HIV/STD Prevention for HIV Positive Women:

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HIV/STD Prevention for HIV Positive Women

• Integration of Family Planning Services and HIV
  Care

2004 National STD Prevention Conference Philadelph
ia, PA. March 2003
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Authors

• Brian M. Green, MS
• Manager-Quality Improvement Planning
• Circle of Care
• Erika Aaron, RN, CRNP
• Director of Womens Services
• HIV/AIDS Medicine Section
• Drexel University School of Medicine
• Jill Foster, MD
• Medical Director
• Special Immunology HIV Family Clinic
• St. Christophers Hospital for Children

Jim Witek, MD Medical Director Partnership
Comprehensive Care Practice Rashidah
Abdul-Khabeer, RN, MHS Deputy Director, Circle
of Care Alicia Beatty, MA Director, Circle of
Care Marie Ransell Coordinator, Perinatal
Services Circel of Care
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Learning Objectives

• Discuss different approaches to integration of
  HIV/STD prevention and family planning
• Identify 5 steps that will enhance your clinics
  ability to integrate HIV/STD prevention, family
  planning, HIV care

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CDC New Initiatives

• Circles integration of HIV/STD prevention for
  PLWH predates CDCs Advancing HIV Prevention
  Initiatives
• Routine HIV testing in medical settings
• Rapid HIV testing for diagnosing infection
• Secondary Prevention for PLWH
• Further decrease Perinatal transmission of HIV
• Purpose increase who know their HIV status
  increase HIV into care

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Circle of Care

• Ryan White Title IV GranteePhiladelphia, PA
• Network of HIV clinical and support service
  providers
• Served 1400 HIV affected families FY03
• Built upon a vision of integrated and family
  focused services

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Integration Settings

• Family Planning Clinic with integrated HIV
  prevention services immediate linkage to care
• HIV Ambulatory Family Clinic in pediatric
  hospital. Integrated STD, family planning, and
  ob/gyn services.
• HIV Ambulatory Clinic in teaching hospital,
  integrated STD, family planning, and ob/gyn
  services (presentation focuses on this last one)

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Partnership Comprehensive Care Practice (PCCP)

• Comprehensive HIV clinic, integrated family
  planning services in 1999.
• 1,400 patients, 40 women
• Heterosexual transmission of HIV
• Increase in planned pregnancies among HIV women.
• Uninsured-20 family planning-33

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PCCP, continued

• Integration of on-site GYN and colposcopy
  services
• Co-management of pregnant women with Dept. of
  OB/GYN
• Pre-conceptual counseling
• HIV Rapid Testing pilot project

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PCCP, Planning for Services

• Needs Assessment
• Consumer focus groups
• Service utilization data
• Ensure practice wide buy-in
• Internal staff education
• Presentations by Title X (FP) staff
• Multi-disciplinary planning meetings
• Cross-department meetings
• Service utilization forecasting

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PCCP, FP Patients
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PCCP, Family Planning Data
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Case Study Common Elements

• Identifying the range of care and prevention
  issues/challenges/needs for any given client is
  ongoing and complex
• Screening services and other prevention services
  may need to be offered to consumers many times
  over long periods of time before they accept
  services
• Consumers need support for disclosure decisions,
  critical for effective prevention
• Peer counselors can have a key role in bridging
  care and prevention for a client (or reconnecting
  client to care)
• Establishing rapport/building trust key

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PCCP, Integration Challenges

• Change from traditional ID control focus to
  collaborative model of care
• Staff-additional education training on family
  planning/prevention issues
• Tensions in providing new services that address
  sensitive issues
• Added clinical responsibilities
• Increased administrative/reporting functions

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Integration Readiness Assessment

• What services are most needed to address HIV
  prevention needs of your clients? What services
  are most needed to address STD prevention needs
  of your clients? What services are needed to
  integrate care and prevention?
• What services are likely to be accepted and used
  by clients? Is co-location of services feasible?
  Are staff ready for co-management and
  coordination challenges? Which staff are
  affected? Can you provide cross-training of
  staff?
• Are prevention services offered continuously to
  clients (not just at intake or annual visits)? Do
  providers assist HIV positive clients with
  disclosure decisions?
• Is there a role for peer counselors for hard to
  reach clients?

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Essential Steps for Integration

• What are you trying to achieve? Plan your
  outcomes
• Know the prevention and care needs of your client
  populations
• Integration Readiness Assessment
• Implement core services 1st, add additional
  services incrementally
• Use CQI process to continually monitor, assess,
  and modify integration efforts

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Team Assessment Process

• Process for assessing integration ideas
• Identify potential services to integrate
• Rating of potential services
• Why is this item important to our clients? our
  outcomes?
• What can it tell us about quality of care?
• Process helps consolidate, eliminate, or revise
  items, or identify root causes

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Conclusions

• Prevention Interventions for PLWH must include
  support for disclosure decisions
• Need clear protocols for Partner Notification
  (PCRS) and consent for PCRS
• Providers considering integrating prevention
  services for PLWH need to have ability to provide
  range of support services (ex domestic violence
  screening referral)
• Prevention for PLWH is not a one-time service,
  need for ongoing services, and continual
  assessment and support
• HIV Rapid testing offers considerable promise for
  getting HIV into care as soon as possible, but
  provider trust and need for disclosure support
  and connection to peers only heightened