The Center for HIV/AIDS Care and Research (CHACR) at Boston Medical Center (BMC): A Model for the Integration of STD, HIV and HCV Counseling, Testing and Referral Services

Background:
BMC's CHACR is the largest provider of HIV services in Massachusetts. Formerly known as Boston City Hospital, it merged with Boston University to become a licensed non profit academic medical center, emphasizing on community-based care of neighboring urban underserved populations. The missions of STD, HIV and HCV prevention and treatment programs overlap greatly, but coordination of multiple funding sources has been challenging for different organizational and grant-related reasons.

Objective:
This session will examine the experience at BMC, reviewing the development, challenges and successes of the integration of STD, HIV and HCV services from the clinical, managerial, surveillance, program monitoring and evaluation perspectives.

Method:
By streamlining funding and partnering with several community based organizations, BMC has created a public health organization within a medical center, providing crucial free services to diverse populations without the clients' awareness of the different funding sources supporting their care.

Result:
In August 2005, BMC inserted a Center for Disease Control and Prevention (CDC) funded counselor to perform rapid HIV testing in their Massachusetts Department of Public Health (MDPH) funded STD Clinic. As of July 2007, 3168 HIV tests has been completed (1.55% seroprevalence); the strongest performing site of the BMC CTR program.
In June 2007, BMC's HIV/HCV CTR site incorporated STD testing. This new Integrated Counseling, Testing and Referral (ICTR) model has yielded 297 tests in its first two months: 82 Gonorrhea tests (0% prevalence), 82 Chlamydia tests (6.2% prevalence), 78 Syphilis tests (1.3% prevalence) and 55 Hepatitis C tests (14.5% prevalence).

Conclusion:
BMC provides an integrated model of public health and clinical care by incorporating programs with funding streams from BMC, CDC and MDPH (HIV/AIDS and STD divisions).

Implications:
This is a model for the integration of HIV, Hepatitis and STD counseling, testing, referral and care services that is cost-effective, client-centered and successful.