1、Integration of HIV/AIDS, STD, TB and Viral Hepatitis New York States Experience,Guthrie S. Birkhead, M.D., M.P.H. Director, AIDS Institute Director, Center for Community Health NYS Department of HealthExternal Consultation: Program Collaboration and Service Integration Atlanta, GA August 21-22, 2007
2、,Why Integration?,An effective way to plan programs and services from the perspectives of: Common risk factors; Same people being served; Same providers in the community. Recognize multi-factorial nature of disease causation and risk Make most efficient use of scarce resources,NYS DOH Org Chart,NYS
3、Organizational Matrix For HIV/STD/TB/Hepatitis,Division,Division,Bureau,Important Related Offices for Integration,Department of Health Medicaid Managed Care Science and Public Health Hospital regulation Other State Agencies Correction Alcoholism and Substance Abuse Services Mental Health Parole Othe
4、r Pubic hospital system,Evolution of Program Integration, New York State,Mid -1980s AIDS Institute formed AIDS Surveillance/Epi = Epi Division Enhanced Medicaid $ = AIDS Institute Early 1990s Address heavy impact of IDU on HIV HIV testing/care collocated with substance abuse treatment services = AID
5、S Institute/OASAS Mid -1990s Provide partner notification HIV partner notification program = STD program Late 1990s / Early 2000s Hepatitis Work Group Hep vaccine Immunization Program + STD + HIV/IDU prgs. Hep surveillance = Epi division Hep C coordinator moved Epi = AIDS Inst,Multiple Approaches to
6、 Program Integration,Structural Pros: Better align major players Cons: cant be relied on to address all integration issues; reorganization can lead to confusion Collaborative (cross functional) Pros: Flexible, rapid implementation Cons: not sustainable if not institutionalizedBoth approaches are nee
7、ded.,Avoid Over-Reorganization,NYS Approach to Integration,Active involvement of providers, consumers; Leverage multiple funding streams; existing programs; Mobilization of other state agencies, systems; Open lines of communication; Joint development of messages and materials; Collaboration on fundi
8、ng proposals; Link prevention and care. Utilize cross functional teams frequently,Integration Example: Hepatitis,Focus on hepatitis began without new resources Establish widely representative working group meets quarterly Joint development of strategic plan Given lack of dedicated funding, program c
9、omponents were located where resources exist: Surveillance with communicable disease Vaccination piggy-back on existing service settings - STD Link to health care settings AIDS healthcare program,Hepatitis Integration 2006,Hepatitis Integration Successes,Hepatitis Integration Project (CDC funded) Bu
10、ilds on co-located HIV Testing/Primary Care in Substance Use Treatment and harm reduction settings National Hepatitis Training Center Hepatitis A and B Vaccination STD, state corrections, harm reduction sites Hepatitis C surveillance and follow up: Communicable Disease Hepatitis C Coordinator AIDS I
11、nstitute,Targeting High-Risk Adults for Hepatitis A and B,Hepatitis Integration Status,Collaborative approach is successful in the absence of dedicated funds Takes advantage of expertise and populations served by various existing units Structural changes (move Hep C coordinator to AIDS Institute) in
12、cluded Remain open to reorganization in the future as resources become available.,Impediments to Integration,Different philosophies; Organizational separation; Limitations of categorical grants; Competition for financial resources; History of poor relationships; Personality conflicts.,Facilitators o
13、f Integration,Communication Leadership; Realization of shared goals; Plan from perspective of the “customer”: patients, clients, providers; Identify needed components and build on the different strengths of programs; Realize economies of collaboration; Organizational connections.,CDCs Role,Recognize
14、 the need for flexibility to meet local needs; Recognize and promote “Models that work”/“Best Practices”; Foster interaction among Project Officers in different program areas; Consider cross-training, joint site visits; Convene joint national conferences or overlap at same locale;,Coordinate with ot
15、her federal agencies, e.g. substance use; Build in integrative goals into cooperative agreements; Give data standards and provide flexibility for providing equivalent data; Be consistent in definitions/data elements (age, race, etc.); Request adequate and stable resources.,CDCs Role,Summary,Integration must be a broad, organizing principle, even beyond these 4 programs; Although structural integration may be desirable, collaborative integration must also be practiced. Integration must be an organizational priority backed by leadership; Integration cant overcome inadequate funding.,
