Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12DATA POINTS: A Health Department Roadmap for Enhancing Data to Care Programs 7 Best Practices andLessons Learned UtilizingSurveillancedataasaprevention strategytoincreasethenumberofHIV- diagnosedindividualslinkedtocareand therebydecreasingHIVtransmission. KeepingPeopleliving withHIV(PLWH)in carebyidentifyinggaps andbarriersand buildingaresponseto guideapositive effectisthekey. Colorado:D2C:Improving HealthAcrosstheCare ContinuuminColorado In 2007, the Colorado Department of Public Health Department (CDPHE) wanted to understand the barriers PLWH were facing when engaging in HIV care due to the high percentage of PLWH who were not in care. Addition- ally, as Colorado exceeded the nation- al average for percent of population who were uninsured, the STI/HIV/ Viral Hepatitis Branch took steps to understand why. The branch created a linkage to care coordinator (LTCC) position to understand the barriers and challenges PLWH were facing. In addition, the LTCC created a process to assist clients getting back into care. Since its beginning, the primary data source for identifying individuals who were never linked to care after diagnosis or who are not in care has been the CDPHE laboratory report- ing system (LRS). The LRS provides CDPHE with CD4 and viral load results. In Colorado all CD4 and viral load tests are reportable to CDPHE by Board of Health Rule (6 Code of Colorado Regulations 1009-9). Analyzing the data was the begin- ning of this process. The Linkage to Care (LTC) program also identified other areas for improvement. These included engaging providers to actively keep patients in care and develop a stronger Retention in Care (RIC) component. By creating mech- anisms for private practice providers to notify the LTCC of clients who are at risk of not being in care, drop-out rates can be minimized. For example, if the LTCC is made aware of frequently missed appointments, more timely in- terventions can occur. Problem solving and support strategies followed. LTC is a valuable intervention, which improves client health and decreases infection potential by identifying and eliminating barriers to care. PLWH face many barriers for continuing and/or not engaging in care. These include stigma, financial hardship, lack of insurance, cultural/religious beliefs, substance use/mental health issues, lack of transportation, service location, and personal choice. Based on CD- PHE experiences, the most frequently cited reasons for not engaging in HIV care are: (1) personal choice (i.e., “I feel healthy, why should I go to the doctor?”), and (2) lack of adequate medical insurance. Providing active LTC assistance to clients known to be not in care is an ef- fective method for reaching vulnerable populations. Throughout the years, the STI/HIV/VH Branch has expanded D2C activities to create a seamless transi- tion for clients. Now, advance Disease Intervention Specialists (DIS) provide linkage and retention in care activities to clients newly diagnosed or previous diagnosed who are co-infected with a sexually transmitted infection (STI). D2C-Related Activities to Date Overview of current D2C Activities Colorado utilizes the DIS field inves- tigation as a model to conduct active linkage to care activities. All LTC activ- ities are tracked in PRISM (the STI/HIV database). CDPHE has an established LTC program. There are three cate- gories of PLWH who are not in care; CDPHE uses the following methods to identify and offer linkage and/or reten- tion services for each category: 1) Out of care (OOC) reports are gen- erated from surveillance data on at least a quarterly basis. The first list is a line listing of PLWH who have not had a CD4 count or viral load test reported to CDPHE in the preceding 12 months. The second list is a retention/continuous en- gagement in care report for PLWH who have had two or more CD4/ VL tests performed at least three months apart in the preceding 12 months. Individuals are prioritized for follow-up based on CD4 counts and viral load levels. Individuals with recent diagnoses and those with unsuppressed/high viral loads or low CD4 counts are the highest priority for follow-up. 2) CDPHE receives referrals from medical providers for individuals who miss weekly appointments. If a patient misses an appointment, a referral is faxed to the LTC coordinator. Eight providers in the Denver metro area and two pro- viders outside of the Denver metro area send referrals for missed ap- pointments. CDPHE estimates that these providers care for 75% of the population of PLWH in Colorado. 3) DIS staff identify people new- ly testing positive or previously diagnosed with a reported unsafe exposure (relapse) and not in care. Maria G. Chaidez State Linkage to Care Coordinator Colorado Department of Public Health and Environment 303-692-2734