Needs Assessment Committee Meeting January 12th, 2023

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Members Present: Fay Barrett, Billy Fields, Arthur Fitting, Graham Harriman, Beth Hribar, Jennifer Irwin, David Martin, Freddy Molano, MD, Scott Spiegler (for Guadalupe Dominguez Plummer), John Schoepp, Marcy Sedlacek, Claire Simon, Steven Wilcox

Other Council Members Present: Charmaine Graham, Marcelo Soares

DOHMH, PHS, NYS, CHAIN and Other Staff Present: David Klotz, Melanie Lawrence, Doienne Saab, Adrianna Eppinger-Meiering, Connor Reynolds, Maiko Yamagida

Guest Present: Daria Boccher-Lattimore, NE/Caribbean AETC

Agenda Item #1: Welcome/Roll Call/Moment of Silence/Minutes:

Mr. Harriman opened the meeting noting that Mx. Kaywin is out of the country and Ms. Thompson had a death in the family.  After a moment of silence, he introduced new Council staff Doienne Saab, who will take over as the new staff liaison for this committee.  Ms. Saab introduced herself, described her background in public health and HIV, and expressed her enthusiasm to work with the Committee.  This was followed by Committee member and staff introductions.  The minutes of the November 10th meeting were approved with no changes.

Agenda Item #2: AETC Workforce Assessment

Mr. Harriman introduced Daria Boccher-Latimore from the Northeast/Caribbean AIDS Education and Training Center (AETC), which has conducted a survey on the HIV workforce in the EMA in support of the Needs Assessment Committee’s Provider Capacity Workgroup (one of the four workgroups created to collect data for the full needs assessment).

Ms. Boccher-Latimore presented preliminary results from the AETC study, conducted from Nov. 29, 2022 to Jan. 5, 2023.  Further data cleaning and analysis will take place before the final report.  The survey was sent to the full range of HIV service providers, and 1749 responses were received from NYC and Tri-County (1620 of them in NYC).  The gender breakdown was 54% male, 44% female, 2% transgender MTF.  69% were white, 26% Hispanic, 18% Black, 7%Asian.  The most common job categories were physician assistant (about 400), social worker/case manager (about 25), pharmacist (about 175) and dietician/nutritionist (about 175).  About 60 were physicians.  16% worked in an HIV or infectious disease (ID) clinic, 13% in a CBO, 9% in an FQHC.  Other settings included substance use settings, corrections, pharmacy, long-term care.

About a third of respondents receive Ryan White Part A funding, and smaller but significant numbers receive other RW funding.  Slightly over half are relatively new to the HIV field (less than 5 years).  The number of unique PWH served by each respondent varied evenly across numbers from 1-10 to 501-1000.  Most describe their HIV expertise as adequate to very high.  Two-thirds plan to continue working in HIV care in the next 3-5 years.  The third who plan to move out of HIV care or retire was concerning, given the existing workforce shortages.  When asked about the most fulfilling parts of their jobs, the top responses were roles and responsibilities, care and service delivery interactions, and salary and benefits.  The most cited least fulfilling parts were workload, salary and benefits, burnout and limited growth opportunities.

Respondents were asked about challenges to the HIV care continuum in linkage, retention, durable viral suppression and referrals to care.  The area found most challenging was referrals.  The unmet needs and challenges of clients most cited were mental health (about 47%), substance use (about 39%), and housing (about 32%).  Ways of making things less challenging include: population-specific needs, staff support/empowerment, better technology, better leadership/management.  When asked about the priority of creating racial equity and reducing stigma in the work setting, more agreed that reducing stigma was a higher priority, and most agreed that their workplace was capable of addressing stigma.  Most respondents said that they were likely to participate in trainings on PrEP, rapid ART, HIV and aging, racial equity and cultural humility.  Other training needs cited most often were ARVs, care coordination, harm reduction and PEP. 

A summary of the ensuing discussion follows:

  • Many ID doctors got burned out during COVID, as they often were assigned to lead their clinic’s response.
  • With the large number of new providers and the large number of those expected to retire, it raises concerns about quality of care in the future.
  • It would be interesting to know if satisfaction with salary and benefits is correlated to union membership.
  • There needs to be a way to address the lack of many providers’ confidence in the ability to make referrals, as this is a key part of care.
  • Additional analysis cross-tabulated by profession will be added.
  • Anti-stigma trainings such as ESCALATE) need to be promoted more widely.
  • There is a question about whether younger clinicians adequately understand aging issues.  There were questions in the survey about sensitivity to aging issues that can be explored.
  • Inappropriate disclosure of HIV status is an issue and a barrier to care for some and must be addressed.

Agenda Item #3: Needs Assessment Update

Mr. Harriman reported that Ms. Saab will be the lead writer for the Needs Assessment, with support from the Committee and weekly internal meetings with Council staff.  The current timeline is to have a full draft by April, and to present the final Needs Assessment to the Executive Committee during a planned HRSA site visit in mid-May.  As noted previously, the Needs Assessment Document will be a compilation of work that was conducted last year by the four workgroups (Epidemiology, Resource Inventory, Service Needs and Gap, Provider Capacity).  Any gaps identified in the process of compiling drafts will be noted and presented to the committee.

From February through April, the Committee will review content through slide presentations in each meeting, and will use Google docs for a shared input process on sections of Needs Assessment narrative with clear deadlines for input.  The results of that input will be summarized in each monthly meeting presentation.  Any member who needs assistance using Google Docs can contact Council staff.

There being no further discussion, the meeting was adjourned.