FOCUS RENEWAL PROPOSAL TEMPLATE HIV-HCV-HBV_MARICOPA COUNTY CORRECTIONAL HEALTH SERVICES_06112018_UPDATE.PDF

FOCUS
Frontlines of Communities in the United States
Partnership Continuation Form
HIV, HCV & HBV Screening
Part I
1. Contact Summary and Project Summary
Name of applicant organization: Maricopa County Correctional Health Services
Legal name of applicant organization: Maricopa County
Name of Project Director / Key Contact: Dr. Grant Phillips
Telephone: (602) 876-7114
E-mail: G.Phillips@mail.maricopa.gov
Application date: May 3, 2018
Prior Year’s Budget: $348,944
Budget Requested: $436,032
2. Project Summary:
Please provide a brief summary of 2-3 key accomplishments of your FOCUS project; include
objective progress made towards testing goals and other key findings. As part of your summary,
please describe how this proposal represents an improvement or expansion from your current
practice. Limit 500 words:
Over the past year Correctional Health Services (CHS) has implemented procedures to offer
Hepatitis C testing to all inmates remaining in the jail for at least 5 days. Testing is being offered
between incarceration days 5-7. Based on the information gathered from this last year of testing
we have learned that approximately 20% of jail population are infected. We have improved
provider proficiency at delivering linkage to care, educating patients, engaging in substance use
counseling, and coordinating discharge planning.
In the coming year CHS will expand the program to include HIV testing. By offering opt-out HIV
screening to all inmates on day 5-7 of booking, this will allow for a large scale screening
program and linkage to care while in Maricopa County Jails. The number of daily bookings into
jail are up to 300 inmates per day, with an average daily census of 7,500. This large scale
screening program will help identify new cases of HIV, working in concert with the public health
department in education and prevention of the spread of HIV and other diseases. Depending on
the length of stay in jail, a linkage to care appointment will occur, along with follow up testing to
verify the diagnosis of HIV. Once the diagnosis is confirmed, then arrangements can be made
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for treatment, as well as coordination with community partners. This will include ‘reach-in’
services to schedule social services and medical care upon leaving incarceration.
Part II
1. Summary of Proposed Reach
Please populate TABLE 1 summarizing your proposed reach for the partnership continuation as well as
your prior year’s screening and linkage to care outcomes for comparison. (Please define baseline period,
i.e. from Month/Year to Month/Year).
Note: FOCUS supports HIV, HCV, and HBV screening in patient populations identified by CDC and
USPSTF recommendations as well as screening models intended to develop new and replicable best
practices. It is the responsibility of each FOCUS Partner to evaluate the patient population it serves and
to determine the appropriate scope of its proposed screening model.
TABLE 1
HIV PROPOSED REACH PRIOR YEAR’S REACH (M/Y-M/Y))
# Eligible Patients 9,952 8,543
# HIV Tests Conducted 9,952 5,659
# HIV Positives Identified 50 27
# Acute HIV Cases Identified Unk Unk
# or % HIV+ LTC 45 23
HCV PROPOSED REACH PRIOR YEAR’S REACH
(M/Y-M/Y)
# Eligible Patients 9,952 6,165
# HCV Tests Conducted 9,952 6,165
# HCV AB+ Identified 2,268 1,365
# HCV RNA + Identified 1,905 1,059
# HCV RNA+ LTC 1,121 635
2. Tabular summary of changes/ expansion/ improvements over current practice
In the TABLE 2, please summarize current practices related to your systems and processes for HIV,
HCV, and/or HBV testing and linkage to care and proposed practices/ improvements over current.
Note: Clinical projects must address each component of the TEST Four Pillars framework below as part
of the tabular summary.
TEST Four Pillars Summary:
Pillar I: Testing integrated into normal clinic or work flow - to promote the normalization and
sustainability of routine testing. An integrated testing model is one that is not dependent on dedicated
testers and is fully integrated into regular patient flow. Please attach a proposed flow chart of how the
test will be integrated into clinic flow (see Appendix C1 and C2 is an example of best practice automated
flow).
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Pillar II: Electronic Medical Record (EMR) modification - to prompt testing, automate processes,
populate lab-orders, and track performance. FOCUS encourages the use of smart EMR algorithms to
automate the screening process; this includes automation of eligibility criteria for testing, auto-population
of lab order forms to cut down on human error, improved tracking of testing outcomes, and scaling up
testing.
Pillar III: Systemic Policy Change - a multi-level, organization-wide commitment to implement routine
HIV and/or HCV, and/or HBV testing and linkage to care.
Pillar IV: Training, Feedback and Quality Improvement - to identify and reinforce best practices and
motivate staff.
TABLE 2
CURRENT PRACTICES PROPOSED UPDATES / ENHANCEMENTS
Current EMR System: TechCare EMR System:
1. Development of HIV Specific Form
Current Test Technology: 2. Development of HCV report
3. Development of HIV report
Test Technology:
4. Project Data Reporting
Beginning in 2016, Project Data will be submitted to Gilead or Gilead’s designee on a quarterly basis.
The specific data elements have been revised for 2016; they can be found in Appendix D. Monthly top
line data will also be reported to the Regional Lead. Specific monthly top line data can be found in
Appendix D.
5. Dissemination Plan
It is critical to share best practices and lessons learned to advance understanding of screening and
linkage to care. Please use the following table to outline all opportunities you will seek to disseminate
your work at local, regional, national, and international conferences and through publications and other
efforts. Add rows as needed.
TABLE 3: Planned Conferences, Presentations and Publications
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Local or Regional Opportunities Presentation Title/ Content
Submission Timeline
to Share Best Practices area
Routine Opt-Out Screening in
Arizona HIV State Symposium March 2018
Urban Jail
Abstract or Manuscript Title
Conference or Publication Name Timeline
/content area
National Commission on
TBD November 2018
Correctional Health Care
National Commission on
Correctional Health Spring TBD April 2019
Conference Conference
Part III
Goals, Sustainability Plan & Timeline
A. Plans for sustainability. Please describe your plans to sustain the efforts described within
your organization. For example, specify whether your organization can ultimately be supported
through improvement of billing systems; and/or policy change at the system level leading to
sustained effort within your organization. Limit 150 words.
B. Goals & Activities Timeline. Please provide a detailed timeline outlining key goals and
expected timeframes. Please be sure to include specific milestones/benchmarks of progress in
timeline (Appendix B - timeline template).
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Part IV
Proposal Budget
Important Notice. This continuation award and any ancillary project support are not provided as an
inducement or reward for the purchase, use or recommendation of any product manufactured or
marketed by Gilead Sciences, Inc. or to promote such products (and Organization shall not promote
Gilead products, directly or indirectly). Gilead may be required to post or report to government entities all
amounts disbursed to your organization under this partnership including any salaries, consultant fees,
travel, and meal expenses paid to physicians and total grants to teaching hospitals.
The interim and final reports will contain, in addition to a compilation of the project data, an accounting of
all FOCUS program expenditures as compared to budgeted amounts.
Budget Instructions
• Continuation budgets are expected to show efficiencies over prior year’s budget (i.e., lower costs
due to systemic enhancements in prior year that has been sustained).
• Line-item budget (sample table follows is available in MS Excel.)
• All personnel listed on the project are expected to dedicate the projected amount of time on the
project. (See notice above regarding payments to physicians and teaching hospitals.) The following
should be attached to each proposal that includes personnel expenses:
o Verification of salary of any existing personnel
o A detailed FTE analysis (sample follows)- for each individual employee describing the specific
tasks and time commitments expected
• Office supplies is considered part of the total allowable indirect costs/administrative overhead and is
not allowed as a separate line item
• National travel expenses are limited only to conferences and meetings to which there is an accepted
abstract and where the organization will be presenting on outcomes related to its FOCUS project.
Please include travel for at least 2 senior level staff members to attend the FOCUS National
Summit. Travel expenses should include only reasonable and modest transportation, meal, lodging,
and conference registration expenses, and should be estimated as closely as possible.
• Indirect rate is limited to a maximum of 10%
• Budget Justification. Please add a succinct description and justification of each budget item. For
all personnel, briefly outline their role and percentage of time on the project. Please note that
percentage of time dedicated to the project should reflect the actual amount of time and effort that
the personnel will dedicate to their role in the project. In addition, please describe in detail any
budget line-items dedicated to EHR modifications or upgrades
Other Funding. FOCUS supports the use of alternative funding streams for testing supplies or other
program costs. Please describe any other funding sources that support HIV and/or HCV, and/or HBV
screening and/or Linkage to care at your organization. Please be specific about funding amount and
what is supported. If none, please indicate as N/A.
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Appendix A- Budget
Maricopa County Correctional Health Services
Organization Name
Budget Period: 7/1/18 – 6/30/19
Name of Program HCV/HIV Screening at Maricopa Jail
Gilead Non-Gilead
Item Description (describe item and how
BUDGET ITEM the total cost per item was calculated) Program Funding In-Kind Support
Budget Support
PERSONNEL (Name and Include % FTE and # months on project
Title)
Medical Assistant 1 FTE, 12 months, Full Salary $37,139, jail $37,139 $0 N/A
site M-F
.5 FTE 12 months, full salary $91,872, jail
Registered Nurse $45,936 $0 N/A
site M-F
Infection Control Data
Manager .22 FTE, 12 months, Fully Salary $ 83,686 $15,091 $0 N/A
Physician 0.01 FTE, 12 months, Full Salary $179,861 $0 $0 N/A
Fringe Benefits 19.45% Variable Benefits ($19,093)
$40,078 $0 N/A
$11,856 Fixed benefits per FTE ($20,985)
Subtotal Personnel $138,244 $$0 N/A
OTHER DIRECT PROJECT
COSTS
HIV testing including confirmatory testing
HIV Testing $102,620 $0 N/A
(7,000 @ $14.66)
HCV Testing HCV Ab 9,952 tests/year @ $9.28 $92,355 $0
HCV RNA 2,268 tests/year @ $27.85 $63,174 $0
Subtotal Other Direct Costs $258,149 $0 N/A
PURCHASED SERVICES
N/A N/A N/A N/A N/A
Subtotal Purchased Services $0 $0 $0
Indirect Rate Not to exceed 10% $39,639 $0 N/A
TOTAL PROGRAM BUDGET REQUEST $436,032 $0 $0
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FTE Analysis
For each healthcare provider on the budget, please use the below table to complete an FTE analysis. The
descriptions should include tasks completed on a monthly basis for the FOCUS partnership. Such tasks
include, but are not limited to, weekly meetings with staff, data and CQI analysis, monitoring EMR
modifications, etc. The following provides a sample calculation.
Provider, Title: Dr. John Smith, M.D., MPH, Principal Investigator and Project Director
Description of Task(s) Hours Per
Month
(160 hours per
FTE)
Medical Assistant/CHT – 5 of these at 21% FTE 168 hours
Prepare daily list of patients to be pulled for lab draws, offer opt out testing, draw
the labs, and prepare labs to be sent to lab
Infection Control/Admin Costs – 22% FTE 38 hours
Review data and outcome
Prepare daily notification of normal/negative results to patients
Enter vaccination data into patient HER and state immunization database
Collect data to prepare monthly administrative reports
Provider 1.5 FTE 240 hours
Review patient data, meet with patients to discuss treatment options
Total Hours 23 hours
Total FTE (Hours divided by 160 hour work month) 14% FTE
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APPENDIX B - TIMELINE TEMPLATE (Please populate activities that are specific to your
project and organization)
Mo Mo Mo Mo Mo Mo Mo Mo Mo Mo Mo Mo
GOALS AND ACTIVITIES nth nth nth nth nth nth nth nth nth nth nth nth
1 2 3 4 5 6 7 8 9 10 11 12
Testing, Linkage and Tracking /Person
Responsible
e.g. pilot test clinic/work flow / Project Dir.
e.g. Policy Update/ Launch / Project Dir
e.g. Provider training
e.g. Testing begins
e.g. Hire Staff
EMR modification
e.g. Develop and program smart screening
algorithm
e.g. Create CQI testing reports to track progress
Dissemination
e.g. Develop abstract and submit for conference
X, Y, Z
Monitoring & Evaluation
e.g. Integrate HCV LTC into medical director’s
monitoring
e.g. Feedback on LTC performance to sites
Program Administration
e.g. Task Force conference calls/meetings
FOCUS Quarterly Data Report Submission
FOCUS Interim Report Submission
FOCUS Final Report Submission
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Appendix C 2- Policy Driven Screening: Automated flow for HIV, HCV and HBV testing
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Appendix C 1- Policy Driven Screening; Automated flow for HIV, HCV, HBV testing with verbal
notification of HIV test
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Appendix D
Project Data
Organization will submit the following Project Data to Gilead or Gilead’s designee (which may include
ICFI, Inc.), on a quarterly basis:
Aggregate Summary Variables (where applicable)
All Tests
• Clinic/Site Name
• Month and Year of Project Data
• Data Reporting Quarter
• Unique Number of Patients(clinical settings)
HIV Tests
• Unique Number of Clients/Patients Eligible for HIV Testing (clinical settings)
• Number of HIV Tests Performed
• HIV Test Results of Clients Tested (positive, negative, indeterminate, or no result)
• Number of Clients Testing HIV Positive Linked to Care
• Number of Individuals Testing HIV Positive with Diagnosed Acute Infection (Ag/Ab +, Ab –, HIV
RNA + Test Result)
HCV Tests
• Unique Number of Clients/Patients Eligible for HCV Testing (clinical settings)
• Number of Clients Born Between 1945-1965 (Birth Cohort) Tested for HCV Ab
• Number of Clients Born Outside of the Birth Cohort Tested for HCV Ab
• HCV Ab Test Results of Clients Tested (positive, negative, invalid/indeterminate/no result)
• Number of Clients Testing HIV Positive Linked to Care
• HCV RNA Test Results of Clients Tested (positive, negative, invalid/indeterminate/no result)
• Number of Individuals Testing HCV RNA Positive Linked to Care
HBsAg Tests
• Unique Number of Clients/Patients Eligible for HBV Testing (clinical settings)
• Number of HBsAg Tests Performed
• HBsAg Test Results of Clients Tested (positive, negative, invalid/indeterminate/no result)
• Number of Clients Testing HBsAg Positive Linked to Care
Test-Level Variables for Positive Clients/Patients Only (where applicable)
All HIV, HCV ab, or HBsAg Positive Clients/Patients
• Client ID (de-identified in accordance with HIPAA)
• Clinic/Site Name
• Data Reporting Quarter
• Year of Birth of Positive Client/Patients
• Race and Ethnicity of Positive Clients/Patients
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• Gender of Positive Clients/Patients
HIV Positive Clients (tested or not tested)
• Previous HIV Test Result
• HIV Test Conducted
• HIV Test Result
• Linkage to Care: First Appointment Kept (Y/N)
• Reasons First Appointment Not Kept
• Possible Mode of Transmission
HCV Antibody Positive Clients (tested or not tested; where applicable)
• Ever Injected Drugs (only for clients not in birth cohort)
• Previous HCV Ab Test Result
• HCV Ab Test Result
• HCV RNA Test Conducted by Partner
• HCV RNA Test Result
• HCV RNA Positive Client/Patient Newly Identified
• HCV RNA Positive Clients/Patients Linked to Medical Care: First Appointment Kept (Y/N)
• Reason First Medical Appointment Not Kept
• HCV Positive (Ab or RNA)/HIV Co-Infection? (Y/N)
HBsAg Positive Clients (tested or not tested)
• Country of Origin has a HBsAg prevalence >=2%
• Ever injected drugs (only for clients not from country with HBsAg prevalence>=2%)
• HBsAg Test Result
• Linkage to Care: First Appointment Kept (Y/N)
• Reasons First Appointment Not Kept
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Monthly Top Line Estimate Data
HIV
HIV Tests Performed
HIV Positive Patients Identified Through Testing
Diagnosed Acute HIV Infections
HIV Positive Patients (identified through testing) Attended First Appointment
HCV
HCV Ab Tests Performed
HCV Ab Positive Patients Identified Through Testing
HCV RNA Tests Performed
HCV RNA Positive Patients Identified Through Testing
HCV RNA Positive Patients (identified through testing) Attended First Appointment
Hepatitis B
HBsAg Tests Performed
HBsAg Positive Patients Identified Through Testing
HBsAg Positive Patients (identified through testing) Attended First Appointment
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