Kansas City Care Clinic Uses Integrated Testing and PrEP for HIV Prevention

KC CARE Prevention and Prep Navigation Team (or PrEP Squad) from left to right: Johnny Gonzalez, Blake Weston, Tim Nye, Shawna Shipley-Gates, and Wes Warner.Kansas City CARE Health Center HRSA BPHC exit disclaimer (KC CARE) serves more than 9,000 patients in the Kansas City metropolitan area. CARE stands for Care, Access, Research, and Education, so their name reflects what services they provide to the community. KC CARE is dually-funded by HRSA’s Health Center Program and Ryan White HIV/AIDS Program. They provide comprehensive HIV primary specialty medical care, and they have a large outreach and prevention team to do testing in their region.

Approach

KC CARE emphasizes HIV prevention and makes HIV treatment and care a continuum. They operate an HIV-integrated care model to provide comprehensive, wraparound service for their patients. Case managers specialize in supporting specific groups like youth, lost-to-care, family, and linkage to care. Warm hand-offs are given to behavioral health consultants at all locations within the HIV clinics. KC CARE emphasizes short wait times and trains staff to use specific terminology, such as calling the HIV Clinic the T3 Clinic (Providers will recognize T3 as triiodothyronine, a thyroid hormone commonly affected by HIV) to address stigma concerns.

Outreach

Outreach is a core pillar of HIV testing and prevention efforts. They use community events and partnerships to do outreach with colleges, youth centers, and other local groups. Outreach focuses on groups that serve their priority populations such as LGBTQ, Blacks, and injection drug users to build relationships. Peer-to-peer educators also assist with HIV outreach.

Testing

KC CARE offers many ways for patients to be tested for HIV: outreach testing in the home (a staff member will go to a patient’s home for testing), walk-in testing at their main location, and mobile testing at community events. Testing also is offered at every dental visit via an opt-out protocol; a pilot study showed a high degree of acceptance among dental patients. They have integrated rapid HIV testing for all general practice, primary care patients. In 2018, KC CARE performed 4,471 rapid HIV tests in the general medicine clinics, 1,087 rapid HIV tests in the dental clinics, and tested 1,343 individuals in the walk-in clinic. As part of an expanded testing coordination program in the region, KC CARE has a full time staff member who goes to community sites and trains/implements HIV rapid testing. This includes emergency rooms, other health centers, local health departments, and community-based organizations. In 2018, these sites performed 16,295 HIV tests.

Prevention

All patients who request PrEP or who with screening are determined to be a candidate for PrEP receive laboratory testing and PrEP medication. Standard lab orders are in the Electronic Health Record (EHR) for PrEP labs for initial and follow-up testing. A sliding scale and free medication assistance program are available to patients. A PrEP navigator helps patients with insurance coverage, transportation, and any other barriers to care; a Navigator of the Day system allows any staff member to receive phone support for assisting patients with PrEP. All staff and providers receive training on PrEP. In 2018, KC CARE served 498 patients in their PrEP program. In addition, 59 patients received post-exposure prophylaxis (PEP), and of those, 50 patients followed up for at least one encounter to then start PreP.

Date Last Reviewed:  June 2019


More Information

HRSA HIV Webpage

KC CARE Clinic Health Center Uniform Data System (UDS)

For more information about this promising practice, contact: Dr. Craig Dietz, chief medical officer