Tuesday, March 16, 2021, 12:30 – 2:00PM
By Zoom Video Conference
Committee Members Present: Lisa Best (Co-chair), Randall Bruce (Co-chair), Atif Abdul-Haqq, Asia Betancourt, Paul Carr, Maria Diaz, Billy Fields, Lawrence Francis, Charmaine Graham, Graham Harriman, David Martin (Consumer-at-Large), Michael Rifkin, Leo Ruiz, John Schoepp, Rob Walker
DOHMH: David Klotz,Melanie Lawrence,José Colón-Berdecía, Cristina Rodriguez-Hart, Kimbirly Mack
Guest: Moisés Agosto-Rosario (NMAC)
Agenda Item #1: Welcome/Introductions/Review of the Meeting Packet
Lisa and Randall opened the meeting, followed by introductions and a moment of silence. The minutes of the February 16, 2021 meeting were approved with one change from David M. adding his comment that DOHMH needs to reinforce COVID protection mandates (masks, etc.) as compliance is slipping.
John commended Lisa and Melanie for their excellent presentation at last week’s HRSA Planning CHATT (national Ryan White Part A technical assistance webinar) on the challenges and successes of planning during the pandemic.
David M. asked that calendar invitations for meetings, as well as revised minutes and other materials be consistently sent at least several days before each meeting.
Agenda Item #2: OPWH Service Directive Timeline
Graham presented the draft timeline for the development of the service directive for Older People with HIV (OPWH). Next month there will be presentations on Health Care Systems Issues for OPWH and Co-morbidities of Older Women with HIV. Committee members will also explore holistic treatment issues, as well as continue review of the materials on Google Drive. In May, the Committee will review all the data to date and draft a directive (two meetings), followed by the forum on June 4th and a meeting later that month to incorporate feedback into the draft. The directive will be presented to the Integration of Care and Executive Committees and full Council in July, after which PSRA will determine an allocation in the fall for programs to be implemented in September 2022.
In response to questions, Graham noted that there are no existing templates for this kind of directive, but that there are programs for OPWH in San Francisco and Chicago that have models that the Committee can look at for possible service elements. David M. requested that all OPWH materials be accessible in one location on Google Drive.
Agenda Item #3: Presentation on HIV & Aging
Graham introduced Moisés, a longtime treatment advocate and educator for PWH who has played a crucial role in ensuring that communities of color have equal access to care and treatment. Moisés presented on HIV and Aging and the needs of the growing population of PWH. He talked about the impact for long-term survivors of facing the new reality that they will live longer than expected, particularly after losing so many friends and family. The list of services OPWH need as they age with HIV is long (housing, food, transportation, legal, adult day care, in-home services, health education and wellness, case management). In addition, there are behavioral health and cognitive services (general counseling, trauma/PTSD, substance use, memory/dementia, etc.).
Among the physical co-morbidities that OPWH face are cardiovascular disease, kidney disease, diabetes, obesity, bone density loss, lung disease, cancer, liver disease and cognitive issues. For OPWH, the mean number of comorbidities was significantly higher compared to older people without HIV. Research presented at the recent Conference on Retroviruses and Opportunistic Infections showed that over one third of those with HIV in the US will suffer from Multi-morbidity by 2030. Researchers forecast a “silver tsunami” in multi-morbidity, polypharmacy, and healthcare costs in US residents with HIV. The burden of multi-morbidity will grow, with a projection of 36% of people using ART experiencing more than 2 physical comorbidities (in addition to HIV). The burden will be different by age and among 15 sub-groups. Ending the HIV Epidemic goals are rightly focused on prevention, but without a cure, the HIV epidemic will not be over in the next decade and people must consider if our healthcare system support this. We need new HIV care models that build out support for prevention and management of comorbidities among people aging with HIV.
Racial disparities in care for OPWH also needs to be a major focus. All racial minority groups were less likely to have an annual dental exam and had lower rates on two asthma medication measures than White members. Additionally, Black members were less likely than White members to use a beta-blocker after a heart attack, and had worse diabetes results (i.e., less likely to have their blood pressure and blood glucose under control). Black members with diabetes or cardiovascular conditions were less likely than White members to receive, and adhere to statin therapy. Hispanic members with diabetes or cardiovascular conditions were more likely to receive statin therapy than White members but were less likely to adhere to taking the medication. Other drivers of disparities are: age, socioeconomics, psychosocial factors, medical mistrust, gender, and sexual orientation.
Drivers of better health outcomes were described under the broad areas of Economic Stability, Neighborhood and Physical Environment, Education, Food, Community & Social Context, and Health Care System. To impact health outcomes for minorities, we need to develop strategies that are tailored to socioeconomic and cultural realities. Healthcare and psychosocial services must be provided in the communities where people live. Structural barriers must be removed, and we must address social determinants of health.
Top priorities for OPWH are: 1) Ending isolation by building community; 2) Addressing structural challenges; 3) Providing behavioral and mental health services; 4) Offering trauma-informed care and preventing and monitoring comorbidities under the framework of geriatric and HIV care; 5) Educating the consumer on healthy living; 6) Training care providers on the particularities of care and prevention for those HIV+ and over 50; and 7) Services and care that are culturally sensitive. Evidence based practices are key to have an impact, and robust implementation research is needed to validate the strategies adopted to serve communities.
A summary of the discussion follows:
- There is a need to form alliances with other communities where there is an intersection with OPWH.
- Once it is safe, community outreach efforts, such as targeted health fairs, need to resume to reach more people.
- There is much overlap between OPWH and the broader aging population, particularly on issues around social isolation. Social support is crucial for older people, especially OPWH.
- There should be an examination into services already being provided to all PWH that can be highlighted to identify concerns of OPWH (e.g., food services tailored to the needs of OPWH)
- There needs to be holistic and alternative care, particularly to help mitigate the effects of polypharmacy (i.e., having to take multiple medications).
- The needs of the partners, families and caregivers of OPWH must also be addressed.
There being no further business, the meeting was adjourned.
The meeting was followed by a tribute to retired Council staff member Darryl Wong.