By Eboni Winford, PhD, MPH, Director of Research and Health Equity, National Clinical Training and Consulting Director, Licensed Psychologist and Behavioral Health Consultant Cherokee Health Systems
“Wait. You treat that here?”
“Stacy” made this comment while looking at the massive number of sticky notes, which clutter the back of my office door during a routine integrated care follow up appointment. One sticky note had the words PrEP/HIV. I inquired further, and she tearfully stated, “you mean I can come here and get my HIV treatment?” I immediately responded in the affirmative and asked about her tears: “What’s making you cry?” Stacy shared her fear of going to one of the local HIV care centers and feeling as though “everyone knows you only go there for HIV or food stamps. I don’t even like to go because people are just going to talk about me and judge me.”
Patients are our guide.
At Cherokee Health Systems (CHS), we practice within a care model where patients can access a wide range of interdisciplinary and collaborative services at the point of care and often without having to return for separate visits. Stories like Stacy’s prompted CHS to embed HIV screening, prevention, and treatment into its routine primary care continuum. This model allows us to follow patients’ leads about their concerns, preferences, values, and about how and when they would like to receive their care. Integrated care also provides a robust environment to engage in the continuum of care: prevention, intervention, and tertiary care. It allows us to transform our care practices in such a way that patients like Stacy who feel shame and stigma associated with her receipt of care can feel welcomed, embraced, and empowered.
HIV care is a routine component of primary care.
We recognized the need to remain true to our integrated care model even as we expand the types of services we provide, and we wanted to utilize the hub and spokes model of resource allocation and training. To this end, we completed a needs assessment and provider comfort survey to identify a hub–a clinic that had passionate staff, interest, administrative support, flexible team members, and operational buy in to support such a big change.
At the identified hub, we integrated a PrEP Navigator, a team member who is trained in motivational interviewing, de-stigmatizing language, trauma-responsive care, and methods of HIV/other communicable disease prevention. This Navigator was located in the primary care workflow–they did not have a private office on a separate floor or in another wing of the building; they were located where the PCPs and nurses collaborate. The Navigator was available “on-demand” for warm hand offs from the primary care providers to discuss HIV risks, harm reduction strategies, and prevention methods while patients are present for their routine visits.
Related: Get Ready — PrEP is a Game Changer
This method of care mimicked CHS’s integrated care model, which emphasizes care coordination, team-based care, communication, and collaboration. This model promotes equity by reducing barriers to engagement (e.g., there is no need to go to a separate appointment for a referral when the “referral” walks into the primary care room as you’re sitting there!).
To track this strategy’s effectiveness, we monitored our UDS metrics–percentage of patients who received HIV screening–as well as internal metrics:
- the number of patients who received specific ICD-10 codes as their diagnoses
- the number of PrEP prescriptions written
- the number of PrEP prescriptions filled
After observing an increase in these metrics, we identified a “spoke” clinic. Providers in this clinic were trained in HIV screening, PrEP prescribing practices, reporting requirements, linkage to care strategies, and laboratory monitoring. We added an additional PrEP Navigator to the team and tried using telehealth equipment to provide these Navigation services. It worked!
With this success, we expanded our spokes to include our mobile clinic, clinics located in rural communities, and clinics that serve populations who may be at an increased risk for HIV transmission because of social drivers of health including their built environment, neighborhood safety, and access to prevention and other forms of care.
Community Health Centers serve patients where they live and how they show up.
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World AIDS Day is here. And it’s a time to reflect on the progress we’ve made in the areas of treatment, prevention, harm reduction, and quality of life improvement for HIV/AIDS. Patients such as Stacy remind CHS that the best type of care is the care that the patient accepts and follows. Listening to our patients and being willing to provide the care they need when they want it and when they are willing to engage is pivotal. Community Health Centers welcome patients as they are. As they show up.
With them as our guide, we can work to reduce the stigma that comes from negative stereotypes about treatable chronic conditions such as HIV. We can honor our values of providing care to anyone–regardless of their ability to pay. Of their histories. Of their lived experiences. Of their language. Of their ethnicity. Of their country of origin. Of their diagnoses. We meet them where they are and join them along the way.
As you honor Worlds AIDS Day at your health center, I encourage you to reflect on ways to meet patients where they are. To allow them to be your guide, and to work to reduce barriers to their ability to receive some of the best care our nation has to offer.
More about HIV/AIDS
Visit NACHC’s Resource Library for more about HIV/AIDS. Go to library.
*We struggled to identify the “correct” ICD code. We considered factors such as stigma, patients’ insurance status (i.e., are they insured under guardian and guardian is unaware of this care), and strategies for communicating with patients (i.e., ensuring understanding of patients’ beliefs about HIV screening, transmission, and treatment).