appointment reminders - ny links summary package svs.docx · web viewa secondary benefit is that...

Summaries of NY Links Interventions

For Wide-Scale Implementation Phase

November 6, 2013

NY Links, November 6, 2013 Intervention Summaries of 17

IntroductionPurpose

Prompt linkage to HIV care and continuous engagement in care improves individual health outcomes. A secondary benefit is that persons with suppressed viral load are less likely to transmit the HIV virus to uninfected partners. In 2011, the Health Resources and Services Administration (HRSA) funded six jurisdictions across the United States to develop interventions to address testing, linkage and retention in HIV/AIDS care, and evaluate their impact at the agency and statewide levels. Since 2011, NY Links, administered by the New York State Department of Health AIDS Institute, has worked with providers of HIV services in New York State (NYS) to develop innovative and systemic models of linkage to care to improve access to and retention in HIV care. The project has brought networks of service providers together in local collaborative partnerships that represent defined geographic areas. The goal is to assist HIV providers across NYS to establish and/or improve activities that promote linkage and retention in HIV care thereby reducing disparities in morbidity and mortality, as well as transmission rates, below their current levels. Over time, NY Links has measured and evaluated the effectiveness of interventions executed in the collaboratives to identify best practices for dissemination and scale-up throughout NYS. The intervention package summaries that follow outline five interventions that have been selected for statewide dissemination and scale-up.

Introduction Timeline and Scope

In October and November 2013, four providers who are members of existing regional provider groups, and one provider outside of the regional groups, will be asked to pilot, for four months, one of the NY Links interventions. This pilot period will allow for finalization of each intervention prior to wide-scale dissemination. Concurrently, between November 2013 and January 2014, existing regional provider networks will be asked to consider the interventions from the NY Links menu of evidence-based interventions1, and will begin the process of assessing implementation of them across their network in a way that will have the greatest impact on their regional HIV cascade. Participating sites may also choose to continue an existing linkage and/or retention activity. Ten individual providers outside of these regional provider networks will also be engaged to implement interventions from the same menu before the end of February 2014.

Collaborating Partners

The interventions will first be selected and rolled out in active NY Links regional provider groups (Upper Manhattan, Queens/Staten Island, and Western New York [Buffalo, and Rochester]). After this roll-out, NY Links will reach out to other providers from other NYS Ryan White regions to engage them in this important activity. These regions include: Albany, Binghamton, Lower Hudson Valley, Mid-Hudson Valley, Lower Manhattan, Brooklyn, the Bronx, Nassau-Suffolk, and

1 The SPNS menu includes five evidence-based interventions: 1) Outreach for patients who have been out of care for >6 months; 2) Peer Support interventions for patients new to the HIV care agency (i.e., newly diagnosed and returning to care); 3) Systematic appointment procedures; 4) consistent team-based messaging and case conferencing; and 5) the Anti-retroviral Treatment and Access to Services (ARTAS) intervention, which is a strengths-based case management intervention aimed at facilitating linkage to care among newly diagnosed persons.NY Links, November 6, 2013 Intervention Summaries of 17

Syracuse. Providers will be targeted to ensure that each NY Links intervention achieves broad geographic distribution.

In addition to these regional provider groups, NY Links will continue the work with local health departments and representatives from the NYS prison system to further disseminate the chosen interventions to these stakeholders.

Responsibilities

NY Links staff and collaborators are principally responsible for developing these intervention packages; however, feedback from HIV provider organizations is welcomed. NY Links staff will provide technical assistance (TA) to local agencies during implementation of the interventions. Local agencies are responsible for 1) participating in training for the selected intervention; 2) implementing the core elements of the intervention; 3) submitting required process data in a timely manner; and 4) participating in ongoing TA and site visits during 2013-2015.

Impact Evaluation

The CUNY School of Public Health is evaluating the NY Links initiative. They are working closely with the New York State Department of Health and the New York City Department of Health and Mental Hygiene to leverage population-based HIV/AIDS Surveillance data for the impact evaluation of NY Links on agency-level and region-level outcomes (i.e., HIV Care Continuums). They will also use intervention process data collected from sites implementing these five menu interventions. ‘Control’ groups will be chosen from agencies and sites that have not yet implemented any of the interventions from the NY Links menu.

Intended Outcomes

Participation in this initiative will contribute to NYS’s and HRSA’s ability to evaluate the feasibility, uptake, effectiveness, and impact of evidence-based interventions implemented by networks of providers, as well as individual agencies. It is anticipated that implementation of the NY Links menu interventions will improve linkage and retention and other downstream outcomes for the local agency and region.

Timeline

The timeline for the implementation of these five interventions is detailed in the NY Links Work Plan for Year 3 and Year 4 and further described in detail in the NY Links Wide-scale Implementation Plan for Years 3 and 4.

Interventions

What follows are summaries of the five interventions that have been selected for piloting and broader dissemination.


Appointment Procedures

Brief definition/description of intervention: Standardized appointment procedures facilitate scheduling and remind patients of their upcoming appointments to reduce no-show rates, and to ensure that patients are retained in care. If a patient misses an appointment, follow-up occurs to reschedule the appointment ensuring continuity of care. Reminders and follow-ups are systematically and consistently made for all patients via their preferred method of delivery (home phone, cell phone, SMS, email, letter).

1. Intervention impact area: Retention

2. Target population: All clients. However, if resources are limited, clients can be prioritized based on frequency of no-show, disease status, recent labs, and the timing of the most recent visit.

3. How it works (how the intervention is delivered):Patient Enrollment: Patient is informed of appointment reminders and follow-up procedures. Ensure that the patient has a valid emergency contact available in his/her medical record and confirms that the emergency contact number can be used to help find the patient if the patient has not been scheduling or keeping appointments consistently. Ask the patient for additional contacts and contact options so a full range is available.

Patient Contact Information: Ask every patient at check in to confirm their current contact information. Double check with each patient at check in that the listed preferred method of contact is still accurate.

Appointment Reminders: Provide the patient with reminders of upcoming medical appointments. Confirm that the patient has requisite resources for all relevant appointments and service access (e.g., transportation, accompaniment) and make arrangements to remove barriers if possible.

Missed Appointment Follow-up: Assist the patient in scheduling and rescheduling appointments, when necessary. Staff inform the patient what they should do if the patient cannot make an appointment de-stigmatizing the issue and providing tools in the patient’s hand (i.e., “we understand that things come up and that you might not be able to make a scheduled visit for some reason. The most important thing is that you call this number and reschedule right away. Also, if you miss a visit, you might get a call from us.”)

4. Core components of intervention:Patient Enrollment

If possible, revise forms utilized during enrollment as necessary to include information on the appointment reminders procedure

Expanded contact information for patients is collected at this point. This allows patients to designate alternate methods to be used for contact, i.e. cell phone, texting, face book, family, friends, etc.


Patient Contact Information Establish a mechanism by which patients can confirm or update their contact information

on a regular basis or at each visit. Include a confirmation of patient’s preferred method of contact. Allow patients the option to include information for a secondary contact, i.e., family member, friend.

Appointment Reminders Establish a system to generate regular lists of upcoming appointments (appointments

scheduled at least 5 business days in advance, and appointments scheduled for the next business day). These lists will be used in making reminder calls or inputting into an automated call system. At a minimum the list should include: patient name, preferred method of contact, phone number, date of appointment, last appointment.

Provide the patient with at least two reminders of upcoming appointments; for example, at 5 business days and 1 business day prior to scheduled appointment.

The frequency and timing of reminders will be determined by the program and consistent for all patients.

Reminder messages will include a statement about the importance of keeping up with appointments to patient’s health.

Assist with rescheduling appointments if needed by the patient. Automated systems might include a message concerning who to call within the organization to reschedule.

Missed Appointment Follow-up Establish a system to generate daily lists of missed appointments for use in making follow-

up calls or inputting into an automated call system if one exists. When a patient misses an appointment:

o Daily contact attempts are made to the patient: that include a statement about the importance of keeping up with appointments

to patient’s health. after the missed appointment for up to 2 weeks or until the patient reschedules

an appointment .o Subsequent contact to the last listed address is not warranted when it becomes

apparent that the patient has permanently moved. after two weeks of daily contact attempts without reaching the patient, outreach

staff, if they exist, are notified to try to locate the patient.o When patients are contacted, a new appointment can be offered on the spot.o If 30 days passes and all contact efforts have failed, a certified letter will be sent to

the patient expressing concern about the patient's wellbeing and asking them to contact the clinic.

Conduct internet-based searches for persons whose address may have changed. A second, certified letter to the patient is necessary after two sequential months of failed

outreach by phone and field/home visit in which no contact with the patient is made. This letter should specify the patient's case may be closed.


All efforts to contact the patient will be documented in the appropriate vehicle within the organization—case file, EMR, health record, etc.

5. Tools/manuals to be derived or adapted from: Care Coordination Program Manual for People with HIV

6. Providers who have implemented something similar to this intervention: Ryan White Part A funded Care Coordination Providers, and in+care Campaign providers including: Mount Sinai Medical Center, Beth Israel Medical Center, The Institute for Family Health, St. Luke’s- Roosevelt Hospital, Harlem Hospital Center, NY Presbyterian Hospital, Lenox Hill, Safe Horizon.

7. Level of evidence and recommendation: The choosing of this intervention was a consensus-driven process. An intervention panel consisting of experts and staff from the NY Links Evaluation Team, NYC DOHMH and NYS DOH, in addition to consumers and providers participating in existing NY Links collaboratives, were convened in order to prioritize and select interventions for statewide scale-up. A list of interventions used to improve linkage with and retention to HIV care was compiled, assessed and ranked based on the level of evidence, feasibility, specificity, expected impact on linkage or retention, and cost-effectiveness. Given these criteria, the intervention panel deemed this intervention to be one of the most appropriate interventions to be included in the statewide NY Links intervention menu. This intervention has been implemented by 28 NYC agencies with success through the NYC DOHMH Care Coordination Program. Preliminary data from care coordination has shown improvements in engagement in care post enrollment into the program. In Year 2 of NY Links, Erie County Medical Center invested in an automated system that allows patients to choose text or voice appointment reminders and to confirm receipt of call. Reminders are made regardless of staffing (August 2012). HIV+ patients newly enrolled with a medical provider with prescribing privileges who had a medical visit in each of the 4-month periods in the measurement year improved from 57% in August 2012 to 89% in June 2013, entering the top 10% for New York Links at same time national and state averages remained stagnant or decreased. Additionally, other published studies have shown appointment reminders to be effective in increasing rates of kept appointments.

8. Citations: NYC Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and

Control, Care, Treatment, and Housing Program. Care Coordination Manual. Updated May 2013

NYC DOHMH Care Coordination Evaluation Team. “Patient Navigation: A network perspective from the NYC HIV Care Coordination Program.” PowerPoint presentation. Presented to In+Care campaign provider, NYC, NY. 6 August 2013

Perron et al. Reduction of missed appointments at an urban primary care clinic: a randomized controlled study. BMC Fam Pract. 2010 Oct 25, 11:79

Hahim et al. Effectiveness of telephone reminders in improving rate of appointments kept at an outpatient clinic: A randomized control trial. J A Board Fam Prac. 3, 2001,pp 193-196

9. Intervention documents prepared by: Jacqueline Rurangirwa, NYC DOHMHNY Links, November 6, 2013 Intervention Summaries of 17

Michael Hager, NYS DOHSteve Sawicki, New York Links ProgramBeau Mitts, NYC DOHMHJohn Anthony EddieCarol-Ann Watson, NYS DOH


ARTAS (Brief Strengths-based Case Management)

Brief definition/description of intervention: Anti-Retroviral Treatment and Access to Services (ARTAS) is an individual-level, multi-session, time-limited intervention with the goal of linking recently diagnosed persons with HIV to medical care soon after receiving their positive test result, or re-engaging those no longer in medical care/treatment. ARTAS is based on the Strengths-based Case Management (SBCM) model and encourages the client to identify, and to use personal strengths; create goals for himself/herself; and establish an effective, working relationship with client services staff.

1. Intervention impact area: Linkage to medical care/treatment

2. Target population: Newly diagnosed clients (diagnosed within the last 6-12 months) or those returning to care after a more than 6-month lapse

3. How it works (how the intervention is delivered): Newly diagnosed clients who are not engaged in medical care/treatment or who are returning to care after being out of HIV care for more than 9 month are referred to a CM or staff providing client-level supportive services. Five client sessions are conducted over a 90 day period or until the client links to medical care - whichever comes first. The intervention is strength-based case management resource where client sessions are encouraged to take place outside the office or wherever the client feels most comfortable. Following the final client session, the client may be linked to a long-term case management program and/or other service delivery system to address his/her longer term barriers to remaining in care, such as substance use treatment, mental health services, etc.

4. Core components of intervention: Conduct between one and five structured sessions with each client Focus on the client's strengths by conducting a strengths-based assessment and

encouraging client to identify and use his/her strengths, abilities, and skill to link to medical care and accomplish other goals

Facilitate the client's ability to identify and pursue his/her own goals, and develop a step-by-step plan to accomplish those goals using the ARTAS session plan

Conduct active, community-based services by meeting each client in his/her environment and outside the office, whenever possible

Coordinate and link clients to available community resources, both formal (e.g., housing agencies, food banks) and informal (e.g., friends, support groups, spiritual groups) based on each client's needs

Advocate on the client's behalf, as needed, to link him/her to medical care and/or other needed services

5. Accompanying tools/forms/checklists/appendices:ARTAS ProtocolARTAS Client Flow ProcessTraining and Technical Assistance Program (T-TAP) Training Catalog


6. Providers who have implemented something similar to this intervention:ACQC, Project Hospitality, Community Healthcare Network

7. Level of evidence and recommendation: The choosing of this intervention was a consensus driven process. An intervention panel consisting of experts and staff from NY Links, NYC DOHMH and NYS DOH, in addition to consumers and providers from our existing collaboratives, were convened in order to select interventions for statewide scale-up. A list of interventions used to improve linkage and retention to care was compiled, assessed and ranked based on some level of evidence, feasibility, specificity, expected impact on linkage and retention, and cost-effectiveness. Given this criteria, the intervention panel deemed this intervention to be one of the most appropriate interventions to be included in the NY Links intervention menu. This intervention was considered by IAPAC to have a high level of evidence and is recommended for most clients (see Gardner and Thompson citations).

8. Citations: Gardner et al. Efficacy of a brief case management intervention to link recently diagnosed

HIV infected persons to care. AIDS. 2005 Mar 4;19(4):423-31 Thompson et al. Guidelines for Improving Entry Into and Retention in Care and

Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel. Ann Intern Med. 2012 Jul, Volume 156, Number 11

J.A. Craw, L.I. Gardner, G. Marks, R.C. Rapp, J. Bosshart, W.A. Duffus, A. Rossman, S.L. Coughlin, D. Gruber, L.A. Safford, J. Overton, and K. Schmitt, “Brief Strengths-Based Case Management Promotes Entry into HIV Medical Care: Results of the Antiretroviral Treatment Access Study-II,” Journal of Acquired Immunodeficiency Syndromes 47, no. 5 (2008): 597-606

J. Craw, L. Gardner,a. Rossman, D. Gruber, N. O'Donnell, D. Jordan, R. Rapp, C. Simpson, and K. Phillips, "Structural factors and best practices in implementing a linkage to HIV care program using the ARTAS model," BMC Health Services Research 2010, 10:246

Danya International Inc. “Effective interventions: HIV prevention that works—ARTAS”. 2012. Web: 26, Sep. 2013. http://www.effectiveinterventions.org/en/HighImpactPrevention/PublicHealthStrategies/ARTAS.aspx

9. Intervention documents prepared by: Rexford DeVoe, Chair, Bureau of Community Based Services, NYS DOH/AIDS InstituteSteve Sawicki, New York Links ProgramLenee Simon, New York City Department of Health and Mental HygieneDiane Addison, CUNY School of Public Health


Consistent Team-Based MessagingBrief definition/description of intervention: This intervention focuses on using consistent messages for patients who are newly diagnosed, new to the clinic, or re-engaging in care. These messages are positively phrased and action-oriented, and are delivered by all members of the care team. The care team may, through the use of case conferencing, develop additional individualized messages for patients struggling with treatment adherence. The aim of this intervention is to engage or re-engage the patient in care.

1. Intervention impact area: Retention in care, treatment adherence

2. Target population: All HIV diagnosed consumers engaging or re-engaging in care. Agencies will prioritize patients in need of case conferencing through criteria they establish but based on treatment adherence.

3. How it works (how the intervention is delivered): Three categories of standardized messages are developed and distributed by the care team to patients. Messages emphasize the importance of being and staying in care and/or maintaining ARV regimen. A third category of messages may be developed through a case conference process by the care team to address specific issues and tailor them for identified patients.

4. Core components of intervention: Maintenance in care messages are used to encourage people to maintain engagement in

HIV care at every clinic appointment ARV education/support messages are used for patients newly placed on ARV therapy or

facing challenges to ARV adherence at every clinic appointment Care team delivers a short script focused on patients who are new to care Care team delivers a short script focused on patients who are engaging or re-engaging in

care Through case conferencing the care team a) identifies and prioritizes a list of patients who

have difficulties adhering to ARV regimens or to staying in care; and b) develops and delivers individualized messages for patients struggling with treatment adherence or retention

The agency uses a regional referral list to assist consumers to make referrals as needed and informs patients about these available resources/tools

5. Accompanying tools/forms/checklists/appendices:Examples of scripts for standardized messaging

6. Providers who have implemented something similar to this intervention:Boriken Community Health Center, Center for Comprehensive Health Practice

7. Level of evidence and recommendation: The choosing of this intervention was a consensus-driven process. An intervention panel consisting of experts and staff from the NY Links Evaluation Team, NYC DOHMH and NYS DOH, in addition to consumers and providers participating in existing NY Links collaboratives, were


convened in order to prioritize and select interventions for statewide scale-up. A list of interventions used to improve linkage with and retention to HIV care was compiled, assessed and ranked based on the level of evidence, feasibility, specificity, expected impact on linkage or retention, and cost-effectiveness. Given these criteria, the intervention panel deemed this intervention to be one of the most appropriate interventions to be included in the statewide NY Links intervention menu. This is an evidence-based intervention. Consistent messaging was found to improve attendance for HIV primary care in a recent study published by Gardner (2012).

8. Citations: Gardner et al. A Low-Effort, Clinic-Wide Intervention Improves Attendance for HIV Primary

Care. Clinical Infectious Diseases 2012;55(8):1124–34

9. Intervention documents prepared by: Dan Belanger, NYS DOH AIDS InstituteSteve Sawicki, New York Links ProgramBeau Mitts, Director, Technical Assistance, NYC DOHMHJacqueline Rurangirwa, Director of Quality Management, NYC DOHMHJulian Brown, Outreach Work, Trillium HealthcareDiane Addison, CUNY School of Public HealthBen Katz, CUNY School of Public Health


Outreach/Return to CareBrief definition/description of intervention: Outreach/return to care is the systematic search for patients who have not been seen in the clinic or facility for more than 9 months2. These individuals may have dropped out of care and efforts are taken to re-engage them and ensure continuity of care. The aim of this intervention is to engage or re-engage patients in ongoing HIV medical care.

1. Intervention impact area: Retention

2. Target population: Patients who had at least one medical visit to the facility with a primary care provider within

the last two years; AND Have not been seen in primary medical care for the past nine months or more at the facility;

AND Do not meet the following criteria: expired, long term incarceration > 3 months, transferred

care to another medical provider or moved out of the area).

3. How it works (how the intervention is delivered): Case Record: The clinic/site’s patient roster is reviewed at the onset of the intervention to identify

persons whose care might have lapsed (i.e., missed appointments). This ‘care’ roster must be reviewed, at a minimum, every three months thereafter.

Filter the list and remove persons who are permanently unable to participate (e.g., expired, long term incarceration > 3 months, transferred care to another medical provider, or moved out of the area)

Prioritize the list so that the most recently lost patients are outreached to first Create a case finding record for each eligible patient and assign each case to an outreach

staff member

Case Finding Activities: Phone calls to the patient Other search methods such as internet searches Once an address is identified staff should commence field outreach, physically visiting that

address, to determine whether or not the patient is present. If the address does not prove to be accurate, the search should re-commence and the field outreach will be done again when another address is identified.

Upon contact, determine if client is engaged in medical care elsewhere, or whether they want to return to the Program

For clients not located after three months:o Inform the affiliated primary care provider of the patient's disposition and document in

a tracking tool Document case finding activities in a tracking tool

2 Note: HRSA definition of in care – 2 medical visits, 6 months apart, within a 12-month period. NY-LINKS in care definition – 4 medical visits, 6 months apart, within a 24-month period with at least 60 days between visits.NY Links, November 6, 2013 Intervention Summaries of 17

4. Core components of intervention: Maintain care roster in order to identify patients who are out of care (no HIV primary care

visit in the previous nine months) Perform case finding: listed emergency contacts, social media such as Facebook, Google,

mailed letter with handwritten notes in unmarked envelopes Perform field outreach to identify whether or not patient is at the identified location Determine whether patient is engaged in care elsewhere or whether they want to return to

the program. If patient is not in care and declines to return to care, provide a list of existing community resources patient may access.

Identify barriers to care, update contact information, including additional contacts (family, friends, natural supports) and preferred means of contact (phone, email, text, mail)

Assist with scheduling of appointments Ensure patient has relevant resources to attend the appointment (resolution of barriers,

e.g., transportation, accompaniment)

5. Accompanying tools/forms/checklists/appendices: Model return to care tracking toolModel process measures tracking formModel field safety protocolContact information form. This document helps programs get the necessary information at the beginning of their interactions with clients to allow them to find clients later if they fall out of care.Model contact letterModel call script and protocolHIPAA Compliant Authorization for Release of Medical Information and Confidential HIV Related Information Form

6. Providers who have implemented something similar to this intervention: Ryan White Part A funded Care Coordination Providers including: Trillium Health, Mount Sinai Medical Center, Beth Israel Medical Center, The Institute for Family Health, St. Luke’s- Roosevelt Hospital, Harlem Hospital Center, NY Presbyterian Hospital, Lenox Hill, Safe Horizon.

7. Level of evidence and recommendation: The choosing of this intervention was a consensus-driven process. An intervention panel consisting of experts and staff from the NY Links Evaluation Team, NYC DOHMH and NYS DOH, in addition to consumers and providers participating in existing NY Links collaboratives, were convened in order to prioritize and select interventions for statewide scale-up. A list of interventions used to improve linkage with and retention to HIV care was compiled, assessed and ranked based on the level of evidence, feasibility, specificity, expected impact on linkage or retention, and cost-effectiveness. Given these criteria, the intervention panel deemed this intervention to be one of the most appropriate interventions to be included in the statewide NY Links intervention menu. This intervention has been implemented by 28 NYC agencies with success through the NYC DOHMH Care Coordination Program. Preliminary data from care coordination has shown improvements in engagement in care post enrollment into the program. Additionally, in a recent study, systematic outreach of those lost to care has been shown to be an effective method to re-engage patients Outreach strategies for individuals presumed lost


to care have also been shown to be effective for Trillium Health in Western New York during the pilot phase of this project.

8. Citations: NYC Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and

Control, Care, Treatment, and Housing Program, Care Coordination Manual NYC DOHMH Care Coordination Evaluation Team. “Patient Navigation: A network

perspective from the NYC HIV Care Coordination Program.” PowerPoint presentation. Presented to In+Care campaign provider, NYC, NY. 6 August 2013

Udeagu, C., Webster, T., Bocour, A., Michel, P., Shepard, C. (2013). Lost – or just not following up?: Public health effort to re-engage HIV-infected persons lost to follow-up into HIV medical care. AIDS, 27. DOI:10.1097

9. Intervention documents prepared by: Jacqueline Rurangirwa, Director of Quality Management, NYC DOHMHSteve Sawicki, New York Links ProgramMichael Hager, NYS DOH AIDS InstituteBeau Mitts, Director, Technical Assistance, NYC DOHMHGraham Harriman, NYC DOHMHRich FowlerEscott SullivanCarol-Ann Watson, NYS DOH AIDS Institute


Peer Support Interventions (for Patients New to Clinic and Re-engaging in Care)

Brief definition/description of intervention: The early peer support intervention focuses on strategies by peers to engage patients new to the clinic, including those who are newly diagnosed, transferring their care to the clinic, and returning to care after a long lapse (>9 months out of care), to foster their involvement in their HIV care. The aim of this intervention is to engage patients in ongoing HIV medical care and to establish a foundation and relationship between patient and medical provider. Peer support interventions may include: peers meet and greet patients, introduce them to clinic staff, let the patient know of available services, review educational materials and how to access them, inform case managers about referrals needed, and provide general social support.

1. Intervention impact area: Early engagement, linkage and retention, Viral Load suppression

2. Target population: Newly diagnosed clients (diagnosed within the last 6 months), those transferring their care to the clinic, or those returning to care after 9 months since their last kept medical appointment

3. How it works (how the intervention is delivered): Consumers who are newly diagnosed, transferring their care to the clinic, or returning to care are matched with a peer who they can work with based on gender, race/ethnicity and other identity factors to the extent possible. Each peer will be responsible for introducing the consumer to the clinic and clinic staff, describing services available and other important information to assist the consumer in becoming more comfortable with the health care system. The peer will, along with other clinical staff, will offer consistent messages on the importance of maintaining clinic visits and adhering to ARV treatment, and answer questions and act as a liaison between clinic staff and the consumer. Peers will assist consumers in better understanding the treatment recommendations of the clinic staff, follow-up via email and telephone when appointments are missed, and assist staff in understanding the consumer’s psychosocial and other environmental factors.

4. Core components of intervention: The patient is introduced to the peer and the peer support intervention by either the case

manager who sends a letter to the new consumer introducing the program or at check in to the clinic appointment; staff asks the new consumer if the consumer would like a peer to give him/her a tour of the clinic, explaining the services available and how to access them (case management, support groups, etc.). If the consumer does not want a peer, this will be documented in the consumer’s clinical record with a note as to why the consumer does not want to participate.

Peer then gives the consumer a tour of the clinic, introducing the consumer to clinic staff, and available educational materials/resources, letting the consumer know of available services and how to access them, answering questions and providing liaison services as needed between clinic staff and the consumer


The peer, along with other clinic staff, offers a standardized consistent message on the importance of attending clinic visits and adhering to medications

5. Tools/manuals to be derived or adapted from: N/A

6. Providers who have implemented something similar to this intervention:Harlem Hospital Center St. Luke’s Comprehensive Care Clinic AIDS Service Center Columbia Presbyterian

7. Level of evidence and recommendation: The choosing of this intervention was a consensus-driven process. An intervention panel consisting of experts and staff from the NY Links Evaluation Team, NYC DOHMH and NYS DOH, in addition to consumers and providers participating in existing NY Links collaboratives, were convened in order to prioritize and select interventions for statewide scale-up. A list of interventions used to improve linkage with and retention to HIV care was compiled, assessed and ranked based on the level of evidence, feasibility, specificity, expected impact on linkage or retention, and cost-effectiveness. Given these criteria, the intervention panel deemed this intervention to be one of the most appropriate interventions to be included in the statewide NY Links intervention menu. Peer support is considered by IAPAC to be a medium-level evidence-based strategy for treatment adherence and retention in care, with a recommendation that this intervention be considered on the basis of individual patient circumstance. Additionally, multiple studies have shown some evidence that peer support interventions are effective in improving adherence (please see articles below).

8. Citations: Thompson et al. Guidelines for Improving Entry Into and Retention in Care and

Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel. Ann Intern Med. 2012 Jul, Volume 156, Number 11

Pearson CR, Micek MA, Simoni JM, Hoff PD, Matediana E, Martin DP, et al. Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique. J Acquir Immune Defic Syndr. 2007;46:238-44. [PMID: 17693890]

Ruiz I, Olry A, Lo´pez MA, Prada JL, Causse M. Prospective, randomized, two-arm controlled study to evaluate two interventions to improve adherence to antiretroviral therapy in Spain. Enferm Infecc Microbiol Clin. 2010;28:409-15.[PMID: 20381924]

Chang LW, Kagaayi J, Nakigozi G, Ssempijja V, Packer AH, Serwadda D, et al. Effect of peer health workers on AIDS care in Rakai, Uganda: a cluster-randomized trial. PLoS One. 2010;5:e10923.

Bradford, J. B., Coleman, S., & Cunningham, W. (2007). HIV System Navigation: an emerging model to improve HIV care access. AIDS Patient Care and STDs, 21(S1), S-49.

Simoni JM, Pantalone DW, Plummer MD, Huang B. A randomized controlled trial of a peer support intervention targeting antiretroviral medication adherence and depressive symptomatology in HIV-positive men and women.Health Psychol. 2007;26:488-95. [PMID: 17605569]


Simoni JM, Huh D, Frick PA, Pearson CR, Andrasik MP, Dunbar PJ, et al. Peer support and pager messaging to promote antiretroviral modifying therapy in Seattle: a randomized controlled trial. J Acquir Immune Defic Syndr. 2009;52:465-473. [PMID: 19911481]

8a. Additional resources Emily Gantz McKay, Harold Phillips, Hila Berl, Project Consumer LINC webinar, December 5,

2011. Developing a Peer-Based Early Intervention Services Program: https://careacttarget.org/library/developing-peer-based-early-intervention-services-program-project-consumer-linc-webinar.

The Target Center: https://careacttarget.org/content/organizations-care-toolkit-employing-consumers-ryan-white-care-act-programs.

The Peer Education and Evaluation Center: http://peer.hdwg.org. Community Health Workers National Workforce Study:

http://bhpr.hrsa.gov/healthworkforce/chw/ Building Blocks to Peer Success - 2 toolkits - PEER Center, Boston University:

http://www.hdwg.org/peer_center/training_toolkit Integrating Peers into Multidisciplinary Teams: 2 toolkits - Cicatelli Associates -

http://careacttarget.org/ library/peers/ToolkitForPeerAdvocateSupervisors.pdf “The Utilization and Role of Peers in HIV Interdisciplinary Teams” - HRSA/HAB Consultation -

http://hab.hrsa.gov/newspublications/peersmeeting summary.pdf

9. Intervention documents prepared by: Dan Tietz, NYSDOH AIDS Institute Dan Belanger, NYSDOH AIDS InstituteSteve Sawicki, New York Links ProgramJacqueline Rurangirwa, Director of Quality Management, NYC DOHMHDawn Trotter Consumer Peer, ECMC Ben Barile, Paid Peer, Hudson River Healthcare Gina Osori, Provider Staff Patricia Freedman, Provider Staff, Elmhurst HospitalJohn Schoepp, Elmhurst Hospital Kelly Piersanti, CUNY School of Public HealthBen Katz, CUNY School of Public Health


appointment reminders - ny links summary package svs.docx · web viewa secondary benefit is that...

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