Integration of Care Minutes – April 24, 2024

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Minutes of the Meeting of the

Integration of Care Committee

Veronica Fortunato & Steve Hemraj, IOC Co-Chairs

Wednesday, April 24, 2024

10:00am-11:50pm

Minutes

Committee Members Present:

Ronnie Fortunato (Co-chair), Steve Hemraj (Co-chair), Raffi Babakhanian, Mitchell Caponi, Billy Fields, Charmaine Graham, Deborah Greene, Christopher Joseph, David Klotz, Hondo Martinez, Jeff Natt, John Schoepp, Claire Simon, Brenda Starks-Ross, Joel Zive

Staff: Adrianna Eppinger-Meiering; Doienne Saab; Scott Spiegler, Johanna Acosta, Monika Pathak, Mary Irvine

Agenda Item 1: Welcome, Roll Call & Moment of Silence

Steve opened the meeting followed by a roll call and a moment of silence.  The minutes from the March 20th meeting were approved with no changes.

Agenda Item #2: Early Intervention Services (EIS) Directive

David presented the revised service model section of the directive based on the information and discussions from the previous three meetings.  A summary of the edits include:

  • Boilerplate language that is now covered in the Framing Directive (e.g., trauma-informed, cultural competency) is deleted.
  • There is no longer a distinction between service conducted in clinical and non-clinical settings, as clinical providers can perform testing in community settings.
  • Language around “high risk negatives” was strengthened with the citation of a specific population (young MSM of color).  A requirement to provide education on the need for routine testing for these populations was added.  Provision of educational resources was added as a footnote.
  • The former requirement for confirmatory testing done at the agency’s site was deleted.
  • A paragraph was added that those who test positive be immediately linked to a primary care provider with specified levels of HIV care experience.
  • Time frames for linkage to care were set at no more than 14 days after a positive test result.
  • Basic treatment education requirements were added, along with linkages and referrals to longer-term treatment adherence support.
  • The list of services for screening and referrals was updated.
  • Language around enrollment in NYS health insurance plans was updated.

A summary of the discussion follows:

  • As per CDC guidelines, all who test negative should get referrals to PrEP, but it is not a good use of RWPA funds to test broad populations.  Testing and education on routine testing should be targeted to those with higher prevalence rates as per DOHMH HIV surveillance data.
  • RWPA funds should be used for direct testing and linkage, not to advertise on social media and apps, even if that were an allowable use of the funds.
  • Initiation of HAART should begin immediately after a positive test result as it is important to bring viral load down and reduce infectiousness, but there needs to be leeway for situations when that is not possible.  The maximum amount of time for making an appointment with a primary care provider should be seven days.  Ordering ARVs and lab tests can usually be done within 3 days.
  • Twelve months of experience in HIV primary care is not a high bar for referrals.
  • Linkages can be made to a range of medical case management/care coordination programs, not just those funded under RWPA.

The revised directive, as amended, was approved by consensus and will be sent to the Executive Committee and full Council for review and approval in May.

The next directive for revision is Medical Case Management/Care Coordination, the most complex in the portfolio.  The Committee will not meet in May in order to give the staff more time to request and collect data.  David announced that a new community planner will hopefully be on board by then, who will support this Committee, as well as the Consumers Committee.  Also, David’s appointment as Director becomes official on April 29th.  Someone has been named to succeed him as deputy director and the position of community outreach coordinator is in the interview process. There being no further business, the meeting was adjourned.