GEORGIA DEPARTMENT OF PUBLIC HEALTH PROGRAM COLLABORATION AND SERVICE INTEGRATION (PCSI) WORKSHOP NOVEMBER 29-30, 2011 Macon Marriott City Center 240 Coliseum Drive, Macon, Georgia 31217 [THIS PAGE INTENTIONALLY LEFT BLANK] Table of Contents 1. Executive Summary 3 2. Workshop Agenda 5 3. Workshop Presentations 7 4. Evaluation Summary 99 1 of 102 [THIS PAGE INTENTIONALLY LEFT BLANK] 2 of 102 Executive Summary The Infectious Disease Program Collaboration and Service Integration (PCSI) of the Georgia Department of Public Health (DPH) began work as a steering committee in August 2010. The rationale for PCSI is to maximize the health benefits that persons receive from prevention services by increasing service efficiency by combining, streamlining, and enhancing prevention services (CDC). With this rationale in mind, the committee focused on promoting collaboration and service integration between the following programs: TB, STD, HIV (Prevention, Care), Hepatitis, Peri-natal Hepatitis, Refugee Health, and Immunization. PCSI is a mechanism for organizing and blending interrelated health issues, activities, and prevention strategies to facilitate comprehensive delivery of services. Several districts have staff who serve as coordinators in multiple programs. A unified training session re-enforces the support of the public health leadership in promoting PCSI. During committee discussions, the group identified opportunities to address communication barriers at both the state and local level. Because of the aforementioned, the group realized a need to deliver a combined workshop that provided program specific information and updates. In addition, the committee decided to include opportunities for team building, networking and cultural diversity training at the workshop. The workshop was held on, November 29-30, 2011, at the Marriott City Center in Macon, GA. A total of 64 participants attended with representation from all districts and each PCSI state level program. Participants included state program managers, district program coordinators, clinicians, nurses, case managers, epidemiologists, communicable disease specialists, and CDC federal assignees. The feedback from the workshop reflects an overwhelmingly positive response to the PCSI concept. The workshop presentations were found to be informative, collaborative, and motivational. The workshop comments indicated that staff desired more training in areas such as internet partner services, State Electronic Notifiable Disease Surveillance System (SENDSS), and collaboration. Additionally, the need for technical assistance was requested. Attendees suggested that this workshop become an annual event and expand to include more programs and district health directors. The PCSI committee will continue to facilitate communication between programs and seek opportunities for collaboration both at the state and district level. Projects for 2012 have been identified to include an annual workshop, information dissemination, and inviting additional programs to the state PCSI steering committee. The committee appreciates the continued administrative support of the PCSI activities. The state PCSI steering committee welcomes future opportunities to enhance the health benefits of our shared clients. This package includes: Workshop Agenda, Presentations, and Evaluation Summary. 3 of 102 [THIS PAGE INTENTIONALLY LEFT BLANK] 4 of 102 PROGRAM COLLABORATION AND SERVICE INTEGRATION (PCSI) MEETING November 29-30, 2011 Macon Marriott City Center 240 Coliseum Drive, Macon, Georgia 31217 AGENDA Day 1: November 29, 2011 11:00 12:00 12:30 12:45 1:15 2:15 2:30 3:00 3:30 4:30 5:00 Registration Lunch Welcome Workshop Overview Introductions Transition Program Collaboration and Service Integration (PCSI) Internet Partner Services Break TB Update STD Update HIV Update Care Prevention Hepatitis Update SWOT Analysis Discussion Dinner on your own Division of Health Protection Ann Poole Michelle Allen Stephan Adelson Dr. Rose-Marie Sales Michelle Allen Michael Coker Brandi Williams Ami Gandhi Valerie Underwood 5 of 102 PROGRAM COLLABORATION AND SERVICE INTEGRATION (PCSI) MEETING November 29-30, 2011 Macon Marriott City Center 240 Coliseum Drive, Macon, Georgia 31217 AGENDA Day 2: November 30, 2011 7:30 8:30 9:00 10:15 10:30 12:00 1:00 2:00 Breakfast Icebreaker Case Study Break Team Building Lunch Diversity in the Workplace Wrap up/Evaluations Michael Coker Valerie Underwood Lawsey Thomas, Sr. Lawsey Thomas, Sr. 6 of 102 Program Collaboration and Service Integration Program Collaboration and Service Integration (PCSI) Presentation to: PCIS Meeting (Macon, GA) Presented by: Michelle Allen, STD Office Director Date: November 29, 2011 Program Collaboration and Service Integration (PCSI) Introduction Historically, the public health approach to disease prevention begins with: define disease, define the population, identify the conditions that sustain health in the population, and determine how to address those conditions. 7 of 102 11/29/2011 Program Collaboration and Service Integration What is PCSI? PCSI is a mechanism for organizing and blending interrelated health issues, activities, and prevention strategies to facilitate comprehensive delivery of services. Rationale: Program Collaboration Minimizes duplication of services Reduces cost through joint funding Strengthens programs by increasing assess to different types of information Sharing data can help identify emerging trends i.e. data sharing can help an increase of rates other STDs among HIV-positive persons who find partners on the internet Five Principles of Effective PCSI Appropriateness Effectiveness Flexibility Accountability Acceptability 8 of 102 11/29/2011 Program Collaboration and Service Integration Ties that Bind HIV, viral hepatitis, and STDs share common risk factors and modes of transmission STDs increase risk for HIV infection HIV is a risk factor for progression to TB disease TB is an AIDS-Defining opportunistic condition A Framework for Collaboration: 10 Essential Public Health Functions (1) Monitor community members' health status to identify and solve community health problems (2) Diagnose and investigate health problems and health hazards in the community (3) Inform, educate, and empower people about health issues (4) Mobilize community partnerships and action to identify and solve health problems A Framework for Collaboration: 10 Essential Public Health Functions (5) Develop policies and plans that support individual and community health efforts (6) Enforce laws and regulations that protect people's health and ensure their safety (7) Link people to needed personal health services (8) Ensure the competency of the public and personal healthcare workforce 9 of 102 11/29/2011 Program Collaboration and Service Integration A Framework for Collaboration: 10 Essential Public Health Functions (9) Evaluate the effectiveness, accessibility, and quality of personal and population-based health services (10) Conduct research to identify innovative solutions to health problems. The 10 essential public health functions, developed by the US Public Health Service Core Public Health Functions Steering Committee in 1994 Service Integration Goals To make it easier for persons to access needed services by providing them with a single point of entry To increase staff members' knowledge about available resources that are share with other programs or agencies, thereby minimizing duplication of services (while allowing agencies to specialize in its own area of expertise. 11/29/2011 10 of 102 Program Collaboration and Service Integration 11/29/2011 PCSI Applied Will... Optimize the capabilities of each public health position Learn the benefits of working together to improve public health infrastructure Assist the community to receive maximum benefit of the public health system. Projected Integrated Yields Eliminates duplication of services i.e. public health workers will provide more than one service Increases communication between staff Increases patient education for co-infected clients 11 of 102 Program Collaboration and Service Integration Cross Training Staff Goals Eliminates stagnated services in any area due to absence Staff becomes one self sufficient Enhances communication and team work between staff Barriers To Integration May increase workload of staff and supervisors (largely due to training) Inadequate space for training Difficulty rewarding employees for extended work hours Next Steps Integrate Surveillance Integrate Training Become a PCSI Champion Join the State Office Efforts 12 of 102 11/29/2011 Program Collaboration and Service Integration What will happen when we become PCSI-ed? By jointly addressing the needs of clients we will find that through integration, collaboration, and staff cross-training clients will have increased access to care. The End I welcome your questions and comments 13 of 102 11/29/2011 Internet-Based Partner Services Internet-Based Partner Services Stephan Adelson, Senior Advisor, MSM, Sexual Health and Technology Georgia Department of Public Health November 30, 2011 Terms Internet-Based Partner Services vs. Internet Partner Services The phrase `Internet Partner Services' implies usage of the Internet as the tool used to conduct Partner Services. There are many tools available though the Internet that can be used for all phases of partner services, these tools reside on the Internet; and are Internet-based. Internet-Based Partner Services (IPS) includes activities Researching virtual identifiers and converting them to traditional contact information Improving interviews through social search (living conditions, sexual preferences, legal circumstance, employment, personal interests, social /sexual contacts, etc.) Provide Internet-based information resources (testing locations / information, definitions, symptom descriptions and images, treatment information, linkages to care and other services, etc.) Internet-Based Partner Notification (IPN) The specific act of notification A Duty and Privilege Duty to warn: Certain states have laws that in certain situations require medical or public health officials to notify known partners who are at risk for infection Privilege to Warn: Generally, laws permitting but not requiring practitioners to warn persons that they are at risk Are you asking about Internet-based locating information? What are you doing with it? Centers for Disease Control and Prevention. Recommendations for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection. MMWR October 31, 2008 / Vol. 57 / No. RR-9 / page 75 14 of 102 11/29/2011 Internet-Based Partner Services Evaluation of IPS for Syphilis, Washington, DC 1/07 6/08 361 early syphilis patients 888 sex partners 381 (43%) via the Internet 83% more sex partners being notified of their STD exposure 26% more medically examined and treated if needed 8% increase with at least one treated sex partner "...without IPN these 381 partners would not have been investigated." Evaluation of an Innovative Internet-Based Partner Notification Program for Early Syphilis Case Management, Washington, D.C., January 2007-June 2008 Key Goals Maximize the proportion of partners who are notified of their possible exposure through the use of the Internet, particularly when the only locating information is an email address, screen name or other virtual identifier. Gather enough traditional locating information through Internet-based tools, to close a case with "traditional" disposition code Converting Internet cases into traditional: Experience improves outcomes 2009 NYS 162 Internet-based investigations 71% partners to STD 17% of STD partners dispo'ed as A or C 29% partners to HIV 2010 NYS 253 Internet-based investigations 83% partners to STD 40% of STD partners dispo'ed as A or C (+23%) 17% partners to HIV (101) 62% of cases dispositioned (110) 43% of cases dispositioned as internet code (L...) as internet code (L...) (-19%) (61) 38% converted to traditional dispositions (143) 56% converted to traditional disposition (+18%) A disposition = preventive treatment C disposition = infected, brought to treatment 15 of 102 11/29/2011 Internet-Based Partner Services The Online Dating Game 17% of couples married in the last 3 years, or 1 in 6, met each other on an online dating site In the last year, more than twice as many marriages occurred between people who met on an online dating site than met in bars, at clubs and other social events combined 1 out of 5 single people have dated someone they met on an online dating site 1 out of 5 people in a new committed relationship (including marriage) met their significant other on an online dating site Married couples who met online have an average courtship period of 18.5 months. Married couples who met offline courtship period last on average 42 months**. * Match.com and Chadwick Martin Bailey 2009 - 2010 Studies: Recent Trends: Online Dating Marriage Survey: 7000 US adults age 18+, married within the past 5 years, Online Dating Survey: 3000 US adults age 18+, who used online dating in the past 5 years ** Cast, A., "Simply Clicking: A Direct Comparison of Newly M arried Online and Offline Couples ", Iowa State University "At Risk" Changing Culture, Venues, Challenges "Gay communities undergoing structural decline" with many identifying the Internet as the underlying cause...These changes in the gay community were noted as increasing the complexity of sexual decision making and HIV risk, while decreasing effective prevention". More than 2.5 million active profiles, over 26 million monthly visits1, and 120,000 men online nightly, More than 750 million active users, 50% login daily 250 million access through mobile devices Rosser Simon B.R., West William and Weinmeyer Richard Are gay communities dying or just in transition?, Minneapolis : AIDS CARE, May 05, 2008. - 5 : Vol. 20. - pp. 588-595. Most Popular Websites in Lifestyle - Dating (ranked by visits); Experian Hitwise US, July, 2011 MSM cases reporting internet partners in 2004 (32) in 2007 (127) 396% increase. Popularity CDS Attention (Interviews) In 2007, MSM accounted for 53% (372 out of 697) of all primary and secondary (P&S) cases. Of those cases, 34% of P & S cases reported having met partners via the internet. 16 of 102 11/29/2011 Internet-Based Partner Services Its NOT Just Gay Men and MSM 11/29/2011 Primary and Secondary Syphilis (2009) Guam 1.1 2.1 1.5 0.2 0.4 0.6 3.5 1.1 5.2 2.1 3.6 3.1 0.0 2.6 0.6 1.4 0.0 0.3 1.1 2.7 6.8 0.8 0.8 5.8 2.9 9.6 8.1 16.8 6.1 2.3 2.7 3.1 2.5 0.4 3.8 2.2 6.3 6.5 2.7 9.8 8.9 0.3 VT 0.0 NH 1.1 MA 3.7 RI 1.9 CT 1.9 NJ 2.4 DE 3.1 MD 5.6 DC 27.5 Rate per 100,000 population <0.2 (n = 5) 0.212.2 (n = 19) Puerto Rico 5.7 5.7 >2.2 (n = 30) NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 4.6 per 100,000 population. Primary and Secondary Syphilis (2009) IPS Profiles (2011) Guam 1.1 2.1 1.5 0.2 0.4 0.6 3.5 1.1 5.2 2.1 3.6 3.1 0.0 2.6 0.6 1.4 0.3 0.0 0.3 1.1 2.7 6.8 0.8 0.8 5.8 2.9 9.6 8.1 16.8 6.1 2.3 2.7 3.1 2.5 0.4 3.8 2.2 6.3 6.5 2.7 9.8 8.9 5.7 Puerto Rico 5.7 DC Morbidity/Profiles None One + High Med Low NOTE: The total rate of primary and secondary syphilis for the United States and outlying areas (Guam, Puerto Rico, and Virgin Islands) was 4.6 per 100,000 population. 17 of 102 Internet-Based Partner Services Using the Internet To Trace Contacts of a Fatal Meningococcemia Case August 2010 HIV+ patient died of invasive menigococcal Contacted by RN as health representative of BBRT Linked RN with PS team and DIS Connected with website (BBRT) Changed profile text If you had contact please call 15 notifications At least 1 known to be prophylactically treated Journal of Public Health Management & Practice: Accepted for publication, October 22, 2011 Imagine Knowing a person's social circle, viewpoint on health, home life, neighborhood, family makeup, income, employment, interest, education, etc... ...before you interview them (patient or partner) That and more, is what access and use of the Internet can provide when CDS know how to use the available tools and are supported by key decision makers and supervision Assisting in ALL Cases 11/29/2011 18 of 102 Internet-Based Partner Services All CDS are IPS CDS 11/29/2011 What to Obtain Screen names and associated websites spelling matters (hotguy4u vs. hotguyforyou) Have the OP write screen names Email addresses Physical descriptions (OP and partners) for confirmation Location of encounter The OP's screen name, websites, email and description in case they are `named back' Dates and Times of Contact Address, Phone Numbers (check emails, text messages, website data) Screen Names and Email Addresses A screen name is a virtual identifier that is used online by an individual in place of their real name. Many are permanent and unchangeable, but not all (Grindr) An Avatar is virtual representation of an individual Screen names and email addresses are often related Yahoo, Windows Live (MSM), and AIM screen names are also email addresses Prettygirl on Windows Live is PretyGirl@live.com 19 of 102 Internet-Based Partner Services Eliciting Internet Partners What websites are you a member of? What websites do you use to meet partners? Facebook? PlentyofFIsh, Adam4Adam? What is his/her screen name? (Ask patient to spell or write the name) When was the last time you had sex with someone you met on____? What is his/her email address? (Ask patient to spell or write the address) What does he/she look like? How is he/she built? What does his/her profile picture look like? Is there anything unique about their profile that makes it stand out from others? Do you have a smart phone? Can we log in and find their screen names through the site's mobile site or app? (Manhunt, Adam4Adam, Recon, Scruff) IPS: Turning Internet locating Information into Traditional Locating Information Searching ... Putting the pieces together..... Search Types: Screen Name Email Phone Name Phone Address Reverse Phone Reverse Address Useful Information: Social / Sexual Network Interests Memberships Employment Likes/Dislikes HIV Status (as stated) 20 of 102 11/29/2011 Internet-Based Partner Services Detailed Searching 11/29/2011 Advanced Search: more Screen Name = Location > Email 21 of 102 Internet-Based Partner Services Email / location = Phone 11/29/2011 You can Search NOW Search sites for IPS Radaris.com Google.com Bing.com Yahoo.com Peekyou.com People.yahoo.com Pipl.com Spokeo.com Skipease.com Zabasearch.com Zoominfo.com 411.com Whitepages.com Intelius.com Search for new search sites! Websites Where Patients and Partners Meet Message boards Similar to bulletin boards or classified section of newspaper Social networking websites Websites that people use to network or keep in contact with friends Dating websites Website to meet looking for relationships Hook-up websites Website focused on finding sex partners Mashups Xtube (and other `tubes') Cam sites 22 of 102 Internet-Based Partner Services Websites Have Feelings Facebook `feels' public Adam4Adam `feels' private BareBackRT `feels' extreme Twitter `feels' informative YouTube `feels' entertaining Sex-seeking environments are best suited for notification because of their private feeling. Social Networking Sites and sites with a public `feel' should be a last resort for notification. Notification Not all sites are ideal for IPN Sexually explicit sites where public/private relationships exists are the best venue for IPN Relationship: webmasters are aware of the program, understand the sensitivity, respect the privacy of their members (they are held responsible by the members) Privacy: most hook-up/niche/sex-seeking sites use proprietary email systems and there is limited possibility for breach in privacy Settings: talking about STDs/HIV in an adult setting where sex-seeking behavior takes place is an appropriate setting Social Networking sites where the intention is social are not ideal for IPN Perceived and real `public' nature of SNS sites Potential privacy breach Parents monitoring minors Spouses/significant others checking up Manhunt.net 303,529 unique visitors 76% of the members account for 97% of the visits Older / Less Diverse 34% 18-34 46% 35-49 80% White http://siteanalytics.compete.com http://quantacast.com 23 of 102 11/29/2011 Internet-Based Partner Services Adam4Adam.com 804,529 unique visitors Younger / Diverse 46% 18-34 38% 35-49 42% Black 39% White 15% Hispanic http://siteanalytics.compete.com http://quantacast.com BGCLive (BlackGayChat) 200,121 unique visitors http://siteanalytics.compete.com www.quantcast.com BareBackRT Dedicated to UAI What do (can) your risk reduction conversations look like? July 2011 83,895 unique visitors Rank #24,926 http://siteanalytics.compete.com 24 of 102 11/29/2011 Internet-Based Partner Services Facebook, Social Hub of the World More than 750 million active users 50% log on daily Average user has 130 friends 250 access through mobile Mobile users are twice as active as non-mobile users 10,000 new websites interact with Facebook EVERY DAY http://www.facebook.com/press/info.php?stat istics Facebook for Hookup What is your motivation to use social networking sites? Mark all that apply. Community Research, Inc. LGBT Consumer Index, 2009-10 FaceBook 11/29/2011 25 of 102 Internet-Based Partner Services Facebook for More Information You must be a member to search Great for verifying location, pictures, personal info Should not be the first choice for notification Log On Together Confirm spelling of screen names, email addresses Obtain forgotten information Confirm physical description, pictures, see network Review likes, dislikes, behavioral preferences There is a fantasy element to profiles and sex-seeking sites, profiles are marketing tools. What you see in profiles may be fantasy or specifically written to attract sex partners. Homework for the OP? What screen names are on your computer at home? Who is on your buddy list? What about your blog list? (Maybe give them a form that asks for screen names, email addresses and other virtual identifiers to remind them) 26 of 102 11/29/2011 Internet-Based Partner Services Documenting IPS: Document exact spelling of screen name Document what site(s) partner uses (@adam4adam.com) Have the positive client write it down for you to double check for accuracy. Make sure you can read what was written. Craigslist / Bulletin Board 11/29/2011 Craigs List and MSM Bulletin boards Postings are `disposable' No membership required Contact is anonymous Locations can be faked 27 of 102 Internet-Based Partner Services MSM On Craigslist Total number of ads under the MSM personals section, using specific search terms over a 7 day period, a casual sample of 7 cities City Atlanta Boston Dallas Detroit Louisville Miami Seattle "married" "bi" "discreet" 420 450 615 340 570 880 425 570 870 90 110 180 50 60 80 85 180 320 188 188 406 Bulletin Board for PS? IPN Not for notification... but Many men will post the same ad over and over Can be used for record searching Phone numbers are written (sex one seven...) Photos are often the same Confirm locations Local behavioral surveillance There are many websites that can be used for surveillance, http://listings.cruisingforsex.com is an example. These `venues' are ideal for MSM, married, or discrete men. What's Different Now? `Assimilation' with the population go the behaviors Sexual network mixing through online venues and communities *18% of Americans have had sex with someone met over the internet `Private' exposure Public action (cams, videos, chat) Ubiquitous availability of a variety of partner `types' (Niche sites) Dramatically increased capacity to act on impulse through non- traditional Internet sources (all sites) 1 in 10 men say they're straight and have occasional sex with men (70% heterosexually married) Removal of societal constraints / education / norms Increases in communication / behavioral awareness through technology- based tools Role and options in religions / denominations Decrease in religion as a behavioral intervention Role or marriage and expectations of married couples Sex Census, Trojan, June 14, 2011 Neuroscientists Ogi Ogas and Sai Gaddam . Publication May 5, 2011 Discordance between Sexual Behavior and Self-Reported Sexual Identity: A Population-Based Survey of New York City Men , Annals of Internal Medicine, September 19, 2006 28 of 102 11/29/2011 Internet-Based Partner Services Sexual Orientation: Not The Full Story Sexual Behavior: What has been done sexually, attraction to a specific gender or body part is not required Sexual Orientation: Physical attraction linked to identity but not identity Sexual Identity: How one thinks of themselves as a sexual being. Influenced by social preferences, community norms, family of origin, sexual behavior, denial, shame and guilt. Sexual Attraction: To whom (and what) a person is sexually attracted 17% of heterosexual adults admit being attracted to someone of the same gender Sexual Fantasies: Often outside of orientation, behavior and identity. (Occur during masturbation, daydreaming, as part of real life, or purely in the imagination.) conscious and unconscious fantasies about our bodies and our sexuality influence the development of stable patterns of sexual identity, and with that, sexual behaviors. Adam & Eve Sex Survey, October 29, 2010 International Psychoanalytical Association. Final Thoughts On Male Desire Internet venues and online media outlets, provide anonymity (perceived and real) in essence; removing the awareness of societal / peer / and external moral constraints. The exposure to `new' and/or taboo behaviors at the height of sexual arousal , the removal of societal constraints combined with availability, and the ease of acting impulsively through fast passed communication technologies, allow for suppressed desires and fantasies to be acted on with little thought and may be based on the community `standards' found within the users CURRENT online `community'. Is male desire is evolving as a result of technology? If this is true, how can Public Health Respond? Smart Phones / Apps Application 29 of 102 11/29/2011 Internet-Based Partner Services Understanding Apps Location-based (near me) Search options vary A4A, screen name search (N/A: Grindr, Manhunt) Rapid / local communication Types of Apps Web-based applications Native "downloadable" applications Apple Store Android Market Shared database Adam4Adam, GayDar, Manhunt Stand alone Text Message for PN (txtPN) The goal of text messaging by CDS is to motivate the recipient to communicate via voice. To used text message for partner services you must be issued a local health department wireless phone and you must adhere to the templates provided in the guidance. CDS are never permitted to exchange disease specific information through text messaging. Text messages can be received at any time of day or night and you should be aware that you may receive a reply to your text message at any time of day or night. 30 of 102 11/29/2011 Internet-Based Partner Services Verify Cell Phone Number Intelius.com USSearch.com Peoplelookup.com TXT Outcome January 2011-September 2011 162 clients were sent a text immediately after a phone call 56% of cases responded with a call after receiving the SMS. Response rate over 50% for HIV, early syphilis, and gonorrhea Cases respond to SMS within 10-15 minutes (opposed to 3-4 days for a response to a letter) Only one case responded that they did not want to be contacted by SMS. Multnomah County Health Department and Oregon Public Health Division, Portland, Oregon Txt Content 11/29/2011 31 of 102 Internet-Based Partner Services Coming Soon... Module 1: IPS Program Overview Module 2: The Internet, Chat Rooms, IM and Mobile Module 3: General Operating Procedures Module 4: IPN and Patient Response Guidelines Module 5: Joining Websites and Creating Profiles Module 6: IPS Training and Staff Agreements Module 7: IPS Quick Guides and Reference Information Module 8: IPS Workflow and Diagrams / Data Systems Module 9: PN Email Templates Module 10: IPN CDS Logs Resources ICCR IPS / IPS Presentations IPS / IO Protocols guides - agreements Screen name Databases (Access) txtPN resources Stephan Adelson Senior Advisor, MSM, Sexual Health and Technology National Coalition of STD Directors sadelson@sadelson.com 617-953-9366 32 of 102 11/29/2011 HIV Care Update HIV Care & Collaboration Presentation to: PCSI Workshop Presented by: Michael (Mac) Coker, RN, MSN, ACRN Date: November 29, 2011 HIV Care Overview Care for PLWHA Must be HIV-infected Uncomplicated primary care ADAP Lab support Prevention for Positives Medical Case Management Referrals as needed Programs & Collaboration may differ by district TB: How do we collaborate? Intake: TB hx assessed and TST/IGRA initiated TB screening questions on CM intake form Screening performed yearly Ensure tx for LTBI and active disease (per TB) On treatment Must collaborate on medications: many interactions! May require dosing or medication changes Encourage adherence Monitor for side effects Medical Case Management (HIV) continues to follow client to address ongoing medical and psychosocial needs 33 of 102 11/29/2011 HIV Care Update TB: How can we collaborate better? From HIV chart reviews*: TSTs (not done, placed on those with hx., placed & not read, and refusals) Treatment of LTBI Better coordination when HIV and TB are closely linked Positive findings: TST report forms, some TB records in HIV charts * Slide from Rosemary Donnelly STD: How do we collaborate? STD screening done yearly & as needed on all clients GC, CT, RPR, herpes, genital warts, hepatitis serology Tx provided but may need to refer For example warts that need surgical removal Partner Notification Through HIV or in partnership with CDS STD: How can we collaborate better? Better linkage to care for HIV+ clients out of care and accessing STD clinic "I have HIV and last saw my provider 2 years ago" Role of medical case management (HIV) Refer to CDS to link to care? Communication with HIV clinic when client accesses STD clinic Better continuity of care, decrease cost by sharing test results so don't have to repeat 34 of 102 11/29/2011 HIV Care Update Questions HIV Care Contacts Eva Williams, MSN, FNP, MPH HIV Nurse Consultant - Team Lead (404) 657-3113 Pamela Phillips, MHA HIV Quality Management Coordinator (404) 463-0390 Michael (Mac) Coker, MSN, RN, ACRN HIV Nurse Consultant (404) 463-0387 11/29/2011 35 of 102 HIV Prevention Update HIV Prevention Update Presented by: Brandi Williams 11/29/2011 36 of 102 HIV Prevention Update Counseling and Testing (Jan. Sept.) T.E.S.T. Georgia 14,425 115 positives identified SEATEC CTL Trainings Walgreens Initiative Contracts T.E.S.T. Georgia General Prevention RFP ECHPP/ General Prevention Capacity Building Counseling and Testing Intervention Trainings CRIS System 37 of 102 11/29/2011 HIV Prevention Update Evaluation Evaluation Web 2012 HIV Test Forms PEMS Special Projects ECHPP Implementation: SAMSHA Phase II: 9/30/2011 to 9/29/2013 Awarded: $1,542,206 ($664,717) HIV testing Condom Distribution Prevention with Positives Linkage to Care Partner Services Prenatal Social Marketing 10/1/2011 to 9/30/2016 Awarded: $1,327,647 Mental Health Substance Abuse Substance Abuse Prevention 11/29/2011 38 of 102 HIV Prevention Update PS12-1201 Five (5) year HIV Prevention Funding Aligned with NHAS Reduce HIV incidence Focusing on areas with higher incidence Increase HIV CTL Increase access to HIV care Improve healthcare outcomes Increase awareness and educate Expand efforts to prevent HIV PS12-1201 (cont'd) Category A HIV Prevention Programs for Health Departments Category B Expanded HIV Testing Category C Demonstration Projects HIV Prevention 2012 Category A (funding allocation) 75% Prevention for positives CTL Condom Distribution HIV Policy 25% Prevention for high-risk negatives Social Marketing/Community Mobilization PrEP 39 of 102 11/29/2011 HIV Prevention Update Grant In AID Funding Comparison 2011 $1,751,110 22% High risk negatives HIV CTL ** Additional $2.5M Salaries 2012 (Proposed) $1/2,000,000 (Depending on funding level) Comprehensive prevention for positives HIV CTL Condom Distribution 75% of Funding (CDC requirement) Salaries Counseling and Testing Supplies Condoms Distribution Lab Processing (State and Chatham) Community Planning Misc. (i.e. travel, administrative costs, supplies, indirect, etc.) 25% of Funding (CDC requirement) Prevention high-risk negatives Social Marketing Community Mobilization PrEP/PEP 40 of 102 11/29/2011 HIV Prevention Update CBO Contract Comparisons 2011 $1,497,062 19% Contracts 2012 (Proposed) $1,200,000 16% Contracts 2011 Contract Allocations 0% 11% 89% 89% Prevention for High-risk negatives 11% Prevention for positives Positive Negative Current CBO Prevention Allocations 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0 Positive Negative Allocations 158,362 1,338,700 41 of 102 11/29/2011 HIV Prevention Update 2012 CBO Funding Allocations 1.2 M 700,000 600,000 500,000 400,000 300,000 200,000 100,000 0 Positive Negative 500,000 700,000 Category B: Expanded HIV Testing Increase the number of people tested Increase the number of people who are unaware of their HIV status Provide routine testing in healthcare settings Expand targeted HIV testing in non-healthcare settings Ensure that positive clients are linked to care Expanded Testing Comparison 2011 $2.6 M (Awarded) 2012 (Proposed) $1.5 M (Requested) Difference $1.1 M. 42 of 102 11/29/2011 HIV Prevention Update Funding restrictions (CDC requirement) 70% Healthcare settings 0.1% rate of newly diagnosed positives 30% Targeted non-healthcare settings 2% rate of newly diagnosed positives Category C: Demonstration Project Innovative/creative approach (CDC requirements) Decreasing incidence Cost effectiveness of HIV testing Enhancing linkage and retention to care Enhanced use of technology Programmatic and epidemiological use of CD4 viral load and other surveillance data "Georgia's Test-Treat-Care Network" Linkage and access to care system Identify and link; improve primary care Network of Linkage Care Coordinators 43 of 102 11/29/2011 HIV Prevention Update Brandi Williams blwilliams4@dhr.state.ga.us 404-657-3100 11/29/2011 44 of 102 Viral Hepatitis Update Viral Hepatitis Presentation to: PCSI Meeting Presented by: Ami P. Gandhi, MPH Adult Viral Hepatitis Prevention Coordinator Georgia Department of Public Health, Epidemiology Date: November 29, 2011 Hepatitis A Hepatitis B Hepatitis C Fever; Fatigue; Loss of Appetite; Nausea; Vomiting; Abdominal Pain ;Gray-colored bowel movements; Dark Urine; Joint Pain; Jaundice Fecal-oral Blood, body fluids Blood Vaccination Contaminated food or water International travel Household or sexual contact Men who have sex with men Injection drug use Vaccination Sexual contact Sharing needles or syringes or other drug equipment Perinatal exposure Close household contact Occupation exposure No vaccination available Sharing needles or syringes or other drug equipment Getting tattoos from an unlicensed, professional parlor Blood transfusions prior 1992 Clotting factors prior 1987 Long-term hemodialysis Perinatal exposure Occupation exposure Sexual exposure No chronic infection Immunity after recovery Immunity if recovery from acute infection 10% adults - chronic infection 90% chronic if infected at birth 80% chronic infection No lifelong immunity if recover from acute infection No treatment Treatment available Treatment available HOW DOES VIRAL HEPATITIS FIT IN TO THE PCSI MODEL? 45 of 102 11/29/2011 Viral Hepatitis Update Why PCSI? COST-EFFECTIVE Overlap in high risk populations, risk behaviors Target populations at risk for multiple infections Preventing missed opportunities Viral Hepatitis and STDs 65% of hepatitis B cases are sexually transmitted Hepatitis A can be transmitted sexually (oral/anal sex behaviors) Hepatitis C can be transmitted sexually but rare (~5% of cases) Highest risk in those with multiple sex partners, MSM Viral Hepatitis and HIV ~1/3 of HIV+ individuals co-infected with HCV Up to 90% HIV+ IDU are co-infected with HCV Same transmission risks (blood, body fluids) Same high risk behaviors and populations (IDU, MSM, multiple sex partners) Hepatitis B and hepatitis C are more infectious than HIV HIV co-infection allows HCV infection to progress more rapidly 46 of 102 11/29/2011 Viral Hepatitis Update Viral Hepatitis and Tuberculosis Similar high risk populations (immigrant, refugees, incarcerated) Important to test TB patients for viral hepatitis and vaccinate against hepatitis A and B prior to treatment WHAT'S HAPPENING IN GEORGIA? Confirmed Hepatitis A, Georgia 1000 900 800 700 600 500 400 300 200 100 0 913 499 2001 2002 751 306 124 2003 2004 2005 56 2006 69 2007 53 2008 54 2009 38 2010 The increase in Hepatitis A cases in 2001 was due to an outbreak in MSM populations in Georgia. The increase in Hepatitis A cases in 2003 was due to a multi-state outbreak involving contaminated green onions. 47 of 102 11/29/2011 Viral Hepatitis Update Confirmed Hepatitis B, Georgia 2500 2000 1500 1000 500 0 1112 204 2005 1892 1597 198 2006 158 2007 Confirmed Acute HBV 1983 2088 1735 183 2008 142 2009 Confirmed Chronic HBV 156 2010 Confirmed Hepatitis C, Georgia 1000 900 800 700 600 500 400 300 200 100 0 852 724 667 701 8 2005 328 9 19 2006 2007 Confirmed Acute HCV 17 31 2008 2009 Confirmed Chronic HCV 915 31 2010 * Note that surveillance data for confirmed cases of acute and chronic hepatitis C is limited. Therefore, data does not depict true prevalence in Georgia. Hepatitis C Virus (HCV) 1.6% of the US population have been infected with HCV (4-5 million people) Estimated up to 75% of HCV+ unaware of status 50-90% of injection drug users are infected with HCV 14-42% of incarcerated people are infected with HCV ~42% of homeless people may be infected with HCV HCV is leading cause of liver transplants in the US 48 of 102 11/29/2011 Viral Hepatitis Update At the Federal Level...... 1st ever Action Plan dedicated to Viral Hepatitis released by a collaboration of Federal agencies in May 2011 http://www.hhs.gov/ash/initiati ves/hepatitis/actionplan_viral hepatitis2011.pdf Budget Allocation from CDC/National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention TB, 13% Viral Hepatitis, 2% STD, 14% Domestic HIV, 72% Adult Viral Hepatitis Prevention CDC funds 1 AVHPC in each jurisdiction Collaborate with and integrate hepatitis prevention into existing public health programs Prevention activities, training, & education Raising awareness of viral hepatitis and impact on high risk populations 49 of 102 11/29/2011 Viral Hepatitis Update Adult Viral Hepatitis Prevention Limited federal resources for prevention No state funding for hepatitis prevention in Georgia Emphasizes the need for program collaboration and service integration (PCSI) So....where to begin? PCSI!!!!!! Focus on building collaborative partnerships with programs within the health department Awareness and education/training Educating public health staff to prevent missed opportunities Current and Future Collaborations Collaborate with GA Immunization Program to promote availability of hepatitis vaccinations for adults in public health clinics Collaborating with STD program and GA Immunization Program to increase testing and vaccination in STD clinics Ryan White Continue to support current protocols Provide education/training to staff on hepatitis testing, vaccination & care issues in relation to HIV care 50 of 102 11/29/2011 Viral Hepatitis Update Current and Future Collaborations HIV Prevention: Training/education on viral hepatitis and relationship to HIV to CBOs/funded agencies Inclusion of viral hepatitis prevention messages during HIV counseling and testing Linkages to health department for testing/vaccination Where to go from here...? Further integration of services Evaluate burden of HIV/HCV co-infection Hepatitis C testing along with HIV testing among high risk populations OraQuick HCV Rapid Antibody Test Ensure staff/agencies providing STD and services are trained to identify those at risk for viral hepatitis and trained to provide accurate information on testing, vaccination, & care Develop linkages for follow up testing and care CONTACT INFORMATION Ami P. Gandhi, MPH Adult Viral Hepatitis Prevention Coordinator Georgia Department of Public Health, Epidemiology apgandhi@dhr.state.ga.us 404-463-0849 51 of 102 11/29/2011 Tuberculosis Update An Overview of the Georgia Tuberculosis Program Presented by: Dr. Rose-Marie Sales TB Program Director/TB Epidemiology Section Chief, GA-DPH What is Tuberculosis (TB)? Tuberculosis (TB) is an infectious disease caused by the germ Mycobacterium tuberculosis or tubercle bacilli. It usually affects the lungs but can affect any part of the body. TB is transmitted when persons with pulmonary or laryngeal TB cough, sneeze, speak, or sing, and expel droplets containing TB bacilli. A susceptible person may inhale the tubercle bacilli and get infected. Signs and Symptoms of TB Persistent, productive cough for more than 2-3 weeks Coughing up blood Fever Night sweats Weakness Weight loss 52 of 102 11/29/2011 Tuberculosis Update How to stop TB transmission Immediate respiratory isolation of infectious TB patients Starting effective treatment and completing treatment Identifying and screening contacts of TB patients Risk Factors for TB Close contacts of a person with infectious TB HIV infected individuals Immunosuppressed persons Foreign-born persons from endemic countries Injecting drug users Residents and employees of homeless shelters, nursing homes, jails, and prisons Risk Factors for TB Mycobacterial laboratory personnel and health care workers who serve high-risk clients Persons with diabetes mellitus, silicosis, end stage renal disease, gastrectomy, jejunoileal bypass, leukemia, lymphoma, or cancer of the head or neck 53 of 102 11/29/2011 Tuberculosis Update Difference between active TB disease and latent TB infection (LTBI) Active TB disease: Person is symptomatic and TB bacilli are actively multiplying. Persons with active TB disease can infect other people Latent TB infection: TB bacilli are present in the body but are inactive and not multiplying. Persons with LTBI have no symptoms and are not contagious, but may develop TB disease later in life if they do not receive treatment for LTBI. The Georgia Tuberculosis Program The mission of the Georgia Tuberculosis Program is to control transmission of, prevent illness from, and ensure treatment completion of tuberculosis (TB) This is accomplished by the following: Identifying and treating persons who have active TB Finding, screening and treating contacts of TB cases Screening high-risk populations What does the TB Program Do? Conducts case reviews to ensure that all TB cases in Georgia are evaluated and treated appropriately Provides individualized case management to TB patients Identifies, locates, and evaluates persons exposed to TB Provides tuberculin skin testing, bacteriology, radiologic services, and anti-TB medications to persons with active TB and their contacts 54 of 102 11/29/2011 Tuberculosis Update What does the TB Program Do? (2) Provides education and treatment to contacts with latent TB infection (LTBI) to prevent future illness Maintains statewide TB surveillance system and ensures complete, accurate, and timely reporting of newly diagnosed and suspected TB cases Provides QA/QI oversight and builds capacity of health providers to identify, treat, and control transmission of TB through education, training, and technical assistance TB Program Services Physician/nurse consultation Directly observed therapy (DOT) Individualized case management Free anti-TB medications, bacteriology exams, radiographic services and screening of contacts Housing for homeless TB clients Incentives and enablers Oral nutritional supplements Social services consultation and referral Language Line Services with over 170 languages TB Program Services (2) Provides assistance to Health Districts for involuntary commitment of noncompliant TB clients Tracks movement of TB cases to ensure continuity and completion of treatment Assures timely reporting of TB cases Maintains computerized register of TB cases in Georgia Analyzes and monitors epidemiologic trends Leads outbreak investigations 55 of 102 11/29/2011 Tuberculosis Update State TB Program Staff Administrative Physician consultant Education, training and outreach Program evaluation and incidence response Medical records and surveillance Epidemiology Pharmacy TB Prevention & Control Funding Provides personnel for state, health districts and county health department staff Travel to perform TB prevention and control activities (e.g., DOT, contact investigation, TB education for healthcare providers, outbreak investigations) Contracts to provide special services (e.g., medical consultation, temporary housing for homeless patients, Grady laboratory for smears and culture identification Georgia Public Health Laboratory TB lab Training and education activities Training and Education TB Update & Skin Test Certification Course Contact Investigation and DOT Course TB Case Management Course Training for Correctional Facilities Quarterly TB Task Force Meetings Nurse protocol training Training for cohort reviews Technical assistance for outbreak response 56 of 102 11/29/2011 Tuberculosis Update What is Reportable by Georgia Law? Any laboratory confirmed or clinical case of TB TB suspects on at least two anti-TB drugs LTBI in children under 5 years of age "In-patient or out-patient treatment of a case of active TB and treatment of a suspected case with two or more anti-TB drugs shall be reported to the Epidemiology and Prevention Branch of the Department through the local county health department or its designee." - Rules and Regulations of the State of Georgia Chapter 290-5-16 TB Surveillance Case Definitions Laboratory Case Definition Isolation of M. tuberculosis complex* from clinical specimen Demonstration of M. tuberculosis complex from clinical specimen by nucleic acid amplification test, e.g. MTD test Demonstration of acid fast bacilli from clinical specimen when culture can not be obtained (usually post-mortem setting) *Mycobacterium tuberculosis complex: Group of closely related mycobacteria that can cause active TB (e.g., M. tuberculosis, M. africanum, M. bovis) TB Surveillance Case Definitions (2) Clinical Case Definition In absence of laboratory confirmation, case meets all of the following criteria: TB infection based on positive tuberculin skin test or interferon gamma release assay test Signs/symptoms compatible with current TB (e.g., abnormal CXR/CT scan/other chest imaging study, or clinical evidence of current disease Current treatment with two or more anti-TB meds Completed diagnostic evaluation 57 of 102 11/29/2011 Tuberculosis Update Provider Diagnosis CDC accepts cases to be included in a state's morbidity count when a health provider has assessed the patient to have TB and patient is under treatment for TB even if patient may not meet surveillance case definition criteria Number of TB Cases and TB Case Rates Georgia,1982-2010 Number of Cases Case rate/100,000 Number of TB Cases by Health Districts Georgia, 2010 Haralson 1-2 2-0 Gordon 1-1 Bartow Polk Paulding 3-2 3-4 10-0 3-1 3-5 Rockdale 3-3 4-0 5-2 Number of TB Cases: Low incidence: 2-10 Medium incidence: 11-20 High incidence: >20 (29-86) 6-0 7-0 8-2 Seminole Decatur 5-1 9-1 9-2 8-1 58 of 102 11/29/2011 Tuberculosis Update 11/29/2011 TB Case Rates by Health Districts Georgia, 2010 1-2 Gordon 2-0 1-1 Bartow Polk Paulding 3-2 3-4 Haralson 3-1 3-5 Rockdale 3-3 10-0 4-0 5-2 Case rates/100,000 population: <= 3.5 (2000 national target) 3.6 to 4.2 > 4.2 (2010 state average) 6-0 7-0 8-2 Seminole 5-1 9-1 9-2 8-1 US-born and Foreign-born TB Cases Georgia,1993-2010 Number 59 of 102 Tuberculosis Update HIV Status of TB Cases Georgia,1993-2010 Unknown Negative Positive Number 900 800 700 600 500 400 300 200 100 0 1993 1995 1997 1999 2001 2003 2005 2007 2009 Year Primary Drug Resistance and MDR-TB Georgia, 2006-2010 Number Percent 45 16 40 14 14 35 12 30 10 25 9 20 7 15 6 8 7 6 10 4 5 0 2 1 2 32 0 0 2006 2007 2008 2009 2010 Year MDR-TB: multidrug-resistant TB (resistant to at least INH and Rifampin) INH RIF MDR-TB % INH-R Timely (In 12 Months) TB Treatment Completion and Directly Observed Therapy (DOT) Georgia, 1993-2009 67 DOT became standard of care 60 of 102 11/29/2011 Tuberculosis Update Completion of Latent TB Infection Therapy Georgia, 2005-2009 80 70 66 66 68 60 57 60 50 Completed LTBI Therapy 40 Missing data 30 20 14 10 0 1 4 6 8 2005 2006 2007 2008 2009 Year Percent Program Evaluation Plan 2011 - 2015 National Tuberculosis Indicator Program (NTIP) Goals: NTIP Goal #1: For patients with newly diagnosed TB for whom 12 months or less of treatment is indicated, increase the proportion of patients who complete treatment within 12 months to 93% by 2015 (Not met: 87%) NTIP Goal #8: Increase the proportion of patients who are started on the recommended initial four-drug regimen when suspected of having of TB disease to 93% by 2015 (Met: 92%) Benchmarks Number of case reviews held in the state per year and number of cases reviewed. Number of cohort reviews held in the state per year and the number of cases reviewed. Number of record audits performed in the state per year and number of records audited. Include summary of audits. Percentage of public health staff who provide TB services who are TST certified. World TB Day, March 24, 2011 1,514 registered, 950 t-shirts were distributed at the Walk 61 of 102 11/29/2011 Tuberculosis Update New Initiatives for the New Year Implementing electronic medical records Implementing statewide cohort reviews Using peer educators to improve LTBI treatment completion in metropolitan Atlanta counties Developing Program Evaluation Manual Updating TB Policy and Procedure Manual and Georgia Reference Guide 11/29/2011 62 of 102 STD Update Georgia On My Mind: State of The State STD Office Presented by: Michelle L. Allen, STD Office Director Date: November 29, 2011 Overview During this presentation, you will be provided information as follows: State STD Office Mission and Vision Current Rankings Georgia Program Updates Healthy People 2020 STD Office MISSION & VISION STATEMENT Mission: To provide technical assistance and programmatic support to the Public Health Districts and Community Based Organizations to prevent Sexually Transmitted Infections ensuring the availability of quality prevention, intervention, and treatment. Vision: We envision healthy Georgia communities free of Sexually Transmitted Infections. 63 of 102 11/29/2011 STD Update CDC 2010 STD Surveillance Report Highlights Georgia ranks... 2nd for Primary and Secondary Syphilis 7th for Gonorrhea 12th for Congenital Syphilis 15th for Chlamydia Source: Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2010. Atlanta: U.S. Department of Health and Human Services; 2011. STD Office Programs Comprehensive STD Prevention Systems (CSPS) Infertility Prevention Project (IPP) Syphilis Elimination Effort (SEE) Gonoccocal Isolate Surveillance Project (GISP) The program activities implemented in carrying out these program components support the achievement of many STD-related Healthy People 2020 objectives. Does the STD Office Support My District? Yes GC\CT Testing Supplies and Lab Services STD Treatment STD 101 CDS and CDS Supervisor Training Microscope Training Staff***(FTEs) GIA (metro and beyond) STD Nursing Protocols Condoms, Lube, and Literature Equipment and Supplies 64 of 102 11/29/2011 STD Update Services and Activities Services -Provides technical assistance to health districts and CBOs -Programmatic Support -Rapid Response -Training Activities -Conducts SEE Bimonthly Meetings -Funds two Metro Atlanta CBOs AID Atlanta ARCA -Participates in community outreach -Capacity Building - MSM Forums Program Updates STD Surveillance (Surveillance Manager Latasha Terry) Case Management ICCR\OOJ Transactions EPI STD Program (Program Manager Linda Allen-Johnson) SENDSS Technical Assistance Data Request\Data Analysis GA Public Health Lab Syphilis and HIV Testing Update Budget cuts -$$ Program Updates MSM Forums Georgia on My Mind Updates Selected HIV Testing Sites to become GC\CT Testing Sites Revising STD Nursing Protocols HIV Office \HBCU Tour with Greater Than AIDS Campaign National HIV Testing Day Emory MPH Students Disease Intervention 101 Collaboration DJJ \ Corrections Collaboration Provider Workgroup STD 101 PCSI Conference Billing Advisory Workgroup 65 of 102 11/29/2011 STD Update Program Collaboration and Service Integration Healthy People 2020 Objectives Sexually Transmitted Disease STD-1 Reduce the proportion of adolescents with Chlamydia infections. STD-2 Reduce Chlamydia rates among females aged 15 to 44 years. STD-6 Reduce Gonorrhea rates. Family Planning Increase the proportion of sexually active persons aged 15 to 19 years who use condoms to both effectively prevent pregnancy and provide barrier protection against disease. Healthy People 2020 Objectives Sexually Transmitted Disease STD-9 Reduce the proportion of females HPV. Immunization and Infectious Disease IID-25.2 Reduce new hep B infections among at-risk populations Injections drug users (IDU). IID-25.3 Reduce new hep B infections among at-risk populations Men who have sex with men (MSM). 66 of 102 11/29/2011 STD Update 2010 STD Treatment Guidelines Several STDs can be effectively prevented through pre-exposure vaccination, including HAV, HBV, and HPV. Clients treated for an STD should receive vaccination (unless already vaccinated). MSM and IDUs should also receive Hep A. Contact Information Georgia Department of Public Health Division of Health Protection Infectious Disease and Immunization Program Michelle L. Allen STD Office Director 2 Peachtree Street 13th Floor Atlanta, GA 30303 Phone (404) 404-657-3155 Fax (404) 657-3133 mlallen2@dhr.state.ga.us http://health.state.ga.us ThankI Ywoeulcome your questions & comments... 67 of 102 11/29/2011 SWOT Analysis 2011 SWOT Analysis Presentation to: Program Collaboration and Service Integration (PCSI) Presented by: Valerie Underwood Date: 11/29/11 SWOT Analysis A Strengths, Weaknesses, Opportunities, Threats (SWOT) Analysis is a tool used to understand programs and provide decision-making strategies for achieving program goals Surveys Received= 15 State Office = 3 District Level = 12 Programmatic Think about your individual program. If you work for multiple programs, please include answers based on each program: What do you perceive are the strengths of your program? What do you perceive are the weaknesses of your program? What do you perceive are the opportunities of your program? What do you perceive are the threats of your program? 68 of 102 11/29/2011 SWOT Analysis 2011 Strengths Teamwork (6) Expertise (5) Technical assistance (5) Client focused (4) Communication (4) Committed staff (3) Innovation (2) Partnerships (2) Support staff (2) Weaknesses Funding (10) Training opportunities (6) Understaffing (6) Data-IT systems (4) Leadership/Politics (4) Clinical structural division (2) Private Providers (2) Referral systems (2) Salary (2) Opportunities Progressive mindset (7) Training (6) Collaboration (5) Community Education/Involvement (5) Leadership development (4) Partnership (4) Service/systems improvement (3) Data use (2) New hires (2) 69 of 102 11/29/2011 SWOT Analysis 2011 Threats Budget cuts (12) Loss of employees (5) Increased morbidity (4) Providing services (4) Lack of foundation (3) Overworked (3) Staff turnover Stagnant salary (3) Collaborative Now, think about how the HIV, STD, and TB units work together? Answer based on the collaboration and integration of services with your program(s) and the other infectious disease programs (HIV, STD, TB): What do you perceive are the strengths of the current program collaboration? What do you perceive are the weaknesses of the current program collaboration? What do you perceive are the opportunities of the current program collaboration? What do you perceive are the threats of the current program collaboration? Strengths Linking clients (6) Shared facility/management (4) Integrated approach (3) Helping on large scale outbreaks (2) Expertise (2) 70 of 102 11/29/2011 SWOT Analysis 2011 Weaknesses Little to no collaboration (4) Separation of programs (4) Communication (2) Follow-up (2) Unclear Goals/Objectives (2) Opportunities Collaboration (7) Serve clients (6) Cohesive departments (5) Communication (4) Training (4) Meet PH goal (2) Threats Funding (10) Competing priorities (5) State office hands-off leadership approach (4) Understaffed (4) Separation of programs (3) Continuity of care (2) Lack of effective collaboration (2) Lack of clear communication (2) 71 of 102 11/29/2011 SWOT Analysis 2011 Discussion How can we use this information to help our programs? What is my role in program collaboration? What training is needed? Does my organization have a strategic plan? Work plan? HIV Prevention HIV Care Thank You! Tuberculosis Hepatitis Refugee Health Sexually Transmitted Diseases 11/29/2011 72 of 102 Team Building TEAM BUILDING Presentation to: Program Collaboration and Service Integration (PCSI) Presented by: Lawsey Thomas, Sr. Date: November 30, 2011 Team Building 11/30/2011 Objectives To identify ways that a group can accomplish more than an individual To identify what it means to be an effective team player To identify and define the four team-player styles 73 of 102 Team Building Objectives To identify the preferred individual team-player style To recognize the positive and negative effects of each team-player style To explore the five strategies for becoming a better team player and maximizing team effectiveness Objectives To identify the keys to making diversity a constructive force in developing team work To describe personal and organizational benefits of building more successful teams In The Cards 11/30/2011 74 of 102 Team Building Team Building What things can a team accomplish that one person cannot accomplish alone? Question? Identify instances when the team's effectiveness suffered due to personality/style clashes among members Debrief What are the team-player styles? What were the problems in the beginning of the team's project? How did they resolve them? How do diverse team members work together to form a cohesive and effective team? 75 of 102 11/30/2011 Team Building Contributor Task-oriented, perfectionist Focuses on details Highly skilled and stable Expects higher standards Proficient and dependable Views the team as experts Collaborator Appreciates "big" picture Resists the specifics Focuses on overall goal Keeps organization's vision in mind Communicator "People" person Focuses on human relations and group process Resolves conflict Creates an inviting atmosphere 76 of 102 11/30/2011 Team Building Challenger Asks the tough questions Provides reality checks Keeps group on course Saves the team from bad ideas Team-Player Styles Strengths and Contributions Detailed characteristics, using adjectives Weaknesses and Excesses Detailed characteristics, using adjectives Learner Styles Usually have a more preferred style Not confined to just one Does not exclude all other styles Everyone has a mixture of all four 77 of 102 11/30/2011 Team Building Five Team-Player Strategies Identify your style and others Use style to maximum advantage Avoid carrying too far Acknowledge value of others Learn to switch style Identify Your Style & Others What are your team-player style strengths? What are your team-player style weaknesses? Identify Your Style & Others What are your team-player style strengths? What are your team-player style weaknesses? 78 of 102 11/30/2011 Team Building Question How do you relate to other team members whose team-player style is most like yours? How do you relate to other team members whose team-player style least like yours? Use Style to Maximum Advantage Know team's strengths and weaknesses Assign tasks based on team member's strengths Use your style to the team's advantage Avoid Carrying Too Far Diminishes the team's effectiveness Causes dissention Brings down team moral Similar to a cake: Too much of any one ingredient ruins the whole cake 79 of 102 11/30/2011 Team Building Acknowledge Other's Value Recognize other's talents Respect other's contributions/ideas Understand the need for balance among the various styles Remember the sum is always greater than one Learn To Switch Styles Always remain flexible Do not be afraid to leave comfort zone How does your willingness to change impact the team's success/failure? Balancing Team How would having imbalances on your team impede the performance of the team? 80 of 102 11/30/2011 Team Building Lost at Sea 11/30/2011 Key Learning Points Teamwork is critical for group development, recognize the impact of one person monopolizing the group Be aware of the negative effects of excluding members, therefore get input from silent members Key Learning Points Be aware of verbal and non-verbal communication in order to have effective two-way communication The key to effective problem-solving is having a process for decision-making When ideas are shared, the results are better solutions and greater ownership 81 of 102 Team Building Keys to Making Team Diversity Work Self-Awareness Interpersonal Honesty Mutual Respect Trust Flexibility Self Awareness Individual awareness of what constitutes his/her essential nature and distinguishes him/her from all others Interpersonal Honesty Effectively Communicating with others - Using Listening and feedback skills Being open and honest Helps to create trust 82 of 102 11/30/2011 Team Building Mutual Respect The Golden Rule: Treat Others As You Would Like To Be Treated!!! Regard other member's worth, value and contributions The PLATIUM RULE Treat others as they want to be treated. Trust Foundation to all interrelationships Makes a team a cohesive unit No trust = No team Flexibility Ability to adapt and adjust Workable and able to bend Ability to bounce back Capable of being shaped, bent or molded 83 of 102 11/30/2011 Team Building 11/30/2011 By Milton Olson adapted by Angeles Arrien Lesson One Each goose flaps wings to uplift those that follow Flying in "V" formation adds 71% greater flying range than each flying alone People who share a common direction get to the goal quicker and easier because they are traveling on the trust of one another Lesson Two When a goose falls out of formation, it feels the drag and resistance of flying alone It quickly moves back in formation for the lifting power of the bird in front If we have as much sense as a goose we'll stay in formation with those headed where we want to go We will accept their help and give our help to others 84 of 102 Team Building Lesson Three When the lead goose tires, it rotates back and another goose flies to the point position As with geese, people are interdependent on each other's skills, capabilities, talents, and resources. It pays to take turns doing the hard tasks and to share leadership Lesson Four Geese flying in formation honk to encourage those up front to keep up their speed We need to make sure our honking is encouraging. In groups where there is encouragement, the production is greater Lesson Five When a goose gets sick or wounded, two geese drop out of formation and stay with it until it can fly again or dies. Then they launch out with another formation or catch up with the flock If we have as much sense as geese, we will stand by each other in difficult times as well as when we are strong. 85 of 102 11/30/2011 Team Building Lesson Five When a goose gets sick or wounded, two geese drop out of formation and stay with it until it can fly again or dies. Then they launch out with another formation or catch up with the flock If we have as much sense as geese, we will stand by each other in difficult times as well as when we are strong. "IT IS INDEED A REWARD, A CHALLENGE AND A PRIVILEGE TO BE A CONTRIBUTING MEMBER OF A TEAM" 11/30/2011 86 of 102 Understanding and Valuing Diversity in the Work Place Understanding and Valuing Diversity In the Work Place Presentation to: Program Collaboration and Service Integration (PCSI) Presented by: Lawsey Thomas, Sr. Date: November 30, 2011 Understanding and Valuing Diversity In the Work Place TERMINAL PERFORMANCE OBJECTIVES Upon completion of this course of instruction, the student will be able to recognize diversity in the work environment and complete a written test with 70% accuracy. 87 of 102 11/30/2011 Understanding and Valuing Diversity in the Work Place Enabling Objectives a. Define Diversity b. List three (3) types of diversity and give examples of each. c. Demonstrate diversity as it relates to DPH d. Describe diversity as it relates to the facility. e. Describe the new diversity within the workplace Diversity Defined Diversity is an environment that allows for the total spectrum of differences to be valued and integrated in support of the organization's mission and overall business operations. Types of Diversity 1. Cultural Diversity 2. Racial Diversity 3. Age Diversity 88 of 102 11/30/2011 Understanding and Valuing Diversity in the Work Place The Importance of Culture "We have become not a melting pot but a beautiful mosaic. Different people, different beliefs, different yearnings, different hopes, different dreams". Jimmy Carter Working Together Works Working together can never be a policy. It can only be an idea. It can never be a code of rules. It can only be a way of looking at the world. We can say, "This is mine," and be good, or we can add, "This is ours" and become better. We can think, "I'll do my share," and be satisfied, or we can ask, Can I do more?" And become prosperous. We can work alongside each other and function, or we can work With Each other and grow. UNDERSTANDING AND VALUING DIVERSITY 55.0% 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 52.8% 24.3% White, NH Hispanic Afr-Amer Asian/ PI Native Amer 13.2% 8.9% Year 2050 Projected 89 of 102 11/30/2011 Understanding and Valuing Diversity in the Work Place Our Country's History Our country's history makes it clear that combining all efforts into one has been the only way to achieve that progress and that strength we take such pride in our unity. Pride not only in what we've achieved but pride in knowing that we've achieved it together, with our own work and our own visions. That's really the key. Because when all is said and done, working together doesn't only bring out the best in all of us, it brings us all the best. What is Valuing Diversity Respecting the differences which exist among us due to our respective life experiences; allowing for an atmosphere which values customers and employees in such a way that the mission is enhanced. CULTURAL COMPETENCE is Communicating in Open HONEST And Caring ways To promote healthy conflict management. 90 of 102 11/30/2011 Understanding and Valuing Diversity in the Work Place What is Valuing Diversity "Without each other's help through change we choose to stagnate." COME LET US REASON TOGETHER AS MEMBERS OF THE GREATEST RACE ----THE HUMAN RACE--- C. Everett Koop What is Valuing Diversity If we have no peace, it is because we may have forgotten that we belong to each other Mother Theresa Change----Enemy or friend You choose------One or the other Yoshira Zama Who is Responsible for Diversity GLOBAL TECHNOLOGY AND SERVICE DRIVEN ECONOMY 91 of 102 11/30/2011 Understanding and Valuing Diversity in the Work Place Who is Responsible for Diversity Women and others in the workplace CRASH-Course Concepts Culture Respect Assess / Affirm Sensitivity / Self-awareness Humility Culture Race Ethnicity National Origin Geographic Region History Religion 92 of 102 11/30/2011 Understanding and Valuing Diversity in the Work Place Culture Expressed Through Individuals Gender Age Race Ethnicity National Origin Geographic Region History Religion Family Dynamics Personal Psychology Culture Expressed Through Individuals Over Time Gender Marriage Family Age Social Status & Power Race Ethnicity National Origin Geographic Region History Religion Acculturation Family Dynamics Education & Vocation Personal Psychology Self-Awareness: Becoming aware of our own cultural norms, values, and "hot-button" issues that lead us to mis-judge or to miscommunicate with others. 93 of 102 11/30/2011 Understanding and Valuing Diversity in the Work Place CONFLICT A process of social interaction involving a struggle over claims to resources, power and status, belief, and other preferences and desires. A disparity existing among parties over facts, methods, goals, and values. ASSUMPTIONS Conflict and disagreements will develop Some conflict can be minimized There are some unavoidable conflict The resolution of conflict does not have to result in a winner or a loser Types of Conflict Type Defining Characteristics _______________________________________________ Interest/communication conflict characterized by a genuine class of opposing interests or commitments Induced conflicts conflicts intentionally created in order to achieve other than explicit objectives 94 of 102 11/30/2011 Understanding and Valuing Diversity in the Work Place Types of Conflict Misattributed conflicts Illusionary conflicts conflicts involving incorrect attributions as to the behaviors, participants, issues, or causes. conflicts based on misperceptions of misunderstandings Types of Conflict Displaced conflicts Expressive conflicts conflicts in which the opposition of antagonism is directed toward persons or concerns other than the actual offending parties or the issues conflicts characterized by a desire to express hostility, antagonism or other strong feelings. CONFLICT IS CONSTRUCTIVE WHEN IT: Opens up issues of importance, resulting in their clarification. Results in the solution of problems Increases the involvement of individuals in issues of importance to them. Causes authentic communication to occur. Serves as a release to pent-up emotion, anxiety and stress Helps build cohesiveness among people by sharing the conflict, celebrating in its settlement and learning more about each other. Helps individuals grow personally and apply what they learned to future situations. 95 of 102 11/30/2011 Understanding and Valuing Diversity in the Work Place CONFLICT IS DESTRUCTIVE WHEN IT: Diverts energy from more important activities and issues. Destroys the morale of people or reinforce poor self-concepts. Polarizes groups so they increase internal cohesiveness and reduce intergroup cooperation. Deepens differences in values. Produces irresponsible and regrettable behavior such as name-calling and fighting. Self-Awareness When people won't make eye contact with me, ______________________. When patients show up late for their appointments, ___________________. When people touch me a lot or get in my personal space, ___________________. When dealing with conflict, people should ____________________________. Success Factors Demand that stereotypes be dropped, that ideas be given consideration on their merit regardless of source, and that good working relationships be maintained. Positive feelings about others are both a cause and an effect of collaborations and coalition building. "Learn to always use kind words No one resents them." Maya Angelou 96 of 102 11/30/2011 Understanding and Valuing Diversity in the Work Place UNDERSTANDING BIASES AND STEREOTYPES SELF-APPRAISAL What is my vision and supporting values and beliefs? How did I come by those values and beliefs? What positive messages did I receive about aspects of my identity which are still motivating and sustaining forces for me even now? What were the sources of those messages? What negative messages (stereotypes) did I receive early on about different others? How did those affect me then? How do those continue to affect me now? What concrete steps am I taking to continually discover my biases? What am I doing that is working? What more should I be doing? Humility: Recognizing that none of us ever fully attains "cultural competence" Making a commitment to life-long learning Peeling back "layers of the onion" of our own perceptions and biases Being quick to apologize and accept responsibility for cultural mis-steps Embracing the adventure of learning from others' first-hand accounts of their own experience. BIAS DISCOVERY Realizing you are holding on to a bias in the face of evidence to the contrary BIAS RECOVERY Taking steps to appropriately remove bias. 97 of 102 11/30/2011 Understanding and Valuing Diversity in the Work Place MENTAL MODEL FRAMEWORK No matter what the other person is doing or saying, my response must be: What is the most kind, caring, helpful and loving way I can respond RIGHT NOW!!!!! 11/30/2011 98 of 102 Scantron Report: Program Collaboration Service Integration (PCSI) Evaluation This report contains 51 evaluation results for the Georgia Department of Public Health Division of Health Protection - PCSI Training held in Macon, GA, November 29-30, 2011. The question categories are listed first, followed by individual question values using the follwoing Likert Scale: 5 = Excellent 4 = Very Good 3 = Good 2 = Fair 1 = Poor Free text comments are verbatim as transcribed from evaluations. 12/01/2011 Class Climate evaluation 99 of 102 Page 1 PCSI Training November 29-30, 2011 No. of responses = 51 PCSI 2011 Tuesday - November 29, 2011 Registration Ice Breaker Welcome / Workshop Overview Program Collaboration Service Integration (PCSI) Internet Partner Service Notification TB Update STD Update HIV Update Hepatitis Update 12/01/2011 0% 2% 10% 40% 48% Poor Excellent 1 2 3 4 5 0% 4% 8% 52% 35% Poor Excellent 1 2 3 4 5 0% 2% 13% 47% 38% Poor Excellent 1 2 3 4 5 0% 2% 6% 28% 64% Poor Excellent 1 2 3 4 5 0% 0% 8% 27% 65% Poor Excellent 1 2 3 4 5 0% 0% 11% 41% 48% Poor Excellent 1 2 3 4 5 0% 0% 9% 43% 49% Poor Excellent 1 2 3 4 5 0% 2% 18% 49% 31% Poor Excellent 1 2 3 4 5 0% 0% 20% 45% 35% Poor Excellent 1 2 3 4 5 Class Climate evaluation 100 of 102 n=48 av.=4.33 md=4 dev.=0.75 n=48 av.=4.19 md=4 dev.=0.76 n=47 av.=4.21 md=4 dev.=0.75 n=47 av.=4.53 md=5 dev.=0.72 n=49 av.=4.57 md=5 dev.=0.65 n=46 av.=4.37 md=4 dev.=0.68 n=47 av.=4.4 md=4 dev.=0.65 n=49 av.=4.08 md=4 dev.=0.76 n=49 av.=4.14 md=4 dev.=0.74 Page 2 SWOT Analysis Wednesday - November 30, 2011 Icebreaker Case Study Program Capacity Building or Team Building Cultural Sensitivity Other Thoughts 0% 5% 21% 37% 37% Poor Excellent 1 2 3 4 5 PCSI 2011 n=43 av.=4.07 md=4 dev.=0.88 2% 0% 25% 33% 40% Poor Excellent 1 2 3 4 5 2% 2% 24% 30% 41% Poor Excellent 1 2 3 4 5 0% 2% 16% 35% 47% Poor Excellent 1 2 3 4 5 0% 5% 16% 30% 50% Poor Excellent 1 2 3 4 5 n=48 av.=4.08 md=4 dev.=0.92 n=46 av.=4.07 md=4 dev.=0.98 n=49 av.=4.27 md=4 dev.=0.81 n=44 av.=4.25 md=4.5 dev.=0.89 Any other thoughts you'd like to share with the PCSI Steering Committee? Create a "Train the Trainer" or share info on how we could create & implement this training in our own district. (2 Counts) Excellent! We need to have this every year! More case studies & speakers like Mr. Adelson. Program updates helpful to understand how different programs work. (1 Count) Would love to hear more information about the use of internet partner search. (1 Count) Nice enthusiastic speakers, but not necessarily all benificial - games! (1 Count) Great meeting - great information. (1 Count) Great conference!!! (1 Count) -Needed more interaction with capacity building. -All updates were very informative. (1 Count) Overall a well organized conference. The enue was appropriate and the food was good. Look to see other program areas included in PCSI in the future. (1 Count) Great Training (1 Count) This was a wonderful training. I would like more input on how to actually implement collaboration with our daily work. Also, with presentations please suggest that they take a role that everyone does not know the "lingo" in our respective sections. (1 Count) (PPENFFUJOH*XPVMEMJLFUPIBWFNPSFDPMMBCPSBUJWFBDUJWJUJFTBUUIFNFFUJOH*XPVME MJLFUPEJTDVTTDPMMBCPSBUJWFXPSLHSPVQTBOEOFYUTUFQTBUUIFOFYUNFFUJOH 12/01/2011 Class Climate evaluation 101 of 102 Page 3 PCSI 2011 1st Day - This great conference should be reproduced for Health Directors over the state (G.P.H.A.?) They are the gatekeepers for what is allowed to occur in the district. 2nd Day - Speaker too wordy, too long, & boring for those of us who have had similar trainings over the last 10 years. This is old news & time could be better utilized toward other efforts. He seemed to have some good useful slides that he did not address. Too bad! (1 Count) Excellent program - please continue annually. (1 Count) Invite other programs. (1 Count) Well planned, very informative, one of my favorite conferences. (1 Count) Nice venue, good conference, nice to have breakfast & lunch provided, I liked the way you kept to the schedule. (1 Count) Very good & gave items to think about. More collaboration & communication is needed among programs (esp. due to budget restrictions). *FYI - Rm was too cool - everything else was very nice. (1 Count) - Add a motivational speaker for a segment of the meeting to encourage & enpower us as we work that difficult times within our areas/differences. - Suggest that this meeting be continued. -Include Refugee Health. (1 Count) PCSI is new concept for me. Awesome meeting. Gives new perspective on collaboration efforts. (1 Count) Thanks for the workshop. I really enjoyed it. The speakers were all excellent - really enjoyed the laughter from Mr. Thomas's speech. (1 Count) May be nice to develop a program for sharing within districts. (1 Count) Great Training! (1 Count) Have more of these meetings. (1 Count) Great for everyone from the different programs to get together. We need more of these type of meetings. (1 Count) Would like to see activities/presentations that result in "actionable" items. For example, exercises that incorporate specific barriers to PCSI. (1 Count) The event was well organized. I look forward to next year. (1 Count) The meeting with the combined program was na excellent idea. I learned a great deal and was able to network with so many other colleagues. I belive that the addition of Women's Health * Immunization programs would be helpful. This was a wonderful session (conference). Thanks you. (1 Count) Really enoyed coming together with fellow case workers. We all agree the meetings of the minds from our various disciplines is needed. Great Job! More SENDSS Training!! (1 Count) Looking forward to next year!! (1 Count) I would like to commend those individual who brought this training opportunity into being. The concept was great and I wishit will continue. The updates and the presentatins were very good. (1 Count) Exceptional job steering committee! I received a wealth of information to share with my health district. Also, the speakers were awesome! I am looking forward to the next PCSI training in 2012. Training request: Grant writing to compete for funding opportunities. (1 Count) &YDFMMFOUXPSLTIPQ&OKPZFEUIFPQQPSUVOJUZUPDPMMBCPSBUFMFBSO5IJTXBTNVDIOFFEFE *USVMMZFOKPZFEUIJTXPSLTIPQMPPLGPSXBSEUPNBOZNPSFJOUIFGVUVSF (SFBUGPPE HSFBUUJNFNBOBHFNFOU &YDFMMFOUDPPSEJOBUJPOPGFWFOUT WFSZQSPGFTTJPOBM 12/01/2011 Class Climate evaluation 102 of 102 Page 4