enable effective and efficient domestic incident management by integrating a combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure. Under the ICS structure, ICS Chiefs first met daily beginning 2/5/16 where situation reports were prepared to document meeting outcomes. A T&T Action Plan was developed to address the high rates of HIV in Broward County. The Action Plan was championed by the DOH-Broward Communicable Disease Director using the approach laid out in the Program Collaboration Service Integration Model (PCSI). In February 2017, the Incident Action Plan was reviewed and updated weekly to monitor key processes that included 1.) Training/Outreach, 2.) Social Marketing, 3.) Data Monitoring and Evaluation, 4.) Ryan White Part A Provider Engagement, 5.) T&T Implementation and 6.) Pharmacy.
Steps taken to implement the program
Step 1: Referral for Newly Diagnosed Clients
A. Newly Diagnosed Client Identified at a Testing Site that does not Provide HIV Primary Care Under the Ryan White Part A Program:
B. DIP LRS Newly Diagnosed Client who is Identified at a Testing Site that Provides HIV Primary Care Under the Ryan White Part A Program:
C. DIP LRS Newly Diagnosed Client Identified at a Private Physician’s Office:
DIP LRS Step 1: Referral for Lost to Care Clients
Step 1: Referral for Newly Diagnosed or Lost to Care Client Identified while Hospitalized
DIP LRS Step 1: Referral for Newly Diagnosed or Lost to Care Clients who are identified while in the ED
DIP LRS Step 2: T&T Visit with ART Initiation
A. Recommended ART Regimens for T&T Program
B. ART Availability - ART will be available on-site at all Ryan White Part A offices that provides emergency assistance to localities (EMAs) disproportionately affected by the HIV/AIDS epidemic. This includes outpatient medical care, AIDS Pharmaceuticals Assistance, Oral Care, Health Insurance premiums and cost sharing assistance, mental health services, Medical Case Management, Outpatient Substance Abuse, Food Bank/home delivered meals, legal services, and primary care providers.
C. T&T Visit Process at a Ryan White Part A Primary Care Provider Site
1. An expedited eligibility process will be conducted. The site’s designated T&T Champion (Designated T&T Champion: A dedicated T&T Program Staff member located at each community testing site that provides HIV Primary Care) will collect and enter client’s eligibility information (proof of residence, proof of income (may be self-declaration), HIV+ test) into Provide Enterprise (PE), ensure the client completes the “Authorization to Treat” form, and contact CIED to schedule client’s appointment within two weeks to complete eligibility.
2. Client will see the on-site HIV Primary Care physician who will perform a history and physical examination, order the necessary laboratory tests, select a T&T regimen, as deemed appropriate by the physician and acceptable by the client, and provide a 30-day ART prescription. The physician may choose from one of the three recommended ART regimens or prescribe a different regimen based on client history and clinical judgment. The ART will be prescribed with laboratory results pending.
3. Client will receive a 30-day ART regimen either through the provider onsite pharmacy or physician dispensing.
4. Ideally, the client will take the first dose of medication in the physician’s office.
5. The physician will document the visit in PE.
D. T&T Process for Clients who are Identified at a Private Physician’s Office and May be Newly Diagnosed or Lost to Care
E. T&T Process for Clients who are Identified while Hospitalized (Newly Diagnosed or Lost to Care)
2. If the prescription is not provided, the DIP LRS will assess the client’s insurance status.
F. T&T Process for Clients who are identified while in the ER (Newly Diagnosed or Lost to Care)
Notes:
1. For all of the above scenarios, DOH-Broward will work with clients who are non-Broward and/or non-Florida residents on a case by case basis.
2. Any client who refuses the T&T appointment or the initiation of ART will be followed by the DIP LRS.
3. Any T&T client who cannot obtain medication following the completion of the initial 30-day supply because they could not complete the RW Part A and/or ADAP eligibility process or due to private insurance or other barriers should receive a second 30-day supply of medication from the T&T provider.
Linkage to Care, Re-engagement and Retention
A. Day 1 to 3 after ART initiation:
B. Day 5 to 14 after ART initiation:
Any criteria for who was selected to receive the practice?
Eligibility for T&T
A. Newly diagnosed HIV clients defined as:
B. Previously diagnosed HIV clients lost to care defined clients who have had any interruption in their ART.
What was the timeframe for the practice?
T&T implementation began May 1st, 2017. However, additional planning milestones are as follows:
What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s)
Training/Outreach: Training and outreach on T&T protocols have been updated and are being implemented at HIV testing sites. This includes: primary care and infectious disease providers, Hospital and Emergency Department staff, STD Disease Intervention Specialists (STD DIS), and HIV Linkage and Re-engagement Specialists (DIP LRS). T&T All STD DIS and DIP LRS are trained quarterly. To date, there are a total of 13 DIP LRS. Two supervisors have been hired as well as a Project Consultant and an Administrative Assistant. Training and outreach will be an activity that is ongoing and will be sustained throughout the implementation of the T&T program.
Ryan White Part A Provider Engagement: The engagement of the Ryan White providers in T&T involved developing a T&T training protocol, identifying insurance plans accepted by Ryan White Care providers, documenting which providers and pharmacies are in network for each insurance plan, creating a directory of insurance plans, identifying Ryan White T&T Champions, ongoing contact with Ryan White Part A providers and Infectious Disease practitioners, and monthly updates of insurance status.
T&T Implementation: Implementation encompassed finalizing the T&T protocol, presenting the protocol to Ryan White Part A, Broward County HIV Health Services Planning Council, South Florida AIDS Network, and the Broward County HIV Prevention Planning Council. The identification of insurance plans accepted by Ryan White Care providers, documentation of providers and pharmacies that are in network for each insurance plan, creation of a directory of insurance plans, and identification of Ryan White T&T Champions were completed in April 2017. All of these activities for this Key process will be ongoing and continuous.
Any start up or in-kind costs and funding services associated with this practice? Please provide actual data, if possible. Otherwise, provide an estimate of start-up costs/budget breakdown.
For Fiscal year (FY) 18 - 19, the allocation for Test and Treat is $2,010,452 (Below is the budget).
Employee salaries and benefits = $971,150
Prescription Drugs expenses = $1,000,000
Other expenses = $30,737
Collocated, Risk Management and HR Expenses = $8,564.88
Total for FY 18 – 19 $2,010,451.88
Total for FY 16-17 (May 2017 to June 2017) = $2,000,000 for prescription drugs.
Total = $4,010,451.88
Pharmacy: The provision of pharmaceuticals for the T&T Program required an initial bulk purchase, working with each Ryan White Provider receiving bulk purchase to determine the most effective dispensing (pharmacy versus physician) and developing a procedure and toll for inventory monitoring and reporting. The T&T Protocol was completed in February 2017, presented to Ryan White Part A in March 2017, Broward County HIV Prevention Planning Council in April 2017, HIV Health Services Planning Council in May 2017, and South Florida AIDS Network in June 2017. Implementation of T&T in Broward County began May 1st 2017. Within the first year of T&T, the total pharmacy expenditures for medications have been $1,239,223.73.
Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improve practice. Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
Evaluation
What did you find out? To what extent were your objectives achieved?
During the first two years of the T&T Program implementation (May 1st, 2017 through April 30th, 2019), a total of 2,016 individuals diagnosed with HIV and currently not on ART medication were referred to the T&T program. Of the total referred, 1,696 (84%) were eligible for the program, meaning they were confirmed HIV positive, and 320 were ineligible. Of the total eligible for the program, 1,696 (84%) were successfully enrolled in the T&T Program which is determined by receipt of ART medications, and 72 refused participation. The enrolled clients consist of 665 (39%) newly diagnosed and 1,031 (61%) previously diagnosed clients who were lost to care. T&T enrollment is the best measure of linkage to care because it ensures clients receipt of ART medications. Using T&T enrollment as a best measure for linkage to care, the percent enrolled is 84% which is just below the national target (85%) for linkage to care.
The one-year evaluation showed a viral suppression rate of those retained at 12 months of 87%, compared to an estimated 64% for the continuum of care in Broward County. Of those clients enrolled in Broward's Test & Treat program for the first two years, 50.8% were virally suppressed within 90 days of enrollment, whereas, 36.8% of enrolled clients acquired viral suppression in more than 90 days. The DOH-Broward Test and Treat program assists clients newly diagnosed with HIV, in addition, the program also assists clients who have fallen out of care. 93% of newly diagnosed clients enrolled in the program are virally suppressed, whereas, 79% of clients who have fallen out of care and enrolled are virally suppressed.
The goals and objectives of Broward County’s Test and Treat (T&T) Program are aligned with measures/indicators and targets set forth by the CDC. The CDC’s most recent PS-18-1802 Integrated HIV Surveillance and Prevention Programs for Health Departments Evaluation and Performance Measurement Plan is to:
The long-term outcome will be a reduction in community viral load; therefore, decreasing transmission of the virus and rates of new HIV infection in Broward County.
Data, Monitoring and Evaluation
Data Monitoring and Evaluation activities included the development of variables in the current Ryan White database for non-Ryan White Clients, Provide Enterprise (PE), ensuring fields match desired outcome metrics, training DOH staff in PE use, developing referrals for ‘lost to care’ clients in PE, ensuring undetectable viral loads are reported to DOH-Broward, and determining outcomes and metrics entered into Active Strategy (DOH-Broward’s performance measurement system), and identifying a follow-up protocol. PE developed by Groupware Technologies, Inc. (GTI) is a web-based relational, integrated data system used by the Broward County Ryan White Part A program to collect client-level data on sociodemographic and epidemiologic characteristics, intake and eligibility, detailed procedure-level service units, clinical outcomes, invoices, and payments. This software is used system-wide across a network of providers to collect data that is subsequently utilized for electronic reporting as well as synchronized real time care coordination of Broward County Ryan White Part A Clients. The referral system for the lost to care in PE was completed in April 2017 along with the determination of the follow-up protocol. In May 2017, variables were developed in the Ryan White database PE for non-Ryan White Clients, ensuring PE fields match desired outcome metrics, and DOH staff were trained in PE. T&T metrics and outcomes were added to Active Strategy in September 2017. The modules for Test and Treat client follow-up are currently being developed.
Did you evaluate your practice?
List any primary data sources, who collected the data, and how (if applicable)
Data Collection
List any secondary data sources used (if applicable)
Not applicable
List performance measures used. Include process and outcome measures as appropriate.
A comprehensive Monitoring and Evaluation Protocol was completed for the T&T program. This protocol uses both incidence and prevalence-based HIV continuum of care methodologies, to evaluate and monitor T&T Implementation. Using Surveillance data, a final two-year evaluation was conducted. Surveillance data is collected through both passive and active forms using mandatory HIV case reporting forms and through laboratory reporting. In addition to surveillance data, monitoring of certain T&T variables are conducted on a weekly basis. These data are collected from STD DIS and DIP LRS and then filtered through an internal T&T database. STD DIS and DIP LRS collected information through STD PRISM data-base (PRISM: DOH data management system for STD surveillance and investigation), and client and provider interviews. These monitored variables are as follows:
Metrics
Describe how results were analyzed
Active Strategy were used to monitor the process objectives above, in addition to the following monthly: 1.) The percent of clients enrolled in the T&T Program (Numerator: Total clients enrolled/denominator: Total clients referred), 2.) Percent of newly diagnosed clients in the T&T program, 3.) Percent of previously diagnosed clients enrolled in the T&T program, 4.) Percent of Clients on ART, 5.) Percent of Clients not on ART. The goals and objectives of Broward County’s Test and Treat (T&T) Program are aligned with measures/indicators and targets set forth by the CDC. The CDC’s most recent PS-18-1802 Integrated HIV Surveillance and Prevention Programs for Health Departments Evaluation and Performance Measurement Plan is to increase linkage and retention in HIV medical care among people living with HIV (PLWH). The states HIV Surveillance Data Analysis was used for linkage, retention, and suppressed viral load percentages.
A full year 2-year evaluation was conducted after May 1st, 2019. The following Evaluation Indicators were used for this process:
Indicator | Data Source | Numerator | Denominator |
Percent of newly HIV positive individuals enrolled in T&T (Goal: 85%) | T&T Database | Number of newly HIV positive individuals enrolled in T&T | Number of HIV diagnosed individuals (both New and Previous) |
Percent of previous HIV positive individuals enrolled in T&T (Goal: 85%) | T&T Database | Number of previous HIV positive individuals enrolled in T&T | Number of HIV diagnosed individuals (both New and Previous) |
Percent of HIV diagnosed individuals that achieve virologic suppression at 12 months | T&T Database | Number of HIV diagnosed individuals that achieve virology suppression at 12 months | Number of HIV diagnosed individuals (both New and Previous) |
Percent of HIV diagnosed individuals re-enrolled in T&T | T&T Database | Number of HIV diagnosed individuals that re-enrolled in T&T | Number of HIV diagnosed individuals (both New and Previous) |
Percentage of HIV diagnosed individuals screened for risk reduction intervention needs | T&T Database | Number of persons in denominator who are screened for risk reduction intervention needs | Number of HIV diagnosed individuals (both New and Previous) |
Percentage of HIV diagnosed individuals, screened for risk reduction intervention needs and identified as needing an intervention | T&T Database | Number of persons in denominator identified as needing an intervention | Number of HIV diagnosed individuals (both New and Previous) screened for HIV risk reduction intervention needs |
Percent of HIV diagnosed individuals identified as needing an intervention who were provided an intervention (FOA Target: 85%) | T&T Database | Number of persons in the denominator provided a risk reduction intervention | Number of HIV diagnosed individuals screened and identified as needing a risk reduction intervention |
Percentage of HIV diagnosed individuals screened for other essential support services* | T&T Database | Number of persons in denominator who are screened for essential support services | Number of HIV diagnosed individuals (both New and Previous) |
Percentage of HIV diagnosed individuals, who are screened and identified as needing one or more essential support services | T&T Database | Number of persons in denominator identified as needing one or more essential support services | Number of HIV diagnosed individuals screened for other essential support services |
Percent of HIV diagnosed individuals, screened and identified as needing other essential support services that are actively referred to one or more of these services | T&T Database | Number of persons in the denominator who are provided one or more of these services | Number of HIV diagnosed individuals who are screened and identified as needing one or more essential support services |
Percentage of HIV diagnosed individuals referred to any prevention service FOA target: 80% | T&T Database | Number of HIV diagnosed individuals in denominator who are referred to any prevention service | Number of HIV diagnosed individuals (both New and Previous) |
Percent of HIV diagnosed individuals retained in continuous medical care | T&T Database | Number of HIV diagnosed individuals in denominator with =2 tests (CD4 or VL) =3 months apart | Number of HIV diagnosed individuals (both New and Previous) |
Since the program’s inception on May 1, 2017 through April 30, 2019, 1,696 clients have enrolled in the program. The enrolled clients consist of 39% newly diagnosed and 61% previously diagnosed clients who were lost to care. The one-year evaluation showed a viral suppression rate of those retained at 12 months of 87%, compared to an estimated 64% for the continuum of care in Broward County.
Of those clients enrolled in Broward's Test & Treat program for the first two years, 50.8% were virally suppressed within 90 days of enrollment. Whereas, 36.8% of enrolled clients acquired viral suppression in more than 90 days. The DOH-Broward Test and Treat program assists clients newly diagnosed with HIV, in addition, the program also assists clients who have fallen out of care. 93% of newly diagnosed clients enrolled in the program are virally suppressed, whereas, 79% of clients who have fallen out of care and enrolled are virally suppressed.
Were any modifications made to the practice as a result of the data findings?
No modifications were made to the practice at this time.
Sustainability is determined by the availability of adequate resources. In addition, the practice should be designed so that the stakeholders are invested in its maintenance and to ensure it is sustained after initial development (NACCHO acknowledges that fiscal challenges may limit the feasibility of a practice's continuation.)
Sustainability
Lessons learned in relation to practice
Lessons learned in relation to partner collaboration
Is there sufficient stakeholder commitment to sustain the practice?
Having the right stakeholders and subject matter experts from the appropriate organizations has been instrumental in establishing community ownership. In addition, ensuring the proper communication channels exist between T&T Champions and T&T Key Contacts is critical in maintaining collaboration efforts.
Describe sustainability plans
Ongoing Retention and Re-engagement:
For the second year of T&T, each client will be contacted by a T&T internal surveillance clerk to ensure the client does not have any new barriers or need navigational assistance. The DIP LRS will contact the client’s provider to monitor adherence by whether the client has missed any HIV primary care appointments, labs or any medication pickups (if ADAP or RW pharmacy clients); if so, the LRS will conduct field visits and record searches to ensure the client does not have a break in their antiretroviral therapy.
Training/Outreach:
Training and outreach for HIV testing sites, primary care and infectious disease providers, Hospital and Emergency Department staff, STD Disease Intervention Specialists (DIS), and HIV Linkage and Engagement Specialists (DIP LRS), and HIV Navigators is ongoing and continuous.
Ongoing Monitoring and Evaluation:
A Monitoring and Evaluation Team is in place to ensure the T&T protocol is followed and the T&T Program is evaluated.
2019 Sealing and Educating All Little Smiles, Model Practice
