Project Grant H8H46170

FY 2021 ENDING THE HIV EPIDEMIC - PRIMARY CARE HIV PREVENTION - SAINT JAMES HEALTH, INC., (SJH) GRANT NUMBER H80CS29015, PROPOSES TO USE FY 2022 ENDING THE HIV EPIDEMIC (EHE) PRIMARY CARE HIV PREVENTION (PCHP) FUNDING TO DECREASE RISK OF HIV TRANSMISSION AMONG PERSONS WITH HIV AND AT RISK FOR HIV DISEASE CONSISTENT WITH FEDERAL EHE GOALS THROUGH EXPANDED HIV TESTING, TO INCREASE ACCESS TO AND PRESCRIPTION OF PREEXPOSURE PROPHYLAXIS (PREP), AND TO INCREASE LINKAGE OF NEWLY-DIAGNOSED PLWH TO HIV MEDICAL CARE. NEED. SJH CLINICS ARE LOCATED IN THE CITY OF NEWARK, NJ WHICH IS THE EPICENTER OF NEW JERSEY'S HIV EPIDEMIC - HOME TO 15% OF NEW JERSEY'S PEOPLE LIVING WITH HIV (PLWH) DISEASE BUT ONLY 3% OF THE STATE'S POPULATION. SJH SERVES PATIENTS IN THE GREATER NEWARK SERVICE AREA INCLUDING MUNICIPALITIES AND ZIP CODE AREAS IN TWO OF THE 48 FEDERAL EHE JURISDICTIONS - ESSEX COUNTY (INCLUDING NEWARK) AND ADJACENT HUDSON COUNTY. SJH CURRENTLY CONDUCTS TESTING FOR INDIVIDUALS AT RISK FOR SEXUALLY TRANSMITTED INFECTIONS (STIS) WHICH ARE THE SAME RISK FACTORS FOR HIV DISEASE. SJH ALSO CONDUCTS HIV TESTING. PERSONS TESTING HIV POSITIVE ARE REFERRED TO THE CITY OF NEWARK CHC (MARY ELIZA MAHONEY HEALTH CENTER) FOR HIV MEDICAL CARE PROVIDED BY AN INFECTIOUS DISEASE SPECIALIST. FEDERAL CDC FUNDING SUPPORTS HIV TESTING IN THE SERVICE AREA BUT NEW HIV DIAGNOSES HAVE DECLINED FROM 2017-2020 ACCORDING DATA ON AHEAD.HIV.GOV. PROPOSAL. WITH EHE PCHP FUNDING, SJH WILL IMPLEMENT A STATUS NEUTRAL APPROACH TO PATIENTS AT RISK FOR HIV VIA SEXUAL ACTIVITY AND INJECTION DRUG USE. GOAL 1: SJH WILL INCREASE HIV TESTING OF SJH PATIENTS (DOUBLE THE NUMBER OF PATIENTS TESTED IN 2020) THROUGH COORDINATION WITH STI TESTING AND WILL IMPLEMENT RAPID HIV TESTING ONSITE TO PROVIDE HIV TEST RESULTS WITHIN 20 MINUTES (CONFIRMATORY HIV POSITIVE WITHIN ONE HOUR). SJH WILL SEEK TO IMPLEMENT "OPT OUT" HIV TESTING FOR PATIENTS IN COLLABORATION WITH THE EHE ESSEX COUNTY INITIATIVE. SJH WILL ALSO PROVIDE OUTREACH SERVICES FOR HIV TESTING AND FOLLOW UP. GOAL 2: SJH WILL INCREASE PRESCRIPTION OF PREP FOR INDIVIDUALS TESTING HIV NEGATIVE THROUGH EDUCATION AND DIRECT ASSISTANCE. (1) SJH WILL PROVIDE PREP EDUCATION TO BOTH INDIVIDUALS TESTING HIV NEGATIVE AND THOSE TESTING HIV POSITIVE FOR THEIR HIV NEGATIVE PARTNERS. THIS WILL INCREASE DEMAND FOR PREP. (2) SJH WILL INCREASE PRESCRIPTION OF PREP TO ALL INTERESTED INDIVIDUALS IDENTIFIED IN (1). (3) SJH WILL FOLLOW UP WITH PREP PATIENTS ACCORDING TO CDC CLINICAL PRACTICE GUIDELINES FOR PREP RELEASED DECEMBER 8, 2021. GOAL 3: FOR INDIVIDUALS TESTING HIV POSITIVE, SJH WILL PROVIDE HIV MEDICAL CARE ON SITE WITH MEDICAID, CHC AND OTHER FUNDING. SJH HAS APPLIED FOR FY 2022 ESSEX COUNTY EHE FUNDING FOR RAPID ANTIRETROVIRAL (ART) TREATMENT SCHEDULED TO START MARCH 2022. IT IS EXPECTED THAT MORE HIV DIAGNOSES WILL COME FROM THE WEST WARD LOCATION BASED ON CURRENT ZIP CODE HIV DATA FROM AIDSVU.ORG AND SJH TESTING DATA - BUT ALL OF NEWARK IS IMPACTED. IN 2019, OVER 2% OF NEWARK RESIDENTS HAVE HIV THROUGHOUT ALL ZIP CODES, COMPARED WITH 0.8% OF ESSEX COUNTY RESIDENTS LIVING OUTSIDE OF NEWARK AND 0.4% OF NEW JERSEY RESIDENTS. THE PCHP INITIATIVE WILL BE SUPPORTED AT THE TWO SJH SITES BY TWO MEDICAL TEAMS (TOTAL 0.4 FTE INFECTIOUS DISEASE SPECIALISTS, 0.4 MEDICAL ASSISTANTS), 0.2 FTE LICENSED CLINICAL SOCIAL WORKER (BEHAVIORAL HEALTH), 1.0 FTE PATIENT EDUCATION/PREP NAVIGATORS, AND FINANCIAL AND HUMAN RESOURCES SUPPORT. DIRECT COSTS WILL INCLUDE PURCHASE OF HIV RAPID TESTS, PATIENT EDUCATION MATERIALS, LAB COSTS FOR UNINSURED INDIVIDUALS, COST OF PROGRAMMING ELECTRONIC MEDICAL RECORDS AND PRACTICE MANAGEMENT SYSTEM TO CAPTURE HIV TESTING AND PREP DATA AND PROVIDE NECESSARY EHE TRIANNUAL REPORTS. SJH WILL COORDINATE PCHP WITH THE EHE ESSEX COUNTY INITIATIVE AT THE NEWARK DEPARTMENT OF HEALTH AND COMMUNITY WELLNESS/RYAN WHITE UNIT.