CrescentCare Start Initiative

Summary

CrescentCare partnered with the New Orleans Office of Health Policy to implement the CrescentCare Start Initiative (CCSI), which aimed to start all people with HIV who have been newly diagnosed on antiretroviral therapy (ART) within 72 hours of diagnosis to increase treatment uptake and viral suppression outcomes. The intervention provided a 24-hour navigator to coordinate linkage services, and it streamlined the intake process for a focused HIV visit with a treatment provider.

Summary

Resumen

Implementation Resources

Implementation Guide

Intervention Outcomes

• 92% of patients were linked, saw a treating provider, and started ART within 72 hours of diagnosis.
• The mean time to linkage in the historical cohort was 30 days compared to 1.3 days in CCSI.

Intervention Components

• Linkage to medical care by the Patient Navigator
• Provider visit to perform intake
• Administration and prescribing of ART medication
• Lab visit
• Linkage to benefits and social services
• Patient navigator check-in

Cost Analysis

The CCSI cost analysis is not currently available. However, you can use the CIE Cost Calculator to create an estimate of the cost of implementing the intervention at your organization.

Challenges & Solutions

Challenge	Solution
Service-Delivery Changes	Discuss the reasoning behind prescribing ART before intake and laboratory results with clinicians. Gather input as they adopt the new practice.
Limited Resources	Secure funding to support patient navigation, immediate patient access, and medication coverage for the first 30 days of medication.
Disruptions in ART Coverage	Offer flexible hours and insurance navigation services for clients.
Organizational Limitations	Ensure provider and leadership are invested in the care model.
COVID-19	Maximize access to care and minimize unnecessary in-person visits by leveraging alternative tools such as telehealth.

Supplementary Resources

Publications

• Linkage and Antiretroviral Therapy Within 72 Hours at a Federally Qualified Health Center in New Orleans
• Rapid Antiretroviral Therapy: Time for a New Standard of Care
• A Care Continuum of Immediate ART for Newly Diagnosed Patients and Patients Presenting Later to Care at a Federally Qualified Health Center in New Orleans

Resources

• Rapid HIV Care Cuts Time to Viral Suppression
• Same-Day ART Increases Rates of Retention-in-Care, Sustained Viral Suppression in HIV Patients
• CrescentCare Start Initiative – Standard Operating Procedures (PDF
• CrescentCare Start Initiative Webinar – Southeast AIDS Education and Training Center (PDF)
• CrescentCare Start Initiative – 2018 Ryan White Conference Presentation (PPTX)