Minutes of the Meeting of the
Integration of Care Committee
Veronica Fortunato & Steve Hemraj, IOC Co-Chairs
Wednesday, January 22, 2025
10:05am-11:30pm
Minutes
Members Present: Ronnie Fortunato (Co-chair), Steve Hemraj (Co-chair), Raffi Babakhanian, Mitchell Caponi, Michael Ealy, Dorothy Farley, Billy Fields, Charmaine Graham, Deborah Greene, David Klotz, Marcelo Maia, Jeff Natt, Cesar Nuñez, Leah Richberg, John Schoepp, Scott Spiegler (for Guadalupe Dominguez Plummer, ex-officio), Gretchen Ty
Staff Present: NYC DOHMH: Doienne Saab, Michael Navejas, Adrianna Eppinger-Meiering, Johanna Acosta, Nicki Harris, Gina Gambone, Grace Herndon, Marilyn Baculima, Jacqueline Graham
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Ms. Fortunato opened the meeting followed by a roll call and a moment of silence. The draft minutes from the December 18th meeting were approved with no changes.
Mr. Maia reported that the Consumers Committee’s CAB Town Hall is scheduled for mid-April, details to follow.
Mr. Nuñez announced that Destination Tomorrow is holding a health conference on the health needs of LGBTQ+ people of color on February 21st.
Mr. Hemraj noted that there is promising research on gene editing techniques for HIV treatment.
Agenda Item #2: Medical Case Management/Care Coordination (CCR) Service Category
Care Coordination Provider Listening Sessions
Ms. Eppinger-Meiering and Harris presented the results of listening sessions held in October with current CCR providers on program successes and challenges, recommendations for program improvements, and services and additional support for aging clients. Highlights of the findings include:
- Clients are empowered to achieve viral load suppression VLS) through individualized support, with modified directly observed therapy (mDOT) particularly effective.
- Programs have been successful helping clients overcome barriers to treatment adherence, incl. transportation, scheduling appointments.
- Programs have helped clients enhance their social support through group sessions.
- Virtual mDOT should remain an option in the program, as its effectiveness has been demonstrated.
- Health education is vital to clients’ success.
- Often, getting clients to access needed care external to the CCR program is difficult.
- Administrative burdens should be eased (paperwork, staffing credentials).
- Workforce issues, including turnover, is a challenge.
- More and more work around aging-related issues is being done. Linkages to and direct provision of geriatric care are important, as are efforts to address social isolation.
- Programs need more capacity to serve additional clients, particularly aging clients. More resources would include staff and facilities.
In the ensuing discussion, Committee members noted the importance of training all CCR staff on aging and HIV, having staff of appropriate age to serve older clients, testing for cognitive issues, and ensuring that referrals to clinical services are to providers with competence in treating HIV.
Possible Service Model Revisions
Ms. Saab presented a list of suggested ideas for possible revision of the service model, based on the data presented to the IOC and discussions in the preceding meetings. A summary of the proposals follows:
- Strengthening the language around electronic (virtual) DOT, including suggesting existing interventions that have proven effective, such as “contingency management” through a smartphone-based “PillWatch” app that uses incentive to reward VLS.
- Inclusion of a basic geriatric assessment (BGA) as a standard to screen for multimorbidity, polypharmacy, and cognitive impairments among older PWH, plus referrals to comprehensive services for aging PWH.
- Inclusion of iART as a bridge to regular treatment once clients are fully connected to clinical care.
A summary of the discussion follows:
- It is difficult to measure the long-term effectiveness (e.g., VLS) of virtual DOT after the service ends.
- Using smartphone-based DOT is a good option for some people, e.g., students who are tech-savvy, can’t miss school to come to offices or have a navigator visit them at home.
- Relying on smartphones is a challenge for those who are unstably housed or have problems paying their phone bills. Providers need to address contingencies such as loss of a phone or interruption in phone/Internet service. Also, some clients will need training on using the technology.
- Agencies that provide incentives would need to set up an account for paying clients, among other logistical challenges.
- Ryan White reimbursement for cell phones and plans is extremely limited and subject to strict policies.
- Referrals for clinical services should include the option for long-acting injectables.
- More guidance is needed about the frequency of geriatric screenings, beyond initial intake. It could be burdensome to require it for all reassessments.
- iART is important for people who have fallen out of care, as well as the newly diagnosed.
- DOHMH and ADAP offer iART even before genotype testing is done. The treatment can be changed once the client is connected to a clinical provider.
- Agencies should have the capacity to serve high-intensity clients, including those who need frequent in-person visits or accompaniment.
- Staff retention is always a challenge, but the nature of the job requires that staff work in the field. The Recipient can encourage staff retention but can’t mandate salary increases (most of which are determined by the employee’s union).
At the next meeting, draft revisions to the text of the service model, based on today’s discussion, will be presented for review and discussion. The next IOC meeting will be held on Wednesday, February 26th, 10-am-12pm. There being no further comment, the meeting was adjourned.
