Early Intervention Services and Outreach

The Oregon Health Authority identified a need for priority HIV testing and linkage to care among people with sexually transmitted infections (STIs) in Oregon. They awarded contracts to local public health authorities (LPHAs) across the state to work with community partners to integrate early intervention services (EIS) and outreach services, link people to HIV care, and provide support to help clients reach viral suppression. Quick linkage to care resulted in a median of 57 days to viral suppression for Early Intervention Services and Outreach (EISO) clients.

OR

Emerging Intervention
Support service delivery model
HIV diagnosis; Linkage to HIV medical care
Treat
People with HIV; People with undiagnosed HIV; People with HIV who are not in care
RWHAP Part B
State health department
Need Addressed

Oregon is a state with low HIV incidence overall, but high rates of syphilis, gonorrhea, and HIV-STI co-infection. The Oregon Health Authority identified the need to conduct priority testing (HIV testing for clients with a STI diagnosis) to diagnose HIV among people who were unaware of their status as well as the need to provide intensive support services to these clients to help them reach viral suppression. The Oregon statewide planning group that advises the Oregon Health Authority on matters related to HIV, hepatitis and STIs, recommended approaches that were tailored locally to engage underserved people in outreach testing.

Core Elements
LPHAs worked with community partners

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 were given flexibility to develop their own approaches best suited to the local needs and context.

Priority testing

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. 

Linkage to care

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.

Health education and prevention

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.

Outcomes

EISO results from 2019 are displayed below.

Category Information

Evaluation data

  • Surveillance data and EISO program data

Measures

  • Percent of clients linked to EISO after diagnosis of a STI
  • HIV tests completed
  • Of those with positive test results, percent who were linked to care within 30 days of HIV diagnosis and average time to viral suppression
  • Referrals to partner services and prevention services
  • Data are stratified by area, demographics, and risk factor

Results

  • Priority testing yielded an HIV positivity rate of 3% compared to 0.01% of traditional outreach testing in community settings. Partner services yielded 7% new positives
  • 79% of EISO clients were linked to care within 30 days in 2019, compared to 66% average during 2013–2017
  • Average time to viral suppression was 57 days
  • Viral suppression improved for all groups and disparities by race improved
Planning & Implementation
  • Prior to the implementation of the EISO project, Oregon transitioned disease intervention specialist (DIS) 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 DIS must perform.
  • 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.
  • 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.   

See the Resources & Tools section below for more details related to planning and implementation. 

“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.”

Sustainability
  • 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.”

Lessons Learned
  • 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.
Contact the Innovator
Oregon Health Authority, EISO
Alicia Knapp
EISO Coordinator

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