Jacobi Medical Center & North Central Bronx Hospital - Project BRIEF

Overview

The Bronx has been particularly hard hit by HIV, with up to 2 percent of its population living with AIDS and a death rate from AIDS that is nearly 10 times the national average. In 2001, the North Bronx Healthcare Network, which includes Jacobi Medical Center and North Central Bronx Hospital, established Project BRIEF (Behavior intervention, Rapid HIV test, Innovative video, Efficient cost and health care savings, and Facilitated seamless linkage to outpatient HIV care). The goal was to streamline the HIV screening process to identify people at risk and provide counseling and clinical care faster, and thus reduce disease transmission.

Screening is provided in the emergency department (ED) during all shifts, using customized technology and educational videos that are available in English or Spanish. The on-screen technology allows people to privately answer sensitive questions about high-risk behavior and sexual history. Rapid testing provides results before the patient leaves the hospital. If the patient is HIV-negative but engages in risky behavior, he or she gets immediate intervention. Patients testing positive are linked to clinical care. A public health advocate guides patients through the process.

Impact

From October 2005 to April 2009, 29,094 people presenting in the urgent care area and ED were tested for HIV; 134 were diagnosed or confirmed as positive for HIV. More than 70 percent of those were deemed eligible to start HIV treatment. More than half of the patients on treatment have achieved undetectable viral loads.

Challenges/success factors

Many of the patients most at risk for HIV are also among those marginally covered by the health care system. Often, these patients lack primary care providers. Instead, they use the ED to address their urgent care clinical needs, which include sexually transmitted diseases, trauma, mental illness, pregnancy and women’s health concerns. By providing screenings in the ED, the program reaches people most at risk for HIV.

Future direction/sustainability

This model is very portable, flexible and easily sustainable. Support has come from throughout the community, from the borough president to social service agencies. One program, Mentoring in Medicine, arranges for young adults from minority groups who are interested in careers in medicine to be trained and then serve as public health advocates with the program.

Advice to others

Assess the dynamics of your health care system, including how patients access medical care. In addition, understand the population’s learning barriers and develop a model that can meet the needs of the community at large. Finally, identify those affected by the disease process, and focus on rapid linkage of those individuals to specialty care.

Contact: Barbara DeIorio
Director, Marketing & Public Relations
Telephone: 718-918-4055
E-mail: Barbara.deiorio@nbhn.net