MATEC Indiana Office Reopened

MATEC Indiana has reopened their office and is fully operational after their office building suffered significant water damage in late August.

Staff can now be be reached by both email and phone. To contact MATEC Indiana staff:

Malinda Boehler, Director
Email: mboehler@iupui.edu
Phone: (317) 880-3520

Karen Curd, Program Manager
Email: kcurd@iupui.edu
Phone: (317) 880-3519

Steve Everett, Special Projects Lead
Email: steveret@iu.edu
Phone: (317) 880-3527

Rachel Fogleman, Programming Coordinator
Email: rfoglema@iu.edu
Phone: (317) 880-3517

Quality Matters: How Monitoring and Measurement Influences Quality Improvement

Source: Ibrahim Dandakoye, Part A/MAI Grant and Quality Management Coordinator | Marion County Public Health Department Ryan White/HIV Services Program

Once upon a time, people infected by the Human Immunodeficiency Virus (HIV) had little hope to live beyond 6 months. Nowadays, with the discovery of the Antiretroviral Therapy (ART), HIV-infected individuals live a normal life, and life expectancy for People Living with HIV (PLWH) is almost the same as the general population, thus making HIV a chronic disease. With chronicity comes management; management requires measurement, and measurement leads to quality and improvement. The Marion County Public Health Department (MCPHD)’s Ryan White HIV services program is dedicated to ensure that all HIV patients living in the Transitional Grant Area (TGA) get the best quality of care defined by the Health Resources and Services Administration (HRSA). This goal is achievable by measuring services sub-recipients provide and program staff providing technical assistance in areas where improvement is needed.

Quality of Care

The HRSA’s HIV/AIDS Bureau (HAB) is committed to improving the quality of HIV care and treatment services for people living with HIV. Under the Ryan White HIV/AIDS Program, quality management is a series of activities that focus on enhancing the quality of HIV care provided and increasing access to services. These efforts focus on how health and social services meet established professional standards and user expectations.

The HIV/AIDS Bureau’s quality initiatives are designed to help Ryan White HIV/AIDS Program recipients implement quality management programs that target clinical, administrative, and support services.[1] Clinical Quality Management is the coordination of activities aimed at improving patient care, health outcomes, and patient satisfaction. Under the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (Public Law 109-415), all Ryan White HIV/AIDS Program recipients are required to establish clinical quality management programs to:

  • Assess the extent to which HIV health services are consistent with the most recent Public Health Service guidelines for the treatment of HIV disease and related opportunistic infections.
  • Develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV services.

Clinical quality management activities should be continuous and fit within and support the framework of grant administration functions. Components of a clinical quality management program include: infrastructure, performance measurement, and quality improvement.

In an effort to align with these policies and procedures mentioned in the Policy Clarification Notice (PCN-15-02), the MCPHD Ryan White HIV Services Program is undertaking quality management monitoring starting fiscal year 2019-2020.

Quality Management Monitoring Site Visits

The Marion County Public Health Department (MCPHD) Ryan White Services Program will undertake QM monitoring site visits to all its sub-recipients. The goals of these visits are to measure the quality of services provided to clients, to offer technical assistance if needed and to provide support to sub-recipients in their day to day activities that they have misunderstandings in regard to QM. The site monitoring will also ensure that providers (sub-recipients) are compliant with Health Resources Services Administration (HRSA)/HIV AIDS Bureau (HAB) guidelines in quality HIV services

QM site visits are recommended by PCN 15-02[2] in order to: (1) assess the extent to which HIV health services provided to patients under the grant are consistent with the most recent Public Health Guidelines for the treatment of HIV disease and related opportunistic infections; (2) develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV services; (3) collect data in a timely manner in CAREWare; (4) provide services as mentioned in PCN 16-02, and; (5) ensure QM plan(s) is implemented as mentioned in Indianapolis TGA QM plan. QM site visits are solely designed to assist Ryan White sub-awardees provide the best of care to PLWH, and therefore, PLWH are getting quality standard of care (Quality Assurance).

In sum, the goal of quality improvement is achievable with monitoring and technical assistance provided by the MCPHD, and quality of care for PLWH is feasible as “Ending the Epidemic” is looming on the horizon for the next decade or so. Quality improvement aiming at 95% of viral load suppression[3] among PLWH and increasing number of at risk populations getting to know their status[4] at 95% will help in Ending the Epidemic.

______________________________

[1] Quality of care: https://hab.hrsa.gov/clinical-quality-management/quality-care

[2] Policy Clarification Notice: https://hab.hrsa.gov/program-grants-management/policy-notices-and-program-letters

[3] https://www.cdc.gov/hiv/pdf/risk/art/cdc-hiv-art-viral-suppression.pdf

[4] Ending the Epidemic: https://www.hiv.gov/ending-hiv-epidemic

Pap Rates for Indianapolis TGA Parts A and C Recipients, and Tips/Resources for Improving Pap Screening Rates

Source: Ibrahim Dandakoye Part A/MAI Grant and Quality Management Coordinator at the Marion County Public Health Department.
Published November 12, 2018

The Marion County Public Health Department’s Ryan White HIV Services Program (RWSP) manages Part A, Minority AIDS Initiative (MAI), and Part C funding to address the needs of people living with HIV (PLWH) in central Indiana, including those out of care or historically underserved or uninsured. The program helps out-of-care clients gain access to points of entry; provides a comprehensive HIV continuum of care; and complies with the National HIV/AIDS Strategy (NHAS). This article sought to encourage HIV providers to offer Papanicolaou (Pap) tests for all adult (18 years and older) HIV infected female patients seeking care.

About Cervical Cancer

Cervical cancer caused by Human Papillomavirus (HPV) is the most common gynecological cancer in women infected by HIV. Knowledge regarding cervical cancer cause and pathogenesis is rapidly expanding[1]. Persistent infection with one of about 15 genotypes of carcinogenic HPV causes almost all cases. There are four major steps in cervical cancer development: infection of metaplastic epithelium at the cervical transformation zone, viral persistence, progression of persistently infected epithelium to cervical pre-cancer, and invasion through the basement membrane of the epithelium. Infection is extremely common in young women in their first decade of sexual activity. Persistent infections and pre-cancer are established, typically within 5–10 years, from less than 10% of new infections. Invasive cancer arises over many years or decades, in a minority of women with pre-cancer, with a peak or plateau in risk at about 35–55 years of age. Each genotype of HPV acts as an independent infection, with differing carcinogenic risks linked to evolutionary species.

Continue reading Pap Rates for Indianapolis TGA Parts A and C Recipients, and Tips/Resources for Improving Pap Screening Rates

Public Health Epidemic Declared in Marion County due to Hepatitis C

On Thursday, May 17, 2018, the Marion County Public Health Department Director, Dr. Virginia Caine, declared a public health epidemic due to a 1,000 percent increase between 2013 and 2017 in Hepatitis C cases. In response to the epidemic, Dr. Caine is proposing a safe syringe exchange program for Marion County at the next City-County Council meeting on Monday, May 21st.

Continue reading Public Health Epidemic Declared in Marion County due to Hepatitis C

Drug Information Update: Dolutegravir and Neural Tube Birth Defects

The U.S. Food and Drug Administration (FDA) is alerting the public that serious cases of neural tube birth defects involving the brain, spine, and spinal cord have been reported in babies born to women treated with dolutegravir used to treat human immunodeficiency virus (HIV). Preliminary results from an ongoing observational study in Botswana found that women who received dolutegravir at the time of becoming pregnant or early in the first trimester appear to be at higher risk for these defects.

Continue reading Drug Information Update: Dolutegravir and Neural Tube Birth Defects

HIV Medication Updates from CROI 2018

Source: AETC National Coordinating Resource Center
Published April 12, 2018

Six new HIV Meds Updates have been added online to the AETC National Coordinating Resource Center’s (AETC NCRC) ShareSpot. Summaries include key findings and treatment updates from CROI 2018:

HIV Meds Updates are written by Susa Coffey, MD, medical editor of the AETC NCRC, and are posted as new treatment information becomes available.

Click here for other treatment updates, as well as more HIV/AIDS news.

Test and Treat: A New Model for Better Patient Outcomes

Source: AAHIVM’s HIV Specialist Magazine
Published April 2018

Congratulations to Brooke Stevens, PharmD, BCPS, AAHIVP, from IU Health LifeCare, along with Blake Max, PharmD, AAHIVP, from the University of Illinois in Chicago, on their recent article titled “Test and Treat: A New Model for Better Patient Outcomes” that was published in the April 2018 edition of AAHIVM’s HIV Specialist Magazine:

Continue reading Test and Treat: A New Model for Better Patient Outcomes

Local HIV Studies Actively Enrolling Research Participants

Source: Samir Gupta, MD, Indiana University School of Medicine
Published April 19, 2018

The Indiana Center for AIDS Research (CFAR) is working to increase collaborative research throughout the state of Indiana in all aspects of HIV/AIDS prevention and care. CFAR is currently conducting research in a variety of areas, including finding an HIV cure, improving quality of life for patients living with HIV, preventing new HIV infections, providing HIV care in resource-limited settings, and testing new HIV treatments.

To conduct successful research, CFAR needs community engagement from both people living with and without HIV. Currently, CFAR is seeking individuals to participate in their open studies. Community members interested in participating in open studies can click the link below or visit the IU School of Medicine’s Infectious Disease Clinical Research Program website by clicking here.

Click Here to Access the Current List of Studies 

 

For more information about CFAR and upcoming studies, visit the CFAR website by clicking here, or contact Samir Gupta, MD, at sgupta1@iu.edu or (317) 274-7926.

2018-2019 Clinician Scholars Program Applications Now Open

APPLICATIONS ACCEPTED THROUGH
JULY 15, 2018

Click Here to Access Application Materials
.

The MATEC Clinician Scholars Program is designed for front-line clinicians who are interested in expanding their capacity to provide HIV/AIDS care, and increase the number of clinicians that provide care to underserved or disproportionately affected populations.

Continue reading 2018-2019 Clinician Scholars Program Applications Now Open

Disparities in HIV Viral Suppression in Central Indiana

Source: Tammie L. Nelson, MPH, CPH, Epidemiology Manager at the Marion County Public Health Department
Published March 9, 2018

The Marion County Public Health Department’s Ryan White HIV Services Program (RWSP) manages Part A, Minority AIDS Initiative (MAI), and Part C funding to address the needs of people living with HIV (PLWH) in central Indiana, including those out of care or historically underserved or uninsured. The program helps out-of-care clients gain access to points of entry; provides a comprehensive HIV continuum of care; and complies with the National HIV/AIDS Strategy (NHAS).[1]

Viral load suppression is the ultimate measure of health for individuals living with HIV. Comparing HIV care outcomes over time or between groups of PLWH requires evaluation of community viral load (CVL) – an average of all viral load results taken from among PLWH in defined populations. Evaluating CVL is important to identify differences in HIV health outcomes among various populations. CVL analysis assists in identifying disparities in HIV care outcomes. The RWSP has undertaken a clinical quality management project to monitor differences in viral load among PLWH in Central Indiana. This project includes viral load analyses of PLWH in the Ryan White Part A transitional grant area (TGA). TGA counties include: Boone, Brown, Hamilton, Hancock, Hendricks, Johnson, Marion, Morgan, Putnam, and Shelby.

In 2017, 6,050 PLWH resided in the TGA, and health outcomes among these individuals have been improving. The percentage of the TGA’s HIV-positive residents who had suppressed viral loads increased from 50% to 64% during the period 2013-2017. These improved health outcomes were not equitable, however, and it is the goal of this article to identify disparities among PLWH in Central Indiana, arming both medical and supportive care providers with this knowledge so that resources can be focused to serve those who need help the most.

Continue reading Disparities in HIV Viral Suppression in Central Indiana