CP29 - Innovations to Sustain HIV and Hepatitis C Screening and Linkage to Care Efforts: Point-of-Care Testing Through Street Medicine Teams
Poster Type: Innovation
Primary Funding Source: Gilead FOCUS Grant and LA Christian Health Centers, Street Medicine Funding
Category: Expanding Access to Care and Other Services; Improving Care for Special Populations; Patient and Community Engagement; Quality of Care and Quality Improvement; Social Determinants of Health
Issue or Challenge: Over the course of 2020 we saw a 40% decrease overall in Hepatitis C and HIV screenings as patient visits decreased and the clinic shifted to more telehealth visits. Our linkage to care rates remained stable at 96% for Hep C and 91% for HIV. To sustain our Hep C and HIV screening, diagnosis, and linkage to care efforts during the pandemic, we began testing patients for HIV and HCV in non-traditional settings, offering point-of-care screenings both in and outside the clinic in shelters, through street medicine teams, and a mobile van testing unit in collaboration with LA County DPH.
Description of Innovation: LA Christian Health Centers is a federally qualified health center founded in the 1990’s with 2 full-time and 13 part-time satellite sites. Our mission is to serve and improve access to care for the homeless population and those living in public housing. We have performed upwards of 800 point-of-care tests to date in the community as part of our innovation to sustain Hep C and HIV screenings and linkage to care efforts. Planning involved determining a funding source for testing, collaborating with the Los Angeles County Department of Public Health in order to secure access to the mobile van testing unit, establishing workflows and clinical guidelines for screening and linkage, and supplying to and training street medicine teams for use of rapid test and implementation of screening workflows. The point-of-care tests are performed by roaming street medicine teams throughout the week and weekly testing at different locations in the community using a mobile van unit through Los Angeles County DPH. Upon detection of rapid positives on the mobile van testing unit or by street medicine teams, we draw confirmatory labs same day and schedule patient appointments for linkage to care through our HIV/Hepatitis C Care Coordinator.
Impact or Result: We have detected 50 positive Hepatitis C patients at a 12.6% seropositivity rate and 6 positive HIV patients at a 1.38% positivity rate with 67% linked to care and 2 started on rapid start ART therapy day of. All positive patients are offered confirmatory blood-based screenings in the street medicine, mobile van, or clinic settings and scheduled for linkage to care appointments to discuss diagnosis and further care. 32% of the Hepatitis C positives have been new positives. Of these new positives, we have confirmed 43% and are currently working to link the confirmed positives to care. Testing patients in non-traditional settings has allowed us to uncover both new and known Hep C and HIV positive individuals, engage with patients in a familiar setting, and increase access to healthcare services; this has also has changed the way we outreach to patients, emphasizing meeting patients where they are at.
Replicating this Innovation: Replication of these innovations in other organizations would require a similar expansion of street medicine teams and outreach, utilizing teams of healthcare providers, nurses, medical assistants, and a care coordinator to facilitate screening and linkage to care efforts from street medicine to clinic setting. These efforts would additionally require close community partnerships with organizations providing similar community-based and social service-related resources and engaging regularly with patients in street-based settings, such as case management and housing navigation teams. Finally, a means of processing, tracking, and analyzing through EMR via cooperation with IT specialists in your organization, would be an important development to allow for the successful implementation of this innovation.
Kathryn Fulton, HIV and Hepatitis C Care Coordinator, Los Angeles Christian Health Centers