a referral to an HIV specialist. She had spent six months suffering from severe flu-like symptoms that left her unable to hold down her job as a labor compliance officer. She was rendered homeless and put her son in foster care. Soon after her diagnosis, she attempted suicide. Only after three and half years passed did she finally find an HIV specialist. “If I was diagnosing people,” Mendez says,“I would shuttle them somewhere where they would get the social support and the medical knowledge to get information so that they know what they’re dealing with. You need the social support in order to care enough to take care of yourself and your HIV.”
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(PREVIOUS SPREAD AND THIS PAGE) JONATHAN TIMMES
T JUST SO happens that the shuttles Mendez imagines do exist. When outreach workers at DC’s Community Education Group get a positive result in one of their mobile testing units, they send a “linkage team” in unmarked vehicles to offer a ride to the doctor right then and there. Such tactics are working—and getting noticed. Last year, during the XIX International AIDS Conference, held in DC, U.S. Secretary of Health and Human Services Kathleen Sebelius singled out CEG for achieving a 95 percent linkage rate. Ingrid Floyd, executive director of New York–based Iris House, which provides comprehensive support services to women and families affected by HIV, says the system of care “really works when the client feels accountable to the case manager. We treat our clients as family. There is a genuine care and concern about seeing improvements in health for everybody.” Iris House has a 98 percent linkage into care rate. These agencies serve as an adjunct to area clinics or hospitals that have neither the wherewithal to conduct outreach into specific hard-hit communities, nor the funding to provide non-medical services like case management. DC’s increasingly symbiotic system of engaging people with HIV into care appeared broken in 2007 when Sharon L. Hader,
MD, MPH, became director of the HIV/AIDS, Hepatitis, STD and TB Division of the District of Columbia Department of Health. The district had a 3 percent HIV prevalence rate, and over 6 percent of black males had HIV. With just 48 percent of the HIV population in care and 24 percent on medications, only 12 percent were virally suppressed. “We were still having a high rate of AIDS-related mortality, which is ridiculous in the era we’re in,” says Hader, who is now vice president and director of the Center for Health Systems and Solutions at the Futures Group, a global health consulting firm. Beginning in 2009, Hader borrowed a highly successful model from DC–based Whitman-Walker Clinic (now known as Whitman-Walker Health) called the“Red Carpet Program.” HIV testing sites were encouraged to direct newly identified people with HIV to care providers who agreed to schedule a doctor’s appointment within 48 hours. She also worked to improve connections between outreach groups and health clinics to ensure more effective cooperation and communication between all the city’s players in the HIV care system. Each summer Hader sponsored a“recapture blitz”in which health care providers went all out trying to reel in lost patients. While the average patient required numerous contacts before returning to care, they typically came back because they felt a social obligation to the person on the other end of the phone. “In many cases, they had dropped out of care because someone had been rude to them the last time they came in,” Hader says.“The longer people had been out of care, the less likely they were to remember why they stopped going and they were actually easier to get through the door.” Thanks to such efforts, the proportion of people with HIV entering care within three months of diagnosis in DC increased by 31 percent between 2006 and 2010. In 2010, 90 percent of new cases entered into care within a year and 76 percent within three months.
“I WAS IN DENIAL ABOUT BEING POSITIVE.”
Monica Thompson made a dramatic turnaround in her HIV care.
poz.com MARCH 2013 POZ xx