Slide 1 Community Health

Navigation Sinai Health System

Centers for Disease Control and Prevention Site VisitDecember 10, 2014

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Slide 2 Presentation Outline

• Background Information on Sinai Health System

• Program Overview

• Genesis of routine HIV screening

• Models of screening used

• Linkage to Care

• Outcomes to date

• Opportunities

• Community Health Navigation

• CAPUS

• Project Planning

• Project Implementation

• Project Management

• Project Evaluation

• Lessons learned

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Slide 3

Background and Program

OverviewDR. NANCY GLICK

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Slide 4

Feb 2013: Visit to ED, no HIV test; Admitted to floor, routinely tested

Feb 2013 tests: CD4: 48/ VL: 5,144

April 2013 tests: CD4: 94/ VL: <75

Why is routine HIV Screening

important?

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Slide 5 Sinai Health System

Westside of Chicago

Level 1 trauma center

319-bed teaching hospital

Urban Health Institute

outpatient care (primary and specialty care – HIV Primary care)

ED Census is about 60,000 patients/year

Multi Complex laboratory

HIV Clinic on site with wrap around services

HIV Prevalence in North Lawndale:1,027.5/100,000 persons

Chicago Community Map source: Chicago Department of Public Health. HIV/STI Surveillance Report, 2013. Chicago, IL: City of Chicago; December 2013.

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Slide 6 Genesis of Routine Screening

HIV Testing in the ED 2001 – 2004

HIV/STD Counseling &

Testing 2004 - 2005

CDPH HIV Prevention in

Deaf Populations 2005-2006

HIV Rapid Testing/STD screening in the ED 2004 – 2007 (CDC)

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

HIV F.O.C.U.S. (Gilead) Routine Screening

Program2011-2014

Outpatient Rapid HIV

Testing/ACHN2005-06

CDC HIV Testing in high prevalence

communities 2008-10 (CDC)

Expanded Testing

Initiative (CDPH)

andCAPUS (IDPH) funding

Initiation of

provider-initiated

screening

HIV testers

begin to routinely

offer patients

tests in ED

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Slide 7 Genesis of Routine Screening

Limited capacity to provide around the clock testing

Desire to expand to inpatient and outpatient areas/physician interest in those areas

Blood-based testing would be more sensitive than rapid testing technology

Met CDC’s criteria for HIV prevalence: From October 2007 through July 2010, Sinai tested over 15,000 patients for HIV with a 0.9% positivity rate.

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Slide 8

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Slide 9 The FOCUS Model: 4 Pillars

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Slide 10 General Routine HIV Screening Flow

Patient is offered HIV test in ED, bedside, or

outpatient clinic

Physician and/or Navigator meet with

the patient – conduct post-test counseling

Patient navigator is paged

Patient consents to be screened

Blood draw occurs (HIV test is ordered)

HIV Test is reactive

Patient navigator follows patient thru first two

appointments (at Sinai or

elsewhere)

Patient is offered to be linked to care

HIV Test is non-reactive

Physician notifies patient of result

Patient navigator is paged if high risk

negative to provide counseling

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Slide 11 Trainings to Promote Routine Screening

• Orientations (medical residents)

• Staff Trainings (Physicians, Nurses, Medical Assistants, Patient Registration)

• Manager Meetings (Medical Executives, Quality Review)

• CME Credit Presentations (Physicians)

• Assistance from Midwest AIDS Training + Education Center

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Slide 12 Electronic Medical Record Adjustment

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Slide 13 Electronic Medical Record

Adjustment

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Slide 14 Data Reports to Departments

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Slide 15 Strategy: Ongoing Education

• Flyers (ED triage, nurse stations, registration)

• Palm cards (physicians)• Brochures (patient packets)

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Slide 16 Sinai HIV Screening Technology

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Slide 17 Timeline from Consideration to Initiation

of New ScreeningAbbott Architect◦ HIV Medical Director began conversation with lab in March 2012

◦ Lab conducted beta testing from April to October 2012

◦ Lab started using machine at the end of November 2012

MultiSpot HIV-1/HIV-2◦ HIV Medical Director and Manager began conversation with lab

in June 2013 after learning of new proposed algorithm through CDC MMWR

◦ Lab conducted beta testing from July to December 2013

◦ Lab started using machine at the end of January 2014

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Slide 18 Sinai’s HIV Screening

Algorithm

Bio-Rad Multispot HIV-1/HIV-2 Rapid test reflexes if HIVCombo is

reactive (internal lab)

Abbott Architect HIVCombo test

(internal lab)

HIV Viral Load test (external

lab)

Average wait:1 HR neg result

1.5 HR pos result

Wait:15

mins –24

hours

Wait:2 – 5 days

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Slide 19 Benefits of New Technology to Sinai

Preliminary Testing with Abbott Architect: ◦ Allows for quick diagnosis of patients who are very sick

◦ Result notification before discharge for ED patients

◦ Identification of acute infections who do not belong to a high-risk group makes clinicians broaden who they think is at risk for HIV.

◦ HIV team has a pulse on how disease is being spread NOW

Supplemental Testing with MultiSpot:◦ Wait time to confirmed HIV diagnosis is within a day usually (vs.

3-7 days with Western Blot)

◦ Confirm HIV test result internally (vs. using external lab)

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Slide 20 Identifying Acute Infections at

Sinai with New Technology10,716 tests conducted since Nov 2012

53 persons newly diagnosed

(.49% positivity rate*)

7 acute infections identified

(13% acute infection rate)

1,628 tests conducted in the ED since

Nov 2012

6 acute infections

identified in the ED

* CDC recommends routine HIV screening in medical settings that have at least a .1% HIV prevalence.

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Slide 21 Acute Infections at Sinai

Summary of Presenting Symptoms

Patient Presenting Symptoms/Reason for Visit

Risk Gender Age

Case 1 Cocaine poisoning Heterosexual Black Man 47

Case 2 Fever; dizziness; vision changes

HeterosexualHispanic Man 32

Case 3 Fever; confusion MSM White Man 28

Case 4 Hypotension likely heterosexual

Black Woman 56

Case 5 Thrush MSM Black Man 19

Case 6 Confusion; fever; Meningitis Heterosexual White Woman 28

Case 7 Fever, chills, diarrhea MSM Black Man 19

Average CD4 count: 425 Average VL: 440,629 Average age: 33 years oldTest Location where found: 6 in Emergency Department, 1 inpatient (Int. Med.)

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Slide 22 Clinician Education on Acute Infection

• Laboratory memo via email advising clinicians of new tests and how to order

• Preliminary and follow-up education by HIV Medical Director and prevention team during staff meetings to physicians and nurses, medical resident orientation:• Discuss technology

• Discuss how to label lab specimen so lab knows it is from ED (run as Stat)

• Follow-up tests needed to order to complete the screening algorithm

• Case studies of infections found and symptoms to look for

• Linkage to care outcomes

• Palm Cards with new algorithm and signs/symptoms of acute infection

• Navigators and management to assist physicians with screening decision making in real time

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Slide 23

• Flyers in triage to assist nurse and encourage patients to request HIV test if they have symptoms

Source: https://www.health.ny.gov/diseases/aids/general/publications/index.htm and AIDS.gov

Patient Education on Acute Infection

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Slide 24

• Immediate ID consult if inpatient or ID evaluation if in ED

• Patient Navigator is paged and comes to bed side/calls patient

• Establish a medical appointment with very close monitoring

• Offer assistance with partner services (with or w/o CDPH)

• Provide harm reduction counseling to patients given the increased risk of transmitting HIV during acute HIV infection

• Genotypic drug resistance testing

• Complete and submit case report to CDPH

• Determine when to begin ART based on physician and patient/ Initiate ART

• Provide other supportive services, keep in close communication with the patient

Protocol after Acute Infection is Identified

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Slide 25 Routine Screening Challenges

• Limitations because of Illinois HIV Testing Law: not opt-out/consent documented, only a nurse/physician can consent, only a physician can test

• No system-wide policy to date - work in progress

• Executive buy-in was not initially sought out and has been a slow process: Some areas of health system are slow to switch to routine screening

• Make clinicians aware of common risk and symptoms of acute infection without returning to targeted testing behavior

• Timing the counseling of patients about partner notification and utilizing services

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Slide 26 Routine Screening

Successes• Strong lab leadership

• On-site linkage to care

• Wrap around services exist to support patients diagnosed with HIV

• Testing Team is Persistent! When one idea does not work, tried others

• State of the art technology

• Areas of health system where we have reached 35-45% of patients screened

• Sustained funding to make systemic and permanent changes: 2011 – 2016

• All acute infections have been successfully linked to care and remain in care as far as we know: Even in routine screening scenario when testing was not likely planned

• We have been able to get some partners on PreP

• Finding acute infections fairly frequently keeps clinician ‘radar up’ in identifying AHI’s

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Slide 27

Linkage to Care

AUDRA TOBIN

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Slide 28 Purpose of Adding a Patient Navigator to the

HIV Team

To have someone dedicated to:• Go to patient’s bedside upon a positive test result for comfort and discuss

diagnosis

• Address barriers (based on the complexity of patients lives) to appointment attendance

• Educate patients on treatment and initiation of HIV care

• Educate patients on the availability of HIV care resources in the community and help patients complete ADAP applications

• New: Assist patients in obtaining a primary care provider to get permission to go to a specialist (infectious disease provider)

Main outcomes of focus:• To improve attendance at an appointment with an HIV care provider

• To assess patients for Early Intervention Services or Case Management needs

• To increase those who become virally suppressed

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Slide 29 Patient Navigation-Related

Staff• 1 Linkage to Care Coordinator

• 2 patient navigators (at both hospitals –Mt. Sinai and Holy Cross and for outpatient clinics)

• 2 Community Health Navigators

• 1 Early Intervention Specialist

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Slide 30 Patient Navigator Process (In Hospital)

Learn about new patients from EMR

report or being paged by a clinician or lab

Find out if patient has been post-test

counseled

Meet patient and discuss results

Determine how patient is

coping with results

Identify and address potential barriers to care

Schedule an appointment with

patient

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Slide 31

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Slide 32 When Patient Is Lost to Follow-up:

•Activate discharge protocol • 3 phone calls or letter if phone

disconnected

•Post a “Bulletin” in the EMR in patient’s record

•If new, note lost to follow-up status in case report

•Contact Chicago Department of Public Health Partner Services

•Refer patient to Community Health Navigators (more on that later)

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Slide 33 Patient Navigator Process

(In Clinic)

Meet patient at clinic

Case conference on patient with case manager, Mental Health, clinician

Have patient sign lost to follow-up paperwork

Discuss visit with patient

Collect ADAP eligibility paperwork

Schedule next appointment or if patient does not show up call to reschedule appointment

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Slide 34 Supervision and Support

•Daily review of patient tracking form to ensure no patients fall through gaps

•Weekly case conferences

•One-on-one meetings bi-weekly with supervisor

•Regular manager and peer-review of patient chart audits

•On-going in-service trainings with city, state, and training agencies

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Slide 35 Navigators as Valued

Team Members

• Case conferencing with providers, case managers, and mental health specialist

• Provided with access to medical records• Ability to document patient notes in EMR

• Schedules appointments

• Attend team meetings and case conferences

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Slide 36 Qualifications of Patient

Navigators

Education:◦ Health Educator trained in HIV testing and counseling, Red

Cross HIV Curriculum, Testing and Counseling, and Result Notification

◦ 1-2 years of experience working with HIV positive persons

Soft Skills:◦ Ability to be compassionate

◦ Comfort in providing post-test counseling results

◦ Flexible (can work with variety of people)

◦ Basic typing skills

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Slide 37

Navigator Paging Form• Reminds clinicians to page

an HIV navigator:• If they need help with

post-test counseling• If patient screens

reactive• If patient self-discloses

their status

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Slide 38 Patient Navigation Documentation

• EMR patient note

• Hard copy patient chart• Checklist• Tracking form• Release of information• Connect 2 Care• Lab results (HIV, CD4, viral load)• Outpatient appointment confirmation• Case report• Letters to patients

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Slide 39

Outcomes and Opportunities

MONIQUE RUCKER, MPH

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Slide 40 Sinai and 4 Pillar Implementation

Pillar 1: Testing Integrated

into Normal Clinical Flow

Pillar 2: Electronic

Medical Record

Notification

Pillar 3: Systemic

Policy Change

Pillar 4: Training Feedback &

Quality Improvement

Test offer and consent not part

of the general medical consent

at admission or at triage;

Consent done inconsistently in

health system with the reliance

on physician.

Verbal consent

Routine screening is

not prompted through

EMR parameter, but

consent and orders for

HIV testing is

documented in EMR

System-wide policy to

come in 2015

medical providers

educated continuously

including during

medical resident

orientation

Monthly data reports to

departments.

Tracking of quality indicators:

% of eligible patients tested

% dually diagnosed with

HIV/AIDS

% patients with previous visits

and no test

% patients tested for STD and

not HIV

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Slide 41 Sinai Routine HIV Screenings, Aug 2011-Aug 2014

n=14,529 (80 newly diagnosed 7 acute infections)

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Acute infection found

4th gen screening began

MultiSpotscreening began

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Slide 42 Testing Volume and

Department Seroprevalence

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Slide 43 Department Testing Volume by Year

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Slide 44 Previous Three Month Testing

Volume by Select Medical Departments

Quality Measure Benchmark# tested/

patient census

Sinai# tested/

patient census

% of patients tested 50%* ~5%

% of patients tested in ED 50%* 2%

% of patients tested in Family Practice

50%* 43%

% of patients tested in Internal Medicine

50%* 24%

% of patients tested in Outpatient Clinics

50%* 10%

% of patients linked to care 85%** 66%

• Data determined based on custom reports from Meditech (3 month averages)Sources: *FOCUS Gilead Sciences, **National HIV/AIDS Strategy

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Slide 45 Testing Differences by

Type of Consent

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Slide 46 Presenting CD4 and Viral Load for New Infections, Aug 2011 – Jan 2014

n= 61CD4 count n %

CD4 count mean 373CD4 Ct (<200) 16 26.23%

CD4 Ct (200-350) 10 16.39%CD4 Ct (351-500) 12 19.67%

CD4 Ct (>500) 14 22.95%No Data Available 9 14.75%

n= 61Viral Load Data n %

VL-Undetectable (<75) 6 9.84%VL-75-400 1 1.64%

VL-401-55,000 32 52.46%VL>55,001 6 9.84%

VL>500,000 4 6.56%No Data Available 12 19.67%Acute Infection n=4

CD4 Average 319Viral Load Average 409,811*

* 3 VL’s were >500,000

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Slide 47

Linkage to Care RatesAugust 2011 – August 2014: 70.1%

August 2013 – August 2014: 78%◦New Positives: 82%

◦Known Positives: 75%

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Slide 48 Patient Example 1

Risk:MSM

Reported100+ partners

Crystal meth user

August 2013:

Visited ED:FeverConfusion

Screened routinelyHIVCombo: reactiveConnected with navigator

WB: negativeVL: >500,000

Aug - Sept 2013:

Linkage to care:Makes first appointment

Enrolled in EIS, Case Management

Does not show up for second appointment /Staff cannot locate him

Referred to CDPH Partner Services

Relinked to care:Made two appointments

Initiates treatment Initiates Case Management

Mar 2014:28 years old:

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Slide 49 Patient Example 2

Risk:Part of a serodiscordant couple; spouse not adherent to ART

Last neg. HIV test was Summer 2013

April 2014:

Visited ED:FeverConfusionMeningitis

Screened routinelyHIVCombo: reactiveMS: negative

Connected with navigatorCD4: 253 / VL 84,403

April 2014:

Linkage to care:Attends first appointment at Sinai then connected back to primary care provider

Staff work with husband to get him back on ART

Linkage to care:Attends 2nd appointment

Initiates treatment

Children tested for HIV

May 2014:

27 year old mom of 2:

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Slide 50 Missed Opportunities: HIV Positive Patients with Visits and no HIV Test (Aug 2011 –

Oct 2013)

45.90%

28.57%

Patients with Previous Visits Dual Diagnosis (HIV/AIDS)

Percent of Newly Diagnosed with Visits and no Tests within Three Years of Diagnosis

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ED Visits Floor Visits Outpatient Visits Pediatric Visits Home Visit Mammogram OB/GYN Surgery Mental Health

Previous Visits by Location within Three Years of Diagnosis

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Slide 51

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HIV Only HIV and STI STI Only

Missed Opportunities

ED Patients with STI vs. HIV Tests

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Slide 52

Program Needs and

Opportunities

Program Needs Funding/Opportunity

Increase retention in care rates and find patients discharged with no result

CAPUS funding to hire two community health navigators

Maximize routine screening in Fast Track and Outpatient Clinics(e.g. HIV consent in general consent, decrease missed opportunities, system policy)

CAPUS funding to support a Medical Director and coordinator to spend time focused on removing barriers to screening.

Meet the mental health needs of patients routinely screened

CAPUS funding to support psychiatry and mental health therapy

Identify the partners of patients with acute HIV infection to interrupt the transmission of HIV via social networks

Partner with University of Chicago Medicine’s Center for Health Elimination to find negative partners / social network members

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Slide 53

Community Health

NavigationMELISSA GUTIERREZ, MPH

DINITIA ROBINSON

IVAN VILLARREAL, MS

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Slide 54

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Slide 55

• Frontline public health worker

• Trusted member of and/or has an unusually close understanding of the community serves

• Serves as a liaison/link/intermediary between health/social services and the community

• Facilitates access to services and improve the quality and cultural competence of service delivery.

• Builds individual and community capacity by informal counseling, social support and advocacy

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Community Health Workers (CHWs)

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Slide 56

• Titles Case Managers, Case Workers, Health or Peer Educators, Patient

Navigators, Promotores de Salud, Lay Health Workers, Community Outreach Worker, etc.

Roles and Functions Health education, patient self-management, health and social system

navigation, outreach, cultural consultation to medical staff, social support, advocacy, patient follow-up to ensure compliance with treatment recommendations, etc.

• Utilization Breast health, cancer screenings, smoking cessation, diabetes

management, asthma management, maternal and child health programs, nutrition, HIV, immunizations, etc.

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CHW Titles & Utilization

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Slide 57

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CHWs Help Tailor Interventions to

Community Needs

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Slide 58 Demonstrated CHW Impact

• Key to demonstrating the Triple Aim

– Better health, better quality, lower costs

• By

– Securing access to health care

– Coordinating timely access to primary care and

preventative services

– Helping individuals manager chronic conditions

– Reducing health disparites

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Slide 59 CHWs at Sinai

• Sinai Pediatric Asthma Program

– 70% reduction in ED visits

– 67% reduction in hospitalizations

– $5 saved per $1 spent on intervention

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Slide 60 CHWs at Sinai

• Block by Block North Lawndale

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Slide 61 CHWs at Sinai

• Helping Her Live Breast Health Project (2014)

– ~3000 women contacted through outreach efforts

– ~900 women reminded of their annual mammogram & 880

requests for navigation for an appointment

– Completed 835 mammograms (ave. = 75/month)

• Breast Health Patient Navigation

– Assisted ~1,000 women with an abnormal screening

mammogram navigate the health care system

– Reduced lost-to-follow-up for women with abnormal

mammograms by 30%

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Slide 62

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CHW: Successes

• Improve Health– Decrease morbidity and mortality

– Increase access to the healthcare system

• Increase Quality of Life – Empower families to take control of their own health

– Assist families in obtaining assistance in other areas of their lives

• Cost Effective– Decrease health care costs

• Peer Education – breaks down barriers between healthcare system and patient

• Community Outreach– Employing community members

– Community members working to help other community members

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Slide 63

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CHW: Challenges

• Funding

– Reimbursement: Medicaid, Private Insurances

– Short term funding: grants, private foundations

– Hospitals or FQHCs

• Training

– Health topic specific training

– Core competencies

– Computer skills / Office skills

• Supervision

• Acceptance of CHW as ‘medical professionals’

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Slide 64

64

Purpose and Objective:

• Blue print for CHW program

implementation or revising

practices

• Aids programs wanting to

more critically examine

processes, outcomes, cost

and cost-benefits associated

with their CHW interventions

• Grounded in evidence-based

science

This project is supported by

the Lloyd A Fry Foundation

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Slide 65

• Hire CHWs for skills only they can bring (cultural

sensitivity, community connections, etc.). May need

support in other areas (e.g., paperwork, managing a

case load, computers)

• Upper management and staff buy-in of the CHW

model is critical to its success

• Train, re-train, and evaluate the training

• Make the CHW a true part of the team

• Evaluation is key to long-term success and

sustainability65

Keys to Success

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Slide 66 Conclusion

• CHWs play a role in reducing health

disparities

• Hiring CHWs strengthens communities by

providing jobs

• CHWs are a community resource

• Evaluation of CHW interventions is key

• CHWs must be a part of the process and are

integral to the conversation

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Slide 67 Need for HIV Community Health Navigators

Retention Data 2003-2013

30%

11%35%

24%

492 TOTAL HIV TESTED POSITIVE PATIENTS AT MT. SINAI

Not Linked/Care Elsewhere(226)

Lost to Follow Up (86)

Succesfully Linked (266)

Engaged in Treatment/Undetectable Viral Load(180)

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Slide 68

Make phone call out or send certified letter to patient for first attempt of contact to inform them of your visit

Make a visit out to last known address for patient after confirmation over the phone or if the number given isn’t valid

Perform identity confirmation if they choose to be seen or if available

Perform client lead verbal assessment of client and pre-screeners for MH, Case management, and/or EIS

Find out how the client has been and what’s going on in their lives

Allow patient to control meeting location for future sessions

Observe some of the barriers that may have prevented clients from linking to care in the past

Start the referral process based on client needs

Make client’s first appointment plan to attend and/or confirm

Repeat previous step for second appointment

Connect client to Care and keep them there

A Day in the Life of a

Community Health Navigator

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Slide 69 Community Health Navigator

Model for HIV

Make contact with patients who are lost to

care

Assess Patients needs and/or barriers

Make referrals based on Patients needs

Schedule and Attend or confirm at least 2

doctors appointments

Follow-up within 14 days depending on patients

needs

Documentation is made (Tracking form, Pre-

Screener, and Database/System –TBD)

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Slide 70 Community Health Navigator Flow

Identify patients who are not in care:

Previously diagnosed (discharged with no post-test counseling)

Patients lost to follow-up identified from those who missed clinic appointments, or are inactive in

the case managers database, and/or who are identified in the case conference

Residents who self-disclose and/or who may be indentified by other Community Health Workers

Linkage to Care Coordinator provides a weekly patient list:

Case Conference on Friday - patients lost to follow-up/discharged with no result

CHN’s determine plan for finding patients

*** CHN’s locate patients within 14 days (link patient to care in 45 days)

CHN’s make contact with patients, develop rapport, assess needs

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Slide 71

MH, Patient Navigator, EIS, and CM:Follow-up with patients within 14 days (depending on needs of the patient) at home/office/clinic

Documentation is made:CHN tracking form Pre-ScreenerDatabase/system-TBD

Community Health Navigator Flow

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Slide 72 Community Health Navigator Flow

Community Health Navigator’s:

•Update Linkage to Care Coordinator withstatus

•LTCC updates MH, Navigators, EIS, and CM (depending on needs identified) at case conference

•CHN schedules appointments and re/links patient to care (at Sinai or elsewhere) within 45 days: some patients will need to be linked to their primary care providers first

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Slide 73 CHN Referral Process

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Slide 74 Reported Barriers

•Drug relapse/Substance Abuse

•Financial Issues- transportation/employment

•Denial

•Lack of childcare

•Feeling healthy

•Religion

•Inconsistent/Adherence issues

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Slide 75

CHN Metrics of Success• Phone/Face contact (within 14 days)

• Assessment completed

• Verify if person is in care

• Meet with another team member (Mental Health, EIS, Case Manager)

• Schedule an HIV PMC appointment

• Get a Referral from PMC

• Patient attends 1 appointment (within 45 days)

• Patient attends 2 appointments

• Patient is prescribed ART

• Patient achieves viral load suppression

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Slide 76 Case Study and Progress to Date

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Slide 77

Overview of Hired CHN’s

• Before becoming a Community Health Navigator for Mt. Sinai Hospital, Ivan Villarreal worked as a Bi-Lingual Health Educator for the Rauner YMCA under the Otho Sprague Foundation overseeing community based clinical, nutritional, behavioral, and fitness programming on childhood obesity. He spearheaded a campaign to obtain lifestyle change among families in order to improve lifestyle and behavioral health. In addition to his/her current position, he recently completed a Health Education degree and is currently involved within the Pilsen community allowing him to understand the barriers characteristically involved with community navigation.

Before working as a Community Health Navigator for Mt. Sinai Hospital, Dinitia Robinson was a Home Visitor for Sinai Community Institute. She was an advocate and sex educator to first time teen moms from the surrounding communities and high schools (North and South Lawndale, Pilsen, Little Village, East and West Garfield, Austin, and Humboldt Park) . Making sure they made it to school everyday (with good standing grades) or re-enrolled if they dropped out, getting them to doctors appointments on time, and stayed up to date with their method(s) of birth control, because delaying their second pregnancy was focal point of the program. Also referring them to case management and other resources to help get through some of their barriers they faced on a day to day bases.

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Slide 78 Thank you’s!

HIV TEAM

Nancy Glick, MD Audra Tobin Doug Ryan, MSWLisa Russell, MD Sunita Mohapatra, MD Darius Mayfield Ana Fuentes Kimberly Ramirez Monique Rucker, MPH Alberto Martinez Nikiya Pruitt Jacqueline Franqui Claude Hall Jennifer Devries Ivan Villarreal, MS Dinitia Robinson Megan Patton Bess Levin Kristi Allgood Christopher Patron Bobbi Pollard

Funders

Gilead Sciences: HIV FOCUS

Public Health Institute: CAPUS Funding

Illinois Department of Public Health: ADAP Communities of Color Program

Chicago Department of Public Health: Expanded HIV Testing Funding, Ryan White

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