The VDH admired IPHI’s success in supporting the Fairfax County Health Department’s (FCHD) COVID-19 response and recovery containment efforts over the preceding 15 months.

Within six weeks, IPHI recruited, hired, trained, and deployed nearly 200 COVID-19 case and contact investigators to support 21 health departments. This hiring surge was in addition to over 150 additional hires to bolster FCHD’s existing response and recovery efforts to the fall 2021 COVID-19 surge.

IPHI employed over 450 pandemic response workers to support local health departments with:
• case investigators
• contact interviewers
• community health workers (CHWs)
• epidemiologists
• call center staff
• environmental health specialists
• various management and administrative staff

IPHI created a customized Case and Contact Investigator training. The training focused on COVID-19 isolation and quarantine protocols, vaccine education, motivational interviewing, and role-playing.

The hands-on training worked to prepare and deploy staff as quickly as possible to assist with emergency response. Staff also participated in self-guided COVID-19 courses offered by Johns Hopkins University and received extensive training with experienced field regional trainers. After assisting with the pandemic response since June 2020, IPHI has expertise in supporting governmental disease investigation, containment, and systems for rapid workforce scale-up and deployment.

Many of the IPHI team members progressed to permanent public health workforce in various non-profits, government health agencies, and federal agencies. The goal of IPHI’s public/private pandemic response partnerships was to provide immediate and cost–effective workforce expansion for government public health response and to develop models for effective emergency response that can be replicated.

 

The HEAL Cities and Towns Campaign provides free technical assistance and training to help municipal leaders in Maryland’s and Virginia’s cities and towns adopt policies that improve their communities’ physical activity and food environments.

Here’s how it works: 

Educate: Campaign staff help local government leaders understand their role in creating healthy communities. We help them recognize how health behaviors are affected by the environments in which we live, work, and play, and how, as government leaders, they can implement policies and practices that promote healthy eating and active living in those environments.

Assess: We then work with municipalities to help them assess how their existing policies and practices affect the community’s health, and provide a menu of policies and practices that identify new opportunities to promote healthy eating and active living among their residents and government employees.  Recognizing that both the interests and needs of cities and towns vary widely throughout the region, the HEAL Cities & Towns Campaign provides free technical assistance on a wide range of policies and practices — from planning pedestrian and bicycle friendly streets to the adoption of healthy vending policies.

Adopt: As a first step to taking action on creating healthy, more prosperous communities, municipalities articulate their new policy and practice goals in a HEAL Resolution. This Resolution serves as a roadmap to improving the municipality’s physical activity and food environments. Campaign staff provide free technical assistance as the municipalities work to implement their Resolution goals. Technical assistance includes: working with HEAL staff in-person or over-the-phone; presentations, model policies, fact sheets, webinars, training, and marketing materials.

Current Campaign Status

Currently, 65 local jurisdictions in Maryland and Virginia, covering nearly 2 million people, have adopted resolutions and other policies and practices to shape their communities into places where it is easier for residents and employees to make healthy choices about physical activity and nutrition.

The HEAL Cities & Towns Campaign for the Mid-Atlantic is part of a growing national campaign that is also taking place in California, Oregon, and Colorado. IPHI embarked on this initiative in 2012 with funding from Kaiser Permanente, a founding partner, and a strategic partnership with the Maryland & Virginia Municipal Leagues.

 

The goal of EIS & P4P is to decrease the number of under-resourced individuals with HIV/AIDS by increasing access to care. EIS & P4P also provide the added benefit of educating and motivating persons living with HIV on the importance and benefits of getting into and staying in HIV care.

The Institute for Public Health Innovation offers community health worker (CHW) models of early intervention services in Virginia.

IPHI employs four CHWs in Northern and Northwest Virginia to facilitate access to HIV medical care and social services for people living with HIV/AIDS (PLWHA). The project has an emphasis on populations that often face barriers to entering and remaining in care, potentially including communities of color, women living in poverty, immigrants, individuals with substance abuse or mental health challenges, the homeless, young gay and bisexual men, those recently released from prison/jail, and others.

CHWs pursue various short-term activities, typically lasting 3-6 months, until new or disengaged consumers fully engage in HIV care. Our CHWs:

• Find people living with HIV/AIDS who are not currently receiving medical care;
• Build peer-based trust and provide information about living with HIV;
• Provide personalized assistance to help PLWHA enter and navigate service systems; and
• Support PLWHA throughout the early part of their care until they become fully engaged in that care.

CHWs as part of inter-disciplinary teams:

Northern Virginia EIS and P4P CHWs are based at community-based and medical sites and work closely with clinical and case management staff. This is critical so they can effectively identify the clients to focus on and coordinate CHW support services with those of the case manager and other staff.

Presently IPHI CHWs are placed at:

• Fredericksburg Area HIV/AIDS Support Services (FAHASS)
• AIDS Response Effort (ARE)
• Alexandria Neighborhood Health Services Inc (ANHSI)

Some CHWs cover non-clinical points of entry, including testing sites and various community-based organizations, and partner with clinical sites and hospitals to support community outreach and linkage to care, including:

• INOVA Juniper Program
• The Infectious Disease Clinic of Mary Washington Hospital
• NOVA Salud
• Fauquier Clinic
• Health Departments across Northern Virginia

IPHI conducts evaluation for these projects, and analysis captures process outcomes and client-level outcomes for these initiatives.

This project is funded by Ryan White Part A funds through the Northern Virginia Regional Commission and by the Virginia Department of Health.

In 2017, these community partners collaborated to collect data, engage residents, identify common themes, and analyze trends to better understand the region’s health status.

IPHI’s linkage to and retention in care programs aim to:

1. Link people who are not in medical care to a medical home;
2. Increase the frequency of medical visits for all people living with HIV/AIDS to meet the recommended guidelines for HIV care; and
3. Increase the likelihood that people living with HIV will stay in medical care for a lifetime. This lifetime care is increased by connecting patients to resources to address barriers to using care, increasing HIV literacy, and creating treatment self-efficacy and a self-value of staying in care.

Trained Peers to Complement Conventional Medical and Outreach Strategies

Since the beginning of the HIV epidemic, community health workers (CHWs) have been an essential component of the HIV care and prevention system. In 2011, IPHI developed and managed several broad-scale CHW initiatives to increase HIV care use in the District of Columbia, Northern and Northwest Virginia, West Virginia, and Prince George’s County, Maryland. These interventions have systematized the use of CHWs as integral members of medical and HIV care teams across the region.

CHWs worked at host organizations and in the community to identify individuals who are HIV positive and not receiving HIV medical care. Through these relationships, CHWs have

• Built trust and inform patients about living with HIV;
• Provide personalized assistance to help access medical care; and
• Support throughout the early part of care until they are fully involved.

Through the early intervention and retention in care work, IPHI has had formal partnerships with 18 community and medical organizations and 30+ HIV-specialty CHWs. Nearly 20 of those CHWs are IPHI employees placed at partner sites. Through these programs, the team has reached thousands of regional residents.

CHWs are expected to work closely with clinical and case management staff. This allows CHWs to effectively identify eligible clients and coordinate CHW support services with case managers, nurses or physicians, and other staff. Some CHWs cover non-clinical points of entry, including testing sites and various community-based organizations.

Evaluation

IPHI support also includes evaluation for all projects. The team works with contracted evaluators, often with the support of national evaluation teams, to assess the processes and outcomes of initiatives. IPHI has developed internal data collection systems, policies, and procedures to support the safe collection of confidential data by CHWs by HIPAA standards. IPHI CHWs utilize mobile technology to collect and submit real-time data for processing and analysis.

Examples

• Positive Pathways – District of Columbia
• Total Health Partners – Prince George’s County, Maryland
• Early Intervention Services (EIS) and Prevention for Positives (P4P)– Northern Virginia
• WeConnect – D.C., MD, VA, and WV

The strategies included:

• Recruiting, training, and placing 6-8 community health workers (CHWs) at clinical and community-based host sites across the EMA;
• Interconnecting with IPHI’s existing CHW initiatives in D.C., Northern Virginia, and Prince George’s County to create an integrated regional system;
• Concentrating new CHWs in areas with unmet needs, unique barriers to care, and limited existing EIS resources;
• Creating a broad regional network of providers; and
• Integrating group-based psychosocial support and transportation services in strategic locations and for key populations.

WeConnect CHWs are currently placed at the following sites across the EMA:

• MedStar Washington Hospital Center in Washington, D.C.
• Us Helping Us in Washington, D.C.
• Prince George’s County Hospital – Glenridge Clinic (Dimensions Hospital System)
• Prince George’s County Health Department, Maryland
• Montgomery County Health Department, Maryland
• AIDS Response Effort serving Northwest Virginia and West Virginia
• Shenandoah Community Health in Martinsburg, West Virginia

In addition, psychosocial services through CHW-facilitated psychosocial support groups will be offered at:

• La Clínica Del Pueblo, Washington D.C.
• Us Helping Us, Washington D.C.
• Alexandria Neighborhood Health Services, Virginia
• Fredericksburg Area HIV/AIDS Support Services, Virginia
• Shenandoah Community Health, West Virginia

Evaluation

IPHI evaluates these projects, and analysis captures the process and client-level outcomes for these initiatives. By integrating this new project into IPHI’s existing HIV linkage and retention in care activities, IPHI is leading a regional EIS system that includes over 30 CHWs covering nearly every jurisdiction in EMA.

The effort was a partnership with:

• Heart to Hand Inc., a community-based organization
• Greater Baden Medical Services, a Federally Qualified Health Center
• University of Maryland Prevention Research Center
• Prince George’s Hospital – Glenridge Clinic (Dimensions Health System)

IPHI employed five community health workers (CHWs) in PGC who pursued various short-term activities. The CHWs typically worked 6 – 12 months or until program participants were fully engaged in HIV care. Total Health Partners CHWs:

• Found people living with HIV/AIDS (PLWHA) who were not receiving medical care;
• Built peer-based trust and provided information about living with HIV;
• Provided personalized assistance to help PLWHA enter and navigate service systems;
• Supported PLWHA throughout the early part of their care until they became fully engaged in that care; and
• Facilitated linkage to housing and financial wellness training workshops.

The model also incorporated a training series, “My Health, My Life, My Future,” for clients on housing, financial capability, and promotion of mental health and wellness.

AIDS United funded Positive Pathways through a 5-year grant from the Social Innovation Fund, a federal initiative based at the Corporation for National and Community Service. Other funders provided matching funds, including the Consumer Health Foundation, D.C. Department of Health, John Edward Fowler Memorial Foundation, Kaiser Permanente of the Mid-Atlantic States, M∙A∙C AIDS Fund, Morris and Gwendolyn Cafritz Foundation, and World Bank

Watch the Positive Pathways development video below:

Using Trained Peers to Complement Conventional Medical and Outreach Strategies

Positive Pathways established a network of trained peer community health workers (CHWs) who were placed in clinical and non-clinical settings with the goal of identifying and supporting out-of-care HIV-positive individuals. Positive Pathways sites included AmeriHealth Caritas DC, Family & Medical Counseling Services, Whitman-Walker Health, The Women’s Collective, and Unity Health Care, among others.  CHWs focused on building peer-based trust and informing individuals about living with HIV, providing personalized assistance to help them enter and navigate service systems, and supporting them throughout the early part of their medical care until they became fully engaged.

Over 75% of Positive Pathways clients were women.  

Positive Pathways evaluation results showed that 12 months after enrollment, 78% of participants had a suppressed viral load.  The evaluation also showed a reduction in particular reported needs after 12 months in the program. For example, at 12 months, the percentage of program participants needing housing or shelter was cut nearly in half to 13%. Similarly, participants reported reductions in barriers to care at 12 months compared to enrollment. At enrollment, 13% of clients cited no barriers to care, compared to 49% percent of participants after 12 months in the program.