HIV Test, Link to Care, and Navigation Services @ TWC

Tuesday, January 14, 2014

logo weaveWith a combination of funding streams in 2014 we are enhancing our internal prevention and link to care programs and services while further building collaborative partnerships with primary and HIV medical care providers and other social support service agencies.  This network will fortify the continuum of care appropriate for women, by providing for enhanced service delivery, increased capacity, and improved collaboration ultimately leading to the achievement of improved health outcomes.

We will be offering women a range of new services to support their access to and retention in care. These services include: (1) early intervention services; (2) mental health services; (3) medical case management; (4) psychosocial support; and (5) treatment adherence. Together, these services are integral to sustaining women in care in that they address the main barriers women face in becoming active and engaged participants in their health care.  By providing these services, we will bolster the capacity of our agency to work with over 300 women living with HIV/AIDS a year while advancing our collaborations with significant partners in care.  We are committed to providing new and innovative, approaches to move women along the prevention to care continuum. In this context, we continue to provide high quality and gender-sensitive strategies to expand the safety net of services for women to ensure they are retained in care.

TWCs HIV care continuum aligns with the National HIV/AIDS Strategy by addressing the social determinants of health and health disparities faced by women and girls with a system of care that includes innovative programming, maximizes dwindling resource, utilizes highly trained staff, leverages the power of peer support, utilizes wrap-around services, and ensures that policy addresses barriers at a systemic level.  We start with our test and link to care program, which conducts HIV testing for over 600 individuals each year and from which we successfully link all preliminary reactive clients to appropriate primary medical care and support services. We ensure that women who are residents of DC are connected directly to TWC care services at the time of testing preliminary reactive and provide linkages to medical care and treatment via designated, highly trained community health workers (CHWs) who support women in taking full advantage of HIV medical care and other community services to improve their health and quality of life. Peer CHWs utilize their unique position to address barriers to care that can present challenges for other medical professionals. They provide trust-based information and education; help clients overcome fear, denial, and stigma; conduct outreach and support in the community; take the time to walk clients through the often overwhelming healthcare system; and help clients strategize to manage the logistics of caring for oneself in the context of a sometimes complicated life.

Our HIV care department offers a wide range of supportive, educational, prevention, advocacy, and skills-building services and programs to women. While confident in our capacity in each of these areas, we realize that we are not capable of addressing all of the wide-ranging needs and challenges faced by our population. Also, in accordance with our mission to empower women and girls, we believe in offering options for locating the services that best meet their needs—options enable women to stay in care vs. just dropping out. We are committed to providing targeted referrals and linkages to essential services both within and outside the agency in order to support women and girls in attending to their self-identified needs and to move them along the prevention to care continuum.

We maintain an extensive and thorough referral and linkage network to address as many needs as possible that arise in the lives of women and girls. Externally, we work with over 200 AIDS and social service organizations, including agencies that provide primary medical care, oral health, substance abuse treatment, mental health, housing support, food and emergency assistance, domestic violence/sexual assault assistance, pregnancy and prenatal health care, STI screening, assisted living, and others to facilitate the needs of our clients. We develop formal MOU with as many agencies as needed to ensure that women and girls have diverse and widespread options; these MOU reflect and delineate substantive, collaborative, and mutually beneficial working partnerships that ensure quality care and services across the prevention to care continuum.

Staff serve as advocates for clients and work diligently to provide personalized contact with counterparts at each referral site, as well as ongoing contact and ‘handholding’ to ensure linkages are sustained and follow-through contact is made between partners and clients. Existing partnerships and routine case conferencing activities build relationships with referral partners, strengthen the circle of care and support, promote open and supportive communication among shared providers and clients, and enable integrated rather than fragmented systems of care for clients.  We actively and continually exchange information with partners to ensure high quality care.

According to recent research published in the online edition of the Journal of Acquired Immune Deficiency Syndromes people who believe their care providers know them as a person are more likely to keep their HIV clinic appointments. Patients also kept more appointments if their care providers treated them with dignity and respect, listened carefully to them, and gave explanations that could be understood. This is a matter of special concern as only 59% of HIV-positive people nationally remain in specialist care. Dropping out of care is associated with an increased risk of illness and death. There are also concerns that poor patient retention will undermine HIV treatment as prevention. We offer to accompany women to doctor’s appointments, provide transportation assistance, work with women on their communication skills and health and treatment literacy, and support them in finding, accessing and retaining care with providers that they are comfortable with and can have open lines of communication. Many women state they seek providers who are nonjudgmental and supportive and can listen and provide treatment information that is understandable and accessible. Simultaneously we seek to build the cultural competencies of providers to fully support and engage women in the ways that are important to them.

In 2014 we are more committed than ever to ensuring women are not isolated and lost to care. If you need support yourself or know of someone who does please refer them to us. If you are interested in collaborating, please contact us.

Together we can fight HIV and ensure healthy outcomes for all women and girls living with HIV/AIDS in D.C. We look forward to sharing the results of our efforts with the community later in the year.

Best in the New Year,

Patricia Nalls

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