Louisiana stays focused on the people behind the state’s HIV rankings through innovative, first-in-the-nation care models producing better health

According to a 2014 CDC report on state HIV prevention strategies, Louisiana's aggressive push for HIV testing is having a significant impact. Based on the latest data, Louisiana is exceeding national goals and the average number of individuals getting tested. We know we have work to do to decrease the number of people newly diagnosed with HIV in our state, but with Louisiana performing seventh best among the 50 states and the District of Columbia in HIV testing, we're definitely headed in the right direction.

Our innovative strategies to link persons living with HIV to care over the last several years are showing promising signs of improvement for Louisiana's residents. While safe sexual practices and knowing your status are the first lines of prevention in the spread of HIV, treatment itself can also be a strong prevention method as it can allow HIV patients to achieve viral suppression-a low level of the virus in a patient that can significantly reduce the possibility of HIV transmission to others. Critical to achieving viral suppression is accessing and staying in medical care and getting on antiretroviral therapy. Since this can prove challenging for many residents due to socioeconomic status and other factors, the Office of Public Health (OPH) STD/HIV Program has developed a first-in-the-nation system producing some of the best outcomes in the country.

The Louisiana Public Health Information Exchange, or LaPHIE, implemented in 2009 in partnership with LSU Health Care Services Division and the Louisiana Public Health Institute, is a bi-directional, electronic information exchange between the OPH's HIV surveillance systems and participating health care providers that allows providers to monitor the treatment of their HIV patients. For example, when a patient comes to a participating clinic, hospital or emergency department and registers for whatever care they may need, the patient's information is confidentially and securely linked to existing OPH HIV surveillance data real-time through multiple firewalls to determine their HIV status and whether or not they have been in care based on laboratory results. If they are identified as out-of-care, an electronic message is sent to the provider immediately with instructions to refer the patient to HIV specialty care and to receive follow-up and care coordination services.

LaPHIE's impact has been beyond question. To ensure the patient experience with LaPHIE was positive, expert staff from LSU HCSD engaged patients directly about their experiences and perceptions, and ensured it was meeting the needs of both patients and providers. While CDC reports indicate that approximately 40 percent of the more than one million Americans living with HIV are engaged in medical care and 30 percent are virally suppressed, of those who had a LaPHIE alert in 2013, 78 percent were successfully linked to HIV-related medical care within 90 days and 44 percent had achieved viral suppression. On average, those individuals living with HIV who fail to achieve viral suppression can expect to lose 11 years of life expectancy. That's 11 fewer years of work, time with family and enjoying life.

Complementing the extraordinary impact of LaPHIE, Louisiana also received funding from the federal government to tackle HIV disparities among racial and ethnic groups through the LA Links program. Similar to LaPHIE's goals of patient engagement, linkage to care and service navigation, LA Links provides care coordinators in New Orleans, Baton Rouge and Shreveport. These coordinators use HIV surveillance data to identify and engage (1) newly diagnosed individuals and link them to care, (2) previously diagnosed individuals and re-engage them in care and (3) diagnosed individuals with high viral loads and assess any barriers to care, unmet needs or treatment-education needs. LA Links produced conclusive progressive results for patients linked to care, as 74 percent experienced a viral load decrease.

The national Ryan White program supports individuals living with HIV and has been a key contributor of success to provide needed core medical and psychosocial services, though much work remains. In Louisiana, the program has traditionally provided assistance with medications, but it dramatically expanded its health insurance program in 2011 when it began shifting the focus from purchasing medications to supporting health insurance premiums and cost shares for people living with HIV.

The results of this shift provided the state with a dual win. Financially, purchasing health insurance for qualifying patients was cheaper than purchasing medications and allowed the state to maximize grant revenue by transitioning more individuals to health insurance. Since 2011, the number of persons receiving health insurance assistance has increased six-fold and today, more than 3,600 individuals receive these services.

Ultimately, in a recent 12-month period, 81 percent of Ryan White insured clients achieved viral suppression compared to 71 percent of Ryan White medication assistance only clients. Armed with these astounding results, the program transitioned nearly 800 people to health insurance coverage during open enrollment from November 2014 to February 2015. All of these novel or aggressive approaches by Louisiana's HIV experts and community partners have allowed the state to achieve a viral suppression rate of 49 percent among all people living with HIV compared to the national rate of 30 percent.

While the state has much work to do in its overall and HIV-related health outcomes it may not surprise us that a 2014 Science Magazine poll established Louisiana as the happiest state in the U.S. Without a doubt, our unique, lively culture, wonderful food and music play a significant role in our happiness. But we also like to think that we create a better state of being for our patients when we work in collaboration with our community partners, fuel innovation and employ our expertise for the health and wellness of our people-for that is where Louisiana's true richness lies.

J.T. Lane serves as the assistant secretary for public health for the State of Louisiana.
DeAnn Gruber is the director of the STD/HIV Program in the Office of Public Health of the State of Louisiana.

The Louisiana Department of Health strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about LDH, visit www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow DHH's Twitter account and Facebook. 

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