Monday, October 21, 2021, 3:05-4:10pm
By Zoom Videoconference
M I N U T E S
Members Present: Graham Harriman (Governmental Co-chair), Dorella Walters (Community Co-chair), Paul Carr (Finance Officer), Saqib Altaf, Billy Fields, Charmaine Graham, Matthew Lesieur, David Martin, Julian Palmer, Guadalupe Dominguez Plummer, Donald Powell, Leo Ruiz, Finn Schubert, Claire Simon, Marcy Thompson
Members Absent: Ronnie Fortunato, Marya Gilborn, Jeff Natt
Staff Present: NYC DOHMH: David Klotz, Melanie Lawrence, Cristina Rodriguez-Hart, Jose Colon-Berdecia, Karen Miller, George Yee, Giovanna Navoa; Public Health Solutions: Barbara Silver, Gemma Ashby-Barclay
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Ms. Walters and Mr. Harriman opened the meeting followed by introductions and a moment of silence. New Executive Committee members were introduced: Leo Ruiz and Charmaine Graham (co-chairs, Consumers Committee), Julian Palmer (co-chair, Tri-County Steering Committee) and Finn Schubert (co-chair, Needs Assessment Committee). The minutes from the July 22 & 27, 2021 meeting were approved with no changes.
Agenda Item #2: Co-chairs Update
Mr. Harriman announced that HRSA and CDC have issued their guidance for the Integrated HIV Prevention and Care Plan. The Council will be a key component of the plan. Also, further training and education on the use of implementation science will be provided. The acting governmental chair of the NYC HIV (Prevention) Planning Group (HPG), Shirley Torho, will be giving periodic updates to the Council, as will Mr. Harriman to the HPG, to increase communication and coordination. A joint Planning Council/HPG Policy Committee will have its first meeting on October 28th, with Mr. Lesieur as co-chair.
Ms. Walters and Ms. Simon reported that the Super Committee, which is composed of the leadership of all the State’s HIV planning bodies (NY Planning Council, Nassau-Suffolk Council, NYS AIDS Advisory Committee, NYC HIV Planning Group, NYC DOHMH and NYSDOH), have their second meeting in November to discuss the Integrated Plan.
Agenda Item #3: Final HIV & Aging Service Directive
Mr. Harriman and Mr. Martin presented the final text of the HIV & Aging Service Directive. On July 22nd, the Executive Committee approved the broad intent of the Directive, but sent the Directive back to the Consumer Committee in response to request for more details on consumer experience, better use of the Implementation Science Logic Model, and increased use of Peers in service delivery. The Consumer Committee met on August 17th to finalize edits and approve the full Directive, which has been shared with the meeting materials.
PWH over 50 represent a majority of the total PWH population (59% of PWH in NYC in 2019) and yet their intersectional needs are often unaddressed by HIV service organizations. To better understand the lives of PWH over 50 the NYC HIV Care and Treatment Program conducted focus groups the results of which underscore the need for improved resources for PWH over 50, including services to address social isolation, coordination between programs, benefits navigation, services offered in Spanish, and to address medical conditions of women with HIV over 50.
The Directive will Increase capacity to treat the complex needs of PWH over 50 mirroring aspects of the Golden Compass model through use of clinical staff (MD, RN, Pharmacist, Medical Assistant) to address comorbidities and to provide health education, geriatric, psychiatric, and cardiology consultation, and referrals to ongoing specialty care. Resources provided by RWPA will address gaps in current care provided at clinical sites, and funded services should support improved self-advocacy/self-management so that PWH can talk to their medical providers about broader health concerns.
The model will also increase the knowledge of resources available to support Aging PWH among RWPA funded providers; improve referral tracking to ensure Aging PWH are engaged in needed services; and adapt referral practices from the ARTAS model (i.e., the development of referral partnerships, communication /outreach/education, navigation and transportation if needed).
The Directive strengthens PWH networks and funds organizations that provide social support services for older people living with HIV. It will fund social support for exercise and set up buddy systems making contracts with others to complete specified levels of physical activity or set up walking groups and other groups to facilitate friendship and support. It will fund navigation, structured health education, and practical and emotional peer support services to increase engagement in care and promote self-care. It will identify how to leverage technology for social support and to overcome barriers that older people living with HIV face. The Directive calls for an increase in training of RWPA providers to ensure that providers effectively support Aging PWH through increased ability to identify comorbidities, link Aging PWH to needed resources, and that services are delivered equitably.
This program is designed to increase: 1) The number of HIV clinics providing screening/assessment for comorbid conditions; 2) Clinical capacity to provide services for common comorbidities for Aging PWH through an increase in knowledge and skills; 3) Attendance of Aging PWH at specialist appointments; 4) Consumer social support (peer delivered services, support groups, health education groups) activities ; 5) Consumer participation in fitness and exercise classes; and 6) Client perception of self-management skills when surveyed.
A summary of the discussion on the HIV & Aging Directive follows:
- The Directive creates two new service categories in the RWPA portfolio that are currently not funded: Outpatient Medical Care (core), and Referral to Medical and Support Services (non-core).
- After the Directive is approved, PSRA will determine an allocation for the FY 2023 application spending plan.
- The service directive will leverage other payers (Medicare, Medicaid), through benefits navigators.
- The Directive uses “Aging PWH” rather than “long-term survivors” or PWH over 50” to be inclusive of both perinatally infected people who have lived with HIV for many years, as well as older people who are newly diagnosed and dealing with issues related to both HIV and aging.
- Data from a focus group only mentioned the need for services in Spanish, but a sentence was added to the first paragraph of the Directive to note that services should be provided in additional languages.
Mr. Martin moved, on behalf of the Consumers Committee, that the Executive Committee adopt the HIV & Aging Directive as amended. The motion was adopted 13Y-0N.
Agenda Item #4: Recipient Report
Ms. Plummer reported that on October 5th, the U.S. Department of Health and Human Services (HHS) announced approximately $2.21 billion in Ryan White HIV/AIDS Program funding for cities, counties, states, and local community-based organizations was awarded in fiscal year (FY) 2021. HRSA also announced that the 2022 National Ryan White Conference on HIV Care & Treatment will take place August 23-26, 2022 with the theme “The Time Is Now: Harnessing the Power of Innovation, Health Equity, and Community to End the HIV Epidemic.”
On September 21st, the Recipient received the notice of award from HRSA authorizing the carryover of unobligated balance in the amount of $4,981,213. Amendments to contracts are currently in process. Carryover funds were approved by the NY Planning Council in July 2021.
The 8th annual Ryan White Part A (RWPA) Power of Quality Improvement Conference will be held virtually this year on December 14 from 9:00 AM to 4:00 PM. This year’s conference theme is “Building Resilience, Actualizing Equity, and Ending the Epidemic” which will demonstrate the efforts of RWPA programs to manage services throughout the COVID-19 pandemics by providing continuity of care with resiliency and perseverance. The Consumers Committee has submitted an abstract to conduct a workshop on the HIV & Aging Service Directive.
On September 8th, Ms. Plummer was named the permanent Director of the HIV Care and Treatment Program. In this role, she will serve as Project Director for the Ryan White HIV/AIDS Program Part A NY EMA and as the Recipient representative on the Planning Council.
On October 6, Public Health Solutions (PHS), on behalf of the New York City Department of Health and Mental Hygiene (NYC DOHMH) Bureau of HIV (BHIV), released The Ending the Epidemic in New York City: The Undetectables Viral Load Suppression Program and Crystal Methamphetamine Harm Reduction Services concept paper.
DOHMH and CUNY were funded for the project “Strengthening the safety net: Testing a novel data-to-suppression (D2S) intervention strategy in the Ryan White HIV/AIDS Program” to implement and evaluate a novel ‘data-to-suppression’ intervention with RWPA support-service programs to address a viral suppression deficit among RWPA clients in HIV care.
HRSA announced two new policy changes that will impact the RWPA program. The process for applying for a core medical services waiver has been greatly simplified. Also, programs will no longer have to do 6-month reassessments and recertifications. This will greatly ease the burden on programs and clients and will also impact eShare and other administrative mechanisms.
It was also noted that the NYC Board of Health issued a proclamation that racism is a public health crisis. Mr. Harriman noted that the Framing Directive directly addresses that. Ms. Plummer added that this supports the HIV CTP efforts on racial and health equity.
Mr. Harriman added that the Council staff is committed to getting materials out at least three business days before each meeting, but that there will inevitably be delays when getting materials from other partners.
There being no further comment, the meeting was adjourned.