Using Disease Intervention Specialists to Improve Linkages and Access to Care

By Carolyn Campbell, Anne Arundel County (MD) Health Department

This story originally ran in NACCHO’s Stories from the Field.

Fifty-percent of people in the United States who are living with HIV and AIDS (PLWHA) reside in twelve of the nation’s cities. Frequently listed among the top six of these high-morbidity cities are Baltimore and Washington, DC. Anne Arundel County in Maryland is located immediately south of Baltimore, directly east of Washington, DC, and houses the state capital, Annapolis. Maryland ranked third in the United States for HIV diagnoses rates in 2013, and Anne Arundel County ranked fifth among Maryland jurisdictions for percentage of total newly diagnosed HIV cases. In addition, the county has the fourth highest rates of chlamydia, gonorrhea, and syphilis infections in Maryland. Anne Arundel is similar to many other counties in Maryland in its proximity to both Baltimore and Washington, DC and in its combination of residents– mixing rural, suburban, and urban populations and having a wide range of income levels.

Within Anne Arundel County, HIV infections among men who have sex with men (MSM) have steadily increased over the past few years. Providing partner services, that is, the task of soliciting the names and contact information of sexual partners, locating these partners to let them know they have been potentially exposed to a sexually transmitted infection, and then connecting them to testing and treatment remains particularly important. This task has been made more difficult for a number of reasons, but primarily because of the use of internet dating sites and apps by MSM.

Disease Intervention Specialists (DIS) are the health department staff responsible for this work. DIS use many avenues to collect information about a client. Frequently, they contact healthcare provider(s) or labs, do online searches to locate clients and their partners, and request information from other health department offices. They then contact the patient to arrange an interview. In Anne Arundel County, almost all interviews are done in the field—at a client’s home, at one of the contracted private clinics used by the health department, at a Starbucks coffee shop, in a car, in a restaurant, or in any location where there is privacy and the client feels comfortable that his or her confidentiality is respected.

Unless services are declined by the client, all individuals who have an HIV- or syphilis-positive test take part in a partner services interview. Traditionally, providing partner services has stopped with a referral to care. There are a limited number of infectious disease specialists within Anne Arundel County, resulting in many clients seeking care in Baltimore and Washington, DC. This distance can create a barrier to obtaining care; thus, a referral alone has resulted in HIV-positive individuals either not engaging in care or falling out of care. As a result, Anne Arundel County also uses DIS to link its HIV-positive residents to infectious disease specialists and to HIV case management to improve access to care. Linking a client to care means that DIS help clients schedule their medical visits, provide transportation to a limited number of medical appointments, and, when possible, provide additional support to make sure they are able to attend their visits (e.g., assistance from Case Management in the application process for insurance and other social services). Since DIS have relationships throughout the community, they are well-positioned to expand their role in this way.

There are many small steps a DIS can take to make a major difference in whether or not clients engage in or stays in care. It may be talking for a minute longer, asking them what questions they might have, letting them know what resources are available to them, or simply giving them a call to remind them about their upcoming appointment. There have been many instances when taking only one small step further has made a major difference in whether or not a client gets into and stays engaged in care.

This story originally ran in NACCHO’s Stories from the Field.

World AIDS Day 2016: Local Health Department Leadership, Commitment, and Impact

By Alyssa Kitlas, HIV, STI, & Viral Hepatitis Program Analyst, NACCHO 

This story originally ran in NACCHO’s Healthy People Healthy Places.

The U.S. Government theme for World AIDS Day 2016 is “Leadership. Commitment. Impact.” These themes resonate strongly with the work local health departments (LHDs) do every day to address HIV in their communities.

LHDs are key leaders in providing and assuring access to HIV prevention, care, and treatment for the communities they serve. As community health strategists, LHDs facilitate collaboration between public health, healthcare, social services, and other key stakeholders, such as community organizations and small businesses, to achieve more integrated and effective systems for HIV prevention and care. Over the past few years, this leadership and collaborative work with community partners has led to the successful development of local and state plans for ending the HIV epidemic, such as those for Fulton County (GA), San Francisco (CA), Houston (TX), and the State of New York. The value of health department leadership for reducing new HIV infections and improving outcomes across the HIV care continuum was highlighted in a recent study to generate hypotheses to explain declines in HIV incidence in Massachusetts, North Carolina, San Francisco, and Seattle. Researchers found that the most unifying observation was that leadership within health departments is critical to achieving success. Continue reading

Public Health 3.0: A Challenge for the Nation, a Charge for Public Health


By LaMar Hasbrouck, MD, MPH, Executive Director, NACCHO & Karen DeSalvo, MD, MPH, MSc, Acting Assistant Secretary for Health, U.S. Department of Health and Human Services

What will Public Health 3.0 — new model for building healthier communities across America — mean for the nation’s nearly 3,000 local public health departments (LHDs), as they face the ongoing challenge of tackling the full range of factors that influence each citizen’s overall health and well-being?  NACCHO and the HHS Office of the Assistant Secretary for Health (OASH) are working together to define what this means in practical terms trying to help LHDs refine their efforts to address the social determinants of health in the communities in which they serve. Continue reading

Removing Barriers to Breastfeeding in Niagara County

istock_000000346530_mediumBy Elaine Roman, MA, BSN, RN, IBCLC, ANLC Director, Division of Public Health Planning and Emergency Preparedness, Public Information Officer & Elise Pignatora, MS, CLC Public Health Resource & SNS Support Officer, Niagara County Department of Health

For the past three years, Niagara County (NY) Medical Reserve Corps (MRC) has received the MRC Challenge Award from the National Association of County and City Health Officials (NACCHO) for their breastfeeding initiative, “Energizing Partnerships to Advance Support Networks for Breastfeeding Mothers.” Director of the Division of Public Health Planning in the Niagara County Department of Health Elaine Roman, MA, BSN, RN, IBCLC, ANLC and Public Health Resource and SNS Support Officer Elise Pignatora, MS, CLC led the lactation initiative. The Niagara County Department of Health’s inspiration for this intervention to the 215,000 population community came from the 2011 Surgeon General’s Call to Action to Support Breastfeeding.  “We also looked at the Healthy People 2020 numbers and realized our county was not performing the way we would like it to be in regards to initiation, duration, and exclusivity of breastfeeding in our county,” Roman said. Continue reading

LHD Contributions to the National Health Security are Invaluable and Deserve Recognition

nhsBy Stephen Maheux, Senior Program Analyst, NACCHO

This story originally ran in NACCHO’s Preparedness Brief

National health security is a state in which the nation and its people are prepared for, protected from, and resilient in the face of incidents with health consequences. Local health department’s (LHDs) day-to-day operations impact National Health Security across the country on a regular basis. Every time a staff member run a vaccination clinic or spearheads a disease prevention campaign, these efforts also improve health security. Every time an LHD helps track a disease outbreak or connect people with personal health services, like preventive or health promotion services, the agency gives health security a direct boost. Every time LHD staff plan how to coordinate the delivery of drugs, supplies and provisions to disaster survivors and populations at risk or push a colleague to keep his or her knowledge and skills up-to-date, they are also advancing our nation’s health security. Continue reading

Helping Our Communities Kick the Cigarette Habit – The Great American Smokeout Is November 17, 2016

By LaMar Hasbrouck, MD, MPH, Executive Director, NACCHO

On Nov. 17, local health departments (LHDs) will join the chorus of public health and healthcare organizations urging smokers to quit for just one day as part of the American Cancer Society’s Great American Smokeout campaign. LHDs will lead the charge in their communities by providing evidence-based support and information. According to the American Cancer Society, “By quitting – even for 1 day – smokers will be taking an important step toward a healthier life and reducing their cancer risk.” Continue reading

Using IT to Enhance Public Health Practice and Impact Outcomes

binarycodeBy Informatics Workgroup Chairs Joseph Gibson and Oscar Alleyne, Marion County (IN) Public Health Department and Rockland County (NY) Department of Health

This story originally ran in NACCHO’s Stories from the Field.

Informatics sounds like the name of a class that would put any junior in high school to sleep, and the term is often elusive even to those who work in the field of public health. But the reality is reasonably straightforward given that we live in a world driven by technology where we expect to have information electronically at our fingertips in a moment. Informatics brings to mind complicated algorithms and complex technology, but it simply refers to the use of information technology (IT) to improve a business process or outcome. For public health, this means the use of IT to enhance public health practice and impact outcomes. Continue reading