D.C. clinics offer 'red carpet' treatment to people who may be infected with HIV
Tuesday, September 14, 2010
Raped by a stranger and possibly infected with HIV, the law student in her late 20s came to the Washington Hospital Center for help in July.
Nurses from the District government's Sexual Assault Nurse Examiner Program, housed at the hospital, treated her and collected forensic evidence to send to the D.C. crime lab.
It was too early to determine if she was HIV-positive -- that test could not be done effectively for two to eight more weeks -- but because she had been exposed to the assailant's bodily fluids, SANE nurses got her a prescription for the standard menu of drugs that have been shown to reduce the risk of infection. The key was that she had to begin the regimen immediately, and stick to it.
After a couple of days, however, the woman struggled with the drugs' side effects: nausea, diarrhea, vomiting and general malaise. Distraught, she was at risk of quitting the meds -- and possibly becoming another entry in the District's lengthy roster of AIDS victims.
So SANE sent her to the Whitman-Walker Clinic in Northwest Washington and told her, "Just ask for the red carpet."
She did, and though HIV and AIDS were never mentioned, staff members knew exactly why she was there. They quickly led her to a private room and began setting up meetings with the appropriate care providers.
"She was crying," said Justin Goforth, the clinic's community health director. "The waiting area is no place to sit and cry after you've had this traumatic incident."
In quick succession, a primary-care doctor conducted a physical exam, answered her medical questions and started her on a new drug regimen. "She wanted to switch her meds," Goforth said. "She was immediately seen and prescribed one pill, once a day -- she tolerated that."
Other staffers informed her about insurance options, how to pay for the new drugs, further tests and overall care. A nurse/case manager, who would be her advocate throughout her treatment, addressed her questions about future sexual relations, mental health therapy and what to tell her friends and relatives. Within two hours of her arrival, she had a more personalized plan to reduce her chances of developing HIV, including a scheduled follow-up appointment.
"This is rolling out the red carpet," said Erin Loubier, Whitman-Walker's director of public benefits. "We want you to seamlessly move through . . . because we want you in care."
The District is struggling to contain an HIV/AIDS epidemic that involves more than 16,000 people; more than 3 percent of the population older than age 12 is living with the virus or the full-blown disease. Rapid-enrollment programs such as the "red carpet" one at Whitman-Walker have already resulted in more voluntary HIV testing, early diagnosis and early linkage to care, all of which are key to reducing the spread of the disease.
"We've made a lot of progress in D.C.," said Nnemdi Kamanu Elias, the interim director of the District's HIV/AIDS, Hepatitis, STD and TB Administration. "We've shortened the amount of time that people get into care after they've been diagnosed."
The Whitman-Walker Clinic launched its program in 2008. "We built from scratch," Loubier recalled. "We basically flipped everything on its head in an effort to really try to ensure that . . . there weren't barriers to care."
When the D.C. Department of Health learned about the program in 2009, Goforth said, it began pushing other clinics to adopt similar models aimed at anybody in danger of developing HIV/AIDS or spreading the disease: victims of rape or other assault, newly diagnosed patients, patients transferring from other providers and those who have stopped getting treatment.
"We all benefit from this," said A. Toni Young, executive director of the Community Education Group, a nonprofit that provides public health services and refers people to "Red Carpet Entry" clinics.
This spring, the health department established a set of criteria for such clinics, including an offer of primary-care appointments within 24 hours of first contact and access to a case manager who can arrange care. In addition, because the stigma often attached to HIV/AIDS makes some people hesitant to ask for treatment, the clinic must provide a password for new clients to use when they arrive for their appointment: At Whitman-Walker, it's "red carpet"; at Children's National Medical Center, it's "youth connections"; at the Carl Vogel Center, it's "Dr. White."
"Everybody knows what you're talking about," Loubier said, "and you've never mentioned HIV."
Besides Whitman-Walker, several area institutions now have programs publicized by the health department: AIDS Healthcare Foundation/Blair Underwood Healthcare Center, Andromeda Transcultural Health, Children's National Medical Center, Carl Vogel Center, Family and Medical Counseling Services, the Regional Addiction Prevention Calvin Rolark Center and 11 Unity Health Care Centers.
The system greatly shortens an intake process that used to involve hours of paperwork and separate appointments with a social worker, mental health specialist, nurse and doctor over a span of several weeks, Goforth said.
"You're already at the point where you're barely able to walk through that door," he added. "If you have to keep coming to all these appointments . . . you're out and you're not coming back because we've scared you off with the process."
Patients are no longer expected to make several different appointments to address HIV-related concerns, says Katrina Jones, operations director of the Vogel center. "Now it's a bundled service as soon as they come in."
"We've learned that the immediacy of our response is tied to our success of patients," said Angela Fulwood Wood, the chief operations officer of Family and Medical Counseling Service. "The more that we engage people early is our best chance at changing behavior."