PACHA l February 2020 l Day 2 Pt 1: Jumpstart Jurisdictions

PACHA l February 2020 l Day 2 Pt 1: Jumpstart Jurisdictions


>>OKAY, WELCOME EVERYONE TO THE SECOND DAY
OF THE 66TH MEETING OF THE PRESIDENTIAL ADVISORY COUNCIL ON HIV/AIDS. PACHA. I’M CARL SCHMIDT
COCHAIR AND AS YOU HEARD YESTERDAY, MY CO CHAIR JOHN REESMAN IS WITH THE SECRETARY OF
HEALTH AND HE IS BACK IN THE STATE ADDRESSING THE CORONA VIRUS THERE, AND AND HE SENDS HIS
REGUARDS YESTERDAY AND AND GIVE YOU AN UPDATE ON THE EPIDEMIC INITIATIVE, WE ALSO HEARD
SOME GREAT NEWSOT BUDGET AND WE FOCUSED ON THE [INDISCERNIBLE] IN THE D. C. METROPOLITAN
AREA, TODAY WE HAVE ANOTHER GREAT DAY AHEAD OF US, FOCUSING ON ON HEARING REPORT ON FROM
THE JUMP START SERIES AND HE WILL TALK ABOUT HIV AND THEN WE WILL HEAR FROM AMBASSADOR
BROOKS FROM THE APPROVAL–WE HAVE SOME WORK TO DO AND–SO WELCOME PEOPLE IN THE ROOM AND
WELCOME TO THE PEOPLE WHO ARE WATCHING VIA LIVE STREAM AND–THEN AFTER THE ROLL CALL
WE’LL GO AROUND THE ROOM SO WE KNOW ALL OF OUR GUESTS AND FEDERAL COLLEAGUES AT THE TABLE
STARTING WITH THE ROLL CALL P A CHA CO CHAIR CARL SMITH.
>>HERE.>>JOHN WEESMAN.
>>P A CHA MEMBER GRAHAM ALTMAN, MEMBER MARK MEECHAMILLIO, PROBLEM RAFAEL NAVALLE, P A
CHA MEMBER ROBERT CHAP IRB O, P A CHA MEMBER JUSTIN SMITH.
P A C HA AVA STEWART.>>AND LIAISON AS AN JEN KATES, THAT COMPLETES
THE ROLL CALL AND WE WILL START, I ENTERPRISING OUR COLLEAGUES AROUND THE TABLE AND PARTNERS.
>>HI, EVERYONE I’M HEATHER, DEPUTY ASSOCIATE ADMINISTRATOR FOR THE HRS,A HIV/AIDS BUREAU.
>>HI, SAMUEL [INDISCERNIBLE] PUBLIC HEALTH ADVISOR.
>>GOOD MORNING RIFTAL WITH THE MEDICAL OFFICER AT THE CENTER FOR MEDICARE, MEDICAID SERVICES
WITH MEDICARE.>>GOOD MORNING BRETT WATSON SECRETARY FOR
[INDISCERNIBLE]>>OFFICE OF INFECTIOUS DISEASE AND HIV POLICY.
>>GOOD MORNING HARRISON [INDISCERNIBLE] SENIOR ADVISOR OFFICE OF DEED AND HIV/AIDS POLICY.
>>GOOD MORNING–PROGRAM COORDINATOR PER INDIAN HEALTH SERVICE.
>>FEDERAL PARTNERS [INDISCERNIBLE].>>WE ALSO HAVE TWO FEDERAL PARTNERS I WANT
TO–HAROLD PHILLIPS IN THE CHIEF OPERATE OFFICER AND DOROT SETHE OFFICE OF WOMEN’S HEALTH.
>>THANK YOU SO STILL WAITING THE ARRIVAL OF P A CHA MEMBER JUSTIN SMITH, HE WILL BE
MODERATING AND HE IS ON HIS WAY, I DON’T WANT TO LOSE TIME SO WE’RE GOING TO START BUT WHAT
WE’RE GOING TO FOCUS ON FIRST, WITH REPORTS ARE OF THE JURISDICTIONS THAT HAVE RECEIVED
REALLY POETIC DEBEGIN THE EPIDEMIC INITIATIVE IN THE JURISDICTIONS, AND WE’VE INVITED EACH
OF YOU, THE JURISDICTIONS, AND IN THE [INDISCERNIBLE] AND MERO KEY NATION AND GIVING PRESENTATIONS
AND WE WILL BEGIN WITH [INDISCERNIBLE] AND THEN WE WILL TURN IT OVER TO JUSTIN.
>>SO GOOD MORNING EVERYONE, AS YOU KNOW THE JUMP START PROGRAM WAS A WAY FOR US TO REALLY
GET STARTED WITH THIS REALLY IMPORTANT INITIATIVE AND IT’S REALLY IMPORTANT THAT WE LEARN FROM
WHAT WE’VE ALREADY DONE AS WE MOVE FORWARD TOWARDS THE NEXT PHASE OF THIS INITIATIVE,
AND WHAT HAPPENED SO FAR.>>GREAT.
SO HELLO, GOOD MORNING I’M ADENA GREENBALM, I’M THE ASSISTANT DIRECTOR FOR HIV STD VENTION
AT THE BALTIMORE CITY HEALTH DEPARTMENT.>>ON BEHALF OF BALTIMORE’S MAYOR YOUNG AND
DR. LETICIA, THEY THINK YOU FOR INVITINGITOUS SHARE OUR EXPERIENCES WITH YOU AND WE COMMEND
THIS COMMITTEE AND OUR NATIONAL LEADERS FOR YOUR INTEREST IN THE LOCAL PERSPECTIVE.
SO FIRST I WOULD LIKE TO GIVE YOU A REVIEW OF BALTIMORE’S EPIDEMIOLOGY, WE HAVE TWO STORIES
OF HIV IN BALTIMORE AND THE FIRST IS OF INCREDIBLE SUCCESSES, THIS IS THE NEW HIV INFECTIONS
IN BALTIMORE EACH YEAR SINCE 1985 AND WE’VE SEEN 80% DECREASE IN INFECTIONS OVER THE PAST
27 YEARS AND HAVE GONE FROM OVER 1000 NEW INFECTIONS TO UNDER 250 NEW INFECTIONS EACH
YEAR. THIS IS DUE IN PART TO THE SUCCESSES OF SYRINGE
SERVICES AND DECREASES OF INFECTIONS IN PEOPLE WHO INJECT DRUGS.
HOWEVER THERE’S ANOTHER STORY OF HIV IN BALTIMORE. HIV PREVALENCE IS HIGH AT 1800 PEOPLE LIVING
WITH HIV PER 100,000 POPULATION ONE IN SEFBT AND BALTIMORE ARE LIVING WITH HIV.
AND OVER ONE-THIRD OF NEW CASES ARE IN THOSE UNDER 30.
OUR NATIONAL TREND, THIS SHOWS THE PROPORTION OF PEOPLE AND BY EXPOSURE CATEGORY, RACE AND
SEX AT BIRTH. I PRESENT THIS DATA TO YOU HESITANTLY EVERYONING
IT CAN REINFORCE STIGMA AND WE WILL TRY TO USE AN EMPATHETIC LANGUAGE WHILE TALKING ABOUT
IT. THERE ARE MANY STORIES TOLD BY THIS FIGURE
AND TODAY I WILL HIGHLIGHT JUST A FEW, HALF THE PEOPLE LIVING IN HIV IDENTIFY BLACK MEN
REPORTING HETEROSEX Y’ALL, AND EXPOSURE, WOMEN AMONG ALL RACES AND *EGT NITRIC OXIDES MAKE
UP 33% OF PEOPLE WITH HIV. THIS GRAPHIC ONLY PARTIALLY CAPTURES HIV AS
STORY INEQUITY SAYS, THOSE WHO WERE AFFECTED BY POVERTY, ACCESS TO MEDICAL CARE, UNSTABLE
HOUSING, AFFRICKED WITH MENTAL ILLNESSES OR SUBSTANCE ABUSE AND THOSE OF RACIAL, SEXUAL
GENDER MINORITIES AND WE CAN’T IGNORE THE ROLES THAT INNS TUITIONAL RACISM AND SOCIAL
INIQUITIES PLAY IN HIV RISK. I WANT TO SHARE THE FRAMEWORK WE USE IN BALTIMORE
WHEN ADDRESSING HIV. THIS GRAPH SHOWS OUR HIV CASCADE.
OVER 12,000 INDIVIDUALS IN BALTIMORE ARE ESTIMATED TO BE LIVING IN HIV AND 59% ARE VIRALLY SUPPRESSED.
AMONG RYAN WHITE RECIPIENTS BIOSUPPRESSION RATES ARE HIGHER IN THE BALTIMORE METROPOLITAN
AREA 89% OF RYAN WHITE RECIPIENTS ARE SUPPRESSED AN AMAZING ACCOMPLISHMENT.
THE STEPS HERE ARE WHAT WE CALL THE WORK -FRPLT IT’S THE WORK INCLUDED IN ENDING EPIDEMIC
AND THE WORK WE ALL KNOW MUST BE DONE, TESTING, LINKAGE, TREATMENT.
BUT JUST AS IMPORTANT IS WHAT WE CALL THE WORK BEFORE THE WORK.
IT INCLUDES ADDRESSING STIGMA, ADDRESSING MEDICAL AND PUBLIC HEALTH MESS TRUST AND STATUS
NEUTRAL CARE. OUR COMMUNITY LISTENING HAS TOLD US THAT TRUST
IN MEDICAL AND PUBLIC HEALTH INSTITUTIONS IS ERODING AND IN SOME CASES ALREADY BROKEN,
THERE CAN ISSUE FREE HIV TESTING ON EVERY STREET CORNER BUT IF A PERSON DOESN’T TRUST
THE ACCURACY OF THE TEST, IF THEY DON’T TRUST THAT THE PERSON DOING THE TESTING HAS THEIR
BEST INTEREST AT HEART, IF THEY DON’T INTEREST THAT THE MEDICAL SYSTEM WILL BE THERE FOR
THEM AND HELP THEM HEAL. IF THE STIGMA SURROUNDING THE DISEASE IS SO
STRONG THEY CAN’T DISCUSS THEIR DIAGNOSIS WITH FAMILY OR FRIENDS, OUT OF FEAR FOR BEING
OSTRACIZED OROT STREET, IT DOESN’T MATTER HOW ACCESSIBLE THE TESTS ARE, THEY MUST BE
USED AS MUCH AS WE LIKE. WE ALSO THINK ABOUT THE WORK AROUND WORK AND
AS OTHERS HAVE MENTIONED, PREVIOUSLY, WE CAN’T ADDRESS HIV WITHOUT ALSO ADDRESSING THE EPIDEMICS
OF HEPATITIS C, OPIOID EPIDEMIC AND DRUG USE AND MORE SYPHILIS, WHERE THERE ARE THREE AND
HALFTIMES ALREADY HIGH NATIONAL AVERAGES. THE WORK AROUND THE WORK IS ALSO THE SOCIAL
DETERMINANTS OF HEALTH. ADDRESSING HIV PREVENTION MEANS ADDRESSING
POVERTY, HOMELESSNESS, MENTAL HEALTH AND OTHER SOCIAL DETERMINANTS WHICH ARE SOME OF THE
DRIVING FORCES BEHIND THE INFECTION. FOR EXAMPLE, IN BALTIMORE IT IS A 20 YEAR
DIFFERENCE IN LIFE EXPECTANCY BETWEEN NEIGHBORHOODS THAT ARE JUST 6-MILES APART, A THIRD OF CITIES
HAVE ADVERSE TRIALS AND EXPERIENCES, WHICH IS THE LEVELFUL TRAUMA EXPERIENCED IN THE
COMMUNITY AND 18% OF THE POPULATION IS BELOW THE FEDERAL POVERTY LEVEL.
THIS MAP OVERLAYS TRANSMISSION RATES WITH POVERTY LEVELS AND SHOWS HIGHER RATES OF TRAPEZIUS
MISSION ARE MORE HIGHER IN POVERTY COMPARED TO LOW POVERTY.
MOVING THE NEEDLE IN HIV MEANS ADDRESSING THESE ISSUES HEAD ON.
WE TRANSLATE OUR FRAMEWORK TO ANY ACADEMIC PILLARS.
IN ADDITION TO PUTTING PROGRAMMING BEHIND DIAGNOSIS, TREATING, PREVENTING AND RESPONDING,
WE DO IT THROUGH A LENS OF ADDRESSING STIGMA, MISTRUST, SIN DEMICS AND SOCIAL DETERMINANTS.
SUCCESS IN PILLARS DEPENDS ON ADDRESSING THE WORK BEFORE THE WORK AND THE WORK AROUND THE
WORK. SO NOW GENE VVIEVE WILL PROVIDE AN OVERWORK
OF THE ACTIVITY IN THESE COMMUNITIES.>>WE HAD 14 INITIATIVES AS PART OF OUR JUMP
START ACTIVITIES. I WILL HIGHLIGHT A FEW OF THEM HERE, 90% OF
THE FUNDS THAT WE RECEIVED WERE CONTRACTED OUT TO PARTNERS.
ALTHOUGH GROUPED INTO THE EHE PILLARS, WITH KNOWLEDGE THAT ACTIVITIES RARELY FIT SQUARELY
IN ONE CATEGORY SO UNDERDIAGNOSED WE INITIATED A RECORD HIV TESTING PROGRAM, IN THE DEPARTMENT,
AS PART OF OUR MOVE TOWARDS HIV TESTING IN CLINICAL SETTINGS.
WE ALSO INITIATED AT HOME HIV AND STI TESTING, INDIVIDUALS CAN ORDER HIV AND STI TESTS THROUGH
OUR WEBSITE. IN THE PRIVACY OF THEIR HOME, THEY CAN CONDUCT
A RAPID HIV TEST AND THE TEST RESULTS ARE IMMEDIATELY AVAILABLE.
THEY CAN ALSO SUBCOLLECT FOR STI TESTING AND SEND THEM TO THE LAB FOR RESULTS WHICH WE
CAN CHECK THROUGH A SECURED ONLINE PORTAL. OUR GOAL IS TO INCREASE THE NUMBER OF PEOPLE
WHO ARE AWARE OF THIS STATUS BY OFFERING A VARIETY OF HIV TESTING OPTIONS.
WE ALSO EXPANDED NONPRACTICE DITIONAL HIV AND STI TESTING TO INCLUDE CO LOCATIONS WITH
OUR SYRINGE SERVICES PLAN AND PRIORITIZE TESTING AS USEFUL HOST EVENTS.
UNDER THE TREATING PILLAR WE INITIATED–PROVIDES LINKAGE TO CARE, RESOURCES FOR PROVIDERS AND
FASTERINNISHIATION–AND ALSO GETTING TO ZERO WISHES A CLINICAL AND PROVIDER LEVEL OF
AND AND WHO MIGHT BE IN NEED OF ADDITIONAL SERVICES.
PROVIDERS ARE THEN ABLE TO MORE EASILY TRACK PROGRESS ACROSS THEIR PATIENT PANEL, DEDICATED
STAFF PROVIDE ENHANCED CASE MANAGEMENT FOR THOSE WHO ARE NOT VIRALLY SUPPRESSED AND WE
ARE FINDING SOME OF THE MOST IMPORTANT ADDITIONAL SERVICES ARE THOSE THAT ADDRESS SOCIAL DETERMINANTS
OF HEALTH AND OCCUR OUTSIDE OF THE ROLES OF THE CLINICS.
PROVIDERS HAVE REPORTED THAT THE ENHANCED CASE MANAGEMENT OF AN INDIVIDUAL LEVEL INCLUDING
PROVISION OF TRANSPORTATION TO APPOINTMENTS, CLOTHING, TOILETYS, ASSISTANCE WITH OBTAINING
PHOTO ID, AND HEALTH INSURANCE AND GOING TO ASSIST WITH HEPBTAL ASSISTANCE APPLICATION
HAS ALL BEEN INSTRUMENTAL IN ELIMINATING THE BARRIERS TO ENGAGEMENT IN PATIENT CARE.
FOR PREVENTS WE SUPPORTED A PREP NAVIGATION AT TWO SQACS WITH THE FEDERALLY QUALIFIED
HEALTH CENTERS WHICH ARE BOTH INVITED TO JOIN OUR COLLABORATORS.
THEM IS A GUP OF CLINICS AND COMMUNITY BASED ORGANIZATIONS PROVIDING PREP SERVICES WHO
COME TOGETHER TO SHARE DATA, BEST PRACTICES AND ADVICE.
UNDER PREVENT WE ALSO SUPPORTED A NEW FOCUS, TRANSGENDER FRIENDLY EMPOWERMENT AND TRAINING
PROGRAM, WE HAVE SUCCESSFULLY–WE HAVE BEEN SUCCESSFUL AT THROUGH SOCIAL NETWORK AND STRATEGY,
BY BUILDING TRUST, MENTORSHIP, ADDRESSING HIGH PRIORITY NEEDS SUCH AS FOOD, HOUSING,
EMPLOYMENT, AND OTHER SOCIAL DETERMINANTS OF HEALTH, WE CAN THEN MORE EFFECTIVELY ENGAGE
IN THE AREA OF SEXUAL HEALTH RISK REDUCTION INCLUDING PREP AND HIV TESTING.
AND WITH HIV BY EDUCATING COMMUNITY MEMBERS AND PROVIDERS ON THE BENEFIT OF A. R. T. ADHERENCE.
WE ALSO INITIATED SOME WORKFORCE ACTIVITIES WHICH INCLUDE TRAUMA INFORMED CARE, AMONG
OUR STAFF, AND INCREASING AWARENESS OF HIV AMONG THE HIV–AMONG THE HEALTH DEPARTMENTS
NONHIV OUTREACH STAFF. WE ALSO INCLUDED A CROSS CUTTING PILLAR OF
COMMUNITY ENGAGEMENT AND AWARENESS. ACTIVITIES ENCLUEDED LISTENING SESSIONS, MEDIA
CAMPAIGNS, STORY TELLING, EVENTS AND SOCIAL INNOVATION AND DESIGN.
FOR EXAMPLE, THESE PHOTOS SHOW A FEEDBACK SESSION ON A DESIGN PROTOTYPE AND ONE OF OUR
30 TELLING EVENTS. IT’S IMPORTANT TO NOTE THAT OUR COMMUNITY
AND SOCIAL ENGAGEMENT EFFORTS ARE CRUCIAL IN REACHING THE GOAL OF 90% OF HIV REDUCTIONS
IN TEN YEARS,–WHICH HELPS TO INFORM THE DEVELOPMENT
OF OUR ENDING THE EPIDEMIC PLAN. SO WE’VE BEEN VERY FREIGHTFUL TO THIS OPPORTUNITY
WITH BALTIMORE AND ALLOWED US TO ENGAGE WITH PARTNERS AND I WILL MENTION OUR CHALLENGES
AND WHETHER WE GO FROM HERE. SO I WOULD LIKE TO FRAME OUR CHALLENGES AROUND
THREE AREAS, TRUST, COLLABORATION AND ACCORDIATION AND WHAT I CALL THINK NATIONAL, ACT LOCAL.
THE FIRST IS TRUST, WORK, PILLARS ENGAGEMENT, INNOVATION, REQUIRES TRUST OF OUR COMMUNITY
AND OUR PARTNERS. WE KNOW SOME TRUST HAS BEEN LOST, WE MUST
INSURE WE PRESERVE AND BUILD UPON THE TRUST THAT WE HAVE.
COMMUNITY ENGAGEMENT NEEDS TO BE MEANINGFUL COMMUNITY ENGAGEMENT.
WE CAN ONLY MAKE PROMISES THAT WE CAN KEEP, AND WE NEED TO CLEARLY SHOW COMMUNITY FEEDBACK
REFLECTED IN OUR ACTIVITIES. OUR COMMUNITIES KNOW THAT SERB DETERMINANTS
DRIVE HIV. IF WE CAN’T DELIVER ON STATUS NEUTRAL CARE,
ADDRESSING THOSE SOCIAL DETERMINANTS FOR PEOPLE WHO ARE HIV POSITIVE AND HIV NEGATIVE, THAT
TRUST CAN BE THREATENED. SECOND IT’S COLLABORATION AND COORDINATION
AND I’LL PROVIDE THREE EXAMPLES OF THIS. FIRST, THE PROGRESS MADE IN COLLABORATION
AND WORKING ACROSS SILOSSA THE DEPARTMENT OF HEALTH AND HUMAN SERVICES HAS BEEN COMMENDABLE
THE LAST FEW MONTHS AND WE APPLAUD ALL OF THE IMPROVEMENTS IN COLLABORATION.
HOWEVER, CHALLENGES AT THE LOCAL LEVEL REMAIN. AS AN EXAMPLE, WE NEED GREATER AWARENESS AT
THE LOCAL LEVEL OF THE IMPLEMENTATION RESEARCH AND COMMUNITY INTEGRATION ACTIVITIES THAT
ARE FUNDED THROUGH ALL OF THE HHS ACTIVITIES ENCLUEDING SAMSHA, IHS, HRSA, AND NIH, THIS
CAN BE ACCOMPLISHED THROUGH WEBSITE OR OTHER ACTIVITY THAT COULD BE UPDATED REGULARLY,
ACTIVITIES CAN BE COORDINATEDDA THE LOCAL LEVEL AND HEALTH DEPARTMENTS ARE WELL POSSIBLED
TO ASSIST WITH THIS AND IF THEY WERE STANDARD PRACTICE–STANDARD PRACTICALIS TO INFORM US
OF ALL THE EEG ACTIVITIES IN OUR JURISDICTIONS. SECOND IS THE STRONG BODY OF EVIDENCE THAT
SUPPORTS RESPONDING TO THE ENDEMIC OF HIV EPITITIS C AND STIS AND DRAWING USE IN AN
INTEGRATED WAY. THIS IS ALSO VERY RESPONSIVE TO HOW PATIENTS
WISH TO RECEIVE THESE SERVICES. BETTER INTEGRATION OF THE FUNDING STREAM AND
AT THE LOCAL COMMUNITY LEVEL AND EMPOWERING HEALTH DEPARTMENTS TO FOCUS MORE ON PROGRAM
DEVELOPMENT AND INTEGRATION WHERE THERE ARE DATA TO SUPPORT A GOOD RETURN TO THAT INVESTMENT
AND THIRD COLLABORATION AT THE LOCAL LEVEL, WE ARE TRYING TO BUILD A SENSE OF URGENCY
AROUND REPORTING AND RESPONDING TO NEW HIV INFECTIONS AND WITH THE HEALTH COMMUNITY,
JUST AS A SENSION OF EREMERGENCE AND WE HAVE A CULTURE OF RAPID REPORTING FOR HIV SO WE
PROVIDE THE PATIENT AND THE MEDICAL SYSTEM WITH RESOURCES IN A TIMELY MANNER.
AND ANOTHER EXAMPLE IS PREP. SCIENTIFICALLY PROVEN WE’RE STRUGGLING WITH
IMPLEMENTATION ON A POPULATION SCALE FOR IT TO BECOME AN EFFECTIVE PUBLIC HEALTH INTERVENTION.
GETTING ON PREP AND EVEN MORE SO STAYING ON PREP IS HARD.
CONVINCING YOUNG PEOPLE TO TAKE A MEDICATION DAILY WHEN THEY’RE WELL, WITH FREQUENT DOCTOR
VISITS AND TREMENDOUS STIGMA THAT THE MEDICATION IS SAFE AND EFFECTIVE WITH CONCERN ABOUT PRIVACY
AND COSTS THAT GO FAR BEYOND THE COST OF A PILL IS A CHALLENGE.
SO HOW DO WE MOVE FROM THESE CHALLENGES TO INNOVATION.
WE MUST FURTHER INCORPORATE STIS, INCLUDING STI CLINICS AND OPIOID EPIDEMIC WITH HIV PREVENTION,
AND INCORPORATING ENDING EPIDEMIC ACTIVITIES AND DATA, INTO ALREADY ONGOING AND SUCCESSFUL
HIV PREVENTION AND TREATMENT THAT WE’VE BEEN DOING FOR DECADES IS IMPORTANT INNOVATION
IS NEEDED TO IMPROVE SURVEILLANCE SYSTEM WHICH IS FROM THE FOUNDATION OF THE HIV PUBLIC HEALTH
SYSTEM TO MORE RAPIDLY IDENTIFY CASES AND CONDUCT PARTNER SERVICES AND INTEGRATING PRACTICES
VENTION MORE CLOSELY WITH RYAN WHITE AND TREATMENT TO INCLUDE THE AND CULTURE THAT’S CON-STRUCTURALLY
APPROPRIATE AND NEEDS ENHANCES AND DOES NOT HINDER US
REACHING OUR GOALS. WE MUST CONTINUE TO FUND VACCINE AND CURE
EFFORTS ADDRESSING SOCIAL DETERMINANTS REMANYSA THE FOUNDATION NOT ONLY OF HIV TREATMENTS
BUT ALSO HIV PREVENTION AND THE LARGE ROLE THAT STIGMA PLAYS KAOBT BE OVERLOOKED.
ADDRESSING STIGMA ON A POPULATION LEVEL AND DETERMINING NOW TO MEASURE IMPACT IS ESSENTIAL
FOR THE SUCCESS OF THE FOUR PILLARS. AND ALL OF THIS RELIES ON ENGAGEMENT OF OUR
COMMUNITY. THE PEOPLE OF BALTIMORE ARE OUR GREAT ELF
STRENGTH. OUR COMMUNITIES ARE RESILIENT AND THEY’RE
ENGAGED. OUR INNOVATION IS NOT THE INNOVATION OF THE
HEALTH DEPARTMENT ALONE BUT IT LIES–ITS SOURCE LIES IN THE INDIVIDUALS THAT MAKE UP THE COMMUNITIES
WE SERVE. WE RELY ON THEM FOR INSPIRATION GUIDANCE.
I WOULD LIKE TO END WITH OUR CAMPAIGN, EXAMPLE OF OUR CAMPAIGN, PEOPLE WHO LOOK LIKE ME DEVELOPED
AS PART OF OUR COMMUNITY ENGAGEMENT AND AN EXAMPLE OF THE INNOVATIVE WORK WE’RE EXCITED
ABOUT CONTINUING. PEOPLE WHO LOOK LIKE ME ARE DOCTORS, ARE MARRIED,
DOCTORS, NURSING MOTHERS, PATIENTS LIKE ME DESERVE TO BE HEARD.
PEOPLE WHO LOOK LIKE ME WANT EVERYONE TO KNOW WE ALL HAVE A ROLE IN ENDING THE HIV EPIDEMIC.
>>SO ON BEHALF OF OUR HEALTH COMMISSIONER DR. GROIR, AND THE BALTIMORE CITY HEALTH DEPARTMENT,
THANK YOU FOR INVITINGITOUS SHARE OUR THOUGHTS WITH YOU TODAY AND OUR CONTINUED THOUGHTS
AND WORK AND DEDICATION. [ APPLAUSE ]
>>THANK YOU IF ARE THAT WONDERFUL PRESENTATION, SO NOW WE HAVE A QUESTION FOR ADMIRAL GROIR.
>>[INDISCERNIBLE].>>[LAUGHTER]
>>THE INTEGRATION OF SERVICES IS SOMETHING WE REALLY STRUGGLE WITH BECAUSE WE’RE SOMEWHAT
LIMITED BY THE WAY FUNDING STREAMS COME IN HOW THEY BRING TOGETHER.
I’VE ALWAYS AND WE HAVE HRSA FOLKS HERE BUT THE RYAN WHITE PROGRAMS IN THE COMMUNITY AND
HEALTH CENTER HAVE BEEN OUR BEST HOPE OF INTEGRATING THOSE BECAUSE YOU CAN GET BASICALLY ALL OF
THOSE AT ONE SPOT AND THUS WE’VE BEEN VERY SUPPORTIVE OF MOVING THAT FORWARD.
I AM GOING TO ASK YOU A QUESTION ABOUT WHAT YOU MEAN BUT I WILL MAKE ANOTHER COMMENT IS
THAT ON THE FLIP SIDE OF IT, THE SUBSTANCE USE DISORDER COMMUNITY PARTICULARLY THE OPIOID
TREATMENT PROGRAMS, VERY FEW OF THEM EVEN TEST FOR HIV, MUCH LESS HAVE PREP SERVICES
SO I THINK THE INTEGRATION HAS TO COME FROM THE OTHER SIDE YOU KNOW AS WELL SO WE’RE PUSHING
ON THAT SIDE OF THE EQUATION, AND OF COURSE, I WILL GO PREACH TO THE AMA IN A MOMENT ABOUT
ROUTINE HIV TESTING BUT IF YOU CAN TALK ABOUT REALLY WHAT THAT MEANS THAT WE NEED TO DO
TO HELP YOU INTEGRATE THOSE SERVICES, IN A BETTER WAY, IF YOU ARE TALKING NOT ABOUT COMMUNITY
HEALTH CENTERS AWARE, BECAUSE THAT’S SOMETHING WE REALLY WANT HELP YOU FOCUS ON BECAUSE THERE
ARE SIN DEMICS, THEY ARE RELATED AND WE WILL DO OUR BEST TO SUPPORT YOU IN THAT WORK.
>>I CAN AT LEAST PARTIALLY ANSWER THAT QUESTION, THERE’S A LOT OF DIFFERENT WAYS TO ANSWER
THAT QUESTION, I THINK AND IT SORT OF DEPENDS ON YOU TALKING ABOUT AT THE HEALTH DEPARTMENT,
AT OUR VARIOUS LOCAL PARTNERS, SOME THINGS ARE SIMILAR IN THE CHALLENGES WE FACE, SOMETHING
A BIT DIFFERENT AND AND YOU KNOW THEY’RE NOT THE COOL THINGS TO TALK ABOUT, BUT IT’S JUST
HOW WORK GETS DONE DAY-TO-DAY, SO HOW PEOPLE GET PAID, HOW CONTRACTS GET DONE, SO IF WE
WANT AN INTEGRATED PROGRAM, THAT MEANS ONE STAFF MEMBER IS DOING A LOT OF WORK, THEY
MIGHT BE DOING HIV TEST, REFERRING THEM TO PREP, MAYBE DOING A HEP C TEST, AND ASKING
QUESTIONS ABOUT THE DRUG USE, WE WANT THEM DOING THE STI TESTING AND MAYBE OFFER THE
SAME LOCATION THEY’RE GETTING THEIR STI TREATMENT, SO JUST TO PAY THAT ONE PERSON’S SALARY, THEIR
FUNDING ENDS UP COMING FROM MULTIPLE DIFFERENT FUNDING STREAMS AND MULTIPLE FISCAL YEARS
AND SOMETIMES OUR INIAATIVE OF THE FISCAL REPORTING SO WHERE DO WE REPORT THE HIV TEST
TO, VERSUS THE STI TEST, TOO, SO THOSE SORT OF OPERATIONAL THINGS, THAT GET CHALLENGING.
ALSO FOR THE PLACES THAT WE FUND BECAUSE THE VAST MAJORITY OF THE FUNDING THAT COMES INTO
WHAT WE’VE ALL LOCAL HEALTH DEPARTMENT HAS BEEN SENT OUT TO VARIOUS PARTNERS WITHIN THE
COMMUNITY AND BEING ABLE TO COORDINATE EACH INDIVIDUAL CONTRACT, WELL THIS CONTRACTS FUNDS
YOUR HEPC, AND CONTRACT FUNDS YOUR HIV, AND STO, AND I MEAN STAFF WHO ARE DOING INTEGRATED
SERVICES WHERE THE COMPLICATIONS COME FROM.>>SO I REALLY WANT TO WORK WITH YOU ON THIS
AND I KNOW TAMMY DOES TWO, SO WE WANT TO GIVE THE HIV FUNDED AND
SOMETHING THAT WE CAN DO TO GET OUT OF YOUR WAY, LIKE AND IT MAY TAKE A LITTLE WHILE BUT
A COMMON WEB PORTAL THAT YOU REPORT THINGS ONCE AND IT GOES TO DIFFERENT PLACES.
SO YOU KNOW THIS IS NOT–THIS IS THE NONSEXY PART OF THIS BUT IT’S THE STUFF THAT MIGHT
BE ABLE TO HELP YOU, SO LET’S TURN THAT INTO GRANULAR RECOMMENDATIONS WE CAN START WORKING
ON AS WE SORT OF PUT THESE SYNDEMMIC PLANS AND WRAP THEM UP WITH A BOW.
THERE MIGHT BE OVERRIDING RECOMMENDATIONS TO ALL OF THEM, BUT WE NEED TO HELP TURN WHAT
YOU’RE SAYING INTO CONCRETE ACTIONS.>>GREAT, THANK YOU.
>>SO IN THE INTEREST OF MAKING SURE WE GET THROUGH ALL THE RESENTATIONS, DO I SEE THAT
MY COLLEAGUES HAVE THEIR STACKED SO I WILL COME BACK TO THEM.
>>I AM DEANNE TKPWRAOUBER WITH THE OFFICE OF PUBLIC HEALTH IN LOUISIANA,.
>>I AM JACK SKPE BAKUGAN I’M WITH THE DEPARTMENT OF LOUISIANA DEPARTMENT OF HEALTH.
>>I WANT TO START BY THANKING YOU FOR INVITING US TO COME TO SHARE OUR CHALLENGES AND IN.
SIGHTS OVER THE LAST–I HAVE TO SAY, THE LAST SIX MONTHS HAS BEEN A HILL WIND OF BETWEEN
THE NOTICE THAT CAME OUT, HAVING A SHORT TIME TO TURN AROUND AND PRESENT A PROPOSAL AND
THEN BEING ABLE TO IMMEDIATELY HIT THE GROUND RUNNING AND I THINK THAT I AM VERY PROUD OF
THE TEAM THAT WE HAVE IN LOUISIANA AND OUR COMMUNITY PARTNERS AND OUR COLLABORATORS WITH
THE CITY OF BATON ROUGE TO BE ABLE TO THEN SHARE WITH YOU AND TO REPRESENT THESE BATON
ROUGE PARISH AND THE STATE OF LOUISIANA THIS MORNING.
SO JUST TO START OFF WITH AN OVERVIEW OF THE BATON ROUGE PARISH.
AND I’M SURE THAT EVERYONE IS CERTAINLY VERY FAMILIAR WITH THIS AND WHERE THE DIFFERENT
JURISDICTIONS ARE AND YOU CAN SEE THAT IN THE STATE OF LOUISIANA, WE IN FACT HAVE TWO
PARISHES AS EVERYONE IN THE COUNTRY KNOWS OR COUNTIES AND AND WITH BATON ROUGE, AND
EAST BATON ROUGE, FAIRLY CLOSE TOGETHER BUT HAVE IN SOME WAYS VARIOUS EPIDEMICS.
SO WITH THESE BATON ROUGE PARISH IN 2018, WE CONTINUE TO SEE OUR EPIDEMIC WHERE NEARLY
ONE OF FIVE PERSONS NEWLY DIAGNOSED WAS FROM EAST BATON ROUGE PARISH, THESE NUMBERS HAVE
CERTAINLY CHARGED OVER THE YEARS WHERE THERE NEEDS TO–ACTUALLY WE HAD MORE INDIVIDUALS
IN THIS PARISH THAT MADE UP THE ROUGH ATOM PORTION FOR OVERALL DIAGNOSIS BUT WE HAVE
SEEN SOME OF THAT DECLINE OVER THE LAST SEVERAL YEARS.
AND DURING THAT TIME PERIOD OF 2009 TO 2018, THE NUMBER OF INDIVIDUALS DID DECREASE BY
29% IN EAST BATON ROUGE PARISH AND DURING THAT SAME TIME PERIOD THE NUMBER OF PERSONS
NEWLY DIAGNOSED WITH AIDS IN EAST BATON ROUGE PARISH DECREASED BY 67% AND THIS WAS A
TEN YEAR LOW AND 2018 WHERE THERE WERE 55 PERSONS DIAGNOSED WITH AIDS.
I WANT TO ALSO INDICATE THAT WE’RE SEEING THESE DECREASES NOT ONLY IN EAST BATON ROUGE
PARISH BUT ACROSS THE ENTIRE STATE AND IN 2018, IT WAS THE FIRST YEAR, WE TAKE AWAY
THE YEAR OF KATRINA OF 2005 BECAUSE THERE WAS A BIT OF AN ANOMALY OF COURSE, FOR US
AS FAR AS HOW MANY NEW INDIVIDUALS DIAGNOSED BUT WE HAVE LESS THAN A THOUSAND INDIVIDUALS
IN OUR ENTIRE STATE BEING DIAGNOSED WITH HIV AND THAT HAD NOT OCCURRED FOR OVER 30 YEARS
AND SO AGAIN WITH THE CONTEXT OF WHAT’S HAPPENING IN EAST BATON ROUGE BUT ACROSS THE STATE.
BUT WE DO SEE THAT UNLIKE OTHER REGIONS IN OUR STATE EAST BATON ROUGE DOES HAVE A LARGE
PROPORTION OF THE DIAGNOSIS AMONG WOMEN AND WHETHER ONE OF THREE DIAGNOSIS WERE FEMALE
AS WELL AS WITH HETEROSEXUALS, 52% ARE NEW DIAGNOSIS WERE AMONG HIGH RISK HETEROSEXUALS.
AND YOU KNOW WE CAN’T–WE CAN’T TALK ABOUT THIS WORK AND THE INTERVENTIONS AND THE APPROACH
THAT WE ALMOST TAKE IN ORDER TO END THE HIV EPIDEMIC WITHOUT ALSO TALKING ABOUT SOCIAL
DETERMINANTS OF HEALTH. AND FOR EAST BATON ROUGE PARIS LOOKING AT
84% OF BLACKS OBTAINING HIGH SCHOOL DIPLOMA COMPARED TO 95% OF WHITE RESIDENTS AND THAT
ALSO 21% OF AFRICAN AMERICAN OR BLACKS WERE LIVING BELOW THE POVERTY LINE IN 2018 COMPARED
TO TEN%. AND PARTICULARLY THISUMING DISPARITY AS FAR
AS WITH MEDIAN HOUSEHOLD INCOME, WHERE AFRICAN AMERICAN BLACKS AND EAST BATON ROUGE PARIS,
THE MEDIAN INCOME IS 37,600 AND FOR WHITE INDIVIDUALS IT WAS 75,866 PER HOUSEHOLD.
AND ALSO, DISPROPORTIONATE IMPACT AMONG AFRICAN AMERICAN BLACKS, 47% OF THE PARISH POPULATION
AFRICAN AMERICAN AND YET 88% OF ALL NEW HIV DIAGNOSIS IN THAT PARISH WERE AFRICAN AMERICAN
OR BLACK. AND IT WOULD COUNT OF 90% OF HIV DIAGNOSIS
IN 2018. NINETY% OF WOMEN ALSO, THAT IS ACTUALLY NOT
JUST IN 2018, BUT THAT STRETCH THAT FOR THE PAST TEN YEARS AND FOR THE PAST TEN YEARS
WE HAD 90% OF DIAGNOSIS AMONG FEMALES WERE AFRICAN AMERICAN OR BLACK.
AND THAT ALSO WHEN YOU LOOK OVERALL 84% OF INDIVIDUALS DIAGNOSED WITH HIV, WERE BLACK,
GAY, BISEXUAL AND MEN WHO HAVE SEX WITH MEN, BLACK FEMALE, HETEROSEXUALS OR BLACK MALE
HIGH RISK HETEROSEXUAL AND THAT THE NUMBER OF BLACK PERSONS DIAGNOSED WITH HIV, ARE NINE
TIMES HIGHER THAN WHITE PERSON WHO IS ARE NEWLY DIAGNOSED.
AND THIS IS A GRAPH THAT REALLY DOES THEN SUMMARIZE AND VISUALLY DEPICT AGAIN THE HIGH
PROPORTION OF INDIVIDUALS WHO ARE NEWLY DIAGNOSED IN EAST BATON ROUGE AREAS THAT ARE AFRICAN
AMERICAN OR BLACK. AND AT THIS POINT, THEN, I WILL TURN IT OVER
TO JACKY WHO WILL DESCRIBE SOME OF THE MAIN COMPONENTS OF OUR MODEL.
>>THANK YOUINANCE DEANN GRUBER.>>SO RECEIPTLY I WOULD LIKE TO INTRODUCE
TO YOU THE STRATEGIES WE USE UNDER THE PILLARS. SO UNDER DIAGNOSE, SO WHAT WE’VE DONE IS EXPABDING
OUR TESTING COMMUNITY AMONG FIVE BASE POINT AGENCIES AND THESE ARE AGENCIES AND COMMUNITY
BASE PARTS THAT ARE ALREADY CONTRACTING WITH, THEY DO IT WELL, THEY ALREADY HAD THE INFRASTRUCTURE
TO DO IT, SO IT JUST MADE SENSE FORUS TO EXPAND THAT CAPACITY TO DO THAT.
ALSO, WE EXPANDED ROUTINE SCREENINGS FOR THE LARGEST MEDICAL FACILITY IN THE EMERGENCY
DEPARTMENTS WHERE A PARTNER WITH THEM SO THEY CAN IMPLEMENT ROUTINE SCREENS IN THE EMERGENCY
DEPARTMENTS AND ALSO WE EXPANDED SCREENING IN BATON ROUGE PARISH PRISONS AND DEPARTMENT
OF CORRECTIONS. OUR GOAL IS TO SCREEN OVER 9000 INMATES AND
WHAT WE’VE DONE WITH THAT IN ORDER TO GO TO EACH OF THE FACILITIES HIRING WHAT ARE CALLED
OUR MOBILE [INDISCERNIBLE]. WE HIRE THE PHLEBOTOMIST, WHO GO TO THE DEPARTMENT
OF CORRECTIONS SITES WHO DO THIS WITH THE FACILITIES.
NEXT PILLAR IS TREAT. WHAT WE’VE DONE IS WE’VE EXPANDED OUR HEALTH
MODEL WHICH IS PAY PATIENT PERFORMANCES IN OUR PROGRAM.
WITHIN OF OUR FQACS, IT’S PAY PATIENT FOR PERFORMANCE AND PREVENTION.
WHAT IT DOES IS IMPLEMENT AND CLINICS AND SPECIALTY CLINICS WHO SERVICE PEOPLE WHO ARE
LIVING WITH HIV. AND ONCE A MILESTONE IS ACHIEVED, A CLIENT
WOULD BE [INDISCERNIBLE]. FOR INSTANCE IF A CLIENT ENROLLS IN THE PROGRAM,
THEY GET AN INCENTIVE, A CLIENT WHO WAS RECENTLY INCARCERATED, THEY ARE INCENTIVIZED.
THEY ARE ONCE INTEND WIDE APPOINTMENTS BASICALLY SO WE CAN DRAW THE LABS TO SEE WHAT THE VIRAL
LOADS ARE. ALSO IF THERE’S A PARTICULAR SUBSEQUENT DOCTORS
APPOINTMENT THAT THE PROVIDER DEEMS IS NECESSARY FOR THE OVERALL HEALTH, THEY’RE INCENTIVIZED
AND ALSO A CLIENT IS INCENTIVIZED FOR ACHIEVEMENT OF MAINTAINING VIRAL SUPPRESSION.
UNDER’RE ALSO YOU SHOULD TREAT, WE DEPLOYED A TREATMENT THAT WILL EXPED MEDICAL CARE AND
TREATMENT. IF SOMEONE IS NEWLY DIAGNOSED, THE GOAL OF
THE RAPID START NAVIGATION IS MAKING SURE THAT THE PERSON IS RANKED TO CARING AND START
ON THEIR ARVS WITHIN ZERO-SEVEN DAYS. ALSO UNDER THE PILLAR OF TREAT–I’M SORRY
PREVENT, WE SEND OUT OUR TELEPREP PROGRAM TO ADD TELEPREP NAVIGATOR.
IT’S PRETTY MUCH TELEMEDICINE STRATEGY, WHAT WE DO S&P THAT IT’S A VIRTUAL CLINIC THAT’S
HOUSED IN THE HEALTH DEPARTMENT THAT’S HOUSED IN OUR OFFICE AND WHAT IT DOES IT ENABLING
PREP ACCESS AND INFORMATION TO PEOPLE STATEWIDE FOR INSTANCE WE CAN NAVIGATE SOMEONE ON PREP
AND THIS SETTING IN THEIR HOME AND THIS HAS HAPPENED THROUGHOUT THE STATE.
SO WHAT WE DECIDED TO DO, WE WANT TO BUILD THE CAPACITY MORE IN BATON ROUGE TO SEE HOW
WE CAN USE OUR TELEPREP PROGRAM TO HELP THE VULNERABLE POPULATION WHO NEEDS TO BE ON PREP,
GET TO PREP. AND OUR TELEPREP PROGRAM IS A DISCREET INTERVENTION
AND THIS IS ALSO AN OPTION FOR PEOPLE WHO WANT TO GET ON PREP.
IT ALSO REDUCES STIGMA, IF THAT’S AN ISSUE FOR SOMEONE GETTING ON PREP.
THEN WE ALSO DEVELOP A WORLD WIDE SOCIAL MARKETING CAMPAIGN THAT FOCUS ON ENDING THE EPIDEMIC,
ALSO WE EMPLOYED A COMMUNITY NETWORK OF TEAMS TO CONDUCT COMMUNITY ENTKPAEUPBLGMENT WELL
AS TO RECRUIT ACTIVITIES. WE HAVE A LEAD COMMUNITY HEALTH WORKER AND
FOR COMMUNITY HEALTH WORKER WHO IS ARE BOOTS ON THE GROUND, WHO GO INTO VULNERABLE POPULATIONS
AND GO INTO COMMUNITIES TO REACH THE POPULATION, TO MAKE SURE THAT THEY ACCESS THE CARE THAT
THEY NEED. AND LASTLY, WE ALSO EMPLOYED, THE NEED OF
THE HIV COORDINATOR WHO WILL HELP US TO DEVELOP OUR EHE PLAN.
ADDITIONALLY, THIS IS SOMETHING THAT’S WORTH MENTIONING, THIS ISN’T FROM–THE FUNDING WE
RECEIVE HERE IS NOT NECESSARILY–THEY HAVE FUNDS, WE DID GET FUNDING FROM THE DIVISION
OF THE STD PROGRAM IN WHICH WE WERE AWARDED $500,000 TO IMPLEMENT A STAND ALONE SEXUALLY
TRANSMATED INFECTION CLINIC IN EAST BATON ROUGE.
SO IT’S IMPLEMENT INDEED ONE OF OUR QACS, LAUNCHED NOVEMBER 2019 AND AT THE CLINIC CLAIMS
ARE ABLE TO BE SCREENED FOR HIV, SYPHILIS AND EXTRA GENITAL SEIS AND ACVS AND THEY HAVE
ACCESS TO PREP AND PEP AND OTHER THINGS THAT THE CLIENT CAN GO TO.
ALSO TO DATE 680 PLACES HAVE RECEIVED SERVICES AND GET IN 45 INFECTIONS HAVE BEEN TREATED
AND THE PATIENT CAN ACCESS ADDITIONAL HEALTHCARE SERVICES AS NEEDED IN THE MAIN CLINIC SO DEFINITELY
EVEN THOUGH IT WAS PART OF 1802 BUT IT IS SOMETHING THAT’S PART OF OUR EPIDEMIC PLAN.
SO EARLY SUCCESSES, SINCE JULY 1, OVER 3400 PEOPLE HAVE BEEN TESTED FOR HIV, AND 62 PEOPLE
HAVE BEEN IDENTIFIED WITH LIVING WITH HIV AND OUR HELP MODELS PROGRAM, 180 CLIENTS TO
DATE HAVE BEEN ENROLLED AND AMONG THIS GROUP 80% OF THAT GROUP IS VIRALLY SUPPRESSED, OUR
RAPID START PROGRAM HAS HAD 17 REFERRALS TO THAT PROGRAM, AND RAPID NAVIGATION AND OF
THOSE 85 ARE CURRENTLY VIRALLY SUPPRESSED WITH OUR TELEPREP PROGRAM, WE INCREASE OUTREACH
AND CLINICAL SERVICES. OUR SERVICES PROGRAM, WHICH I’M SORRY I DID–FORGOT
TO MENTION ON THE PREVENT THAT WE HAVE EXPANDED THE CAPACITY OF OUR SERVICES PROGRAM.
AND WITH THAT PROGRAM, WE ARE CURRENTLY SERVING OVER 690 MEMBERS IN THE PARISH, AGAIN WE HAVE
SCREENED OVER 175 INDIVIDUALS FOR HIV AND ENGAGE SIX PEOPLE WITH HIV AND CONTACTED PEOPLE
IN DIVISIONS AND HAD OVER 400 ENCOUNTERS. WE ALSO ENRICHED OUR RELATIONSHIP WITH THE
CITY OF BATON ROUGE AND THE MAYOR’S OFFICE, NOT SAYING WE HAD A BAD RELATIONSHIP WITH
THEM, IT JUST ENRICHED OUR RELATIONSHIP AND IT’S BETTER.
[LAUGHTER ] ALSO TALKING ABOUT EARLY SUCCESSES, THIS IS
OUR COMMUNITY HEALTH WORKERS, THE LARGEST NEWSPAPER IN LOUISIANA AND PARTICULARLY IN
EAST BATON ROUGE, THEY HEARD ABOUT OUR ENDING THE EPIDEMIC WORK, ACTUALLY A REPORTER WAS
THERE-ADMIRAL GIROIR, HAD TALKED ABOUT PREP, AND WE WERE TALKING ABOUT OUR EFFORTS AND
THEN THE REPORTER SAID, YOU KNOW WHAT I WANT TO INTERVIEW YOUR COMMUNITY HEALTH WORKERS
BECAUSE YOU KNOW THEY ARE MAKING AN IMPACT AND YOU KNOW SOMETIMES WHEN PEOPLE SAY, THEY
ARE GOING TO DO SOMETHING AND THEY’RE ALL RIGHT, YEAH, SURE, YOU WANT TO DO AN ARTICLE
ON THIS, AND ACTUALLY, DID, SO THIS IS EXCITING THAT WE WERE ABLE TO GET SOME PRESS ON THE
COMMUNITY HEALTH WORKERS, THE BOOTS ON THE GROUND AND ALSO THE ARTICLE ALSO TALKED ABOUT
OUR ENDING EPIDEMIC WORK THAT WE’RE DOING. AND ALSO JUST GOING BACK–WE CAN’T GO BACK,
BUT ANYWAY, EVEN WITH TALKING ABOUT OUR COMMUNITY HEALTH WORKERS, THIS IS VERY IMPORTANT, PARTICULARLY
WHEN WE TALK ABOUT COMMUNITY ENGAGEMENT. OKAY, SO THOSE INDIVIDUALS ARE DEFINITELY
IN THE TRENCHES, BOOTS ON THE GROUND, THEY WAOU 32 PILLARS AND THEY DIAGNOSE INDIVIDUALS
AND THEY CONNECT PEOPLE TO CARE AND THEY MAKE SURE THEY GET TO APPOINTMENTS WITH THEM AND
THEY EVEN, NOW WE’RE GOING TO START PASSING OUT NEEDLES, AND SERVICES PROGRAM.
BUT THE THING THAT’S IMPORTANT IS IN ANOTHER ONE OF OUR PROJECT SYSTEM THAT WE WERE GOING
AROUND THE STATE AND ASKING PEOPLE IN THE COMMUNITY, OKAY, SO, HOW CAN WE REACH VULNERABLE
POPULATIONS? AND THE COMMUNITY SAID, YOU KNOW WHAT, IN
ORDER TO REACH THE POPULATION, YOU NEED TO REACH, YOU NEED TO HIRE US.
SO THAT’S EXACTLY WHAT WE DID WITH OUR COMMUNITY HEALTH WORKERS, THEY ARE GATE KEEPERS, NOT
ONLY IN THE COMMUNITY, BUT THEY ARE THE COMMUNITY. AND THE THING THAT WE ALSO DO IS WE TREAT
THEM WITH RESPECT. THEY OVER 40 OR $45,000 A YEAR, THEY GET BENEFITS,
THEY HAVE THEIR OWN CANNED WHAT, THEY HAVE CELL PHONES, THEY HAVE ACCESS TO THINGS THAT
PROFESSIONALS HAVE AND WE TREAT THEM PROFESSIONALLY. SO I THINK THAT’S ALSO SOMETHING THAT WE NEED
TO CONSIDER. WHEN WE ARE LOOKING FOR HOW TO REACH THE VULNERABLE
POPULATIONS AND WE ARE EMPLOYING INDIVIDUAL WHO IS CAN ALSO HELP US, THEY HAVE ACCESS
TO THOSE VULNERABLE POPULATIONS WE NEED TO TREAT THEM RESPECTFULLY AND VERY PROFESSIONALLY.
>>THANK YOU JACKY AND SO TO TALK A BIT ABOUT SOME AREAS OF BARRIERS AND OPPORTUNITY, YOU
KNOW, AGAIN, THIS HAS BEEN SIMILAR THINGS AS WE’VE GONE THROUGH THIS VERY, VERY HIGH
PROFILE PERIOD OF BEING ONE OF THE JUMP START PROJECTS AND THE EXPECTATIONS THAT OUR FRIENDS
AT CDC AND HHS AND OTHERS HAVE HAD ON US, I MEAN, I THINK THAT, YOU KNOW WE’RE ALWAYS–WE’RE
DEFINITELY ACCUSTOMED AND RESPOND TO WHAT IS NEEDED AS FOR AS DATA REPORTING AND REQUIREMENTS
AND OTHER TYPES OF REPORTS AND WITHOUT A DOUBT WE EXPECT THAT THAT IS PART OF OUR WORK LOAD
AND PART OF OUR ACCOUNTABILITY, YOU KNOW THAT WE WILL FULFILL, I THINK THAT THIS, THE–I
CAN’T REALLY GO ON TO SAY AND TO AND THE DATA REPORTING AND REQUIREMENTS CERTAINLY DID ADD
ON AND SOME ENHANCED CHALLENGE OF MAKING SURE THAT WE ARE GETTING EVERYTHING THAT WE NEED.
I THINK THE OTHER PART TOO, OF YOU KNOW HAVING AND NUMEROUS REQUESTS FOR SITE VISITS AND
THOSE TIMES OF SAYING WE WILL STOP AND HAVE ADMIRAL GIROIR, AND WE WILL HAVE OTHER REPRESENTATIVES
COME AND LEARN BECAUSE THEY WANT TO LEARN WHAT’S HAPPENING AND STUFF, BUT THEN ALSO
IT IS ACHALLENGE AND A BARRIER AT TIMES OF STOPPING OUR WORK AND TRY TO COORDINATE ALL
THOSE THINGS AND MAIC SURE WE ARE BRINGING EVERYONE TO THE TABLE TO TELL THE STORIES
OF WHAT’S HAPPENING. AND THEN THE OTHER CHALLENGE HAS BEEN, YOU
KNOW WE’RE A STATE BUREAUCRACY AND YOU KNOW HAVING THIS ADDITIONAL FUNDING COME IN, YOU
KNOW, I MEAN–OVER $2 MILLION IN A VERY, VERY SHORT PERIOD OF TIME AND SO, YOU KNOW GETTING
THROUGH IN THE SENSE OF DOING WE HAVE ADEQUATE BUMET AUTHORITY AND FOR PEOPLE WHO WORKED
IN STATE AND FEDERAL, THOSE ARE SOME OF THE THINGS THAT WE ALWAYS HAVE TO ADDRESS HOW
CAN–HOW QUICKLY CAN WE AMEND OUR EXISTING CONTRACTS SO THAT WE DON’T NEED TO HAVE TO
PUT ON THE REQUEST FOR PROPOSALS OR WE USE THAT DATA–REALLY DOCUMENTS WHAT IS
HAPPENING AND THAT WE CAN SHOW NOT ONLY IN THE SENSE OF THOSE PROCESS MEASURES, WHICH
RIGHT NOW REALLY MANY OF THE THINGS THAT WE’RE ABLE TO REPORT ARE, YOU KNOW NUMBERS OF YOU
KNOW NUMBER OF PEOPLE TESTED AND NUMBER OF PEOPLE WHO CAME IN, ET CETERA AND BUT ALSO
LOOKING AT DURATION AND MAKING SURE WE HAVE OUTCOME MEASURES INCORPORATED IN THAT.
YOU KNOW ALL THOSE MEETINGS AND CONFERENCE CALLS AND SITE VISIT SCHEDULES, IT DID THOUGH,
WITH THAT INCREASE OUR COMMUNICATION OF COORDINATION, OUR ENGAGEMENT, OPPORTUNITIES TO CONTINUE
TO REALLY HAVE ONGOING INTERACTION WITH THE COMMUNITY, WITH OUR FUNDERS AND OTHER KEY
STAKEHOLDERS AND I THINK THAT WITH THAT, JUST AS JESSE WAS SAYING IS, YOU KNOW WHEN SITE
VISITS OTHER THAN HAPPENING OR WHEN OTHER THINGS, A MILESTONE WAS OCCURRING, IT ALSO
ROSE THE PUBLIC EDUCATION THAT WOULD HAPPEN. SO HERE WAS A REPORTER WHO CAME AND WANTED
TO COVER WHAT WAS HAPPENING, WE ALSO ELEVATED THAT UP OF COURSE TO OUR SECRETARY’S OFFICE
AND DEPUTY SECRETARY WAS ABLE TO PARTICIPATE IN THAT.
MULTIPLE NEWS STORIES HAVE COME OUT WITH THE THINGS THAT ARE HAPPENING AND WE MENTIONED
ABOUT THE STI CLINIC THAT OPENED UP IN THE MIDDLE OF NOVEMBER, AND IN THAT PERIOD OF
TIME, CLOSE TO 700 PEOPLE HAVE BEEN TREATED, WELL THEY HAVEN’T EVEN HAD AN OPEN HOUSE PRESS
CONFERENCE YET. THAT IS ACTUALLY HAPPENING TOMORROW AFTERNOON,
AND SO WE KNOW THAT 700 PEOPLE HAVE BEEN SERVED EVEN PRIMARILY JUST BY WORD OF MOUTH OR BY
THEIR OWN INTERNAL PROPOTION AND DISTRIBUTION OF INFORMATION AND OPEN HOUSE AND THERE’S
GOING TO BE ANOTHER ROUND OF MEDIA, AND AND NAVIGATING THROUGH A STATE BUREAUCRATIC SYSTEM.
AND I SAY THAT, OF COURSE, TONGUE IN CHEEK, BUT YOU KNOW IT IS THE CONTINUED WORK THAT
WE DO, AND THAT WE WILL CONTINUE TO DO AND I THINK THE JACKY IS GOING TO TALK A LITTLE
BIT ABOUT SOME OF OUR INNOVATIVE DISRUPTION AND LESSONS LEARNED FROM SOME OF THESE THINGS.
>>SO ONE OF THE LESSONS WE CAN OFFER ANYONE WHO WILL EMBARK ON THIS JOURNEY AND ALSO JUST
STATE GOVERNMENT SAYS WE HAVE ESTABLISHED PERSONNEL CONTRACT, I THINK THOSE HAVE BEEN
IN PLACE FOR 20 YEARS SO THIS LIKE DR. GRUBER WAS SAYING THAT WE CAN COME UP WITH OPPORTUNITIES
FOR THE BUT OCRATTIC SYSTEM, BY–BUREAUCRATIC SYSTEMS, BY HAVING THESE PERSONNEL CONTRACTS
WE WERE ABLE TO BYPASS A LOT OF THE RED TAPE. IF IT WAS NOT FOR OUR PERSONAL CONTRACT WE
WOULD NOT HAVE BEEN ABLE TO GET STAFF ON BOARD QUICKLY, WE WOULD NONAPOPTOTIC THE HAVE BEEN
ABLE TO UTILIZE AND ACCESS AND COORDINATE OFFICE SPACE, EQUIPMENT AND THOSE TYPE OF
THINGS. AND TO BE HONEST, WE WOULD NOT BE ABLE TO
HIRE THE STAFF WE HAVE ANY HEALTHY WE WILL TRY TO ESTABLISH THE PERSONAL CONTRACT AND
THAT’S THE WAY THAT YOU BYPASS, AND THIS IS IMPORTANT IS INVOLVING COMMUNITY AT THE BEGINNING
AND FINAL JUMP START COLLEAGUES WE HAD 19 DAYS TO DEVELOP OUR APPLICATION.
FIRST THING WE DID WAS WE GOT ON THE PHONE WITH OUR COMMUNITY PARTNERS IN EAST BATON
ROUGE. THEY WERE A PART OF THE PROCESS OF THAT APPLICATION,
ACTUALLY THEY INFORMED THAT APPLICATION, THE THINGS THAT WE TALK TO THEM AND SAY, HEY,
HERE’S A GREAT OPPORTUNITY FOR US, WHAT NEEDS TO BE PUT IN THIS APPLICATION?
SO WE INVOLVED THEM AT THE BEGINNING. ALSO CONTINUE TO BUILD THE RELATIONSHIP OF
OUR PARTNERS AND ALSO INCLUDE THEM IN THE PROCESS, AND THEN ALSO TOO, I KNOW SOMETIMES
WE GET TO A POINT WHERE WEED, OH, OKAY, SO WE GOT FEEDBACK FROM THE COMMUNITY, NO, YOU
KNOW WHAT? THERE’S DIFFERENCE BETWEEN INPUT AND DIFFERENCE
IN FEEDBACK, INPUT IS I’M GIVING YOU, WE COME TOGETHER WITH A CLEAN SLATE.
FEEDBACK IS, I’M ALREADY DEVELOPED THESE AND I WANT YOU TO GIVE ME FEEDBACK ON IT, SOPHISTICATEDY
THAT’S THE DIFFERENCE, SO TRUE COMMUNITY PARTNERSHIP IS SOMETHING THAT WE CONTINUE TO DO.
WE FAIL SOMETIMES ABOUT YOU AT ONE POINT WE CONTINUE TO IT RIGHT.
WE GET BACK UP AND WE DO IT BETTER AND BETTER. SO THE THING IS, DEFINITELY HAVING COMMUNITY
INVOLVEMENT AT THE BEGINNING. ALSO WE VALUE TRANSPARENCY, WE CONDUCT OUR
MEETINGS, WE TELL OUR PARTNERS, WE TELL THEM, HEY, HEALTH DEPARTMENT WON’T BE THE ONLY ONES
ACCOUNTABLE, WE INLEWD OUR MONTHLY EHE MONTHLY NEWS AND TALK ABOUT WHAT’S GOING ON AND ALSO
WE HIRE AND TRAIN AND RETYPE THE RIGHT AREA. WHAT’S NEXT FOR US, IS WE’RE APPLYING FOR
FUNDING ANNOUNCEMENT OPPORTUNITY THAT JUST CAME OUT AND ALSO WE WILL CONTINUE TO AND
CARE FOR SUPPLEMENT ACTIVITIES AT LEAST THROUGH THE NEXT SIX MONTHS WITH THAT.
SO HERE I WANT TO ACKNOWLEDGE THE SCH PROGRAM KNOWN AS SHIP BACK AT HOME, BATON ROUGE WOULD
NONAPOPTOTIC THE VILLAIN ABOUTIBLA TO IMPLEMENT THESE AS KNICKLY AS WE DID.
OUR COMMUNITY WERE DEFINITELY PEOPLE LIVING WITH HIV, BACK HOME WE WANT TO THANK THEM
PER ALLOWING US TO SERVE THEM AND ALSO FOR ALLOWING US TO BE HERE AND REPRESENTING THEM
AND ALSO ALLOWING US TO TELL THESE STORIES. OUR COMMUNITY BASED ORGANIZATIONS, WE COULD
NONAPOPTOTIC THE DO THIS WITHOUT THIS THEM. THEY CHALLENGE US AND THEY REPUCE US BUT THATIA
FINE TOO AND ALSO OUR CLINICAL PROVIDER WHO IS TAKE CARE OF ALL OF US AND ALSO TOO ON
OUR PERSONAL APPROACH, SOMETHING THEY WANT TO LEAVE YOU ALL WITH, WE TALKED ABOUT THE
APPROACH OF PILLARS OF EHE, BUT ALSO I WANT TO SHARE WITH YOU ALL THE PERSONAL APPROACH
OF OUR HEALTH DEPARTMENT. SO IN ORDER TO END THE EPIDEMIC SHIP, WE WILL
FOCUS ON THE ENVIRONMENTAL FACTORS THAT CAUSE HEALTH INEQUITY AND INCORPORATE A SYSTEMIC
ANALYSIS, INTO OUR EHE PROGRAMMATIC ACTIVITIES. WE STRIVE TO BE AN ANTIRACIST AND ANTIHETEROGENEOUS
ROW SEXIST HEALTH DEPARTMENT AND EFTHIMIOS THE HEALTH PARADIGM WHERE RACE, SEXUAL ORIENTATION,
AND GENDER IDENTITY ARE NO LONGER PREDICTORS OF HEALTH OUTCOMES.
UNDERSTANDING AND UNDOING THE INNS TUITIONAL INSTRUCTOR FORCES OF OPPRESSION THAT IMPACT
OUR PARTY POPULATION WHICH ARE THE CITIZEN OF LOUISIANA.
WE MUST BE AND WILL BE AT THE FOREFRONT OF ALL OF OUR EFFORTS.
THANK YOU. [ APPLAUSE ]
>>ALL RIGHT, NEXT UP IS DEKALB COUNTY, GEORGIA, THANK YOU.
>>THANK YOU FOR INVITING THE GREAT STATE OF GEORGIA TO YOUR MEETING, DR. KATHLEEN TUMI,
WHO IS THE COMMISSIONER OF PUBLIC HEALTH, SHE CONVEYS HER DEEPEST REGRETS THAT SHE COULD
NOT BE HERE IN PERSON, BACK AND FORTH ABOUT MEETING WITH BUDGETS WITH THE GOVERNOR’S OFFICE
AND SHE EXPRESSES HER EXCITEMENT FOR THIS HISTORIC OPPORTUNITY TO END THE EPIDEMIC.
SO DEKALB, IS A LARGE PART FALLING BEHIND ATLANTA PROPER.
THIS IS HOW THE MONEY FLOWS, WE GOT THE MONEY FROM CDC, DOWN TO THE DEPARTMENT OF HEALTH
AND THEN WE CONTRACTED OR DIDDAN NECESSARILY–THEYS WITH THE DIFFERENT AREAS AT THE END SO EMORY
UNIVERSITY DOES A LOT OF HIV WORK, SO WE HAD THE PRISON HEALTH CENTER AID ATLANTA WHICH
IS A LONG-TERM PARTNER FOCUS WHICH IS JUST STAFFING AND TRYING TO GET STAFFING RAPIDLY
INTO THE DEKALB COUNTY GOING THROUGH NORMAL HR PROCESSES AND ATLANTA [INDISCERNIBLE] WILL
DO CAPACITY WORKFORCE AROUND SSP. WE HAD A MARKING CAMPAIGN WHICH WE PROBABLY
TALK ABOUT IT LATER BUT SOME OF THE THINGS WE DID WITH THE CAMPAIGN IS WHEN PEOPLE GO
TO THE MOVIE THEATERS, THEY WOULD ACTUALLY SEE THE MOVIE THEY SAW EHE AD IN DEKALB COUNTY
AND SEVERAL MOVIE THEATERS AND THE BOARD OF HEALTH AND I HAVE TO GIVE A SHOUT OUT TO THE
STAFF AT THE COUNTY BOARD OF HEALTH F. IT WASN’T FOR THEM, WE WOULD BE IN A LOT OF TROUBLE,
THEY BENT OVER BACKWARDS TO TRY TO GET THIS WORK DONE.
SO THIS IS JUST A MAP OF DEKALB COUNTY AND THIS SHOWS THE HEALTH CLINICS AND THEY DO
SOME KIND OF HIV STI WORK IN EACH OF THOSE CLINICS.
THIS IS A SNAPSHOT OF MORBIDITY IN THE AREA AS MOST MAPS SHOW THE AREA IN RED IS THE HIGHEST
MORBIDT. AS YOU MOVE OUT TO THE NORTH AND TO THE SOUTHWEST,
THERE’S LESS MORBIDITY BUT IF I’M ALMOST SURE THERE’S ALSO LESS PEOPLE WHO LIVE IN THOSE
AREAS OF THE COUNTY. SO THOSE MIGHT BE SOME UNINCORPORATED PARTS
OF THE DEKALB COUNTY. SO THIS IS ANOTHER SLIDE HA SHOWS YOU THE
OVERVIEW OF WHAT’S GOING ON IN DEKALB COUNTY, THEY HAVE NEW DIAGNOSIS AS OF THE END OF 2018
AND IN A LOT OF PLACES, IT’S MOSTLY NOW AND IT’S MOSTLY IN AFRICAN AMERICANS AND MOSTLY
HAVE HIV IN THAT COUNTY AND THOSE AREAS. ANOTHER SNAPSHOT TELLING YOU THAT NOW OVER
10,000 PEOPLE ARE LIVING IN DEKALB COUNTY AND THE SAME WAY IT’S MOSTLY MALE AND MOSTLY
AFFRIC AN AMERICAN THAT ARE AFFECTED THE MOST. SO IN THE EPIDICKIC ACTIVITY, SO UNDER DIAGNOSE
TREAT AND PREVENT, I WON’T READ ALL OF THESE BUT I WILL LOOK AT A FEW OF THEM BUT I WILL
TALK ABOUT UNDERDIAGNOSED WHERE THE CAMPAIGN CENTERED AROUND TESTING AND PEOPLE TO BE TESTED
AND I’LL ALSO POINT OUT THE DEKALB COUNTY JAIL WE WERE ABLE TO FINALIZE AND ACTUALLY
GET TESTING STARTED BEFORE THE DEADLINE OF DECEMBER 31ST, SO WE ARE DOING MORE TESTING
IN THE JAIL AND THE PLAN IS TO EXPAND THAT UNDER THE NEXT IMPLEMENTATION GRANT, ON THE
TREAT AND WE WILL LOOK AT WE WILL ALSO REENGAGING PEOPLE IN THE CAMP, WE WERE DOING THAT BUT
WE DID HAVE I WOULD SAY LIKE AN ADDITIONAL FOCUS ON GETTING PEOPLE THEIR CARE, WE HAVE
A HUGE MODEL TO CARE ABOUT PEOPLE IN THE STATE OF GEORGIA THAT WE BUILT OUT IN THE LAST COUPLE
OF YEARS WITH THE RYAN WHITE FUNDS AND WITH CDCS FUNDS.
SO ON THE PREVENT SIDE WE WERE ABLE TO ESTABLISH A PREVENT SERVICES CLINIC AND THAT’S WITH
THE EMORY UNIVERSITY PRISM BY THE END OF DECEMBER 31ST THEY WERE ABLE TO GET UP AND RUNNING
BUT IT ALSO WAS–IT WAS A SLOW GOING PROCESS AND A TEDIOUS PROCESS TO GET THAT DONE.
THEY DON’T HAVE THE CLIENTS WE WOULD LIKE TO SEE AT THIS TIME BUT THEY PLAN ON EXPANDING
TO BE ABLE TO DO THAT. WE PLAN ON REALLY EXPANDING OUR CAPACITY TO
BE HONEST WITH YOU THE STATE OF GEORGIA DIDN’T HAVE CAPACITY FOR SSP.
WE ARE ESTABLISHING A PROGRAM. THAT PROGRAM WILL BE HOUSED UNDER THE OFFICE
OF HIV AND AIDS. WE ARE IN THE PROCESS OF HIRING A COORDINATOR,
WE TURNED INTO THE PAPERWORK TO HR AND WE ARE HOPING TO HAVE A PERSON TO START BY MARCH.
AND SO THE CAPACITY PART, WE WILL BE DOING TRAINING TO COMMUNITY BASED ORGANIZATION AND
DOING CAPACITY BUILDING WITH LOCAL LAW ENFORCEMENT AND THEY HAD SOME SUCCESSES WITH PARTNERING
WITH ATLANTA POLICE DEPARTMENT AND TALKING ABOUT SSP, WHAT IT IS, WHAT IT ISN’T, AND
IT’S GIVING THEM TRAINING AROUND NA RCANS AND THINGS OF THAT NATURE.
SO OUR SUCCESSES, EXPLAINING CLINICAL AND NONCLINICAL TESTING SERVICES, EXPANDING ACCESS
TO PREP, INCREASING COMMUNITY AWARENESS AS YOU ALL KNOW THIS HAS BEEN A REALLY COMMUNITY
LED PROCESS, WE’VE HAD A GAZILLION MEETING WITH THE COMMITTEE NOT ONLY THROUGH THE PLANNING
PROCESS BUT THROUGH THE EHE PLANNING PROCESS AND OUR ACTORS WE HAVE THAT ARE HISTORICAL
IN EACH STATE THAT ALWAYS WANT TO CHIME IN ON WHAT WE DO, I WILL CALL THEM FRIENDLY,
YOU KNOW WHEN WE’RE DOING WHAT THEY WANT WITH THEIR FRIENDS BUT THEY’RE NOT, THEY WILL COME
OUT ENEMIES. AND THEN ALSO LIKE TO POINT OUT THE RETENTION
VIA WITH THE REMINDER CALLS WE HAVE A LINK TO CARE PROGRAM THAT WE BUILT OUT BUT THAT’S
SOMETHING ADDITIONAL WE’RE DOING WITH THE APPOINTMENT REMINDER CALLS.
CHALLENGES, I LIKE THE WAY MY STAFF DID THIS. OKAY, AGGRESSIVE PLANNING AND IMPLEMENTATION
TIMELINE. I KEEP THINKING WITH THIS WHOLE PROCESS OF
EHE, THAT THE PERFECT WORD FOR US AND PROBABLY OTHER STATES IS FLEXIBILITY.
IF YOU HAD BEEN RIGID YOU ALMOST COULDN’T DO ANYTHING, IT CALLED FOR A LOT OF FLEXITY.
CALLS FOR EXECUTION, IT IS A BUREAUCRACY, IT TAKES A LONG TIME TO GET THOSE THINGS THROUGH
AND WE HAVEN’T HAD A METHOD IN OUR LEADERSHIP TO EXECUTE CONTRACTS IN 30 DAYS WHICH I THINK
WE SHOULD BE ABLE TO, BUT WAIT FOR THE COMMISSION. BUT OVERLAPPING WITH OTHER COUNTIES, ATLANTA
PROPER WHICH IS FULTON COUNTY AND DEKALB COUNTY SIT RIGHT NEXT TO EACH OTHER, PEOPLE LIVE
AND PLAY IN EACH COUNTY, IT’S A CONSTANT, I WORK IN FULTON, I LIVE IN DEKALB, SO IT’S
A CONSTANT BACK AND FORTH WITH THE PEOPLE WHO ARE MOST AFFECTED.
SO YOU KNOW IT’S VERY TRANSIENT AS FAR AS OVERLAPPING OF THE JURISDICTIONS.
SOMEONE MENTIONED REPORTING BURDEN, EVEN BEFORE EHE, THERE WAS REPORTING BURDEN.
I THINK THE LAST TIME THEY LOOKEDDA THE IT, I THINK IT WAS 250 DATA POINTS THAT REQUIRED
TO REPORT ON AND MOST PLACES UNLESS YOU’RE A BUSINESS–A BUSINESS, THEY DON’T LOOK AT
250 DATA POINTS. I CAN TELL YOU THAT NOW, THEY DO NOT F. THEY
DO THEY HAVE THE PEOPLE TO DO THAT AND THEY’RE ABLE TO PAY THEM A LOT OF MONEY AND WE’RE
NOT ABLE TO DO THAT ON THE PUBLIC HEALTH WITH THE SALARIES.
AND OUR PARTNERSHIP WITH THE EMERGENCY ROOM TESTING THAT TOOK A LONG TIME TO GET UP AND
RUNNING. THEY–I DON’T BELIEVE THEY FOUND THE CONTRACT
YET FOR THAT, BUT THAT IS THE ONGOING PROCESS TO GET ONE OF THE HOSPITALS IN DEKALB COUNTY
TO DO OPT-OUT EMERGENCY ROOM TESTING, I’M ROOTING THAT THEY WILL PULL THAT OFF, THAT
WILL HELP WITH GETTING PEOPLE INTO CARE. DISRUPTIVE INNOVATION, MEETING CLIENTS WHERE
THEY ARE. WE DID SOME SOCIAL MEDIA MARKETING AND SO,
ONE OF OUR BIGGEST MODEL SYSTEM CALLED LENNOX MODEL, IT’S A BIG MODEL BUT WHEN EVERYBODY
COMES TO ATLANTA THEY COME TO THIS TOURIST SPOT ALSO, SO THEY’RE OPENING THEIR BROWSERS
THEY CAN GET GEOTARGETTED ADS WITH CUTCHES WE USE THAT WOULD GIVE THE HIV MESSAGE MORE
THAN LIKELY AROUND TESTING AND WE MAY HAVE SOME ALSO THAT PEOPLE FALL INTO CARE AND LET
THEM KNOW THAT THEY’RE WELCOME AND THEY CAN COME BACK INTO CARE.
WE EXPANDED OUR CONDOM SIZE, WE WERE USING BEAUTY SHOPS AND BARBER SHOPS AND AND THEY
HAVE A PLACE IN ATLANTA AND IT IS THE AU CENTER AND THEY HAVE THREE HISTORICAL BLACK COLLEGES
IN ATLANTA, BUT THOSE STUDENTS ARE ALWAYS TRANSIENT AND THEY APPROXIMATE GO BACK AND
FORTH TO DEKALB, BUT THEY’RE LIVING IN DEKALB BUT THEY’RE GOING TO MOORE HOUSE OR OTHER
UNIVERSITIES IN ATLANTA. AVAILABILITY, PRISM IS EMORY UNIVERSITY’S
FOR LACK OF A BETTER WORD AIDS SERVICE ORGANIZATION, PREP CLINIC THEY HAVE IS A TICK STYLE, IT
DOESN’T LOOK LIKE A REGULAR CLINIC, IT’S NOT CLINICAL, IT’S NICE AND PEOPLE FEEL WELCOME
THERE. SO THAT WAS A FREIGHT–GREAT OPPORTUNITY FOR
US AND THE VISION HEALTH CLINIC WHERE THEY’RE TRYING TO EXPAND PREP ACCESSIBILITY IN THAT
AREA AND IT’S ACTUALLY LOCATED IN ONE OF THE HIGHEST MORBIDITY AREAS IN DEKALB COUNTY.
AND THIS IS ULSA EXPANDED THROUGH MOBILE UNITS, JAIL SETTING WHERE WE’RE REALLY, REALLY, REALLY
PUSHING FOR THAT AND HAD THEN JUST TRY TO COLLABORATE WITH THE FQ HC, YOU KNOW HISTORICALLY
THERE AREA A FEW CLINICS IN THE NATION, EVEN IN THE SOUTH, THAT DO GOOD HIV WORK BUT THERE
HAVE BEEN OTHERS THAT EVEN WHEN THE LATIN ADMINISTRATION GAVE THEM MONEY THEY SHIED
AWAY FROM THE HIV WORK MAYBE BECAUSE THEY DIDN’T FEEL LIKE THEY HAVE THE CAPACITY SO
WE’RE CONTINUING TO HAVE CONVERSATIONS WITH THEM.
IT’S ALL HANDS ON DECK BECAUSE WE NEED THEM TO BE INVOLVED AND DO TESTING WORK, EVEN IF
IT’S JUST ROUTINE TESTING WE WOULD BE HAPPY WITH THAT, IF THEY DON’T WANT TO GET INTO
THE CARE PART OF THAT. WE DO HAVE A LOT OF PLACES IN THE STATE OF
GATE KEEPER GASEOUS WE HAVE A WORKFORCE ISSUE WHERE WE DON’T HAVE ENOUGH INFECTIOUS DISEASE
DOCTORS IN THE STATE OF GEORGIA. WE ABSOLUTELY AS A PART OF EHE AND ANY MONEY
WE GOT, I TALKED TO THE COMMISSIONER WE HAVE TO ADDRESS THAT BECAUSE IF YOU WANT TO GET
PEOPLE INTO RAPID CARE, I GET GET A PERSON IN RAPID CARE BECAUSE THEY DON’T HAVE A FULL-TIME
INFECTIOUS DISEASE DOCTOR OR P. A. SO I COULD SAY IT, THAT WE’RE GOING TO DO
IT OW HOW WILL THEY DO IT WITHOUT THAT WORKFORCE. SO IT’S SOMETHING THAT WE’VE–WE HAVE A MEDICAL
DIRECTIVE AND HIM AND I HAVE A LOT OF CONVERSATIONS ABOUT HOW WE’RE GOING TO DO THAT TOW ME EHE,
WE WILL HAVE TO EXPAND OUR WORKFORCE AND P AS ARE INFECTIOUS DISEASE DOCTORS.
SO NEXT STEPS, THE PLANNING PLAN CONTINUES TO GO ON, WE GET OUR PLANNING GRANT IN ON
TIME, DECEMBER 31ST BUT WE’RE CONTINUING TO UPDATE IT AND WE WILL CONTINUE TO HAVE THOSE
MEANS AND TALK TO OUR COMMUNITY PARTNERS. THE IMPLEMENTATION GRANT WHICH IS DUE MARCH
25TH, WE ABSOLUTELY WILL BE APPLYING IF ARE IT AND I THINK WE’RE SUPPOSED TO RECEIVE THE
FUNDS, I DO LIKE THE WAY MY STAFF PUT EXCLAMATION ON TESTERS BECAUSE TO BE HONEST WITH YOU WE’VE
BEEN EXPLORING IT FOR TWO YEARS AND IT’S BEEN HELD UP IN LEGAL AND OTHER PARTS OF–IT’S
REALLY NOT PEW BUT WE ARE CONTINUING THE WORK ON IT AND I REALLY A DECISION FOR ME HAS TO
BE MADE IN THE NEXT COUPLE WEEKS TO BE HONEST WITH YOU, IF WE CAN’T GET IT DONE IN THE HEALTH
DEPARTMENT, I’M STRONGLY CONSIDERING PARTNERING WITH PRISM UNIVERSITY.
THEY ALREADY HAVE A PROGRAM. AND JUST LET THEM TAKE IT OVER BECAUSE FOR
ME IT’S ABOUT GETTING THE WORK DONE, IT’S NOT WHOSE NAME IS ON IT, I JUST NEED TO GET
THE WORK DONE. AND AS I MENTIONED BEFORE, THE SYRINGE SERVICES
PROGRAM, WE WOULD BE HAPPY TO HIRE A MANAGER AND DO THOSE THINGS IN GEORGIA.
ONE OF THE FUNNY THINGS IN GEORGIA WAS A SHOCK FOR THE LEGISLATURES TO PASS THAT BILL.
THAT TOOK A LOT OF WORK IN THE BACKGROUND. BUT PROBABLY EVEN MORE SHOCKING, PEOPLE WERE
ALREADY DOING THE WORK SO BASICALLY THE BILL WAS LEGALIZED AND THEY DIDN’T GET HARASSED
LEGALLY THEY WERE ALREADY DOING THE WORK AND THERE ARE–THERE ARE SOME OF OUR MAIN PARTNERS,
ATLANTA HARM REDUCTION AND RECOVERY ALSO SO WE’RE VERY, PROUD ABOUT THAT AND GETTING THAT
OFF THE GROUND. AND TELL BE SOON, WE HAVE TO–THE LETTER MANDATED
THAT THE HEALTH DEPARTMENT PROMULGATE THE RULES AND THEY’RE FINISHED WE SENT THEM OUT
TO COMMUNITY PARTNERS TO GET THEIR FEEDBACK AND THAT WAS A LONG PROCESS, TOO BECAUSE THEY
WERE SUPPOSED TO BE FINISHED IN DECEMBER OUR HEAD LAWYER SENT THE FINAL COPY LAST WEEK.
SO THAT’S BEEN A LITTLE SLOW GOING, TOO, AND THAT’S WITH THE IMPLEMENTATION GRANT SO WE’LL
WORK IT OUT BUT WE’RE VERY PROUD OF THAT GEORGIA BEING IN THE SOUTH WILL HAVE THE CENSUS PEOPLE
PROGRAM AND WE’RE ALSO IN PARTNERSHIP WITH [INDISCERNIBLE] AND GETTING THAT UP AND RUNNING
AND ALSO WITH THE STATE OF MASSACHUSETTS AND THE STATE OF TENNESSEE TO GET SOME STUFF ON
BEST PRACTICES.>>QUESTIONS, WE’RE WAITING UNTIL THE LAST
ONE, OKAY. JUMP THE GUN.
[ APPLAUSE ]>>OKAY AND SEE WE WILL HAVE OUR LAST JUMP
START SITE FROM THE CHEROKEE NATION OF OKLAHOMA.>>I’M JORGE MERA, DIRECTOR INFECTIOUS DISEASES
AT THE CHEROKEE NATION.>>I’M WHITNEY ESSEX, AND I’M NURSE PRACTITIONER
SPECIALIST AND I’M WITH THE PROGRAM TO END HIV AT CHEROKEE NATION.
>>SO FIRST WE WANT TO THANK YOU FOR INVITINGITOUS BE HERE AND THANK YOU FOR PROPOSING US AND
INDIAN HEALTH SERVICES FOR CHOOSING OUR SITE AS A JUMP START SITE WITHIN THE NATIVE AMERICAN
COMMUNITY. AND ALSO MARK AND CAROL FOR GETTING US HERE.
WE DON’T HAVE ANY CONFLICTS TO DISCLOSE. AND I’LL BE COVERING AN OVERVIEW, VERY BRIEF
OVERVIEW OF CHEROKEE NATION HEALTH SERVICES AND SOME BASIC HIV STATISTICS AND AMERICAN
INDIANS AND ALASKA NATIVES. AND STATISTICS IN OKLAHOMA AND IN PARTICULAR
THE CHEROKEE NATION AND WITH ME WILL BE COVERING OUR PROGRAM PLAN AND THE INTERVENTIONS THAT
HAVE BEEN TAKING PLACE AS SOON AS WE GOT FUND INDEED SEPTEMBER.
SO, ON THE LEFT YOU WILL SEE A MAP OF THE UNITED STATES WITH A SHOWING AMERICAN INDIAN
POPULATION EXPRESSES A PERCENTAGE OF THE OVERALL POPULATION AT COUNTY LEVEL AND THERE ARE 2.2
MILLION ALASKA NATIVES IN THE UNITED STATES AND MOST OF THEM BELONG TO THE 573 FEDERALLY
RECOGNIZED TRIBES. SO CAN YOU SEE ON THE MAP, THERE ARE MORE
INTENSE THE TKPWREPB COVER, IT’S THE HIGHEST DENSITY OF AMERICAN INDIAN POPULATION AND
CALIFORNIA AND OKLAHOMA HAVE THE HIGHEST RATES OF AMERICAN INDIAN POPULATION IN THE UNITED
STATES. ON THE RIGHT IT’S A MAP OF THE CHEROKEE NATION.
SO CHEROKEE NATIONS LOCATED IN NORTHEAST OKLAHOMA AND A CHEROKEE NATION IN NORTH CAROLINA.
THAT’S WHY I IDENTIFY THAT. WE COVER 14 COUNTY DISTRICT.
WE HAVE THE HRARPLGEST TRIBAL HEALTH SYSTEM IN THE UNITED STATES ALTHOUGH IT’S THE SECOND
LARGEST TRIBE. AND WE MEDICALLY SERVE 132,000 NATIVE AMERICANS
THAT LIVE IN THAT AREA. WE HAVE ONE CENTRAL HOSPITAL IN THE CAPITAL
OF THE THE CHEROKEE NATION AND YOU SEE THE RED CROSSES, THEY WERE BEIGELY COMMUNITY HEALTH
CENTERS FOR NATIVE AMERICAN INDIVIDUALS AND WE HAVE A UNIFIED ELECTRONIC HEALTH RECORD.
AT THIS MOMENT, THE ONLY HIV CLINIC IS IN TALEQUA, AND THE ONLY PLACE WHERE PREP THEREFORE
SIDE IN TALEQUEA, AND OUR GOAL IS TO EXPAND THIS TO EVERY SITE YOU SLEEP APNEA AND OBESITYY
ON THAT MAP. SO ON THE RIGHT HAND SIDE, THIS IS CDC STATISTICS
OF NEW HIV DIGITEXTIS, AMONG AMERICAN INDIANS, ALASKA NATIVE BY TRANSMISSION CATEGORIES AND
SEX, REPORTED THEN IN 2017 AND I WILL GO OVER THE DETAILS BUT I WILL MENTION THE MOST ALARMING
PART IS THAT 21% OF AMERICAN INDIAN MALES WILL ACQUIRE HIV, INJECTION DRUG USE IS RESPONSIBLE
FOR THAT TRANSMISSION AND 31% OF FEMALES ACQUIRE HIV THROUGH INJECTION DRUG USE. THIS IS KPRAEPLLY
RELEVANT WHEN WE CONSIDER THAT IN MANY STATES INCLUDING OKLAHOMA, SYRINGE SERVICE PROGRAMS
ARE ILLEGAL AS OF TODAY. SO THAT IS A MAJOR OBSTACLE TO MITIGATE THAT
PROBLEM. WHEN YOU LOOK AT GAY AND BISEXUAL MEN THE
INCREASE HAS BEEN 81%. ON THE LEFT IS THE MAP OF THE UNITED STATES,
WITH THE RATES EVER HIV AMONG AMERICAN INDIANS AND ALASKA NATIVES, THE HIGHER THE DENSITY
OF THE COLOR, THE HIGHER THE RATE. OKLAHOMA IS NOT ON THE HIGHEST YEAR BUT IT’S
NEXT TO THE HIGHEST TIER OF HIV PREVALENCE. I WANT TO MENTION THERE’S 1.3% OF THE U.S.
POPULATION ON AMERICAN INDIANS AND ALASKA NATIVES AND ONLY ONE% OF THE HIV POPULATION
ARE AMERICAN INDIANS AND ALASKA NATIVES SO IT SEEMS LIKE WE HAVE A LESSER PROBLEM, I
JUST THINK IT’S UNDERREPORTING OF THE ETHNICITY WHEN YOU ARE DOING STATISTICS AND I DON’T
THINK WE HAVE A LESSER PROBLEM THAN THE OTHER ETHNIC GROUPS.
OT BOTTOM LEFT IS A TABLE OF THE STUDY THAT WAS DONE BY INDIAN HEALTH SERVICES AND THEY
REPORTED THE NEW HIV DIAGNOSIS FROM 2005 THROUGH 2014 AND WHAT THEY FOUND WAS THAT THE RATE
WAS 15 PER HUNDRED THOUSAND AI AND AN POPULATION PER YEAR AND THAT THE RATE WAS HIGHEST AMONG
MALES AGES 20-54. SO WHY DID IHS CHOOSE CHEROKEE NATION TO START
THIS PROGRAM AND BASICALLY IT WAS BECAUSE WE HAD HAD A TRACK RECORD OF SEVERAL YEARS
WORKING ON HEPATITIS E C PRACTICAL AND THEY WANTED US TO SEE WHAT WE COULD DO WITH THAT
KNOWLEDGE DURING THE YEARS WITH HIV. SO WHAT DID WE LEARN WITH THE HEPATITIS E
C PROGRAM, MANY THINGS, WILL RELAY A FEW, FIRST THAT STIGMA IS THE BIGGEST BARRIER AND
STILL IS THE BIGGEST BARRIER TO GET INDIVIDUALS WITH HEPATITIS C UNDER CARE AND TREATMENT
AND CURED. SECOND THAT INTERVENTIONS THAT ANY INTERVENTIONS
THAT WE IMPLEMENTED IN OUR HEALTH SYSTEM SHOULD NOT DISRUPT THE WORK FLOW OF THE PRIMARY CARE
PROVIDERS OR IT WOULDN’T WORK. SO THAT’S WHY WE CHOSE A PHARMACIST TO HELP
TREATMENT OF PATIENTS WITH HEPATITIS C AND NURSES TO HELP WITH THE SCREENING SO NOT INTERFERING
WITH THE PRIMARY CARE PROVIDERS ACTIVITIES AS MUCH AS WE COULD AND ALSO USING ELECTRONIC
PROMPTS TO FACILITATE THE KNOWLEDGE OF WHICH PATIENT NEEDED TO BE SCREENED, WHEN AND WHERE.
THE OTHER THING WAS HAVING MEDICATIONS ONSITE WAS CRUCIAL AND FOR HEPATITIS C WE DID NOT
HAVE THAT AND WE LOST 20 OR 30% OF PATIENTS BY JUST NOT HAVING THAT PW-LGTS IN THEIR SHELF
TO DISPENSE WHEN WE HAVE THE PATIENT IN FRONT OF US OF THE COMMUNITY HEALTH WORKERS AND
PATIENT NAVIGATORS WERE CRITICAL FOR ADHERENCE, WE DID IMPLEMENT THEM IN OUR HEPATITIS E C
PROSPECT AND WE DID MEASURE THE IMPACT. AND FINALLY, THE ECHO PROGRAM THAT WE USED
TO EDUCATE AND TAKEN OUR HEPATITIS C PROVIDERS WAS VERY SUCCESSFUL AND AS WHITNEY WILL MENTION
WE ARE IMPLEMENTING THAT FOR OUR PREP PROGRAM. SO A FEW THINGS OF HIV AND OKLAHOMA, THE RATE
OF HIV IN OKLAHOMA IS 184 PER 1000 POPULATION WHICH IS NOT THE WORST IN THE U.S. AND NOT
THE LEAST, IT’S AROUND THE MIDDLE BUT OF THE PREP HAS BEEN INCREASING IN THE PREP UPTAKE
HAS BEEN INCREASE NOTHING THE LAST FEW YEARS, IT’S STILL UNDER–SEVERELY UNDERUTILIZED IN
MY OPINION AND THE PREP RATIO IS 248 WHICH IS HIGH COMPARED TO OTHER STATES WHICH HAVE
ROLLED OUT GOODENTIOUS FICIENT PREP PROGRAMS BUT THE WORST PROBLEM IS MORTALITY DUE TO
HIV, IT’S HIGHER AND HAS NOT IMPROVED OVER THE LAST FEW YEARS AND ON THE RIGHT, YOU SEE
A GRAPH SHOWS DEPICTING THE ESTIMATED ADULTS AND ADOLESCENTS DIAGNOSED BOY HIV BOY ETHNICITY
AND NATIVE AMERICANS OCCUPY 7.2% WHICH IS MORE OR LESS THE PERCENTAGE OF THE AMERICAN
INDIAN POPULATION IN THE STATE. SO THIS IS THE HIV PREVENTION PROGRESS REPORT
IN 2019. I CHOSE THREE STATES, OKLAHOMA OF COURSE BECAUSE
THAT’S WHERE I’M WORKING ON AND I USE TEXAS BECAUSE IT’S A NEIGHBOR STATE, MORE OR LESS
THE SAME PROBLEMS IN SOME RESPECTS BECAUSE THEY’RE DOING VERY WELL AND IT WAS GOOD TO
COMPARE. OF THE SEVEN INDICATORS THAT WERE USED TO
MEASURE THIS PROGRESS, ACTUALLY OKLAHOMA DID NOT HAVE DATA FOR FOUR OF THEM.
SO THAT’S JUST TELLING YOU WHAT SOME OF THE PROBLEMS THAT ARE HAPPENING.
THERE WERE SOME PROGRESS IN KNOWLEDGE OF HIV STATUS AND NEW DIAGNOSIS BUT DEATH RATE WAS
WORSE THAN THE PREVIOUS YEARS. SO JUST TO GIVE YOU A BASE LINE OF WHAT WE’RE
DEALING WITH IN OUR STATE TO WORK WITH THIS PROGRAM.
OKAY, SOME CHEROKEE NATION, HEALTH SERVICE HIV STATISTICS SO FROM 2015-2019 WE STARTED
ELECTRONIC HEALTH REMINDER DRIB SCREENING PROGRAM AND 107,950 INDIVIDUALS AGES 13-65,
WHO ACCESS THESE SERVICES OF THOSE 32.7% HAD AN HIV SCREEN PERFORMED.
AND OF THAT POPULATION WE IDENTIFIED 50 INDIVIDUALS WITH CONFIRMED HIV AND GIVING PREVALENCE ON
THIS POPULATION OF 0.14%. IF YOU LOOK AT THE GRAPH ON THE RIGHT, THIS
IS THE 64 PATIENTS THAT WE FOLLOW IN OUR HIV CLINIC, WE GRAPH WHEN WE’RE DATE DIAGNOSED
WITH HIV. YOU CAN SEE THAT AFTER 2012, THIS–THE DIAGNOSIS
GOES UP BUT I HAVE TO MENTION THAT THAT IS THE YEAR THAT WE STARTED OUR HIV CLINIC AT
CHEROKEE NATION AND THE FOLLOWING YEARS IS WHEN WE INCREASED OUR SCREENING RATES FROM
2 PERCENT IN 2012 TO 19% IN 2013 AND NOW IT’S AROUND 32% OF THE POPULATION HAS BEEN SCREENED.
SO THIS DOES NOT NECESSARILY REFLECT ALL THE NEW DIAGNOSIS, IT MIGHT REFLECT AN IMPACT
NOW WE’RE HAVING SCREENING SERVICE AND AN HIV SERVICE SERVICE.
SO OUR CASCADE OF CARE WITH THE PEOPLE LIVING WITH HIV, WE CALCULATE THERE’S 182 INDIVIDUALS
IN THE POPULATION THAT WE SERVE THAT HAVE THE LEVEL OF HIV, THIS IS BASED ON THE PREVALENCE
OF RATES THAT I MENTIONED BEFORE. SO IT’S JUST THE BEST ESTIMATE WE HAVE RIGHT
NOW OF WHICH 64 HAVE BEEN DIAGNOSED, 58 ARE ENGAGE INDEED CARE AND 53 ARE VIRALLY SUPPRESSED
SO IF WE LOOK AT THIS CASCADE, THE BIGGEST GAP WE HAVE IS IDENTIFYING INDIVIDUALS WITH
HIV. ONCE THEY ARE ENGAGED IN CARE, THE NUMBERS
DON’T LOOK BAD. I THINK THEY’RE PRETTY DESCENT AND ACCEPTABLE,
THERE’S ALWAYS ROOM FOR IMPROVEMENT BUT WE’RE AT 90% RATE OF ENAGAINMENT AND VIRAL SUPPRESSION.
SO I WILL LET WHITNEY EXPLAIN WHAT WE WILL DO ABOUT THESE PROBLEMS.
>>THANK YOU DR. ME RA. SO AS DR. MERA MENTIONED, WE ARE STARTING
OUR PROGRAM BUILDING ON OTHER THINGS THAT WE’VE DONE IN THE PAST AND THAT’S BEEN VERY
USEFUL, SETTING GOALS HAS BEEN A DIFFICULT TASK AND ONE THAT SEAMS EASY BUT WHEN WE LOOK
AT THE NATIONAL PLAN GOALS, FOR 75% REDUCTION IN NEW INFECTIONS IN FIVE YEARS AND 90% IN
TEN YEARS, WE SHARE THOSE SAME GOALS BUT WE ARE WORKING TO SET MORE SHORT-TERM GOALS AND
TO DO THAT WE NEED TO ESTABLISH OUR BASE LINE MEASUREMENTS.
AND AS YOU HEARD FROM THE OTHER SIDE, DATA COLLECTION IS VERY DIFFICULT.
SO, WE’RE WORKING ON GETTING OUR GOALS ESTABLISHED AND THAT’S BEEN PART OF OUR START UP EXPERIENCE
SO FAR IS THE DIFFICULTY IN GETTING GOALS ESTABLISHED, AS DR. MERA SHOWED IN OUR CASCADE,
WE HAVE A BIG GAP IN THE DIAGNOSIS COLUMN AND SO THIS–THIS FIRST YEAR OF OUR PROGRAM,
WE ARE FOCUSING MOST ON DIAGNOSING NEW INFECTIONS AND PREVENTING TRANSMISSION OF HIV.
SO, TO DIAGNOSE PEOPLE LIVING WITH HIV, WE HAVE THREE MAIN GOALS AND THAT IS TO EXPAND
OUR EHR BASE SCREENING, SOMETHING THAT WE DEVELOPED IN OUR HEPATITIS C PROGRAM IS A
PROCESS CALLED LAB TRIGGERED SCREENINGS AND BASICALLY IT’S IT’S DRIVEN BY OUR PHLEBOTOMIST
IN THE LAB WHO WE MAKE SURE THE PATIENT HAS SIGNED INFORMED CONSENT FOR HIP TITIS C AND
HIV SCREENING AND WE DROP AN HIV OR HEPATITIS C TEST ON PATIENT WHO IS ARE IN NEED OF THAT
SCREENING AND HAVE SIGNED CONSENT. THIS PROCESS HAS BEEN VERY SUCCESSFUL FOR
OUR HEALTH SYSTEM AND WE EXPANDED THAT IN THE LAST FEW MONTHS TO HIV SCREENING AS WELL.
AND ALSO WORKING ON EXPANDING OUR SCREENING SITES.
SO WITHIN CHEROKEE NATION WE–PRIMARY CARE HAS ALWAYS BEEN THE BASIS FOR HEALTH MAINTENANCE
SCREENING, RIGHT? BUT WE ARE WORKING TO EXPAND TO THE URGENT
CARE AND EMERGENCY DEPARTMENTS, THE DENTAL CLINICS WHICH HAVE BEEN GRIT SUCCESS FOR HEPATITIS
C PROGRAM, THE BEHAVIORIAL HEALTH CLINICS AND OUR MEDICATION ASSISTED TREATMENT CLINICS.
OUTSIDE OF CHEROKEE NATION, WE ALSO WANT TO EXPAND MORE TO THE COMMUNITY.
WE HAVE LOCAL HOMELESS SHELTERS THAT WE’RE GOING TO BE OFFERING SCREENING TOO, THE HIGH
SCHOOL FOR SOME EDUCATION AND SCREENING FOR STIS, OUR LOCAL CORRECTIONAL FACILITY, AND
JUST OUT IN THE PUBLIC AT COMMUNITY EFFECTS. –DECREASING TRANSMISSION.
OUR MAIN ISSUE WHEN WE GO, SO WE HAVE EIGHT OUTLYING HEALTH CENTERS AND THEN ORIGINAL
CENTRAL HOSPITAL, DR. MERA WORK AT CENTRAL HOSPITAL BUT WE TRAVEL TO THE EIGHT OUTLYING
HEALTH CENTERS TO GET EDUCATION ABOUT DIFFERENT INFECTIOUS DISEASE ISSUES.
AND WHEN WE ARE OUT IN OUR COMMUNITY VISITING THE LOCAL HEALTH CENTERS WHAT WE HEAR FROM
OUR PROVIDERS IS REALLY OUTSTANDING BECAUSE I CAN STAND IN FRONT OF A ROOM OF 20 PROVIDERS
AND I CAN SAY HOW MANY HAVE OF YOU HAVE PATIENTS WHO YOU THINK WOULD BENEFIT FROM PREP AND
NOT ONE OF THEM RAISES THEIR HAND. SO THE LACK OF EDUCATION THERE ON TAKING A
SEXUAL HISTORY FOR OUR PATIENTS, IS REALLY LACKING AND IT’S SOMETHING THAT WE’RE WORKING
ON IMPROVING WITHIN OUR HEALTH SYSTEMS. WHEN I ASK THE SAME PROVIDERS, HOW MANY OF
HAVE YOU A PATIENT DIAGNOSED WITH CHLAMYDIA IN THE LAST SIX MONTHS, EVERYONE RAISES THEIR
HAND RIGHT, SO THEY DON’TRYALATE NEEDING HIV PREVENTION TO HAVING AN STI, AND I THINK THAT’S
A BIG LACK IN EDUCATION THAT WE’RE TRYING TO SOLVE.
OTHER WAYS TO GET PREP CANDIDATES, WE ARE TRYING TO DO MORE OUTREACH ON OUR COMMUNITY,
THE ELECTION AND REACH THOSE VULNERABLE POPULATIONS AND THE HOMELESS SHELL, CORRECTIONAL FACILITY
AND THEN UPDATING OUR EHR PROMPTS. YOU KNOW TECHNOLOGY IS AMAZING BUT WE DON’T
USE IT TO ITS FULL CAPACITY WITHIN THE HEALTH RECORD AND WE WANT OUR HEALTH RECORD TO BE
ABLE TO TELL US WHEN SOMEBODY NEEDS PREP TO TAKE IT AWAY FROM THE PROVIDERS TO RELYING
ON THE PROVIDER. FOR PREP DELIVERY AS DR. MERAR MENTIONED OUR
PHARMACISTS WERE A GREAT ASSET IN OUR HEPATITIS C PROGRAM.
WE WERE ABLE TO DELIVER EPITITIS C TREATMENT THROUGH OUR PHARMACY ALONE AND THAT WAS AMAZING
WE WANT TO DO THE SAME THING FOR OUR PREP PROGRAM.
HAVE PATIENTS BE ABLE TO ACCESS A PHARMACY AND GET THE PREP SERVICES RIGHT THERE, AND
NOT HAVE TO SEE THEIR PROVIDER EVERY THREE MONTHS.
PROJECT ECHO PREP IS ANOTHER TOOL THAT WILL BE USING AND WE WILL TALK A BIT MORE ABOUT
THAT IN A MINUTE. AND THEN, EXPLORING DIFFERENT TYPES OF TECHNOLOGY,
APPLICATION, SMART PHONE APPLICATIONS FOR INCREASING OUR PREP UPTAKE IN ADHERENCE USING
APPS. YOU EQUALS YOU, WE ALSO OFFERED TREATMENT
IN OUR PREVENTION IN OUR CLINIC BUT WE’RE WORKING ON MORE SAME DAY STARTS OF A. R. T.
AT THE SAME DAY OF DIAGNOSIS AND TREATMENT OF PREVENTION IN THAT WAY, AND THEN, ALSO
MENTIONED EARLIER, OKLAHOMA DOES NOT HAVE SSPS.
AS MY COLLEAGUE HERE MENTIONED, THERE ARE SOME UNDERGROUND OPERATIONS OF SYRINGE SERVICES
THAT I KNOW OF IN OKLAHOMA, BUT NOTHING THAT IS LEGAL AND THAT’S GROUND WORK THAT WE’VE
BEEN DOING FOR DR. MERA HAS BEEN WORKING ON IT FOR OVER FIVE YEARS TRYING TO GET THAT
DONE. AND THEN ALSO THROUGH SEXUAL TRANSMISSION,
INCREASING CONDOM DISTRIBUTION, WE DEFINITELY ARE LACKING ON THAT AND AS A PROVIDER MYSELF,
I FORGET TO OFFER CONDOMS TO PATIENTS, IT’S JUST NOT PART OF MY WORK FLOW SOMETIMES AND
SO, MAKING SURE THAT THAT’S HAPPENING IS ARE ANOTHER ONE OF OUR GOALS.
SO WHAT WE’VE DONE TO DATE IS WE DEVELOPED AND ENDING THE HIV EPIDEMIC ADVISORY BOARD
WITHIN OUR HEALTH SYSTEM AND WE’VE HAD TWO MEETING SO FAR THAT START INDEED NOVEMBER
OF 2019. WE LAUNCHED A PUBLIC CAMPAIGN FOR OUR PROGRAM
AND ON THE RIGHT, YOU CAN SEE THERE THAT BOTTOM RIGHT IS THE COMMERCIAL THAT HAS BEEN AIRING
ON OUR LOCAL TELEVISION STATIONS AND THEN WE HAVE BILLBOARDS ABOUT PREP AND BILLBOARDS
ABOUT SCREENING AND USING SOCIAL MEDIA MARKETING AS WELL TO GET THE WORD OUT THAT PREP IS OFFERED
WITHIN OUR FACILITIES AND THAT EVERYONE SHOULD BE SCREENED.
AND ANYONE 13-65. LAB TRIGGERED SCREENING AS I MENTIONED EARLIER
HAS BEGAN AND WE ARE SCREENING IN THAT EMERGENCY CARE AND DEPARTMENTS.
AGE TRIGGERED SCREEN SUGGEST ON GOING, UNDER THE PREVENTION PILLAR, WE HAVE TRAINED SEVEN
PHARMACISTS TO PROVIDE FOR OUR SERVICES FOR OUR PROGRAM AND THEN LOCATED AT THE OUTLYING
FACILITIES SO SOON THEY WILL START PROVIDING PREP SERVICES AT THE DIFFERENT HEALTH CENTERS
AND NOT JUST AT OUR CENTRAL HOSPITAL. PREP ECHO IS GOING TO LAUNCH THIS FRIDAY AND
WE’RE VERY EXCITED ABOUT THAT COLLABORATION WITH THE NORTHWEST PORTLAND AREA INDIAN HEALTH
BOARD. WE HAVE ABOUT 15 CHEROKEE NATION PROVIDER
WHO IS WILL PARTICIPATE BUT THE LITTLE FOOT NOTE THERE AT THE BOTTOM SAYS THAT 27 OTHER
IHS/TRIBAL FACILITIES WILL BE JOINING AND THAT’S FROM 13 DIFFERENT STATES.
SO THIS HAS BEEN AN AMAZING OUTREACH AND SHOWS GREAT COLLABORATION AMONG THE IHS SITES AND
WE’RE VERY EXCITED TO BE HOSTING THAT PROGRAM AND I KNOW THAT WHEN–WHEN IHS CHOSE US OR
SELECTED US, IT WAS WITH THE INTENTION THAT WE WOULD HELP TO SPREAD THE WORD AND I THINK
THAT THAT SHOWS THAT THAT’S HAPPENING SO WE’RE REALLY PROUD OF THAT PROGRAM.
WE’VE COMPLETED TWO MEDICAL WORKSHOPS AND THOSE ARE THE ONES I WAS TALKING ABOUT HOW
WE TEACH HOW TO TAKE A MEDICAL HISTORY AND HOW TO TEACH PATIENTS ON WHO MIGHT BENEFIT
PRACTICES PREP. THE NUMBER IS SMALL BUT THE INCREASED PREP
PATIENTS FROM 12-20 SO WE WERE WITHIN OUR HEALTH SYSTEM HAD 12 PATIENTS TO PREP PRIOR
TO THE EHE PROGRAM AND THAT’S NOT VERY MANY, RIGHT?
AND EVERY ONE OF THOSE PATIENTS WAS MINE AND DR. PMERA’S AND WE HAVE A HUNDRED PROVIDERS
IN OUR HEALTH SYSTEM, SO, WE’RE WORKING TO INCREASE THE PREP NUMBERS AND WE HAVE BUT
WE HAVE A LONG WAYS TO GO. THE SYRINGE SERVICE PROGRAMS WE ARE VERY EXCITE
THAD SOME LEGISLATION, HOUSE BILL WILL BE PRESENTED IN FEBRUARY IN THIS MONTH FOR HOPEFULLY
APPROVAL TO START SOME HARM REDUCTION IN OUR STATE AND TO LEGALIZE THAT.
OKAY SO OPPORTUNITIES IT MOVING FORWARD, WE HAVE MENTIONED ALREADY THAT STIGMA IS OUR
PRIMARY BARRIER AND THAT REMAINS. IT’S DIFFICULT TO DESCRIBE STIGMA AND HOW
IT’S–HOW TO PUT IT IN A WAY THAT NOT ONLY EVERYONE UNDERSTANDS BECAUSE STIGMA IS A PERCEPTION
THAT DIFFERS FROM PERSON TO PERSON. AND WE’RE WORKING TO HAVE OUR HEALTH SYSTEM
AND THE COMMUNITY AND THE ADMINISTRATION RECOGNIZE THAT STIGMA IS A PROBLEM AND TRY TO WORK TO
OVERCOME THAT BARRIER TOGETHER. WE WANT TO ESTABLISH A LGBTQ CLINIC AND ALTHOUGH
IT SOUNDS SIMPLE, IT’S MORE DIFFICULT THAN WHAT WE THOUGHT IT WOULD BE SO WE’RE WORKING
TOWARDS THAT. WE WILL CONTINUE TO ADVOCATE THROUGH THE SYRINGE
SERVICE PROGRAM, DESIGNING YEARLYY GOALS AND WE ARE GOING TO BE WORKING ON GETTING SOME
BETTER ESTIMATES WITH THE SOUTHERN PLACE TRAVEL EPI CENTER TO FIGURE OUT HOW MANY PEOPLE IN
OUR AREA NEED PREP, HOW MANY–HOW MANY PEOPLE ARE LIVING WITH HIV IN OUR AREA.
AND HELP US FIND THOSE PEOPLE. I DID WANT TO MENTION A COUPLE OTHER BARRIERS
THAT ARE ON THE SLIDE THAT WE JUST HAVE BEEN LISTENING TO THE OTHER SIDE THAT MAKES YOU
THINK, OH–WE HAVE THAT PROBLEM, WE HAVE THAT PROBLEM.
SO IT’S BEEN MENTIONED ALREADY BUT CONTRACTING IS A BIG ISSUE AND GETTING CONTRACTS IN PLACE
WITHIN A YEAR TIME FRAME IS DIFFICULT. IF YOU CAN BELIEVE THAT IT TAKES, YOU KNOW,
I WON’T MENTION 30 DAYS, I THINK FOR US SIX MONTHS IS DIFFICULT.
AND THEN HIRING NEW PHYSICIANS, SO ALL OF THIS WORKS ALTHOUGH WE’RE BUILDING ON A PROGRAM
WE ALREADY HAD, THAT PROGRAM–THOSE PEOPLE ARE FUNCTIONING AT THEIR MAXIMUM CAPACITY
AND SO YOU WOULD THINK THAT WE WOULD BE ABLE TO SAY, OKAY, YOU WILL DO THIS, TOO, BUT IT
DOESN’T WORK. WE’VE HAD TO HIRE A NEW POSITION AND WHEN
YOU’RE ON A YEAR LONG PROGRAM THAT–AND IT TAKES SEVERAL MONTHS TO HIRE NEW POSITIONS,
YOU WANT TO HIRE GOOD QUALITY STAFF AND FOR ME, I WOULDN’T BE ABLE TO TAKE A JOB THAT
HAS A NINE MONTH COURSE BY THE TIME THAT THE FUNDS ARE THERE AND THE NEW PERSON STARTS
AND THE PROGRAM ENDS IN NINE MONTHS. SO THAT HAS BEEN DIFFICULT AS WELL AND I THOUGHT
I WOULD MENTION IT AT THE BARRIER. I WILL TURN IT BACK TURNOVER TO DR. MERA TO
FINISH UP, FINAL THOUGHTS.>>I JUST WANT TO MAKE ONE FINAL COMMENT AND
TAKE IT WITH ME BECAUSE [INDISCERNIBLE] IS THAT WE HAVE A YEAR TO DO THIS AND WHAT WE’RE
TRYING TO DO IS FIND OUT WHAT WORKS AND WHAT DOES NOT WORK.
WE WILL NOT HAVE ENOUGH TIME IN ONE YEAR TO HAVE MAGICAL RESULTS BUT WE CAN CERTAINLY
FIGURE OUT IF THIS INTERVENTION IS GOING IN THE RIGHT DIRECTION OR NOT OR IF THIS SOMETHING
WE SHOULD EVEN DO AND THAT’S WHY WE’RE EXPLORING MANY THINGS WE THINK WILL WORK OF COURSE BUT
TIME WILL TELL. AND HOPEFULLY, WHEN IHS GETS THEIR 27 MILLION
THERE IS NEXT YEAR, THEY CAN GET SOME INFORMATION FROM US AND KNOW WHAT TO DO WITH THAT MONEY
BECAUSE NOT ALL TRIBAL SITES OR IHS SITES ARE ALIKE BUT MANY BARRIERS ARE VERY SIMILAR
AND ONE I WANT TO MENTION REAL BRIEFLY IS THE READY, SET, PREP MEDICATION AVAILABLE
IN CERTAIN FORMACYS HAVE IN MIND THAT MANY IHS SITES AND MANY CLINICS ARE 70 OR 80-MILES
AWAY FROM A PHARMACY SO IF YOU HAVE TO SEND A PATIENT TO THE PHARMACY TO GET THEIR PREP
MEDICATION THAT’S THE BIGGEST BARRIER AND WE ARE TRYING TO SEE IF WE CAN GET THAT READY,
SET, PREP MEDICATION IN THE IHS BECAUSE EACH SITE HAS A PHARMACY, EACH ONE OF OUR CLINICS
HAS A PHARMACY AND MOST IHS SITES HAVE A PHARMACY WITHIN THE SITE.
BUT CLOSEST COMMERCIAL FORMACY MIGHT BE VERY OPEN AND FAR AWAY, SO WE HAVE A SMALL PROGRAM
BUT IT’S BIG LAND AND THERE’S 50-70-MILES BETWEEN EACH CLINIC AND SOME ARE 120-MILES
SO YOU KNOW TRANSPORTATION IS A BARRIER FOR PATIENTS AND THAT HAS TO BE TAKEN INTO ACCOUNT.
AND THANK YOU VERY MUCH FOR YOUR ATTENTION. [ APPLAUSE ]
STH-RBGS WE DO HAVE A FEW MINUTES TO ASK OUR PANELISTS SOME QUESTIONS, SO I KNOW THAT FOLK
HIS THEIR QUESTIONS UP BEFORE, SO IF THOSE SAME INDIVIDUALS WOULD LIKE TO POSE THEIR
QUESTIONS I WILL GO BACK TO THE STACK I HAD INITIALLY.
SO I SAW RAFAEL, JOSH, AND DR. SCHWARTZ, AND IF YOU WANT TO START WITH YOUR QUESTIONS?
>>GOOD MORNING AND THANK YOU, IT’S BEEN A GREAT PRESENTATION.
>>[LOW AUDIO ]–THEY ARE EXKEYEDINGLY IMPORTANT IN ALL THE WORK WE DO.
YOU KNOW WE DO–IN PUBLIC HEALTH A LOT OF MONEY GOES TO LOCAL HEALTH INSTITUTES BUT
WE HAVE INCREASINGLY TRIED TO PUT MORE MONEY IN OUR COMMUNITY BASED ORGANIZATIONS 92 ZINDERRATIONS
I’VE BEEN DOING THIS 20 YEARS AND TO BE HONEST WITH YOU, SOME OF THE BEST WORK I’VE SEEN
WITH GETTING PEOPLE INTO CARING COME FROM COMMUNITY BASED ORGANIZATIONS, THEY HAVE THE
PULSE ON THE COMMUNITY, WE THINK WE HAVE THE PULSE ON THE COMMUNITY, BUT THEY HAVE THEIR
PULSE AND THEY WORK WITH THESE PEOPLE EVERY DAY AND WE NEED TO ACKNOWLEDGE THAT, SO IT’S
EXTREMELY IMPORTANT AND WE WILL CONTINUE TO WORK WITH THEMING AND BE HONEST WITH YOU,
I WOULD LIKE TO SEE US ADD A FEW MORE IN THE STATE OF GEORGIA TO BE ABLE TO HELP.
THERE ARE A FEW OTHER THAT WANT TO COME IN THE STATE OF GEORGIA AND WE NEED TO FIND A
MECHANISM TO MAKE THAT WORK.>>CAN I ALSO ADD, FOR THE LOUISIANA, AND
I THINK THAT HOPEFULLY IN OUR PRESENTATION WE TALKED A LOT ABOUT COMMUNITY ENGAGEMENT
AND THE DEPENDENCE WE HAVE ON COMMUNITY BASED ORGANIZATION, AND I THINK IN FACT, IT’S CRITICAL
BECAUSE WITHIN OUR STATE ISSUES THE CITY OF NEW ORLEANS AND THE CITY OF BATON ROUGE, THEIR
HEALTH DEPARTMENT IS NOT–THEY DO NOT HAVE A STRUCTURE WHERE THEY ARE PROVIDING ANY KIND
OF HIV PREVENTION WORK AND SO, IT IS UP TO THE STATE TO DIRECTLY FUND, SO WE DON’T TURN
AROUND AND GIVE MONEY TO THE LOCAL JURISDICTION AND THEN THEY TURN AROUND AND WORK WITH COMMUNITY
BASED ORGANIZATIONS BUT INSTEAD ALL OF THOSE SERVICES WE HAVE FOR PREVENTION GO DIRECTLY
FROM THE STATE TO THOSE PROVIDERS, COMMUNITY BASED ORGANIZATION, ET CETERA, SO I THINK
AND AS WE MOVE FORWARD WITH OUR NOFOS THAT ARE DUE TO AT THE END OF MARCH WHERE IT’S
REQUIRE THAT WE HAVE 70% OF OUR FUNDING GO TO THE LOCAL JURISDICTION, LOUISIANA IS A
BIT OF A UNIQUE SITUATION BECAUSE THAT INFRASTRUCTURE DOES NOT NECESSARILY EXIST IN BATON ROUGE
OR NEW ORLEANS. SO WE CONTINUE TO DEPEND ON CBOS.
>>I CERTAINLY ECHO, CBOS ARE INCREDIBLE LOAMACYY IMPORTANT AND JUST TO NAME A FEW OF THE CHALLENGES,
I THINK WE ALL RECOGNIZE THE IMPORTANCE OF THEM AND THEY WANT TO WORK WITH US, WE WANT
TO WORK WITH THEM AND THEY CAN DO THE WORK, THE WORK IS NOT THE ISSUE, BUT WE RUN INTO
CHALLENGES, SOMETIMES WITH REPORT THAGOREAN THEY’RE NOT ABLE TO MEET THE REPORTING REQUIREMENTS,
WHATEVER THE FUNDING STREAM IS AND ALSO THEIR FUNDING STRUCTURE ESPECIALLY THE SMALLER ONES
MAKE IT INCREDIBLY DIFFICULT FOR THEM TO WORK WITH US, BECAUSE IF WE’RE–WE CAN’T PROVIDE
THE MONEY AT THE EXACT SAME TIME THEY’RE DOING THE WORK AND THERE’S A DELAY GETTING THE FUNDING
TO THEM, A LARGER ORGANIZATION CAN ABSORB THAT AND IS ABLE TO WORK WITH US THAT WAY
BUT IN A SMALLER ORGANIZATION IT’S A LOT HARDER SO SOMETIMES THOSE LOGISTICAL AND OPERATIONAL
CHALLENGES THAT MAKE THAT REALLY CHALLENGING.>>THANK YOU EVERYONE FOR YOUR PRESENTATION.
I’M JUST–SO ALL OF YOU TOUCHED ON IN SOME WAY EXCEPT FOR OKLAHOMA, HOME TEST KITS AND
SELF-TEST KITS AND I WAS WONDERING IF YOU COULD SHARE–YOU KNOW WILLIAM SOME OF THE
BUREAUCRATIC CHALLENGES OF GETTING THAT IMPLEMENTED BUT I THINK FOR YOUR OTHER FOLKS, WHAT WERE
YOUR COMMUNITY RESPONSES TO YOU IMPLEMENTING HOME TEST KIT PROJECTS AND OKLAHOMA, I DON’T
THINK I HEARD YOU TALK ABOUT TEST HOME KITS AT ALL AND MAYBE YOU COULD TAKEN–THEYUC ABOUT
WHY MAYBE THAT WASN’T A GOOD OPTION FOR YOU TO IMPLEMENT AT THIS TIME.
>>BALTIMORE FIRST.>>[LAUGHTER]
>>SO, WE’RE–WE JUST STARTED OUR HOME TECHNIQUE PROGRAM AND WE ARE DOING COMBINED STI AND
HOME TESTING AND I THINK ARE PROBABLY ONE OF THE VERY FEW JURISDICTIONS THAT’S DOING
COMBINED TESTING IN THAT WAY AND SINCE IT’S JUST STARTED IN PART I DON’T HAVE A GOOD ANSWER
FOR YOU YET IN TERMS OF THE RESPONSE OF HOW IT’S BEEN BECAUSE IT IS SO NEW AT LEAST VERY
NEW ON A POPULATION LEVEL ON OFFERING THIS AS AN OVERALL PUBLIC HEALTH INTERVENTION AS
OPPOSE TO TARGETED PROGRAM. BUT IT CERTAINLY HAS COME UP IN YOUR COMMUNITY
LISTENING AND ON OUR TONE HALLS AND COMMUNITY MEETINGS AS PEOPLE ARE INTERESTED IN IT AND
IT COMES UP AS A REQUEST, ESPECIALLY THE ACCESS TO THE HOME HIV TEST KITS WHICH WHICH MIGHT
BE AVAILABLE ON THE DRUG STORE SHELF BUT THE PRICE POINT MIGHT BE TOO HIGH.
SO IT’S AN AREA THAT WE’RE INTERESTED IN TRY TO GET MORE COMMUNITY RESPONSE AS TO HOW IT’S
GOING, BUT THERE WAS INTEREST IN IT IN ORD FOR US TO START THE PROGRAM.
>>ALSO ADD THAT WE ALSO EMBARKED UPON MASSIVE SOCIAL MEDIA AND OTHER PARTS, OTHER MEDIA
OTHER WAYS TO GET THE INFORMATION OUT TO THE OTHER COMMUNITIES THAT WHERE AS THEY MENTIONED
WE JUST STARTED THIS IT’S THE STI PART START INDEED SEPTEMBER OF LAST YEAR AND THE HIV
TEST KITS STARTED IN LATE DECEMBER BUT WE DON’T HAVE THE NUMBERS TO SHOW JUST YET BUT
WE ARE MAKING EFFORT EFFORT TO SHOW THAT WE ARE GETTING THE WORD OUT THERE AND THIS IS
AVAILABLE NWAS THERE ANY RESISTANCE FROM YOUR COMMUNITY AROUND IMPLEMENTING THAT?
>>NOTHING WE’VE HEARD, WE HAVE HEARD RESISTANCE IN GENERAL ABOUT THERE CERTAINLY IS A CERTAIN
NUMBER OF VOICES, CERTAIN NUMBER OF PEOPLE–DON’T START THAT PROGRAM, IT’S NOT A GOOD PROGRAM
TO START AND THERE ARE CERTAINLY SOME THINGS TO BE AWARE OF WHEN STARTING THAT SO IT’S
NOT–SO AS FOR AS RESISTANCE, I HAVE NOT HEARD THAT YET FROM A COMMUNITY BASED MEETING BUT
AGAIN, THAT’S NOT TO SAY IT’S NOT THERE. I THINK WE’RE TOO EARLY ON TO KNOW IF THAT’S
GOING TO COME. SO IT’S SOMETHING THAT WE’RE LOOKING OUT FOR
AND STARTING TO LISTEN FOR.>>SO YOU ASKED ABOUT OKLAHOMA.
SO THAT WAS BROUGHT UP IN OUR SECOND ADVISORY BOARD MEETING BY ONE OF THE COMMUNITY MEMBERS
AND I THINK IT’S A GREAT IDEA AND WE ARE GOING TO PURSUE EXPLORING THE FEASIBILITY OF DOING
IT, BUT IT WILL TAKE AT LEAST FOUR-SIX MONTHS UNTIL WE GET ALL THE APPROVALS FROM CHEROKEE
NATION, THAT IS THE USUAL STEPS THAT IT TAKES FOR IT TO BE LAUNCHED SO WE THINK IT IS WORTH
WHILE PURSUING IT BECAUSE IT MIGHT HAVE A GREAT IMPACT BUT IT’S NOT SOMETHING THAT WE
WILL HAVE TO BE ABLE TO REPORT WITHIN OUR YEAR OF ACTIVITIES, SO, WE ARE GOING TO DO
IT, WE MIGHT NOT HAVE RESULTS WITHIN THE YEAR TO SAY HOW SUCCESSFUL OR NOT IT WAS.
>>ALL RIGHT, SO WE DON’T HAVE A LOT OF TIME, BUT SO INSTEAD OF A QUESTION, I WILL MAKE
A COMMENT. AND THAT IS THAT THE WHAT I HEARD IS A THEME
AMONG ALL THE PRESENTATION SYSTEM THAT ON THE 100, INNOVATIVE PROGRAM STARTING THEM
UP, ON THE OTHER HAND THE REQUIREMENT TO MEASURE THEIR IMPACT AND THE DATA POINTS BECOME HARD
TO TRACK AND THERE AREN’T TEAMS ABOUT YOU YET, AT THE END OF THE DAY, WITHOUT THE DATA
WE’RE NOT GOING TO KNOW WHETHER SOMETHING WORKED OR NOT, SO THAT OBVIOUSLY GOES HAND
IN HAND. I WANTED TO DRILL DOWN A BIT, IT WENT BY QUICKLY
IN THE BATON ROUGE PRESENTATION, ABOUT INCENTIVIZING PATIENTS, ET CETERA, I THINK IT’S A GREAT
IDEA, HOWEVER THE DOWN STREAM EFFECTS CONCERN ME A LITTLE BIT THAT. IS ONE WE’VE NOW CONDITIONED
THAT INDIVIDUAL TO RECEIVE PAYMENT FOR BEHAVIOR. DOES THAT EVER END?
TWO, HOW DO YOU MANAGE IT WHEN IT DOES END? AND WE PROBABLY CAN’T TALK ABOUT THIS RIGHT
NOW BUT THREE, AMONG THE OTHER PEOPLE SEE THAT THEY’RE GETTING REWARDED AND THEY’RE
NOT, THAT BECOMES A PROBLEM. SO JUST IF HAVE Y’ALL THOUGHT THROUGH THAT.
>>YES, AND I’LL ANSWER NOT PARTICULARLY IN THE ORDER THAT YOU ASKED, SO PEOPLE–WE IMPLEMENT
THE PROJECT IN HIV SPECIALTY CLINICS SO EVERYONE IS ELIGIBLE TO ENROLL IN THE PROGRAM.
AND ONE THING WHEN WE STARTED THE PROJECT IN 2013 UNDER CAPLESS FUNDING AND OF COURSE
WE NEVER KNOW WHAT THE URGENCY OF FUNDING IS SO IT’S THAT THE PROGRAM IS NOT JUST ABOUT
A TRANSACTION OR INTERVENTION WHERE WE’RE JUST GIVING AWAY MONEY BUT IT IS DEFINITELY
AN INTERVENTION WHERE IT’S MORE TRANSFORMATIVE IN WHICH WE ALWAYS TELL THE CLIENT, HEY, THIS
MAY NOT HAPPEN ALL THE TIME BUT THE THING ABOUT IT IS WHEN WE MEET WITH THE COORDINATOR
AND ALSO HELP THE CAPACITY OF THE CLIENT AND THEY ALSO USE THAT AS A TOOL AND SAY, THIS
IS SOMETHING THAT YOU SHOULD DO ALL THE TIME. MAKE SURE YOU ATTEND YOUR DOCTORS APPOINTMENTS,
DO YOUR LAB WORK, MAKE SURE THAT AND THE GOAL OF BEING MILDLY SUPPRESSED SO IT’S MORE OF
AN INTERVENTION, IT’S NOT LIKE WE HAVE THE CASH REGISTER AND WE GIVE AWAY MONEY BUT IT
IS USED AS A STRATEGY AND AN INTERVENTION AND WE ARE LOOKING TO SEE ABOUT BEHAVIOR CHANGE
OVER A PERIOD OF TIME. ADDITION TO THAT, SOMETIMES WE HAVE FOUND
THAT CLIENTS CANNOT GET TO A MEDICAL APPOINTMENT BECAUSE THEY DON’T HAVE THE FUNDS OR THE MONEY
TO GET THERE, OR THE MEANS TO GET TO A MEDICAL APPOINTMENT OR THAT’S WHY THEY STOP COMING
TO THEIR DOCTORS APPOINTMENT. SO JUST TO GIVE THEM JUST THAT INCENTIVE TO
MAKE SURE THEY CAN GET THERE AND MAKE SURE THAT HARE HEALTHY AND WHOLE, IN ADDITION TO
THAT, LIKE ONE OF OUR CLIENTS SAY, YOU KNOW WHAT INSHALLLY, YOU WERE SAYING, HEY, YOU
NEED TO TAKE YOUR MEDICINE, YOU NEED TO TAKE YOUR MEDICINE.
BUT THEN Y’ALL NEVER TOLD ME I WAS REALLY GOING TO START FEELING BETTER ABOUT IT.
SO MY THING IS IF WE HAVE THIS SMALL INCIDENT WE CAN HELP CLIENTS TO HELP CHANGE THEIR BEHAVIOR,
ATTEND APPOINT AMS, ACHIEVE SUBMISSION, IT’S WELL WORTH IT AND AGAIN, IT’S USED AS AN INTERVENTION
BECAUSE WE ALSO JUST TALK ABOUT TREATMENT ADHERENCE AND HELPING THEM OVERCOME ANY OTHER
BARRIERS THAT THEY MAY HAVE, SO IT’S JUST NOT, WE’RE GIVING MONEY ABOUT YOU WE USE THAT
AS A TOOL AND IT’S USEFUL FOR THE CLIENT AND WE ARE LOOKING TO SEE SOME TYPE OF BEHAVIOR
CHANGE OVER A PERIOD OF TIME. SO IN EFFECT THE MONEY DOES RUN OUT AT LEAST
THEY’VE BEEN–HAVE THE TOOLS TO USE TO STAY IN CARE AND REMAIN IN CARE AND THE IMPORTANCE
OF MAINTAINING VIRAL LOAD.>>I WILL ADD TO THAT, WE USE INCENTIVES AS
WELL. IT’S A NEW PROGRAM AND WE HAVEN’T–WE HAVEN’T
QUITE STARTED IT YET, BUT WE–WE ALSO FEEL THAT IF WE CAN–JUST THE SAME THINGS THAT
YOU’RE SAYING, IF WE CAN GET PATIENTS INTO OUR DOOR, AND GET THEM THERE, FOR ONE OR TWO
VISITS, USUALLY, THEY LOVE IT AND THEY COME BACK AND THEY COME BACK AND THEY COME BACK.
SO I THINK THAT JUST GETTING THEM INTO THE HEALTH SYSTEM IS DIFFERENT.
AND OUR SYSTEM IS DIFFERENT, WE HAVE A PREP REFERRAL INSTANCE SO ANYONE WHO IS LIVING
WITH HIV OR ON PREP CAN REFER A PERSON TO OUR PREP SERVICES AND ONCE THAT PERSON STARTS
ON PREP, THEY RECEIVE AN INCENTIVE AND THE PERSON ON PREP RECEIVES INCENTIVE SO IT’S
A LITTLE BIT DIFFERENT. IT’S NOT FOR EVERY APPOINTMENT BUT IT’S A
PROGRAM THAT WE’RE STARTING TO.>>AND IF I COULD JUST COMMENT, COMMENT ON
REPORTING I 100% AGREE, WE NEED GOOD REPORTING, I WANT EVALUATE MY PROGRAM EVEN MORE SO, PROBABLY
THAN OUR FEDERAL FUNDERS DO TO KNOW HOW WE’RE DOING AND WHERE WE SHOULD SPEND THE NEXT DOLLAR
AND WHAT WE SHOULD DO, SO IT’S NOT THE ACTUAL ACTIVE REPORTING BUT IT’S THE ORGANIZATION
OF THAT REPORTING ISSUES THE REPORTING BEING COORDINATED AND THE REPORTING BEING ABLE TO
EVALUATE WHAT OUR PROGRAMS ARE AND THE INTERVENTION NEUTRAL AND STATUS NEUTRAL IN OUR REPORTING
AND THEN ALSO MEASURING THE IMPACT THAT OUR PROGRAMS.
SO FOR EXAMPLE, BEING ABLE TO MEASURE THE IMPACT AND ENGAGEMENT OF A PERSON SORE HOW
WELL WE WERE ABLE TO INTERVENE IN THE OVERALL HEALTH AND IT MIGHT BE THAT SOMEBODY CAME
INTO A PREP PROGRAM FOR EXAMPLE AND WE DID A WHOLE LOT, WE WERE ABLE TO ENGAGE THEM IN
CARE, ABLE TO TEST THEM FOR STIS AND HIV IN THE END THEY DECIDED NONAPOPTOTIC THE TO BE
ON PREP. THAT PREP WASN’T FOR THEM, THAT CONDOMS WORK
FOR THEM BUT WE CAN’T COUNT THEM AS A PREP PRESCRIPTION BUT WE CERTAINLY OUR PROGRAM
WAS VERY IMPACTFUL IN WHAT WE DO. AND SOMETIMES THAT CAN BE VERY HARD TO MEASURE
AND VERY HARD TO COMMUNICATE. SO CERTAINLY WANT TO REPORT–THE REPORTING
IS ESSENTIAL IT’S JUST THAT THE COORDINATION OF THAT AND THE EFFICIENCY OF THAT I THINK
IS FROM BALTIMORE WHERE WE’RE TRYING TO THINK ABOUT THE BEST WAY TO DO THAT.
>>WELL WILL YOU JOIN ME THANKING OUR PANELISTS FOR NOT JUST THEIR PRESENTATION BUT FOR THE
WORK THEY ARE DOING IN THE COMMUNITY. [APPLAUSE ]>>THANK YOU AGAIN FOR ALL THE ANALYSTS AND
JUSTIN FOR MODERATING. WE ARE A LITTLE BIT BEHIND SCHEDULE SO WE
WILL TAKE A TEN MINUTE BREAK WE WILL BEGIN PROMPTLY AT FIVE AFTER 11 AND AND YOU KNOW
I THINK YOU PROVIDED A LOT OF US TO THINK ABOUT AND TALK ABOUT AND I THINK THIS AFTERNOON
WE’LL CONTINUE TO HAVE THE DISCUSSION, AND YOU WILL HELP GUIDE US IN OUR THOUGHTS AND
I THINK OUR FEDERAL PARTNERS AS WELL, SO THANK YOU FOR ALL YOUR WORK.

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