Ryan White Part C Outpatient Early Intervention Services

Bluegrass Care Clinic (FY 2009 Part C EIS) University of Kentucky Research Foundation - Bluegrass Care Clinic 109 Kinkead Hall Lexington, KY 40506-0057 859-323-4792 (phone); 859-257-3477 (fax) email: thornton'cillkv.edll Web site: http://www.mc.lIkv.edu/bluegrasscareclinic/ Project Abstract 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, BCC services include: medical evaluation and clinical care; medical case management; 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, nutrition, psychiatry, substance abuse counseling and oral health care. Despite an overrepresentation of minorities in the patient population (17% African American and 8% Hispanic), as compared to the service area population (4% African American and 2% Hispanic), the BCC has not received Minority AIDS Initiative (MAl) funds to date. Target Population: The BCC, a university-affiliated clinic, has served as the safety net for HIV primary care in the 63 counties of central and eastern Kentucky since 1990. Of the patients served in 2006, 78% were white, 16% African American, and 5% Hispanic, 61% 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. In addition, 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 779 persons living with AIDS in the BCC service area by the end of 2006. 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 (55%) followed by heterosexual transmission (16%). At the BCC, heterosexual transmission represents 29% of the patient population and 31% of new cases. Sixty percent of new patients at the BCC in 2006 were between the ages of25-44. The number of patients dually diagnosed with active/latent TB is 45; with Hepatitis B is 80; and with Hepatitis C is 87. 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 Title III funds in 2001, the BCC increased the number and range of services to HI V-infected and -affected persons. Board-certified infectious diseases physicians provide primary care services and also serve as ID consultants for hospitalized, HIV -infected patients. A patient service coordinator manages medical services. A team approach to care includes services of an HIV clinical pharmacist and a mental health counselor. Dental services are provided by the University of Kentucky (UK) Ryan White Dental Reimbursement Program. In 2006, 668 HIV -positive patients received primary care services from the BCC, an increase of 7% since 2005. From 2002 to 2006 the annual number of outpatient visits increased by 125% (from 1868 to 4200). Of patients served in 2006, 44% were classified as having AIDS; 17% had CD4 cell counts less than 200, while 36% and 47% had counts between 200 and 500 and greater than 500, respectively. In addition, 82% of patients were on combination therapy; 161 were referred to clinical trials, and 2 were pregnant. Confidential HIV counseling and testing is available daily by our trained Patients Services Coordinator as well as weekly by prevention counselors from the Fayette County Health Department. This service/collaboration encourages immediate access to care for persons newly diagnosed. Two monthly patient support groups (Men's and Women's) are facilitated by our patient services coordinator and clinic social worker. The CDC and the state of Kentucky fund counseling and testing activities and partner notification. The state drug assistance program (ADAP) is accessed for persons living with HIV /AIDS who need pharmaceutical support. 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, 5 HIV Care Coordinators are housed on-site. Limited Medicaid transportation services are available to qualified patients. The BCC is not located in a Title I eligible MSA; no Title I funds are available. The BCC receives support from the state-funded University of Kentucky. Problem: Since the beginning of2001, 557 new patients have been seen at the BCC; the number of patient encounters has increased by 125%; the unduplicated case load has increased from 411 to 668. In 2006, 41% of new patients presented to our clinic with CD4 cell counts less than 350. Our resources are stretched despite numerous creative collaborations to provide on-site testing and counseling; and discounted laboratory, radiology, physician and mental health counseling fees. Level funding, coupled with increases in salaries and lab fees, a growing patient population, and a growing annual deficit of approximately $1,025,000 in BCC operations incurred by the University, will make it difficult for us to continue providing HIV primary care services at our present level. Service gaps such as pain management and substance abuse, as well as transportation needs for rural patients, remains unchanged. 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. 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 30 persons at the BCe. 3. Comprehensive HIV primary medical care to 150 new patients over the next 2 years. 4. Physician access weekdays, 1 evening/month, and after-hours 24 hrl7days, 365 days/yr. 5. Medical specialty care by referral, as appropriate. 6. Nutritional assessment and counseling services to 50%-75% of patients, as appropriate 7. Mental health and substance abuse services to 90%-100% of patients, as appropriate. 8. Oral health care (UK's RW Dental Reimbursement Program) for 80%-100% of patients. 9. A multidisciplinary health/adherence education program to 80%-90% 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).