2. +
Access to Care
Study after study outline the importance of consistent HIV care
n Based on his cumulative research, Edward M. Gardner, et
al. estimates only 50% of those who know they are positive
are retained in care, and a mere 24% of those who know
their positive status have achieved an undetectable viral
load. This is crucial to reducing HIV transmission in light of
recent research headed by Myron Cohen, M.D.
indicating a 96% decrease in HIV transmission between
serodiscordant couples when the partner with HIV
initiated antiretroviral therapy while their immune system
as still stronger (CD4 350 and 550) and builds on years of
mounting evidence that a lower viral load reduces the risk
of HIV transmission.
3. +
Access to Care
n Engagement in routine HIV care, in
addition to the public health benefits of
reduced HIV transmission, reduces
overall costs of treatment through:
delayed disease progression, extension
of productive life years, and avoidance
of costly emergency care.
4. +
Who is out of Care?
In North Carolina generally and the NC Positive Charge Initiative
n In North Carolina, an Age of Clients, NC PCI
estimated 23.4% of those
18-24
who know they are HIV+ are
not receiving HIV medical 25-29
care. 30-39
40-49
NC Epidemiologic Profile for HIV/STD Prevention 50+
and Care Planning (12/11)
Annual Income, NC PCI Race, NC PCI
American Indian/
Alaska Native
<$20,000
Black, non-
$20,000-40,000 Hispanic
$40,000-80,000 Hispanic
Missing
White, non-
Hispanic
5. +
Why are people out of Care?
Barriers to Care and Meeting Basic Daily Needs
NC Positive Charge Initiative clients
Current Needs of NC PCI clients at Enrollment
70
percentage
60
50
40
30
20
10
0
Drug and Housing or Food or other Dental services HIV-related Non-HIV Pharmacy or Mental health
alcohol abuse shelter subsistence medical related medication services
treatment need services medical services (for
services HIV or non HIV
reasons)
6. +
NC Positive Charge
Initiative
Key Partners:
North Carolina Community AIDS Fund
Hertford County Public Health Authority
Mecklenburg County Health Department
Partners In Caring
RAIN
Started in July 2010, the NC Positive Charge Initiative is
designed to find people who know their positive status but
are out of care, connect them to HIV medical care, and
support those in care that face barriers to adhering to care.
NC Positive Charge Initiative access to care.
7. +
Program Outline
North Carolina Positive Charge Initiative
n Teams of 2-3 part-time Access
Coordinators work to identify The Positive Charge Initiative serves rural, suburban, and
people who know they are HIV+ urban areas of the state, reaching clients in 18 counties.
but out of care, bring them into
care, and retain people in care
who are at risk of disengaging
n Access Coordinators received
PETS (peer education) training
and the specially designed
Access Coordinator training:
n planning an event, outreach,
identifying resources, public
speaking, self care n Funding for the Positive Charge
Initiative is provided by AIDS
n Access Coordinators split their United and Bristol-Myers Squibb
time between their HIV agencies
and non-HIV community settings
8. +
n The HCPHA is the lead agency in the local HIV
Network of Care; it is the only agency
providing HIV care in the region. The team
consists of the Program Manager, 2 RNs, 2
Medical Case Managers, 1 Jail Testing
Coordinator and 3 Access Coordinators. Many
of the services that can be, are brought to the
location of the clients for a one stop shop
approach to care.
n The work is accomplished with the aid of a
mobile unit to hold clinics in different areas to
Hertford County Public attempt to overcome the huge transportation
Health Authority challenges in the region. HCPHA has 5 mobile
clinic sites and 1 fixed site clinic.
Tommy Jones, Access Coordinator
Delton Smith, Access Coordinator n We see the clients on a quarterly basis; the
Tracy Bristow, HIV Program more constant contact is needed to keep
Manager them engaged in care. Having the Access
Coordinators has added another layer in the
ability to make that personal connection with
clients. The ACs attend all clinics and lab days
to work with clients as needed which has been
important as issues with clients have popped
up, clients have a chance to meet with them
immediately.
9. + n Two Access Coordinators work in
conjunction with the Access
Coordinators at RAIN to provide
services to the residents of
Mecklenburg County.
n The Access Coordinators have
received referrals from the Disease
Intervention Specialist program, case
managers, HIV testing programs,
Mecklenburg County local clinics, current clients, and other
Health Department service providers.
Lamont Holley, Access Coordinator
n The Access Coordinators invited
DeVondia Roseborough, Access
Coordinator
numerous service providers to an
evening of food, fellowship, and
Brian Witt, Supervisor, Health
Education education in the effort to promote
the Positive Charge Initiative in
Mecklenburg County. The event
allowed providers and Access
Coordinators to develop strategies to
successfully implement the project.
10. + n The team of three Access
Coordinators serve a six-county
region.
n Many of the counties served lack
adequate transportation to medical
care and supportive services.
Partners in Caring Positive Charge
Initiative project offers home visits,
linkage to care, medical transport
and education activities and events.
Partners In Caring
n Access Coordinators work very
Cressie Stokes, Access Coordinator
closely with the New Hanover
Hayden Braye, Access Coordinator
Regional Medical Center’s HIV Clinic
Suzette Curry, Senior Clinical in order to secure continuity of care
Chaplain – Community Educator
for clients. ACs along with with their
supervisor attend monthly quality
improvement meetings with the HIV
Care Team in order to update and
report changes with an out of care
list created by the clinical staff.
11. + n RAIN has been providing HIV services
to the Charlotte community for 20
years. Their team of two Access
Coordinators have expanded that
work to include access to care.
n The Access Coordinators are working
with medical care providers and
case managers to identify people
who have missed three medical
RAIN appointments to bring them back
Regional AIDS Interfaith Network into care.
Dee Dee Richardson, Access
Coordinator
n The Access Coordinators continue to
Richard Mills, Access Coordinator
focus some of their outreach work on
health fairs but are placing more
Cheryl Roberge, Director of CARE
Management focus on events that offer HIV testing.
n Through the Positive Charge Initiative,
a new partnership has been started
to work with the public housing
authority to provide education and
connect residents to care.
12. + n The North Carolina Community AIDS
Fund (NCCAF) is a Community
Partnership of AIDS United,
administering grants statewide and
serving as an AmeriCorps Operating
Site in the Triangle in addition to our
Access to Care work.
n As the project lead, NCCAF
coordinates communication
North Carolina between project partners and
Community AIDS Fund conducts the project evaluation.
Beth Stringfield, Project Coordinator
n NCCAF provides orientation and
Kimberly Walker, Principle
Investigator
annual training for the Access
Coordinators.
Sammy Tchwenko, Evaluator
n Tools have been developed for
Access Coordinators and resources
gathered for agencies working with
peers and conducting access to
care work.
13. + Tools for Partners
To support program development and staff
www.NCcommunityAIDSfund.org/positivecharge.php
Outreach Self Care
14. +
Successes
n Since enrollment began in last 2010, over 100 clients have
entered the project, an additional 40+ people have
received PCI services, dozens have received HIV testing,
and hundreds have received HIV education.
n Preliminary data show an increase in the mean CD4
count and decrease in viral load in six months of clients’
active enrollment in the program.
n Additionally, the percent of clients with an undetectable
viral load has grown, based on preliminary data.
n A skills-based curriculum was developed to prepare
Access Coordinators to fill these newly created positions.
n We have seen improved referrals systems for HIV care and
support and reduced no-shows at medical clinics.
15. +
Successes
n Access Coordinators have conducted HIV education and
prevention outreach at public housing complexes,
community colleges, churches, and colleges, and have
hosted community HIV testing events.
n New partners in HIV prevention and education have
been identified in the three regions.
n Strong integration of the Access Coordinators onto the
staff has increased capacity of agencies and allowed
new services to added.
n Private funding has provided the flexibility needed to
serve clients across county lines, regardless of their current
engagement in HIV medical care, and to have a single
position provide a continuum of services from education
and prevention to supportive care.
16. +
Lessons learned
n Training is important. Challenge: Access Coordinators that
don’t receive the initial training have been at a significant
disadvantage in their position, however logistics and
expenses prevent hosting it for each new person. The 3-
day Access Coordinator curriculum is being broken down
into individual learning modules for new staff members.
n Street and community outreach is difficult. Challenge:
people have been out of care for a reason, finding then
in the broader community is extremely time consuming,
leading us to focus more on those who are new to care
and tenuously in care.
n Basic HIV education is still needed. Challenge: Access
Coordinators have been faced by significant deficits in
general HIV knowledge, as a result they have been doing
more HIV education than anticipated.
17. +
Lessons learned
n Transportation costs remain a barrier. Challenge: the
amount of travel for outreach, connecting clients to care,
and individual clients’ transportation remain high in spite
of PCI funding for transportation, a mobile medical unit in
the northeast, and public transportation in Charlotte.
n Access Coordinators need to be fully integrated in the
agency. Challenge: Access Coordinators that are not
validated as full staff members have not be as successful
in reaching their enrollment numbers, conducting
outreach work, and have lower job satisfaction. Some
factors that contribute to the success of the program
have included providing Access Coordinators adequate
work space and tools, introductions to the staff and clear
distinct job roles, support from the leadership,
incorporating PCI into the referral system, and assuring
Access Coordinators participate in agency meetings and
trainings.
18. +
NC Positive Charge Initiative is a
project of the North Carolina
Community AIDS Fund
2812 Erwin Road, Suite 403
Durham, NC 27705
919.613.5431
www.NCcommunityAIDSfund.org
