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in+care Newsletter

Issue 19

National Campaign to Improve Retention in HIV Care
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In This Issue
Provider Spotlight
Featured Journal Article

13 days

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Data - National Averages*

(as of 07/08/13)

Gap Measure
(n = 149 sites, 102,499 patients)


Visit Frequency Measure
(n = 147 sites, 85,897 patients)


New Patient Measure
(n = 148 sites, 6,346 patients)


Viral Load Suppression
(n = 150 sites, 124,488 patients)


*data not unduplicated
Quick Links

Campaign Headquarters

National Quality Center (NQC)

New York State Department of Health AIDS Institute


90 Church Street, 13th floor
New York, NY 10007


Work: 212-417-4730
Fax: 212-417-4684


Website Updated!

 The in+care Campaign has recently updated its website to make searching for Retention Strategies and Tools easier for you! Visit the website today to explore the new area!

Latinos and Retention


The month of June was dedicated to Latinos and retention. This group of patients is often thought of as a homogenous group, but Latinos come from over 30 countries each with its own cultural traditions, dialects, and considerations for retention in medical care. Our colleagues at the Latino Commission on AIDS presented on the concept of Confianza in the June Partners in+care webinar in Spanish and the June in+care Campaign webinar, which are both saved on the (Campaign website). Learn more about Confianza by listening to the webinars or reading the article on Latino Commission on AIDS below.
If you have implemented retention improvement strategies focused on Latino populations and you would like to share with the Campaign, please spend five minutes to report them at this link.
Upcoming Events
+ Partners in+care Webinar | Engaging Young MSM of Color in HIV Care
Tuesday, July 30, 2013 at 2pm ET
Agenda: National Quality Center is partnering with ACCESS AIDS Care in Norfolk, VA to provide this webinar. The webinar will focus on the care engagement program for young black MSM and all it does to support these young men. Specifically, the program is designed to make connections and inroads within the community to support them through the care process. This approach has enjoyed more success than waiting for people to fall out of care and trying to coax them back into care.
If you have any specific questions you would like to have addressed, please mail them in advance of the webinar to Michael@NationalQualityCenter.org. No pre-registration is needed, just enter the room as a guest at the time of this webinar.
Dial-in#: 866.394.2346
Participant Code: 397 154 6368 #
+ in+care Campaign Journal Club | New York City Care Coordination and Patient Navigation
Tuesday, August 6, 2013 at 2pm ET
Agenda: The New York City Department of Health and Mental Hygiene Department of HIV Prevention and Control will provide an overview of patient navigation services incorporated in their care coordination program model. NYC DOHMH staff will discuss how their program was designed and why in addition to sharing preliminary data with the audience in terms of how the program has affected patient retention in HIV care. In addition, Beth Israel Medical Center and Argus Community program staff will share their experiences in implementing this model of patient navigation.
If you have any specific questions you would like to have addressed, please mail them in advance of the webinar to Michael@NationalQualityCenter.org. No pre-registration is needed, just enter the room as a guest at the time of this webinar.
Dial-in#: 866.394.2346
Participant Code: 397 154 6368 #
+ in+care Campaign Webinar | Patient Navigation in its Many Forms
Thursday, August 8, 2013 at 2pm ET
Agenda: Patient Navigation has been a buzz word for several years. Did you know that there are several types of patient navigation? HRSA-HAB SPNS has funded demonstration projects that examine three of the common navigation program types and this webinar will explore each of these three types of programs. The Ruth M. Rothstein CORE Center in Chicago, IL will present on their peer navigator model. Special Health Resources for Texas of Longview, TX will present on their social work navigator model. University of North Carolina Chapel Hill will present on their nurse navigator model. The webinar will explore what each of these navigators does and how they operate.
If you have any specific questions you would like to have addressed, please mail them in advance of the webinar to Michael@NationalQualityCenter.org. No pre-registration is needed, just enter the room as a guest at the time of this webinar.
Dial-in#: 866.394.2346
Participant Code: 397 154 6368 #



+ Next Campaign Performance Data Submission

August 1, 2013



+ Next Improvement Update Form Submission
August 15, 2013
Keep up-to-date with the latest in+care events through our webpage: http://incarecampaign.org/index.cfm/75283


Latino Commission on AIDS Brings Confianza to HIV Care in the Deep South

Latinos in the Deep South is a program coordinated by the Latino Commission on AIDS.  The program serves to leverage health equity for the emerging Latino community in the southern region of the United States by providing capacity building assistance, community-based participatory research, and community organizing.


In working with service providers and the community, the Commission focuses on four key areas: leadership; unity; knowledge; and action. Fostering leadership in the Latino community is critical, especially when it comes to advocating for services tailored to the needs of Latinos. Leaders are also developed within clinical and social service organizations by providing training and technical assistance to respond in a culturally appropriate manner to the needs of marginalized communities. 
While the Latino community is extremely diverse, there are some characteristics related to Latinos that can have an impact on engagement in care. For example, language can be a significant barrier to care for Latinos that only speak Spanish. Immigration status can deter Latinos from accessing the health care system and other services. In working to build the capacity of service providers to effectively meet the needs of Latinos, the Commission focuses heavily on cultural competency, which can help to address both barriers to care and the stigma associated with HIV, and the importance of linguistic competency.


"Confianza," the process of building trust and confidence, is extremely important with this population. Building this trust requires strong listening skills (e.g., active listening, motivational interviewing skills) on the part of the provider and it also requires the time to devote to building the relationship. Once trust is established and the patient is more comfortable with the provider, the patient is often more likely to discuss their barriers to care. This can begin the discussion of what both the patient and provider can do to maintain engagement.


Providers must also recognize that with this population, "urgent comes before important." HIV may not be the top priority for this population. Other priorities, such as employment, immigration status, or family obligations may take precedence.


Service providers can work incrementally toward bilingual services-it is not an all or nothing prospect. For example, not everyone in a clinic needs to speak Spanish. Bilingual patient navigators can serve as interpreters during clinical encounters and are more likely to have the time to devote to addressing barriers to care and identifying facilitators. Frontline staff, such as receptionists, can serve as important gatekeepers and play an important role in making patients feel welcome and building trust.
While the Latinos in the Deep South Program focuses on a specific region, the Latino Commission on AIDS works with providers across the country to build capacity to provide services to Latinos. For more information on technical assistance and training contact the Commission.


Erik Valera, Program Director
Latinos in the Deep South
Latino Commission on AIDS

Treatment Outcomes in Undocumented Hispanic Immigrants with HIV Infection

Poon, K.K, Dang, B.N., Davila, J.A., et al. Treatment outcomes in undocumented Hispanic immigrants with HIV infection. PLoS ONE. (8)3: e60022. Doi; 10.1371


Little is known about the treatment outcomes of HIV-infected, undocumented Hispanic immigrants. Research has indicated that undocumented Hispanic immigrants may avoid accessing publicly funded clinics due to concerns about deportation. In addition, this population may have difficulty accessing and navigating care due to language barriers. To explore this issue, the researchers sought to compare the treatment outcomes of undocumented and document patients 12-months after entering HIV care.


The researchers conducted a retrospective cohort study of 1,620 HIV-infected adults receiving HIV treatment at the Thomas Street Health Center (TSHC) between 2003 and 2008.  TSHC is a publicly funded, free-standing HIV clinic in Houston, Texas, supported in part by several Ryan White funding streams. It provides care regardless of ability to pay. Proof of residency in the metropolitan area is required to receive care but legal residency in the United States is not.


The findings indicate that undocumented Hispanic patients entered care with more advanced HIV disease (i.e., lower initial CD4 cell counts) compared with documented Hispanic patients, White patients, and Black patients. They also had the highest HIV viral load. Once in care, undocumented patients did as well or better than documented Hispanic patients. One year after entering care, the undocumented patients had similar rates of retention and HIV viral suppression as documented Hispanic and White patients. It is important to note that Black patients were significantly less likely to be regularly retained in care or achieve HIV viral suppression.


In their discussion, the researchers raised the "healthy migrant effect." Undocumented persons often face significant challenges during their journey to the United States. Once in the United States, many work in physically demanding jobs. As a result, undocumented migrants may have high levels of resilience and self-efficacy. Possible explanations of the healthy migrant effect include selective migration, avoidance of adverse health behaviors, and greater social support. In the study, the undocumented Hispanic patients were younger than all other patients. Also, the undocumented patients were more likely to be married, which may be an indication of social support.


The researchers conclude that safety net providers such as TSHC are important sources of care for undocumented Hispanic immigrants living with HIV. Given the late entry into care that the researchers found, HIV testing and linkage to care activities that target this population should be intensified. 

Connect. With patients.
Collaborate. With a community of learners.
Change. The course of HIV. 

incareCampaign.org  |  212-417-4730