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  • Centers of Excellence Services Overview

  • 2

    • Design a system to respond to needs according to race, gender, geographic, linguistic and cultural needs for communities impacted by health disparities

    • CoE offer integrated access to primary medical care and critical support services

    • Allocated funding for CoE proportionate to client demographics

    • Funding for models that offered innovative and effective approaches to reaching individuals not in care and bringing them into care and maintaining treatment and adherence to medication regimens over time

    • Many CoE’s represent a partnership between university, community, and public health service providers

    San Francisco’s Care Model A Comprehensive Service Delivery System

    Centers of Excellence

  • CoE’s Culturally Competent Services

    • This approach culminated in a significant intensification of the integrated services model in the form of the EMA’s seven Centers of Excellence –“one stop shop community center” programs similar to medical homes with wraparound services – work toward the goal of stabilizing the lives of multiply diagnosed and severe need populations – through neighborhood-based, multi-service centers – tailored to the needs of specific cultural, linguistic, and behavioral groups

    • Centers of Excellence programs form a cost-effective system in which – multidisciplinary teams provide high levels of HIV specialist medical care – integrated with medical case management, mental health assessment, referral and/or brief counseling,

    substance abuse assessment, counseling and referral, treatment advocacy, psychiatric consultation and medication monitoring, care coordination, vouchers for transportation, clothing and household goods

    3

  • San Francisco’s Evolution of CoE’s

    • The Center of Excellence model was initially conceived in 2003-2004, with services put out to bid via an RFP in late 2005

    • A Work Group was convened, comprised of HHSPC members, service providers and HIV Health Services staff to look the then Integrated Service Model programs and evolve toward Centers of Excellence

    • CoE services were put out to bid a second time in 2010 and included Prevention with Positives (PWP) services, funded through the HIV Prevention Section. Five of the seven CoE now have funding for these PWP specific services

    • Lead service provider agencies and subcontractor collaborators providing CoE services and have remained very consistent through the 9+ years of program implementation

    • All CoE programs partner with HIV Emergency Housing community services for rapid and prioritized referral

    4

  • Requirements from 2010 CoE Solicitation

    • CoE model establishes primary medical care at the center of an integrated service delivery model that must provide at a minimum:

    – Primary Medical Care

    – Medical Case Management

    – Psychiatric Assessment and Psychiatric Medication Monitoring

    – Treatment Adherence and Medication Assistance

    – Outpatient Mental Health, Substance Use Assessment, Counseling and Referral

    5

  • Definition of CoE Target Populations • Centers of Excellence were established to serve severe need clients and special

    target populations

    • To qualify as “Severe Need” a client must meet all of the following criteria:

    – Disabled by HIV disease or with symptomatic diagnosis

    – Active substance abuse or mental illness

    – Living with adjusted gross income equal to or less than 150% of federal poverty level

    6

  • Definition of CoE’s Target Populations (continued) • Special populations have unique or disproportionate barriers to care, may need

    additional or unique services, or require a special level of expertise to maintain them in care, including:

    – Individuals who identify as Transgender

    – Populations with the lowest rates of use of antiretroviral treatment (e.g., women, African Americans, and IDU)

    – Communities with linguistic or cultural barriers to care, including immigrants, as well as monolingual Spanish speakers

    – Individuals who are being released from incarceration in jails or prisons, or those with a recent criminal history

    – Persons living with HIV/AIDS who are 60 years of age or older 7

  • Center of Excellence Summary

    • All Center of Excellence programs have developed services and program culture to better adapt to serve specific high risk communities with unique needs

    • Health disparities exist nationally where communities of color are more heavily impacted with lower levels of viral load suppression and being on ART. However, in San Francisco, likely due to the work of the CoE’s, ARIES data indicates no disparities exist for those engaged in care. Disparities still exist nation-wide and for S.F. patient’s intermittently engaged in care and not in care

    • Center of Excellence programs has a minimal amount of client (

  • CoE Aggregate - Demographics

    0 - 24 1.9%

    25 - 44 37.9%

    45 - 54 38.1%

    55 - 59 13.0%

    60 - 64 6.4%

    65+ 2.7%

    Age

    9

    Female 17.1%

    Male 77.8%

    Transgender 5.1%

    Gender

    White 31.2%

    Black 29.7%

    Latino/a 27.0%

    Asian & Pacific

    Islander 5.8%

    Native American

    1.5%

    Multi- Ethnic 3.8% Unknown

    1.1%

    Race/Ethnicity

    0 - 100% 73.9%

    101 - 200% 21.4%

    201 - 300% 2.5%

    301 - 400% 0.3%

    401 - 500% 0.2%

    501+% 0.4%

    Unknown 1.3%

    Federal Poverty Level Private

    2.6%

    Medicare 14.5%

    Medicaid 52.3%

    No insurance

    40.8%

    Other 27.6%

    Unknown 13.7%

    Insurance Status

  • San Francisco’s Centers of Excellence Performance Trends

    2008 (n=1720) 2009 (n=2168) 2010 (n=2141) 2011 (n=2129) 2012 (n=1964) 2013 (n=1869) Med. Visits 71.3% 76.8% 78.3% 75.6% 72.4% 68.4% PCP Proph. 26.2% 70.5% 67.6% 69.2% 79.9% 69.1% HAART 74.7% 83.3% 90.3% 91.5% 93.8% 94.4% Hep C 69.0% 86.6% 85.9% 84.3% 84.4% 81.6% Syphilis Screening 43.3% 86.6% 85.9% 70.8% 77.6% 53.8% Viral Load Testing 63.9% 79.2% 90.2% 92.6% 92.3% 94.8% Viral Load Suppression 51.0% 64.9% 74.8% 78.9% 81.5% 78.6%

    20.0%

    30.0%

    40.0%

    50.0%

    60.0%

    70.0%

    80.0%

    90.0%

    100.0%

    SF CoE Performance Indicators 2008-2013

    10

  • Percentage Comparison of HIV Care Indicators for San Francisco , California , and United States , 2010

    80%

    63%

    80%

    43%

    69%

    79%

    61%

    74%

    44%

    72%

    84%

    74%

    80%

    61%

    84%

    % linked to care within 3 months of HIV dx

    % living HIV cases who had >=1 lab test (in care)

    % living HIV cases who had >2 lab tests among those in care

    % virally suppressed among all living HIV cases

    % virally suppressed among those in care

    San Francisco California United States

    11

  • Black Health Center of Excellence

    • UCSF / Positive Health Program is the Lead Agency

    • Partners include UCSF’s Positive Care Center/ aka Men of Color Program (Parnassus campus) and the San Francisco AIDS Foundation. DPH Southeast Health Center participates through the Executive Committee leadership meetings of the CoE.

    • Targeting African-American men and women living throughout the City. Populations include persons disabled by HIV infection or with symptomatic HIV diagnosis, active substance users, have mental health issues, living under 150% FPL, are transgender identified, non-gay identified MSM, infected individuals unaware of their status, affected young people with HIV infected parents, caregivers and families

    • Prevention with Positives (PWP) services offered through CDC prevention funds

    12

    ARIES DATA

    2013-14 MEDICAL UOS

    2013-14 MED. CASE MANAGEMENT UOS

    2013-14 OTHER PROVIDED UOS 2013-14 UDC TARGET

    2013-14 UDC DELIVERED

    1,905 (

  • Black Health CoE - Demographics

    0 - 24 1.1%

    25 - 44 27.5%

    45 - 54 41.5%

    55 - 59 15.8%

    60 - 64 10.9%

    65+ 3.2% Age

    13

    Gender 0.0%

    Female 7.7%

    Male 90.8%

    Transgender 1.4%

    Gender

    Race/Eth nicity 0.0%

    White 9.5%

    Black 73.9%

    Latino/a 11.6%

    Asian & Pacific

    Islander 0.7%

    Native American

    0.4%

    Multi-Ethnic 2.5%

    Unknown 1.4%

    Race/Ethnicity

    0 - 100% 73.2%

    101 - 200% 22.2%

    201 - 300% 1.8%

    301 - 400% 0.0%

    401 - 500% 0.0%

    501%+ 0.4%

    Unknown 2.5%

    Federal Poverty Level Private

    0.7%

    Medicare 18.0%

    Medicaid 51.1% No

    insurance 28.5%

    Other 23.6%

    Unknown 22.2%

    Insurance Status

  • Black Health CoE The Black Health CoE places a strong emphasis on culturally appropriate interventions including community building and social support to combat stigma and isola

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