2009 Model Practice Application (Public)

HIV/Hepatitis/STD, and Immunization Integrated Services

RiverStone Health

Our program sought to integrate HIV, viral hepatitus, STDs, and immunization services at a client level. Our goals were to maximize integrated services to clients; maximize linkage to medical care, treatment, and education to avoid transmission to others; and reduce further rates of transmission by aiding in early diagnosis and treatment of infected patients. We have established outreach testing sites at the county jail,an adult book store, a gay bar,a youth detention center, two massage parlors, two prerelease centers, one addictions treatment facility, two colleges,a youth detention facility,and a tattoo convention. Screening is done on all of our patients with positive STD labs and their partners.

Many young adults in Montana are not aware there is HIV in their age group here, and receive very little HIV education in the schools. Most young people were not aware of the importance of knowing their HIV status. If they had gone into their health care provider they thought the provider would have automatically done an HIV test. Our practice eliminates duplication of services and maximizes staff efforts. This effecient model enables us to give more comprehensive care to our patients by identifying high risk factors, identifying early disease, linking patients to care and treatment, and providing education to avoid transmission to others. In 2003, we had a group of young heterosexual adults between the ages of 19 to 26 who were diagnosed with HIV. Prior to this, our HIV population had been primarily MSMs. In the same year, we had a group of IDUs who became co-infected with hepatitus B and C. Prior to this in Cascade County, 10 drug users had died with co-infection of hepatitis B and C. Because most young adults don’t access the health care system, we developed the model to identify high risk populations and bring the testing to them in the form of outreach testing sites. Our program brings testing and integrated services to the population at risk who otherwise would not frequently access health care. Integrating services in rural health departments is necessary because of inadequate funding and understaffing. There were no model practices that integrated these services at a client level. In the past because of seperate funding streams in areas such as STD, HIV, and viral hepatitus, duplication of services was common and patients were not given comprehensive health care. Our program brings integration of services to the client level and is a more efficient way of using staffing and money.

We provided staff for testing, identified and educated potential high-risk populations, identified and secured appropriate testing sites, educated staff of our partner organizations, provided funding for the outreach projects. The community was essential in allowing the facilities to be used as testing sites, posting testing dates prior to clinics, and coordinating educational presentations for their populations with the public health nurses. Ongoing communication and input by the sites was vital. We offered educational presentations to staff of collaboration partners, and also offered educational presentations to the populations at the sites prior to the outreach clinics to encourage participation.

When we went to the outreach sites, we offered HIV testing, hepatitus C testing, and hepatitus A and B vaccine free of charge. We also did STD testing. Female STD patients were also offered HPV vaccine if eligible. We have continued these outreach clinics since 2003.

When we went to the outreach sites, we offered HIV testing, hepatitus C testing, and hepatitus A and B vaccine free of charge. We also did STD testing. Female STD patients were also offered HPV vaccine if eligible. We have continued these outreach clinics since 2003.

The facilities who allow us to do outreach clinics see it as a community service and a benefit to their clients. We will continue to use public health nurses to staff the outreach clinics. RiverStone Health is committed to the model because of the community benefit of stopping the spread of the communicable diseases.

When we did educational presentations prior to the clinics, participation increased significantly. Hours of the clinics were modified to enable the highest participation of clients possible. When we started in 2003, we did blood draws and our return rate for results was not 100 percent. When the oral swab was made available we began using it. This ensured everyone got their results the day of testing. Between 30 and 40 percent of the jail population tested positive for hepatitis C. Most of the high-risk populations are unaware of the transmission routes of hepatitis. We had to return to the jail as quickly as possible to get them their results before they were released. When we did educational presentations prior to testing, it increased our participation. Not many health care providers in our community treat hepatitus C patients. We switched to a different lab with a faster turnaround time so we could notify patients of their results quicker. We also increased educational presentations to all groups addressing hepatitus C.

Information was not provided in 2009