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in+care Newsletter

Issue 21

National Campaign to Improve Retention in HIV Care
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In This Issue
Patient Navigation Field Examples
Patient Navigation in Networks

55 days

until the next data submission deadline

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Data - National Averages*

(as of 09/10/13)

Gap Measure
(148 sites, 115,302 patients)


Visit Frequency Measure
(146 sites, 98,922 patients)


New Patient Measure
(146 sites, 5,476 patients)


Viral Load Suppression
(145 sites, 135,754 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!

Transitory Populations and Retention


This newsletter issue examines how migration and transitory populations have special concerns regarding their healthcare - since they are on the move, their care can be challenging to coordinate. Strategies to keep transitory populations engaged in ongoing healthcare will be essential to ensure that progress toward the National HIV/AIDS Support goal of an AIDS free generation can be realized.
If you have implemented retention improvement strategies involving migrant or transitory populations and you would like to share your experiences with other Campaign participants, please spend five minutes to report them at this link.
Upcoming Events
+ Partners in+careWebinar | Positive Women's Network - USA Explores Retention from the Community Perspective
Tuesday, October 8, 2013 | 1pm ET 
Agenda: The Positive Women's Network - USA has worked with women living with HIV across the U.S. for many years. Over time, the network has amassed a strong understanding of the issues at play for women of all walks of life regarding their barriers and facilitators to staying engaged in HIV care. Staff from PWN-USA will discuss the range of issues they have encountered regarding retaining women in ongoing HIV care. Common strategies for improving retention will also be shared in addition to nuances and details that are not often well understood by others who are not part of this community. This will be accomplished by sharing the stories of several hypothetical women. 

The webinar will host a panel discussion to cover questions and comments related to retaining in ongoing HIV care. Then panel will include women from many backgrounds and from across the U.S. Please note that no prior registration is needed to participate in this webinar. Just click the webinar link to join and enter the room as a guest. Type your name when prompted to enter the webinar room. If you have any questions, comments or concerns you would like addressed during the presentation, please send them to Michael Hager in advance (Michael@NationalQualityCenter.org).


Dial-in Number: 866.394.2346
Participant Code: 397 154 6368 #
Webinar URL: http://www.nqcqualityacademy.org/incarecampaign
+ Partners in+care Webinar | The Massachusetts SPECTRuM Initiative: Peers & Nurses in Partnership
Thursday, October 17, 2013 at 2pm ET
Agenda: Over the last several months, the in+care Campaign has heard several examples of peer-based programs that improve retention. For this webinar, the Massachusetts Department of Public Health (MDPH) Bureau of Infectious Disease (BID) will share information about its Strategic Peer-Enhanced Care and Treatment Retention Model (SPECTRuM) initiative. SPECTRuM is an acuity-based program that identifies HIV-positive individuals with high levels of need, and provides these individuals with an intensive, short-term set of services to support long-term retention in care. Services are provided by peer/nurse teams and involve the use of HIV laboratory data to identify patients who may benefit from SPECTRuM services. Sophie Lewis, Director of Service Development at the BID Office of HIV/AIDS, and Noelle Cocoros, the BID Director of Research and Evaluation, will share details on how the SPECTRuM model was developed, how it is being implemented, and some of the early program outcomes that have been noted. After the presentation, there will be a panel discussion including NQC's peer consultant Adam Thompson, Sophie Lewis, and two SPECTRuM peer navigators.


As always, please feel free to forward any questions to Michael in advance of the webinar (Michael@NationalQualityCenter.org). Note that no pre-registration is needed to join this webinar. At the webinar start time, click the link below and enter as a guest. When prompted, enter your name or an alias to use during the webinar.

Dial-in Number:    866.394.2346
Participant Code: 397 154 6368 #
Webinar URL: http://www.nqcqualityacademy.org/incarecampaign


+ in+care Campaign Journal Club | Baligh Yehia, MD | Retention in Care and Health Outcomes of Transgender Persons Living With HIV
Tuesday, November 12, 2013 at 2pm ET
Agenda: Transgender individuals are nearly universally seen as being a highly vulnerable group, with regards to both illness and health care. A recent study, however, shows that disparities in HIV care for transgender individuals with access to care in comparison to non-transgender individuals are narrowing. During the webinar, Dr. Yehia will share the results of this study with the in+care Campaign community. In addition, he'll describe how the findings of the study are directly applicable to the ongoing retention work at clinics and health departments across the U.S. The presentation will be followed by a question and answer period with the study author.

Please note that no prior registration is needed to participate in this webinar. Just click the webinar link to join and enter the room as a guest. Type your name when prompted to enter the webinar room. If you have any questions, comments or concerns you would like addressed during the presentation, please send them to Michael Hager in advance (Michael@NationalQualityCenter.org).  
Dial-in Number:     866.394.2346
Participant Code: 397 154 6368 #
Webinar URL:       http://www.nqcqualityacademy.org/incarecampaign
+ Next Retention Measures Submission Date
December 2, 2013



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


Provider Spotlight: Migrant Clinicians Network

Farm workers are what comes to mind when most people think of migrant workers. However, migrant workers-somewhere between 20-25 million of them in the United States-are a diverse population that includes construction workers, workers in the restaurant and hospitality industry, and many other workers who frequently move in search of employment opportunities. Most, although not all, of these jobs are low paying and do not provide benefits
 ,like health coverage.

Such mobility can present many challenges-learning to negotiate new communities, ensuring consistent schooling for children, and maintaining the continuity of health care, especially for chronic conditions. Migrant workers are not necessarily immigrants, although many are. These individuals may face both language barriers and the challenge of functioning in a foreign culture.

The Migrant Clinicians Network's (MCN) goal is to improve health care for migrants by providing support, technical assistance, and professional development to clinicians in Federally Qualified Health Centers (FQHCs) and other health care sites.  In addition, MCN provides critical tools that allow clinicians to effectively serve this population.

Maintaining the continuity of care is perhaps the greatest challenge when working with migrants-how do you retain a patient who may only live in your community for 3-4 months? Subsequent providers may have no idea of the care previously provided due to a lack of access to medical records. This can result in either redundancy or a complete breakdown in care.

To address this challenge, MCN developed the Health Network.  The Health Network assures continuity of care and treatment completion by providing comprehensive case management, medical records transfer, and follow up services for mobile patients. It is an easily modifiable patient navigation system with application in disease surveillance and treatment management. At the center of the Health Network model is the case manager, who retain all patient records in a database. Encrypted medical records are sent electronically to new providers. The Network has been successful in managing patients as they move around the United States and even internationally.

The Health Network is ideal for chronic conditions, such as cancer, diabetes, tuberculosis, and HIV. It is also used to serve pregnant women who move during their pregnancy. In 2012, over 1,100 patients were enrolled in the Health Network and there were over 22,000 encounters between clinics and patients. Patients were followed in 45 states and 63 countries. The results speak for themselves. For example, 84 percent of tuberculosis patients completed their treatment-just slightly below the national rate of 88 percent.

The Health Network helps facilitate access to care for patients. They maintain a relationship with their MCN case manager as they move from community to community. As they build a relationship with new providers they always have access to their trusted case manager. The case manager also identifies providers in each new community so the patient does not need to figure out where they should go for care and worry about things like eligibility.

Ryan White grantees with mobile patients are eligible to use MCN's Health Network. MCN is already working with Ryan White grantees in New Jersey and the NO/AIDS Task Force in New Orleans.

For more information on MCN | http://www.migrantclinician.org

Journal Spotlight - Evaluation of Longitudinal Clinical Outcomes and Adherence to Care among HIV-Infected Refugees

Winston, S.E., Montague, B.T., Lopez, M.J. et al. Evaluation of longitudinal clinical outcomes and adherence to care among HIV-infected refugees. Journal of the International Association of Providers of AIDS Care 2013, 12(3): 202-207.

There is a limited body of research related to the long-term HIV treatment outcomes for HIV-infected refugees in the United States. To explore the impact of refugee status and experiences on success in HIV care, the researchers conducted a retrospective study comparing demographic and longitudinal clinical data from HIV-infected refugees from sub-Saharan Africa with non refugees receiving care at the Miriam Hospital Immunology Center in Rhode Island.

In 1999, U.S. law prohibiting HIV-infected persons from resettling in the United States was revised, allowing HIV-infected refugees to enter by waiver. In January 2010, HIV infection was removed as cause of inadmissibility to the United States. In 2009 and 2010, close to 75,000 HIV-infected refugees entered the United States. The number of HIV-infected immigrants could increase in the coming years given that the United Nations High Commission for Refugees estimates that there are 15 million refugees worldwide. There are 2 million refugees from sub-Saharan Africa, the region with the highest HIV prevalence.

As opposed to foreign-born immigrants who resettle by choice, refugees face many challenges. Fleeing their home country due to fear of persecution, war, and/or violence, refugees often endure difficult living conditions, poverty, malnutrition, physical and psychological trauma, and minimal or no access to health care. Once resettled in the United States, challenges include a lack of familiarity with the American medical system, the concept of preventative care, and management of chronic diseases.

The goal of the study was to identify differences in long-term outcomes of viral load (VL) suppression and immune restoration between refugees and non-refugees and to identify the contributing factors that could indicate potential targets for interventions to improve care for refugees. The study sample included 51 HIV-1-infected refugees from sub-Saharan Africa. Each refugee was matched with two HIV-infected non-refugees by gender, CD4 category, and closest date of their initial appointment. Outcomes analyzed included CD4 counts, VL, antiretroviral treatment use, appointment adherence, opportunistic infections, and resistance mutation. Baseline data were abstracted from medical records. Laboratory data were obtained from clinical databases and verified against the paper chart and hospital electronic records.

The researchers found that a similar percentage of refugees and non-refugees initiated ART at a similar CD4 count and with similar timing. They found no difference in achievement of viral suppression between the two groups and both groups had prolonged periods of viral suppression. While the refugees had similar rates of overall viral suppression, they were more likely to experience recurrent viremia once suppressed. Over time, refugees were also less adherent to their appointments.

Based on their findings the researchers suggest that in working with refugees, service providers should closely monitor engagement in care over time. Since engagement was highest early in care when case management services were most intensive, more research is needed on the role of case management and other support services on retention. The researchers also suggest that given the small sample size, larger studies are necessary to further investigate the recurrent viremia in this population.

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

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