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Last month, our colleague wrote about the successes of the three-year Partnerships for Care (P4C) demonstration project in advancing primary care capacity for HIV diagnosis, treatment, and care among health centers. Preliminary data from the first two years of P4C showed improvement on key indicators, including the numbers of persons tested for HIV and the percentage of people living with HIV who were virally suppressed. (Read about the tens of thousands of patients tested, thousands diagnosed and linked to HIV care, and hundreds of previously diagnosed individuals re-engaged in HIV care during just the first two years of the project.)
In this blog post, we focus on some of the successes that are harder to measure with quantitative data because they represent the systemic and capacity-building changes that contributed to a more effective and efficient way of driving the progress we want to see.
P4C enhanced sustainable partnerships among 22 HRSA-funded health centers and four CDC-funded state health departments in Florida, Maryland, Massachusetts, and New York. A key goal of P4C was to support expanded HIV service delivery in health centers servicing communities highly affected by HIV, especially among racial/ethnic minorities. The health centers and health departments focused on increasing the identification of undiagnosed HIV infection, integrating HIV services into primary care, and enhancing the use of public health surveillance and electronic health record data. Some accomplishments in these areas include:
- Training health center providers and staff in routine HIV testing, care, treatment, and prevention
- Developing electronic clinical decision support tools to facilitate HIV testing and care
- Improving the integration of surveillance and clinical data to enhance re-engagement and retention in care of clients living with HIV
- Building health center capacity and partnerships with community-based organizations to coordinate services for people living with HIV and those at high risk of HIV infection
At the final meeting of the P4C project in September, representatives from 16 health centers and three health departments shared their accomplishments and experiences integrating HIV services into primary care, including how they overcame challenges and how they established and maintained partnerships with each other. Unfortunately, the six participating health centers from Florida and the Florida State Department of Health were unable to attend the meeting due to Hurricane Irma.
Health centers and health departments highlighted the changes they made in systemic processes and procedures that increased efficiency so that more patients at risk for and living with HIV can receive services. Collaborative efforts between the health centers and health departments enabled the use of “Data to Care,” which helps identify and re-engage people diagnosed with HIV who have fallen out of HIV care. (Read about New York’s use of Data to Care.) Both health department and health center representatives shared that their P4C experience had changed their organizations and impacted the people who work there. Examples included how the health center staff developed a greater appreciation for their role in preventing HIV transmission through their delivery of HIV services, and felt empowered in protecting the health and well-being of HIV-positive clients. Health centers noted that P4C’s training and technical assistance were key for learning new information and skills that enabled their staff to adapt and improve health services systems.
“P4C is a great example of how having clearly identified goals and bringing people together to achieve them can lead to incredible results when the right policies, procedures, and resources are in place. It’s great to see how many people were tested and how many people on treatment reduced their viral load, but what’s even more important is how the health services systems changed. Many more people will be able to benefit from these changes in the months and years that follow. Projects that bring about this type of lasting change that can be sustained over time is exactly what the Secretary’s Minority AIDS Initiative Fund was established to do,” observed Richard Wolitski, Director of the HHS Office of HIV/AIDS and Infectious Disease Policy (OHAIDP). “We applaud the health centers, health departments, and our federal colleagues for their hard work, dedication, and perseverance. Many more people will benefit from the policies and procedures, clinical decision support tools, materials, data-sharing agreements and other resources that represent just some of the tangible products from P4C.”
The lessons learned from P4C can’t be put away in a filing cabinet and fade away. There are nearly 1,400 community health centers in the U.S. that were not part of this project. P4C has shown what’s possible if we make the commitment, breakdown barriers to collaboration and data sharing, put the right policies and procedures in place, and continue to build the capacity of the workforce and its ability to adapt to changing circumstances. We can’t just congratulate ourselves and move on to the next thing.
P4C was supported by the Secretary’s Minority AIDS Initiative Fund (SMAIF) and HRSA Health Center Program Funding. OHAIDP, HRSA’s Bureau of Primary Health Care, and CDC’s Division of HIV/AIDS Prevention all collaborated to support the 22 health center and 4 state health department grantees. Additional information can be found on CDC’s website, and for a limited time at the P4C website.