the undetectables project! - hiv housing summit · the undetectables project! ... a nyc...
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The Undetectables Project!North American Housing and HIV/AIDS
Research SummitWashington D.C. • September 15, 2015
• Toorjo Ghose, University of Pennsylvania• Stephen Nolde, Housing Works, Inc.
www.housingworks.org
Who’s participating?
• Housing Works is a NYC community-based organization providing integrated care for homeless and formerly homeless people with HIV/AIDS
– Primary health care– Behavioral health services– Housing and assistance with other basic subsistence needs– Case management and care coordination
• Approximately 1,500 active HIV+ clients– 84% black or Hispanic– 33% identify as gay, lesbian, bisexual, trans or gender non-conforming– > 50% histories of incarceration – > 50% co-infection with HepC– 100% living at or below poverty line– 90% extended histories of mental illness and/or chemical dependence
What is the Undetectables Project?
• Launched in March 2014 using a community support model
• 24-month grant-funded pilot to assist HIV+ participants to achieve and maintain undetectable viral load (≤50 copies/ml)
• Eligibility: clients receiving integrated care (primary health care and case management/care coordination) at Housing Works
• Enrollment: 610 active participants as of the end of August 2015 with an overall 80% retention rate at 18 months
• Goal: at least 80% viral suppression in the HW community
• A core component of Housing Works’ commitment to the New York plan to end the state’s AIDS epidemic by 2020
What’s in the toolkit?
Stepped approach to ARV adherence
Individual-level ARV adherence planning and support– case conferences among client, health providers & case manager– motivational interviewing & assistance to meet subsistence needs – Behavioral health assessment/referral
$100 gift card incentive for quarterly lab result showing undetectable viral load (≤50 copies/ml), up to 4 per year
Cognitive behavioral therapy (CBT) adherence support groups Adherence devices such as pill-boxing and text or other daily
medication reminders Directly observed ARV therapy (DOT) – formal and informal
Evaluation design
• Community based participatory approach in collaboration with academic partners at the University of Pennsylvania
• Study examining efficiency, feasibility & cost-effectiveness• Using each participant as his/her control, assess viral load and
cumulative viral exposure pre and post enrollment• Qualitative interviews and focus groups with participants and staff
to examine attitudes regarding program efficacy• Standard methods of cost analysis to evaluate cost-utility as a
function of incremental program costs and medical costs saved through averted downstream infections
Durable viral suppression at9 months
How is it going?
• High-level agency-wide buy-in and oversight– Regular meetings of executive team and senior staff – 2 Year enrollment goal met early– Successes and challenges
• Program-level evaluation and quality assurance & improvement– Regular meetings of program directors– Ongoing monitoring and evaluation of process and outcome indicators– Evolving agency and program-level strategies – Next steps
• Tracking and monitoring– Tracking systems and tools– Staff survey– Client interviews and focus groups
Results at 18 months:viral load suppression
• Pre-enrollment: among 441 clients eligible for enrollment at project launch:
– 54% virally suppressed using ≤50 copies/mil as the measure– 37% detectable – 9% unknown (refused testing or inconclusive result)
• Current for all 610 clients enrolled at August 31, 2015:– 83% virally suppressed using ≤50 copies/mil as the measure– 15% detectable – 2% unknown (refused testing or inconclusive result)
• Current for 554 clients enrolled ≥ 3 months at August 31, 2015:– 85% virally suppressed using ≤50 copies/mil as the measure– 14% detectable – 1% unknown (refused testing or inconclusive result)
Housing Specific VLS Interventions
• 166 units: 110 in 5 community residences; 56 scatter site• Weekly face-to-face meetings with all housing residents
– Daily case manager contact with clients in community residences– Option of informal DOT or pill boxing through case managers
• Clinical Director & Case Managers check-in monthly on VLS and use strength-based plans for residents with multiple barriers/needs
• Monthly apartment visits by case management team to speak directly with residents in their homes about health
• Share viral load results as well as challenges and success stories monthly within Housing Department and with HW leadership
• Housing clients in the Undetectables at 85% overall• ≥ 95% VLS last 6 months for Undetectables participants living in
transitional residence for recently incarcerated women; ≥80% for Undetectables participants in transgender scatter site program
Viral Load Suppression: All Housing Clients
65 66 66
73 74 73
77
84 83 84
88 8987
85 84 85
70 70
7876
79
75
84
89
84 8588
8587
85 85 85
60 61
54
6966
70 69
77
8183
88
94
87
83 82 8380 80 80 80 80 80 80 80 80 80 80 80 80 80 80 80
% VLS Total (All of Housing) % VLS @ Housing Works Primary Care
% VLS @ External Primary Care Targeted Goal
Why become anUndetectable?
• Becoming an Undetectable is becoming a Hero!
• Becoming an Undetectable improves your health, well being, and your life expectancy!
• Becoming an Undetectable can reduce the likelihood of transmitting HIV to sexual partners!
• Becoming an Undetectable helps to end the HIV epidemic!
Acknowledgements
• Funded by the Robin Hood Foundation • http://www.robinhood.org• Housing Works co-authors:
– Matthew Bernardo– Michael Clarke – Andrew Greene– Charles King – Alison Kliegman– Vaty Poitevien– Ken Robinson– Ginny Shubert
• University of Pennsylvania co-authors:– Sambuddha Chaudhuri
Questions? Contact Ginny Shubert at [email protected]
