Horizon Health Center

FOCUS HIV/HCV

Tracie Meyers, MSW, LCSW

Director of Community Services

About Horizon Health Center

•Horizon Health Center is a Federally Qualified Health Center (FQHC) operating in

Jersey City, Hudson County, New Jersey, offering primary care services at two

separate locations in Jersey City.

•Our mission is to provide high quality, comprehensive, primary, and preventive

healthcare services, social services, and health education; to operate in a cost

effective manner that maximizes revenues while promoting a culture of

accountability, respect and dignity; to be responsive to the needs of the entire

community regardless of race, economic status, age, gender or sexual

orientation with continued emphasis on the underserved and those without

access to care.

•Horizon Health Center offers HIV/AIDS services to the people of Jersey City, and

has done so since 1986. We serve a diverse population including a significant

Latino and African American community as well as other vulnerable populations

such as those who identify as LGBT, and those who are homeless.

•In 2014 Horizon served 13,631 patients. Over 80% of the patients seen are from

minority populations and 77% of Horizon clients have incomes at or below one

hundred and fifty percent of poverty level.

Preparing for FOCUS

• Changes in Agency Policy

• Routinized HIV/HCV Screening

• Modification to the EMR

• Agency wide Education & Training

Agency Policy

• Administration changed agency policy by adding

“opt out only” language to the Consent for

Treatment paperwork, routinizing HIV & HCV

screening for all patients age 18 and over.

Staff Education

• Medical staff was made aware of the changes in

policy and the importance of testing

• Informational “lunch and learns” were held for

nursing staff and providers to review basic

information on HIV/HCV testing and treatment

• Changes in EMR was explained to all staff and

added to new hire training

Trigger Automatic Lab Orders

o Prior to establishing the preferred lab order set for HIV and HCV testing,

we had a hodgepodge of legacy lab test options and provider specific lab

tests to choose from: 22 different types

Examples of HIV and HCV Testing Options in the EMR

Human Immunodeficiency Virus 1 (HIV-1) GenoSure® MG Genotyping

Human Immunodeficiency Virus 1 (HIV-1), Quantitative, Real-time PCR (Graphical)

Human Immunodeficiency Virus 1 (HIV-1), Quantitative, Real-time PCR (Graphical) With Reflex to HIV-1 GenoSure® MG

Human Immunodeficiency Virus 1 (HIV-1), Quantitative, Real-time PCR (Nongraphical)

Human Immunodeficiency Virus 1 (HIV-1), Quantitative, Real-time PCR (Nongraphical) With Reflex to HIV-1 GenoSure® MG

Human Immunodeficiency Virus 1 (HIV-1) PhenoSense GT® Plus Integrase (Monogram® Phenotype + Genotype)

Hepatitis C Virus (HCV) Antibody

Hepatitis C Virus (HCV) Antibody Verification

Hepatitis C Virus (HCV), Quantitative, RNA PCR (Nongraphical) With Reflex to Hepatitis C Virus (HCV) GenoSure® NS3/4A

Hepatitis C Virus (HCV), Quantitative, RNA PCR (Graphical) With Reflex to Hepatitis C Virus (HCV) GenoSure® NS3/4A

Hepatitis C Virus (HCV) RNA, Qualitative, NAA With Reflex to Quantitative PCR

Trigger Automatic Lab Orders

o We streamlined lab orders so that there would be 1 lab for HIV testing and 1 lab for

HCV testing

Worked with Lab and EMR vendor to identify exact test codes

o These preferred labs were incorporated into the ‘lab order template’ which

automatically generates based on “visit type” code

o Trained and educated providers on this change in work practice

Streamlined Lab Orders (n = 2)

HIV (test code: 083935) HCV (test code: 144045)

Human Immunodeficiency Virus

1/O/2 (HIV-1/O/2) Antibody/Antigen

(Fourth Generation)

Hepatitis C Virus (HCV) Antibody

With Reflex to QUAL PCR, VL

Screen

Impact of Automated EMR on Screening

* Baseline Data Period: Jan – Dec, 2014; FOCUS Data Period: Jan – Dec, 2015

Pre FOCUS & Post FOCUS Results

212

3509

0

500

1000

1500

2000

2500

3000

3500

Baseline FOCUS

HCV Testing Increases 1,555%

1102

3952

0

1000

2000

3000

4000

5000

HIV Testing Increases 259%

Baseline FOCUS

* Baseline Data Period: Jan – Dec, 2014; FOCUS Data Period: Jan – Dec, 2015

* Identified 19 new HIV positive clients (0.5%) * 2 of these positive cases were Acute Infections

* Identified 81 HCV AB+ clients of which 39 were RNA+

Profile of HCV RNA+ Clients

• 40% of chronic HCV cases were outside the birth cohort, with 75%

of these cases having no identified risk for substance use

Linkage to Care

• The capacity to treat both HIV and HCV through in-

house providers has resulted in high linkage to care

rates.

• HIV: 89.47% Linked to Care (17 of 19)

• HCV RNA+: 94.87% Linked to Care (37 of 39)

The Case for Routine Screening

• Patients seeking primary

care services

• Routinely screened for

HIV

• Both tested HIV positive

and immediately linked to

care

• Patient accessed

services for cold/cough

• No risk history

• Routinely screened for

HIV

• Tested HIV positive with

High Viral Load –

immediately linked to

care

Male, early 40s

Couple, early 20s Male, early 50s

Female, early 30s

• Patient recently immigrated

from Africa

• Has primary care physician

and was never tested for HIV

• No obvious risk factors

• Tested positive for HIV,

syphilis, and Hepatitis B

• Patient seeking a physical for

employer

• Routinely screened for HCV

• No mention of Injection Drug

Use History/Clear Drug

Screen

• Tested HCV Antibody and

HCV RNA Positive

Next Steps •Horizon is expanding upon our initial screening efforts by adding Hepatitis B testing to the routine opt out only testing for all higher risk patients.

•Additional modification to our EMR will be made to trigger automatic order sets for patients who present for appointments and are eligible for testing.

•Additional exam room specimen collection will be provided for those patients in areas that are less likely to present to the lab (i.e. Dental)