The document summarizes a presentation about early identification of individuals with HIV/AIDS given to the Philadelphia EMA Ryan White Planning Council. It discusses the national EIIHA initiative goals of increasing awareness of HIV status and linking those with HIV to care. The presentation outlines Philadelphia's EIIHA strategy, logic model, and matrix for targeting different high-risk groups. It also reviews HRSA expectations and policies around testing, outreach, and linkage to care to achieve the goals of diagnosing individuals and linking them quickly to medical care.

1. Early Identification of
Individuals with HIV/AIDS:
A National Ryan White Program Initiative
EIIHA
Presentation to
Philadelphia EMA Ryan White
Planning Council
Matthew McClain
March 14, 2013

2. Handouts
Logic Model
Matrix
HRSA Policy Notice 12-01: Outreach
HRSA/CDC letter February 25, 2013
March 14, 2013 EIIHA 2

3. Background
 Individuals who delay testing are likely to have
damaged immune systems because the virus has
had time to replicate in their bodies
 Undiagnosed individuals are more likely to infect
others
 The lower the viral load, the less likely a person is
to infect others – and ART can reduce viral load,
often to undetectable levels
 Untreated co-infections can cause spikes in viral
load
March 14, 2013 EIIHA 3

4. EIIHA Defined
Identifying, counseling, testing,
informing, and referring of
diagnosed and undiagnosed
individuals to appropriate services,
as well as linking newly diagnosed
HIV positive individuals to medical
care.
March 14, 2013 EIIHA 4

5. National EIIHA Goals
1.  the number of individuals who
are aware of their HIV status
2.  the number of HIV+ individuals
who are in medical care
3.  the number of HIV- individuals
referred to services that contribute
to keeping them HIV-
March 14, 2013 EIIHA 5

6. National HIV/AIDS Strategy
new HIV infections
 access to care and improving
health outcomes for PLWH
 HIV-related health disparities
March 14, 2013 EIIHA 6

7. Legislative Language 2009
“… a strategy, coordinated as appropriate with other
community strategies and efforts, including discrete
goals, a timetable, and appropriate funding, for
identifying individuals with HIV/AIDS who do not
know their HIV status, making such individuals aware
of such status, and enabling such individuals to use
the health and support services described section
2604, with particular attention to reducing barriers to
routine testing and disparities in access and services
among affected subpopulations and historically
underserved communities;” Section 2603(b)
March 14, 2013 EIIHA 7

8. EIIHA’s Relationship to Funding
“and demonstrated success in identifying individuals with HIV/AIDS
who do not know their HIV status and making them aware of such
status counting one-third. In making such determination, the
Secretary shall consider—
(i) the number of individuals who have been tested
for HIV/AIDS;
(ii) of those individuals described in clause (i),
the number of individuals who tested for HIV/AIDS
who are made aware of their status, including the
number who test positive; and
(iii) of those individuals described in clause (ii),
the number who have been referred to appropriate
treatment and care’’. Section 2617 (b)
March 14, 2013 EIIHA 8

9. Philadelphia EMA EIIHA Strategy
Maintain and expand a diverse and
coordinated portfolio of early intervention
services such that
(1) HIV screening is routinely available in
clinical settings, and
(2) individuals in high risk groups routinely
come into contact with HIV screening
programs operated in clinical and nonclinical
settings.
March 14, 2013 EIIHA 9

10. Philadelphia EIIHA Logic Model
Figure 2.1: Philadelphia EMA EIIHA Strategy Logic Model
Inputs
Activities Participation Short Term Goals Long Term Goals
 Ryan White Parts: A, B, C,  HIV screening in clinical  City Health Centers  HIV screening is  Increase in the
D, F, and MAI. settings  City STD Clinic routinely available in number of
 Direct CDC cooperative  HIV screening in  Emergency Departments clinical settings. individuals who
agreement funds for HIV nonclinical settings  FQHCs  EMA supports diverse are aware of their
prevention.  HIV opt-out screening at  Substance abuse range of community- status.
 CDC expanded testing, intake in Philadelphia treatment sites based HIV screening
enhanced HIV prevention prisons  Family planning sites for targeted high risk  Increase the
planning (ECHPP), and a  Social networks testing  Labor and delivery populations (risk- number of HIV
test and treat initiative. targeting youth, MSM, and departments based and positive individuals
 NIH/CDC SMILE (Y/MSM) IDU  Private physicians’ geographically-based). who are in care.
initiative.  Social marketing and offices  Opt-out HIV screening
 PA/NJ state counseling and media campaigns  In-patient settings at medical intake in  Reduce health
testing funds.  Rapid testing to increase %  CBO clinics (fixed and Philadelphia prisons. disparities.
 City of Philadelphia of people who receive test mobile)  100% of individuals
counseling and testing results.  Community-based receive their test
funds.  Outreach for targeted settings results.
 Established network of testing  Parole offices  100% of individuals
more than 450 testing  Referral to preventive  Syringe exchange sites will receive
sites. services  Anonymous testing sites confidential
 More than 400, active,  Referral to care  Correctional facilities confirmatory tests
trained and certified HIV  Partner services  CDC Category C even though initial
counselors.  Linkage to care Demonstration grantee test was anonymous.
 Integrated routine HIV  Training and technical sites  100% of high risk
screening in clinical sites assistance for provider  Ryan White SPNS individuals and
and targeted HIV screening agencies grantee sites individuals who test
in non- clinical settings. positive are referred
 Directly funded CBOs. for prevention
 Updated PA State law services and/or care.
allowing opt-out HIV  100% of individuals
testing. who test positive are
 Merck Co. Foundation linked to care.
linkage to care funds.
March 14, 2013 EIIHA 10

11. Long & Short Term EIIHA Goals
EIIHA Service Models
 Routine HIV screening in
 Achievement of the EIIHA
goals contributes directly to health care settings
the triple aims of the National  Targeted HIV screening in
HIV/AIDS Strategy community-based settings
 Intake testing at the
 Represent full realization of
Philadelphia Prison Health
multiple early intervention
System
services models and methods
 Assure tested individuals
implemented in the EMA
receive their test results;
addressing the needs of
referred to care or
different populations.
prevention; linked to care
for preliminary positives
March 14, 2013 EIIHA 11

12. HRSA Expectations
EMA to develop and implement a strategy based on:
 Estimate of HIV+/unaware (21%)
 Assessment of HIV+/unaware to target efforts
 Close collaboration with counseling and testing and partner
services
 Implementation of outreach, testing, referral, and linkage
to care
 Often use of Early Intervention Services (EIS)
Providers and grantee collect and report required data
 Includes data on those who test negative
March 14, 2013 EIIHA 12

13. Early Intervention Services
 Identification of individuals at points of entry
 HIV testing and targeted counseling
 Referral services
 Linkage to care
 Health education and literacy training
 RWP funds to be used for HIV testing only as necessary
to supplement, not supplant, existing funding
 Peer EIS models
 Enables EMA to address both EIIHA and unmet need
March 14, 2013 EIIHA 13

14. Administering EIIHA
 Coordinated with other programs and
Ryan White Program Parts
 Incorporated into RFPs and contracts
 Linked with ADAP and local pharmacy
 Takes into account disparities in access
 Responds to what is known about
challenges to making people aware
 Facilitates routine screening
March 14, 2013 EIIHA 14

15. EIIHA Matrix
 Illustrates how the P1
PHILADELPHIA EMA EARLY IDENTIFICATION OF INDIVIDUALS WITH HIV/AIDS MATRIX
All Individuals in Philadelphia EMA Unaware of their
HIV Status (HIV+ & HIV-)
overall unaware P2
P4
Not Tested in the Past 12 Months
High Risk Individuals
P5
Low and
P3
P6
Tested in the Past 12 Months
Individuals Not Post-test Counseled
population is
Moderate Risk (HIV+ & HIV-)
Individuals
P7 P8
Received Preliminary HIV+ Result Only
Men Who Substance
differentiated by
Have Sex with Users/
(No confirmatory test)
Men Injection Drug
Individuals Tested Confidentially
Individuals Tested Anonymously
Users
Incarcerated Individuals
Socio-Economic Status
Heterosexuals of Low
target population
Sex Workers Who Use Drugs
MSM of Color
White MSM
Youth MSM
Active IDU
Trans IDU
 6 “Parent” groups
T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11
 11 “Target” groups
March 14, 2013 EIIHA 15

16. System Impacts to
Successful EIIHA Outputs
Need to be able to serve
More HIV+ newly diagnosed
clients individuals immediately
Need to estimate what
proportion of newly
diagnosed are likely to
Planning be Ryan White eligible
Emphasis on getting
people onto
Adherent ARV  medications early to
reduce transmission
as prevention
March 14, 2013 EIIHA 16

17. Priority Needs of All Target Groups
 HIV/AIDS stigma and discrimination
 Poor health literacy
 Lack of understanding of effective
HIV treatments
March 14, 2013 EIIHA 17

18. Activities Directed at all Groups
 Routine testing in clinical and nonclinical
settings and social marketing that lowers
stigma
 Extensive training of counseling and testing
providers on general health and HIV
 Extensive training and TA to health care
providers on best practices in serving the target
populations
 Extensive case management system
March 14, 2013 EIIHA 18

19. HRSA/HAB Ryan White Program
Policy Notice 12-01: Outreach
 Outreach is a support service
 Outreach is not a requirement
 Outreach may be used to identify individuals
with HIV disease at points of access to care
 Goal continues: identify and refer individuals
into early intervention services (testing,
prevention counseling, linkage to care)
 Prohibited: activities that exclusively promote
HIV prevention education
March 14, 2013 EIIHA 19

20. Recent HHS Letter on Testing
and Linkage to Care
 Issued February 25, 2013 jointly by HRSA
(Cheever) and CDC (Mermin) to clarify
questions about eligibility of initially reactive
but unconfirmed HIV-positive clients for Ryan
White care
 Clarifies there is no legislative requirement for
a ‘confirmed’ HIV diagnosis prior to linkage to
Ryan White care
 No requirement related to use of Western blot
as only means of confirmatory testing
March 14, 2013 EIIHA 20

21. Ways to Confirm Diagnosis
 Positive HIV immunoassay and positive
HIV Western blot
 Positive HIV immunoassay and detectable
HIV RNA
 Two positive HIV immunoassays (should
be different assays based on different
antigens or different principles)
March 14, 2013 EIIHA 21

22. Overall Goal
 Diagnose and quickly link persons with
HIV into high quality medical care (RW
legislation)
 Establish a seamless system to
immediately link people to continuous
and coordinated quality care when they
are diagnosed with HIV (NHAS)
March 14, 2013 EIIHA 22

23. Thank you!
Matthew McClain
AIDSpolicy@aol.com
March 14, 2013 EIIHA 23