The Campaign's active phase will be transitioning to a sustaining phase as of January 1, 2014. Even though the Campaign's newsletters and webinars will slow down, the Campaign is here to stay! You'll still be able to submit your retention performance data online and receive benchmarking reports for the years to come. News and important content related to the in+care Campaign will be shared and disseminated through the NQC eNewsletter and the ongoing monthly NQC TA Calls. Starting in January 2014, focus will shift to highlight the results of all your hard work and to feature community providers that have shared retention improvement strategies they have put in place at their agencies. 

Cooper University Health Care Early Intervention Program (Cooper EIP), Camden, New Jersey
Cooper EIP provides multidisciplinary services to approximately 800 patients per year. Offering a comprehensive array of services, including HIV testing, all at one site plays an important role in supporting linkage and retention. Currently, for established patients the retention rate is 85 percent.
Patient navigation for new patients and those lost to care is an important component of the program. The on-site testing services, which include a rapid test to confirm infection, allow the navigator to link patients to care quickly, within 24-72 hours. To support ongoing retention, the program provides transportation support, which is one of the greatest barriers to patients returning to care. Reminder phone calls are made three days before appointments and letters are mailed to patients that miss appointments.  New patients and those lost to care are provided immediate access to services-no appointment necessary. The centralization of services is also an important aspect of the program. For example, phlebotomy services are provided on site.  Patients do not have to go to another facility, where they might face additional barriers to care such as co-payments and may once again face the challenge of transportation.

The program has also conducted quality improvement activities to assess patient satisfaction and make services more user-friendly.  These activities are coordinated by the full-time performance improvement outcomes manager.  "Workouts" are conducted, which involve staff dialogs about barriers related to specific services. Based on findings, workflows are developed to improve the patient experience. For example, staff explored the clinic's reception area. Given the large number of services offered, the reception area was extremely congested. A more streamlined process was developed to ease in take.  The process of scheduling appointments was separated from the front office to remove the bottleneck that often occurred at the front desk,

A challenge recently faced by the program was major staff turnover over the course of a year.  It took time for new employees to adjust to the new work environment and co-workers.  It also took time for patients to develop a comfort level with new employees. Filling vacancies as quickly as possible helped to address this challenge.

Ohio Department of Health
Ohio has long recognized the critical role of engaging, retaining and re-engaging Ohioans with HIV in appropriate care services. While counseling and testing services sites have referred people who test positive to Ryan White case management and HIV care providers, an increasing number of newly diagnosed individuals needed more assistance to transition into care.

Efforts to connect newly diagnosed individuals to HIV care revolve around linkage to care (LTC) coordinators. There are eight full-time and one half-time LTCs based in local health departments and hospital emergency departments. The LTC positions were initially funded in January 2013 but the Ryan White Part B program has funded several Early Intervention case managers for several years. While the Ohio Department of Health (ODH) has a standard linkage protocol, local health departments tailor their activities to address needs within the community.
 

An annual needs assessment required by the Ryan White grant found that HIV data are stored in many databases in Ohio. The databases did not align with one another. Durther, it is not easy to use the databases in real time to identify people who are lost to care. ODH recognized the need to provide easy access to a single data system that would allow linkage to care coordinators to identify people who needed to be linked or re-engaged in HIV care and store information about the services provided to these individuals. 

In 2013, ODH's was approved but not funded by CDC to build a bridge among its data systems. Despite this setback, ODH committed funding to develop a solution to link information from CAREWare, HIV surveillance, and partner notification service databases.  The new system is called the Linkage and Re-engagement in HIV Care (LARHC) database.  HIV care, prevention, surveillance, and care subject matter experts worked closely with IT staff in developing the LARHC database. A collaborative contribution of both in-kind and real funding is supporting to the implementation of the LARHC database. 
 

ODH expects that the LARHC database will be available to staff providing linkage to care assistance or case management in 2014. Performance measures and assignment details of retention and re-engagement activities have not been finalized. In particular, ODH is still looking at which staff will primarily be used to reach out to patients that have been lost to care (e.g. Ryan White case managers, surveillance, disease intervention specialists). Most likely, the LTC coordinators will play a significant role since the skills they use to link newly diagnosed individuals to care can also be effective in re-engaging patients. In the new system, each patient will be given a unique identifier to facilitate tracking.