The Oregon Health Authority identified a need for priority HIV testing and linkage to care
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Oregon is a state with low HIV incidence
To ensure that services are appropriately reaching the community and reduce disparities in access, LPHAs were required to develop partnerships with community organizations in their service area.
LPHAs set aside funding to identify community partners, including community-based organizations and community health centers.
LPHAs and their partners
Outreach testing is provided in health departments’ STI clinics and community settings through LPHA partnerships. People with positive test results for syphilis and/or rectal gonorrhea were flagged for follow-up HIV testing, enrolled in the EISO program, and linked to appropriate services as described below. LPHAs were expected to expand STI and HIV testing under this initiative and identify community organizations that would expand access to testing for underserved clients.
After a person receives an HIV diagnosis, or a person with previously diagnosed HIV presents with a new syphilis or rectal gonorrhea infection, they are immediately linked through integrated EISO services to HIV medical care and case management services. Eligible clients are flagged in the Oregon Health Authority’s shared surveillance data system for follow-up by a local provider.
People with a negative HIV test result are offered pre-exposure prophylaxis (PrEP) and prevention services. All people are connected to partner services and health education, as needed.
In 2019, EISO was successful at identifying people with HIV and of those with HIV, increasing linkage to HIV medical care and viral suppression. This trend has continued annually. For the latest evaluation results, view the “EISO Annual Reports” in the Resources & Tools section below.
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Source: Oregon HIV Early Intervention Services and Outreach Program Integrating HIV Innovative Practices (IHIP) slide deck. 2022
Capacity building for LPHAs. Prior to the implementation of the EISO project, Oregon transitioned disease intervention specialist and linkage activities from the state health department level to the local government level. Oregon hosted a series of meetings throughout the state to prepare the LPHAs for the transition, and provided capacity building, training, and technical assistance on what these services must include and a shared list of tasks that disease intervention specialists must perform.
Request for proposals. Oregon Health Authority released a request for proposals to the LPHAs, reviewed and provided feedback on implementation plans, and awarded contracts in 2018. Total funding for this project is approximately $4 million per year for five years. In addition to the requirement to set aside funding for community partnerships, each awardee is required to maintain one full time equivalent (1.0 FTE) coordinator to manage the project and ensure that services are happening as expected. The coordinator’s key role is to ensure that prevention, care, and linkage services are integrated with one another so referrals from the point of testing are seamless.
Ongoing support for LPHAs. The State gives ongoing support to the LPHAs, providing overall guidance, capacity building, and training and technical assistance. Communication has been essential for the success of the program. The Oregon Health Authority hosts monthly calls with the LPHAs, quarterly case review meetings, and an annual meeting for LPHAs to come together.
“The good news was that because we had so many meetings upfront where they [the LPHAs] all got to work together and talk to each other, much of [the training] happened before they even had their grant money in place. They’ve formed a learning collaborative.”
- This project leverages program income generated through 340b for focused EISO services that rely on and build upon the existing infrastructure of Ryan White HIV/AIDS Program (RWHAP) Part B case management; Oregon Health Authority was careful to review budgets and ensure that staffing and services were not already funded by another source. Rather than use an allocation approach, Oregon had LPHAs submit a funding amount request with their application.
- Because this funding period was set for five years, costs to build capacity and train staff were frontloaded into the first year of the project. This means, after staff are trained and linkage processes are in place, resources can maintain staffing—such as the EISO coordinator—and be adjusted as needed in later years. The Oregon Health Authority plans to continue to set aside program income for this purpose of priority testing of people with an STI diagnosis, which supplements and complements traditional outreach testing in community settings.
- The state is conducting a billing assessment to optimize how EISO services are billed to Medicaid, insurance, RWHAP and other payers and to ensure that the project is sustainable in the long term.
“Community mobilization or community engagement was key.”
- LPHAs and their partners were given flexibility to tailor their approaches to best meet the needs of their local communities, but it was sometimes challenging to figure out how to support community connections without “pushing” LPHAs into it.
- Project timelines were somewhat malleable at the front end of the project, as LPHAs varied widely in terms of how much infrastructure they had entering the project; some LPHAs were slower to get their programs off the ground. A solid set of expectations and timelines in the beginning of the project is helpful, as is flexibility when engaging diverse partners who have different levels of experience and capacity.
- Some LPHAs adopted a regional approach to share resources across organizations and partners, which was necessary for some low incidence areas, but it proved to be challenging to figure out how staffing and resources will be allocated across multiple counties with different infrastructure.
- Leadership support and community engagement were critical to the success of the project, as is frequent communication and check-ins with the LPHAs. The programs that have been most successful are those that worked the most with their local communities.
Implementation Resources
Reports & Presentations
- EISO Annual Reports
- Early Intervention Services and Outreach IHIP Presentation Slides (December 2022)
