Ryan White Part C Early Intervention 2014

Summary of Request: The Bluegrass Care Clinic (BCC) proposes to continue providing comprehensive primary care services to HIV-positive persons in central and eastern Kentucky. Located in the Kentucky Clinic at the University of Kentucky Chandler Medical Center, BCC services include: medical evaluation and clinical care; medical case management; nutrition counseling; patient health/adherence education; mental health counseling; the provision of emergency drug supplies; continuous quality improvement (CQI); consumer involvement; access to clinical trials; as well as referrals to medical specialty care, psychiatry, substance abuse counseling, and oral health care. In 2008, the BCC received on-going expansion funding. Due to an increasing overrepresentation of minorities in the patient population (17% African American and 6% Hispanic), as compared to the service area population (4% African American and 2% Hispanic), this expansion grant included $39,710 in Minority AIDS Initiative (MAI) funding. The BCC seeks funding preferences for increased burden, rural areas, and underserved. Target Population: Since 1990, the BCC has served as the safety net for HIV primary care in 63 counties of central and eastern Kentucky. Of the patients served in 2008, 74% were white, 18% African American, and 6% Hispanic; 69% were below 200% of poverty. Forty-eight of the 63 counties served (76%) are federally recognized as economically distressed. Recreational drugs of choice in the BCC service area include alcohol, tobacco, and prescription medications. Kentuckians have among the highest US rates of co-morbid conditions (i.e., cardiovascular disease, obesity, diabetes, and cancer), making patient care complex and time consuming. There were 802 persons living with AIDS in the BCC service area by the end of 2008. Unprotected sex is the most common risk factor for AIDS within Kentucky with the majority of AIDS cases diagnosed among white men who have sex with men (54%) followed by heterosexual transmission (15%). The number of patients dually diagnosed with active/latent TB is 40; with Hepatitis B is 108; and with Hepatitis C is 136. At the BCC, heterosexual transmission represents 26% of the patient population and 31% of new cases. Fifty-seven percent of new patients at the BCC in 2008 were between the ages of 25-44. The proposed project targets persons at-risk for HIV disease in the 63-county service area, including persons of color, migrant farm workers, and medically underserved, rural residents. The project is designed to address unmet needs and to overcome barriers to care. Current HIV Service Activities: With the receipt of Part C funds in 2001, the BCC increased the number and range of services to HIV-infected and -affected persons. Board-certified infectious diseases physicians provide primary care services and also serve as infectious disease consultants for hospitalized, HIV-infected patients. A patient service coordinator manages medical services. A team approach to care includes the services of two HIV clinical pharmacists, a dietician, and a psychotherapist. Three monthly patient support groups (Men’s, Women’s, and monolingual Hispanic) are facilitated by our patient services coordinator and clinic social worker. In 2006, the BCC was awarded grant funds to offer Ryan White Part B services on-site for 32 counties in central and eastern KY. Currently, 6 HIV Care Coordinators are housed on-site. Dental services are provided by the Ryan White Dental Reimbursement Program through the University of Kentucky’s College of Dentistry. Additionally, the BCC receives support from the state-funded University of Kentucky. The CDC and the state of Kentucky fund counseling and testing activities and partner notification. Confidential HIV counseling and testing is available daily by our trained Patient Services Coordinator, as well as weekly by prevention counselors from the Fayette County Health Department and Volunteers of American. This collaboration encourages immediate access to care for persons newly diagnosed. The Kentucky AIDS drug assistance program (KADAP) is accessed for persons living with HIV/AIDS who need pharmaceutical support. Limited Medicaid transportation services are available to qualified patients. The BCC is not located in a Part A eligible MSA. In 2008, 818 HIV-positive patients received primary medical care from the BCC, an increase from 763 patients in 2007 and 668 patients in 2006. From 2002 to 2008 the annual number of outpatient visits increased by more than 136% (from 1868 to 4410). Of patients served in 2008, 51% were classified as having AIDS; 20% had CD4 cell counts less than 200, while 39% and 41% had counts between 200 and 500 and greater than 500, respectively. In addition, 81% of patients were on combination therapy; and 7 were pregnant. Problem: Since the beginning of 2001, 810 new patients have been seen at the BCC; the number of patient encounters has increased by 136%; the unduplicated caseload has increased from 411 to 818. In 2002, we began providing unduplicated outreach services to the medically underserved and communities of color in our rural service area. Our leadership role is crucial because our clinic acts as the only safety net for HIV primary care in our service area, and community-based outreach does not target several high-risk populations. To date in 2009, 48% of new patients presented to our clinic with CD4 cell counts less than 350 (comparable to 53% in 2007 & 2008). Expansion funds have allowed for increased services to meet the growing needs of our aging patient population, and increasing patient load. Despite receipt of these funds we continue to foster numerous creative collaborations to provide on-site testing and counseling; as well as discounted laboratory, radiology, physician and mental health counseling fees. Service gaps such as pain management, substance abuse treatment, as well as transportation needs for rural patients, remain a challenge. Goals and Objectives: The overall goal of the project is to continue providing comprehensive, high quality primary care to PLWHA in central and eastern Kentucky. Provide/implement: 1. Access to and outreach for high quality, comprehensive HIV primary care services. 2. HIV counseling, testing, referral, and partner counseling to 50 persons at the BCC. 3. Comprehensive HIV primary medical care to 75 new patients over the next year. 4. Physician access weekdays, and after-hours 24 hours/day, 7days/week, 365 days/year 5. Medical specialty care by referral, as appropriate. 6. Nutritional assessment and counseling services to 300 patients, as appropriate 7. Mental health and substance abuse services to approximately 75 patients, as appropriate. 8. Oral health care (UK’s RW Dental Reimbursement Program) referral for 65 new patients. 9. A multidisciplinary health/adherence education program to100% of patients. 10. Prevention case management services to patients and their loved ones. 11. Appropriate vaccines and emergency HIV medications. 12. Culturally and linguistically appropriate services. 13. A continuous quality improvement plan. 14. Consumer involvement in program development, implementation, and evaluation activities. 15. A patient-led Clinic Advisory Board, and survey of patient needs/concerns. 16. Patient Support Groups (Men’s, Women’s, & Monolingual Hispanics, Caregivers).