in a Student-Run Clinic Increases HCV Testing at an Addiction - - PowerPoint PPT Presentation

Adjusting Screening Procedures in a Student-Run Clinic Increases HCV Testing at an Addiction Rehabilitation Center

Sonal Mallya

Tulane University School of Medicine MD Candidate 2019 smallya@tulane.edu Expansion Manager Acacia NOLA TUSOM Student-Run HIV & HCV Testing

FINANCIAL DISCLOSURES

 This research was partially funded by a Gilead Frontlines of Communities in the United States (FOCUS) Grant

 Changing Hepatitis C (HCV) screening patterns in a medical student-run testing program in order to impact the proportion of clients tested

OBJECTIVE

 An estimated 2.7-3.9 million people with chronic hepatitis C virus (HCV) infection (CDC, 2017)  HCV incidence increased 294% from 2010 to 2015, driven largely by injection drug use (CDC, 2017)  The disenfranchised disproportionately test positive for HCV

 15-25% of incarcerated  30% of homeless  70-80% of people who inject drugs

HCV IN THE U.S.

HCV IN NEW ORLEANS

 Louisiana has the highest incarceration rate in the nation/the world (in 2014, 816 per 100,000)

 7000+ formerly incarcerated individuals return to Orleans Parish annually

 Homeless population fluctuates, but in 2014, 46.9 out of every 10,000 people in the city were homeless  Opioid epidemic death rate is outpacing the murder rate in Orleans Parish  This is why we should be testing!  UMCNO has opt-out HCV testing in the ED*

 Physician-initiated risk and symptom-based testing was yielding a 17% positivity rate  Can only capture those using healthcare

PROGRAM BACKGROUND

Post Katrina

• HIV screening

introduced into Tulane student-run clinics (2008)

March 2015

• Initial grant

allows for HCV screening at single homeless shelter

January 2016

• HCV

screening expanded to 6 additional sites including homeless shelters, rehabilitation centers, and community clinics

INITIAL PROGRAM STRUCTURE (1/2016)

Approximately 25 active testers

 Each volunteering one shift per month

Testers used state-mandated tuberculosis (TB) PPD testing as a point

• f access to the client population by offering voluntary HIV and HCV

testing afterwards  Patients who tested positive linked to care

IMPROVEMENT PROCESS

• Testers took time to

adapt to combined paper-based HIV data collection with electronic HCV data collection

• Refined the flow of

questions multiple times as testers pointed out flaws and redundancies

• Qualtrics survey, slow

roll out in August 2016

• Better track client

information via electronic data collection

Plan Do Study Act

 Male addiction rehabilitation program in New Orleans that houses approximately 85 clients

 Treats both behavioral and substance addictions

 Clients may enter the six-month program voluntarily or by court order  Clients are state mandated to receive TB screening during the first week of their stay  HIV testing had been present for at least one year when HCV testing introduced in January 2016

MALE REHAB CENTER #2

(*p<0.5, **p<0.1)

DEMOGRAPHICS

IMPROVEMENT PROCESS

• Initial backlog

removed in 4 weeks, but additional changes needed to sustain testing rate

• Combined TB and

HIV/HCV testing, so client was in same room, with same tester

• Expanded testing

hours

• Remove backlog at

MRC2 by testing all clients within first week

Plan Do Study Act

Avg = 9.65/mo

PRINCIPAL FINDINGS

Proper screening for HCV in disenfranchised populations and subsequent access to care is the first step in alleviating the burden of disease  Maximizing screening in this population is an important opportunity to counsel those who may be HCV negative but are at high risk of contracting HCV  Integrating HCV testing into other intake procedures seems to have a positive impact on testing rates

POLICY & PRACTICE

 Clients & patients  Student volunteers

AKNOWLEDGEMENTS

Klinkenberg WD, Caslyn RJ, Morse G a, et al. Prevalence of human immunodeficiency virus, hepatitis B, and hepatitis C among homeless persons with co-occurring severe mental illness and substance use disorders. Compr Psychiatry. 2003;44(4):293-302. doi:10.1016/S0010-440X(03)00094-4. Strehlow AJ, Robertson MJ, Zerger S, et al. Hepatitis C among clients of health care for the homeless primary care clinics. J Health Care Poor Underserved. 2012;23(2):811-833. doi:10.1353/hpu.2012.0047. Viner K, Kuncio D, Newbern EC, Johnson CC. The continuum of hepatitis C testing and care. Hepatology. 2015;61(3):783-789. doi:10.1002/hep.27584. Kamarulzaman A, Reid SE, Schwitters A, et al. Prevention of transmission of HIV, hepatitis B virus, hepatitis C virus, and tuberculosis in

• prisoners. Lancet. 2016;388(10049):1115-1126. doi:10.1016/S0140-6736(16)30769-3.

Zucker DM, Choi J, Emily R. Mobile Outreach Strategies for Screening Hepatitis and HIV in High-Risk Populations. Public Health Nurs. 2011;29(1):27-35. doi:10.1111/j.1525-1446.2011.00970.x. Ward JW. The hidden epidemic of hepatitis C virus infection in the United States: occult transmission and burden of disease. Top Antivir Med. 2013;21(1):15-19. Chak E, Talal AH, Sherman KE, Schiff ER, Saab S. Hepatitis C virus infection in USA: An estimate of true prevalence. Liver Int. 2011;31(8):1090-1101. doi:10.1111/j.1478-3231.2011.02494.x. Chang, C.,, Louisiana is the world’s prison capital. The Times-Picayune. May 13, 2012: New Orleans, LA Hasselle D. and Woodward A., Young and homeless in New Orleans, in The Gambit 2015: New Orleans, LA http://www.umcno.org/Newsletter/ViewNewsletterNoMaster.aspx?x=YTn6r2ViapMciKY/1Ucp2A==#nolaknows Lipinkski, J., New Orleans' drug-related deaths exceed murders in 2016, in The Times-Picayune2017: New Orleans, LA.

CITATIONS

APPENDIX

Disparities and Health Equity Monday, 6:30-8:00pm

APPENDIX

Disparities and Health Equity Monday, 6:30-8:00pm

APPENDIX

Disparities and Health Equity Monday, 6:30-8:00pm

APPENDIX