Planning Council Meeting Minutes April 25, 2019

HIV HEALTH AND HUMAN SERVICES
Bronx Borough Hall, Bronx, NY
Thursday, April 25, 2019 3:15-5:00 PM
MINUTES

Members Present: J. C. Park (Governmental Co-chair), M. Lesieur (Community Co-chair), A. Abdul-Haqq, K. Balovlenkov, F. Barrett, D. Beiling, A. Betancourt, P. Carr, E. Casey (by phone), B. Cockrell, M. Domingo, J. Edwards, B. Fields, T. Frasca, MPH, C. Graham, B. Gross, G. Harriman, J. Hudis, C. Kunzel, Ph.D. (by phone), J. LiGreci, O. Lopez, M. Mackey, J. Maldonado, M. Mañacop, L. F. Molano, M.D., J. Natt, D. Powell (by phone), C. Reyes, A.

Roque, J. Schoepp, C. Simon , M. Singh, A. Straus (by phone), M. Thompson, D. Walters (by phone), B. Zingman, MD

Members Absent: S. Hemraj, M. Bacon, M. Baney, L. Best, R. Bruce, R. Chestnut, M. Diaz, J. Dudley, B. Fenton, MD, S. Grant, A. Lugg, S. Reyes, R. Rios-Vergara

Staff Present: DOHMH: D. Klotz, D. Wong, M. Lawrence, J. Colón-Berdecía, C. Rodriguez-Hart, P. Padgen, A.

Thomas-Ferraioli, J. Kirkland, K. Mack, K. Miller; Public Health Solutions: G. Kaloo; J. Corbisiero (Parliamentarian) 

Guests Present: Bronx Borough President’s Office: Hon. R. Diaz, Jr., D. McCall; Boom!Health: J. DeWalt

Mr. Park and Mr. Lesieur opened the meeting, followed by introductions and a moment of silence in honor of Humberto Cruz, former director of the NYS AIDS Institute, who passed away last week.  Ms. Edwards read a statement from the AIDS Institute, where Humberto worked for 23 years, including 5 as director.  As a long serving member of the Planning Council, NASTAD and the Presidential Advisory Council left a legacy of accomplishments that helped improved the health and lives of PLWH across New York State and nationally, from enhanced Medicaid rates for NYers with HIV to helping develop the National HIV/AIDS Strategy.  Ms. Edwards and other members offered their personal memories of Humberto as a visionary leader and bold fighter for PLWH. 

Bronx Borough President Ruben Diaz, Jr. welcomed the Council to Bronx Borough Hall.  He discussed his personal connection and commitment to HIV issues, having lost two uncles to AIDS.  Also, his long-time chief of staff is a person living with HIV.  He thanked the Council for its critical work, noting that there is still work to do, despite the great progress made over the years.  He noted some of the initiatives that his office has been involved with, including Bronx Knows and the Bronx HIV Roundtable that brings providers and consumers together regularly to share best practices and engage in quality improvement.  Mr. also Diaz talked about the importance of combating stigma and continuing to work to eliminate health disparities.  The minutes of the February 28, 2018 meeting were approved with no corrections

Ms. Hudis presented the draft FY 2019 Reprogramming Plan.  PSRA approves a reprogramming plan every spring so that the Recipient can maximize spending in the course of the year.  As in previous years, the plan gives the Recipient the flexibility to enhance over-performing contracts by moving funds between service categories up to 20% of the original spending plan allocation.  This is done after the Recipient and Public Health Solutions (PHS) enhances over-performing programs from funds taken down from programs within the same service category to the maximum extent possible.  Enhancements are one-time and must be used by the end of the fiscal year, and usually come late in the year.  ADAP is eligible for enhancement after all other service categories have been considered and has no cap.  One addition to this year’s plan is to make initial enhancements to Tri-County and NYC programs from take-downs of programs in their respective regions, and after initial enhancements are made, to put remaining reprogramming money into one EMA-wide pot.  With newly re-bid Tri-County programs, they are mostly performance-based now and able to receive enhancements. 

Ms. Hudis moved on behalf of the PSRA Committee that the Council accept the FY 2019 reprogramming plan as presented.  The motion was adopted by a vote of 28Y-0N. 

HIV Epidemiology in the Bronx Ms. Rodriguez-Hart gave an overview of the HIV epidemic in the Bronx.  In 2017, there were 464 new HIV diagnoses in the Bronx, a 15% decrease in the rate of new infections for the borough (compared to a 26% decrease in NYC overall).  Diagnoses are highest among men and Black and Latinx individuals, but they have declined over the past 5 years (as they have in all boroughs).  People living in their 20s had the highest number of new diagnoses followed by people in their 30s.  MSM account for the largest number of new diagnoses in the Bronx as they do in other boroughs, but what’s somewhat different about the Bronx is that heterosexual contact accounts for a larger number of diagnoses than it does in other boroughs (27% compared to 17% Citywide).  New diagnoses were concentrated in areas of high poverty levels.  People born outside the US accounted for 34% of new HIV diagnoses in the Bronx in 2017.  The Caribbean, Mexico, Central America, and South America accounted for 74% of these new HIV diagnoses.

The age-adjusted death rate among PWHA decreased in the Bronx between 2013 and 2017.  Bronx was the borough with the second highest rate in 2017.  Between 2013 and 2017, timely initiation of care among people newly diagnosed with HIV increased in the Bronx and in NYC.  Among people newly diagnosed with HIV in the Bronx in 2017, a smaller proportion of transgender people were linked timely to care than men or women, and a larger proportion of Blacks and Latinos/Hispanics were linked timely to care than Whites and Asians.  Among people newly diagnosed with HIV in the Bronx in 2017, the 13 to 19 year age group had the highest proportion with timely initiation of care, and transgender people with sexual contact had the smallest proportion with timely initiation of care.  

Bronx neighborhoods with the smallest proportions of people timely linked to care in 2017 were High Bridge-Morrisania (79.8%), Pelham-Throggs Neck (82.7%), and Crotona-Tremont (83.7%).  Hunts PointMott Haven has the highest percentage of people diagnosed in 2017 who were linked to care within 30 days.  Among diagnosed PLWH in the Bronx, a similar proportion of transgender people were virally suppressed compared to men and women, and Asian/Pacific Islanders had the largest proportion virally suppressed among all racial/ethnic groups.  Those ages 20 to 29 had the smallest proportion virally suppressed, and those ages 60 and older had the largest.  MSM had the largest proportion virally suppressed, and people with perinatal transmission risk (most of whom are now in their teens and 20s) had the smallest.  Smaller proportions of people living in higher poverty neighborhoods were virally suppressed.  A smaller proportion of people born in the US or US Dependency were virally suppressed compared to people born outside the US.  Bronx neighborhoods with the smallest proportion of virally suppressed PLWH in 2017 were High Bridge-Morrisania (69.6%), Crotona-Tremont (71.8%), and Hunts Point-Mott Haven (73.0%).  The three Bronx neighborhoods with the highest HIV diagnoses rates (Hunts Point-Mott Haven, Crotona-Tremont, High Bridge-Morrisania) are also the three neighborhoods with the lowest viral suppression.  Of approximately 25,300 PLWHA in Bronx in 2017, 69% had a suppressed viral load.  Among diagnosed PLWHA in NYC, Bronx residents had the smallest proportion virally suppressed (74% compared to 84% in Manhattan and Queens).

Issues raised in the ensuing discussion include:

• There is a need to reevaluate the percentage of heterosexual transmission reported, as stigma may cause people to self-report inaccurately.
• There is a likely undercounting of TGNB cases, as most transgender people are counted as the sex that they identify as, but by using data matching and other methods, DOHMH is trying to improve reporting.
• There has been a leveling off in the decline of new diagnoses among younger people Citywide.
• While surveillance data does not measure barriers to entry into care and viral load suppression, there is data from other studies (e.g., Ryan White program data, CHAIN Study) that shows that factors include substance use, mental illness, unstable housing, food insecurity and stigma. 
• There are a number of initiatives in the Bronx that are working to address the social determinants of health.

Bronx Knows Testing Campaign

Mr. Padgen presented on the NYC DOHMH “Bronx Knows” and “New York Know” HIV testing campaign, which aims to help all NYC residents learn their HIV status and take full advantage of the city’s care and prevention services.  The initiative’s goals are: Provide a voluntary HIV test for every New Yorker who has never been tested; Make HIV testing a routine part of health care; Identify undiagnosed persons living with HIV and link them to medical care; and Connect people who test negative for HIV to prevention services, including PrEP.  Collaborating with hospitals, clinics, CBOs, businesses, elected and community leaders, Bronx was chosen as the first place for the initiative, due to its high HIV case rate and number of people with HIV who were unaware of their status (est. 25%).  

The initiative started in 2007 and ran through 2011 as Bronx Knows, with the Citywide New York Knows beginning in 2014.  In 2018, the initiative hit the 2 million test mark in the Bronx.  The roll out to the other boroughs was described, including beginning with monthly meetings, training and technical assistance, population-specific initiatives (e.g., women, immigrants), and workgroups (e.g., policy, faith-based, youth).  

The data collection to measure the initiative’s success was described, including number of tests conducted and measurement of goals through data collected through sources including Community Health Surveys and HIV Surveillance data.  Mid-initiative partner feedback has shown that being a NY Knows partner has improved providers’ capacity to provide testing information, provide PrEP information, make referrals and provide actual tests.  Partners include pharmacies, colleges, businesses, government, faith-based organizations, hospitals, clinics, and CBOs.  Challenges ahead include: capacity and resources, fostering additional collaborations, and sustained engagement. 

In the ensuing discussion, points raised involved the importance of consumer involvement in the NY Knows campaigns.  Also stressed was the process for promoting linkage to care and PrEP, and the State-funded NY Links efforts to promote maintenance in care and viral load suppression (VLS).  It was also noted that the Council funds many services that promote moving people along the care continuum from testing to linkage and VLS.

Ending the Epidemic Bronx Regional Committee

Ms. DeWalt reported on the Bronx Regional Ending the Epidemic (ETE) Committee.  The ETE priorities in the Bronx are VLS, routine testing, awareness and ending stigma.  The ETE Committee’s priorities are: efficiency, collaboration and diversity.  Challenges to meeting the ETE goals are: combating fatigue, lack of engagement, and silos.  To avoid duplication, the Committee is seeking feedback from collaborations in Brooklyn and Queens and partnership with NY Knows/NY Links.  

Despite incredible gains in research, prevention, and treatment, HIV related stigma persists.  Additionally, many communities in the Bronx and those disproportionally affected by HIV experience other types of stigma and marginalization.  Intersections of stigma and assumptions related to homelessness, substance use, LGBTQ identity, cultural identities, etc. must be addressed.  There are discussions on separating HIV vs. inclusion with other chronic illness and on combating misinformation and behavior related stigma.  Barriers to diagnosis and care can limit access to up-to-date care and treatment information.  

Activities include an Anti-stigma Summit in July 2018 that addressed topics such as U=U and how to support and follow-up with providers who said they would assess and address stigma.  

Mr. McCall discussed the Bronx HIV Roundtable, which brings together providers and other stakeholders to keep the Borough President apprised on efforts to combat HIV.  They have a number of task forces (e.g., faith-based, LGBT) that have sponsored initiatives, such as around PEP/PrEP education and outreach.  

Mr. Harriman reported on the 2018 Ryan White HIV/AIDS Program Services Report (RSR), a client-level data reporting requirement that monitors the characteristics of RWHAP recipients, providers, and clients served. All RWHAP-funded recipients Parts A through D and their contracted service providers (subrecipients) are required to report client-level data annually to the HIV/AIDS Bureau through the RSR.  94 agencies submitted to the RSR for 2018. All reports were submitted on time before the March 25 deadline. There were a total of 38,558 non-unique clients reported in the RSR. Client-level data completeness was high. Three new questions have been added to the Provider Report related to Medical Assisted Therapy (MAT) for opioid use disorder. These questions have been added to provide HRSA with information on organizational capacity to provide these services.

As part of the Conditions of Awards requirement, HRSA requires the submission of the Program Terms and Submission report.  The Program Termsreport identifies direct and indirect service contracts that are being funded for the current grant year and ensures allocations for core medical and support services meet the 75/25 requirement unless a waiver has been submitted and approved, and the report ensures the 10% Administrative and 5% CQM caps are not exceeded.  The Program Submissionreport provides assurance that the Planning Council endorses the funded service categories and allocations reflected in the allocations table and ensures that the Planning Council is in compliance with legislative reflectiveness and representation requirements.

On March 13, on behalf of the Health Department, Public Health Solutions released the Food and Nutrition Program Concept Paper and hosted a town hall on March 25 to allow for potential applicants to ask questions or make comments on the concept paper. For interested applicants, Public Health Solutions will be collecting questions and comments on the concept paper through April 29.

On May 16, DOHMH will hold the 2nd annual meeting of all RWPA-funded programs.  This full- day meeting will bring together RWPA-funded program staff from around New York City to share updates and engage in peer learning to improve the quality of program services.  The agenda is still in formation but potential items include guidelines for telephone counseling, meeting the needs of young people living with HIV, quality management plans, and disparities among women of color with HIV.  This is the second time that we are bringing together providers across service categories for the annual meeting, an efficient way to promote learning across the service system.

The Quality Management and Technical Assistance unit in the Care and Treatment program have been invited by the New York State Public Health Association to present findings summarizing the use of Seeking Safety in Ryan White Part-A funded programs in New York.  The presentation will occur by webinar on April 17.

Grantee staff, to better address oral health needs among RWPA enrollees, will include versions of the following oral health questions (based on CHAIN survey items) in Ryan White-funded program assessments: During the past 6 months, was there any time you had a dental problem, and were unable to get an appointment or the wait for an appointment was too long? If yes, since that time, have you been able to get the care you needed from a dentist, oral surgeon, or other professional dental care provider?  The questions should assist the programs in assessing the extent PLWH are in need of oral health care and if those needs are being met.

The Long Term Survivors Wellness Coalition, in partnership with BHIV, will be hosting their 2nd annual Long Term Survivors Day Event on June 5, 2019, at Baruch College.  The event will include a full day of educational and interactive activities to facilitate building connections and celebrating Long Term Survivors in New York City. More information on the event will be available soon.

On Tuesday, NYC DOHMH Division of Disease Control hosted a documentary film screening and expert panel focused on crystal methamphetamine use in New York City.

Mr. Fields reminded the Council of the importance of consumer involvement in all initiatives.

Ms. Betancourt encouraged more engagement in Staten Island.

There being no further business the meeting was adjourned. 

Minutes approved by the HIV Planning Council on May 30, 2019