Connection to Care Key Element in HIV Battle

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Todd Canning, the director of clinical services for the Partnership in Care Program at MetroPlus Health Plan, at the 2020 Gay City News Impact Awards.
Donna Aceto

For Todd Canning, who has spent more than two decades providing HIV care across the city, the joy of his job is in addressing the critical healthcare needs of everyday New Yorkers.

“It’s a pleasure to work with a company like MetroPlus that as a company is set up to serve a population that mirrors what the city looks like,” he told Gay City News.

MetroPlus Health Plan, which was the presenting sponsor of the 2020 Gay City News Impact Awards, provides managed care to more than half a million Medicaid-eligible New Yorkers. It is a wholly-owned subsidiary of NYC Health + Hospitals, the largest municipal healthcare system in the US.

MetroPlus’ Todd Canning oversees managed care for especially vulnerable New Yorkers

Canning, who rejoined MetroPlus early this year after an eight-year tenure with the group from 2006 to 2014, is the director of clinical services for the Partnership in Care Program, which serves roughly 9,000 clients who are living with HIV or are of transgender experience or homeless experience.

A registered nurse, Canning is a graduate of the University of Pennsylvania School of Nursing, and has also served in management posts at EmblemHealth, the Visiting Nurse Service of New York, NYC Health + Hospitals, the city’s Department of Health and Mental Hygiene, Bailey House, and Housing Works.

All three of the major demographic groups that the Partnership in Care Program serves have specific vulnerabilities. For HIV-positive folks, connection to care is critical in reducing their viral load, not only giving them better health outcomes but also reducing or eliminating the risk they will be infectious to their sexual partners.

For transgender clients, connection to care that is medically and culturally sensitive is vital — and may be difficult to obtain without case management. New Yorkers who experience homelessness often have health challenge co-factors, including poverty, substance use, and mental health issues. Trans and homeless New Yorkers, as well, face greater likelihood of becoming infected with HIV than the average city resident.

Canning’s program does not tally specific demographic data on its clients, though he said that generally speaking, like NYC Health + Hospitals, it serves a population that is largely African-American and Latinx. Designation of sexual orientation and gender identity are also not part of the client intake process, though the program does do significant outreach regarding its transgender care services and its HIV-positive population undoubtedly is skewed toward many gay and bisexual men.

For clients who are living with HIV, a primary goal is connecting them with consistent care, including the antiretroviral treatment most appropriate to their circumstances. Comparing what he sees in that population with the state of care during his earlier years at MetroPlus, Canning noted the significant improvement not only in connection to care and in treatment compliance but also in suppression of viral load.

“Issues of side effects and the complexity of timing of meds have been mitigated,” he explained. “Now that regimens are manageable for so many clients, we can focus our time and attention on other, more problematic groups such as those dealing with mental health challenges and housing instability.”

Because housing instability often goes hand in hand with mental health challenges or substances use, Canning continued, one key goal among those clients is the identification of housing opportunities that provide supportive services. Stabilizing a client’s living situation and beginning to address mental health issues are often prerequisites to getting them into and keeping them in appropriate medical care, especially among those living with HIV.

Among clients who are HIV-negative but consider themselves at risk for infection, PrEP — or, in situations where potential infection just occurred, PEP (post-exposure prophylaxis) — is a big part of the conversation. Noting the state’s Plan to End the Epidemic, which has been embraced by both Governor Andrew Cuomo and Mayor Bill de Blasio, Canning said the treatment is so cost-effective from a public health standpoint that Albany will pay for it and MetroPlus has “fully embraced it” in its managed care plans.

“Removing the barriers,” he said, is the most important factor in advancing good public health policies.

Whether clients adhere to a once-a-day PrEP regimen or one more tied to the rhythm, as it were, of their sexual behavior, Canning said, is a “very individualized decision” best made by the client in consultation with their primary care physician.

One major health outcomes shift Canning has noticed is the reduction in hepatitis C infection among his clients.

“Really effective treatments became available,” he explained, “especially in the past three to four years. It’s still there, but it’s not the huge [and in the past too often fatal] problem it was.”

Canning noted that New York’s transgender community is “a very specific population” for whom getting connected to the right care is absolutely essential but too frequently difficult to navigate. Through managed care, however, MetroPlus is able to make that navigation straightforward, even seamless. The company’s trans clients, he said, “are connected to folks with trans experience.”

From that foundational connection, the Partnership in Care Program provides comprehensive transition-related benefits “including an unlimited amount of community support and counseling support.”

“And then,” Canning added, “that takes care of itself.”

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