With the help of his local health department in New Orleans, Jason Halperin, MD, and colleagues are starting patients on ART within 72 hours of their HIV diagnosis — most of them within 24 hours. A recent study showed that the intervention cut the median time to viral suppression by more than half, and he believes its success can be replicated in other clinics around the country.
“I want to demonstrate to people that this can be done in the resource-poor areas of this country, like the South,” Halperin told Infectious Disease News.
“We really are on the frontlines of the HIV epidemic in the United States,” Halperin said.
Halperin oversees HIV services at CrescentCare, federally qualified health center that runs a large pre-exposure prophylaxis clinic in the city with almost 900 active patients. They conduct approximately 10,000 HIV tests in the community each year. The disease predominantly affects young black men who have sex with men, and the core of their work is committed to this population, he said.
Before the intervention, patients with an HIV diagnosis had to wait 4 to 5 weeks before starting ART, which Halperin suggested is “better than average,” but the lapse still increases the risk for HIV transmission. There are several reasons for the delay, he said. First, it can take up to 2 weeks or more to sort out patients’ insurance, which is often provided through the Ryan White HIV/AIDS program. Second, providers frequently choose to postpone treatment until they know the status of their kidney and liver functions and their CD4 cell counts. HIV drug-resistance testing is also recommended for patients with HIV before selecting an ART regimen, tacking on even more time. Finally, the price of the medication and whether payers will even cover the expense is yet another challenge.
“I really had to lay out all these barriers to start dismantling them,” Halperin said.
With the expansion of Medicaid in Louisiana in 2016 — “a gift from the heavens,” according to Halperin — the clinic could enroll patients in Medicaid services on the same day as their HIV diagnosis. In December of that year, they started a test-and-start strategy called the CrescentCare Start Initiative (CCSI), which links newly diagnosed patients with a treating provider and starts them on ART within 72 hours, ideally within 24. But first, they needed help from the city’s health department.
“So, I got in touch with the Office of Public Health (OPH), and I said, ‘This is our plan: I guarantee that we are going to have a higher rate of linkage and an impact on our time to viral suppression and hopefully 2-year data that show retention and sustained viral repression,’” Halperin said. “‘What I need from you is that when I fax you the form for Ryan White services, you fax it back within an hour. I don’t care how you figure it out, but if you can do it, I can see these patients [within 24 hours].’”
CrescentCare proposed to use Ryan White funds to cover the first 30 days of patients’ medication, giving them 4 weeks to figure out how to refill the prescriptions. The OPH agreed.
“So now, within an hour of a diagnosis I can get patients Ryan White services,” he said. “I can get them signed up for Medicaid if they meet criteria, and 4 weeks of medication are provided.”
Halperin argued that knowing the genotype was unnecessary before starting patients on ART because evidence suggests there is a low risk for resistance to the integrase inhibitor Tivicay (dolutegravir, ViiV Healthcare), which is used in combination with Descovy (tenofovir alafenamide/emtricitabine, Gilead Sciences). In addition, if lab work comes back within 24 hours and indicates that a patient has kidney damage, they can be switched to a new regimen.
In 2016 the state was only second to Georgia for the highest number of new HIV diagnoses. The rate of new cases was 29.7 per 100,000, according to the Centers for Disease Control. One out of five people do not know they are infected in Louisiana.
If current HIV diagnoses persist, one in two black men who have sex with men (MSM) and one in four latino MSM will contract HIV in their lifetime, according to CDC data.
Although highly treatable, the virus which attacks the immune system as it progresses into Auto Immune Deficiency Syndrome (AIDS), can also be prevented.
First approved in 2012 a medication called PrEP or pre-exposure prophylaxis, has been marketed to patients who are at substantial risk of HIV infection. The medication has shown to reduce the risk of HIV transmission by up to 92 percent, according to the CDC. PrEP has also been marketed in New Orleans, but health workers have found several barriers that have made it difficult to access high-risk patients locally.
“There is still so much stigma surrounding HIV in general. Patients feel ashamed to come to their doctor to ask for PrEp. Some people feel that they can’t afford it,” said Dr. Stacy Greene, the Associate Medical Director at St. Thomas Community Health Center. He is also an infectious disease expert.
St. Thomas Community Health Center and CrescentCare are two of the largest providers that can prescribe PrEP in New Orleans.
This weekend, St. Thomas Community Health Center along with the Bureau of Infectious Diseases for the Louisiana Department of Health will host a two-day symposium for primary care givers and health workers on the subject of PrEP and the HIV epidemic in Louisiana, offering information about the high-risk populations in Louisiana that would benefit from the medicine, how they can cover the cost of the prescription, and how to implement an HIV prevention plan.
The event is open to primary care physicians, health workers and individuals interested in learning more about the HIV/AIDS epidemic in Louisiana and will take place at the Hilton Riverside in New Orleans on Fri. March 2 to Sat. March 3 at 8 a.m. A link to the agenda is available here.
“Despite low awareness, primary care providers are already writing more prescriptions for PrEP than are specialists. If more family physicians and other primary care providers feel comfortable prescribing PrEP this strategy for reducing HIV pervasiveness may reach more people who are vulnerable to infection,” said Dr. Greene.
Maria Clark covers healthcare and immigration for NOLA.com | The Times Picayune and NOLA Mundo. Reach her at firstname.lastname@example.org or 504.258.5306.
54,000 Square Foot Health Home at 1631 Elysian Fields is Being Constructed to Revolutionize Health Outcomes in New Orleans.
January 10th 2018 – CrescentCare, a Federally Qualified Health Center which grew out of the NO/AIDS Task Force, has grown at an exponential pace in the past few years. To meet growing need, the agency made plans to build a new health center which will more than double its capacity to serve the community. The new site is going up at 1631 Elysian Fields, and by early 2019 will be offering primary medical care, dental care, behavioral health, and other supportive services for the greater New Orleans area. To complete the building, the agency needs $4 million more of the total cost, approximately $32 million. CrescentCare is turning to the community for this vital funding.
To a room of about a hundred long-time advocates and supporters, CEO Noel Twilbeck introduced the campaign, dubbed Deeply Rooted / Branching Out at Ralph’s on the Park Wednesday evening. An ask for funding was made, but he also requested help in spreading the word and enthusiasm about the necessity of this health center.
Twilbeck States, “This project will ultimately make an incredible impact on the community. As the campaign title suggests, we are poised to offer high-quality services we’ve cultivated over our decades of serving the community to thousands more—every contribution to this campaign will change lives, without question.
CrescentCare’s health homes present valuable opportunities for individuals and families in the neighborhoods surrounding them to access quality services which might otherwise be out of reach. Additionally, the centers operate at various hours that make it possible for workers in the service industry to be seen outside of traditional business hours. The 8th Ward neighborhood and the community at-large stand to reap significant benefits from this facility.
Rodney Thoulion, Director of Development for CrescentCare Remarks: “We are in a great position because sometimes campaigns like this have to start completely from scratch and it can take a long while for the facilities to go up. Because of our incredible partners, we’ve already got work started, so anyone can see where the efforts are going—just drive past the building on Elysian Fields and you can see the future of CrescentCare.”
The new facility is funded in part by New Market Tax credits provided by the Primary Care Development Corporation, Hope Enterprises, and Chase. Gould Evans serves as the artchitects and contractors. Donahue-Favret have been instrumental in the project.
At the conclusion of the event, one donor provided a $50,000 contribution to get the ball rolling. CrescentCare hopes to have more soon.
“We’re going to need a lot more like that,” said Alice Riener, Chief Legal and Policy Officer for CrescentCare, “Just like in the healthcare setting, there’s more work to be done, but it’s worth it, and we’re excited to share this project with the community. In the current policy environment, accessible, high-quality healthcare for everyone needs to be a whole-community priority.”
Individuals and groups interested in contributing to CrescentCare’s mission and the building of this new facility are encouraged to contact Rodney Thoulion, Director of Development at email@example.com or 504.821.2601 ext.
WHERE: New Facility Being Constructed at 1631 Elysian Fields
WHEN: Ongoing throughout 2018
CONTACT: Rodney.Thoulion@crescentcare.org or 504.821.2601 ext
The fundraising events carried out by individuals, like yourself, are what makes our services possible. The fundraising possibilities are endless, but one thing remains the same; every dollar raised will go towards the needs of our clients.
On Thursday, June 07, kick off New Orleans Pride by doing what we do best in New Orleans – going out to eat with your friends and family. What could be easier than Dining Out For Life to help raise money for the programs and services of NO/AIDS Task Force?