Thursday, April 28, 2022
By Zoom Videoconference
M I N U T E S
Members Present: G. Harriman (Governmental Co-chair), D. Walters (Community Co-chair), P. Carr (Finance Officer), A. Abdul-Haqq, F. Alvelo, S. Altaf, R. Brown, G. Bruckno, M. Caponi, R. Chestnut, B. Cockrell, J. Dudley, J. Edwards, B. Fields, R. Fortunato, M. Gilborn, C. Graham, R. Henderson, E. Kaywin, M. Lesieur, D. Martin, L. F. Molano, J. Natt, H. Nguyen, J. Palmer, M. Rifkin, F. Schubert, C. Simon, M. Thompson, T. Troia, R. Walker, S. Wilcox
Members Absent: M. Bacon, M. Baney, L. Beal, A. Betancourt, P. Canady, E. Casey, J. Gomez, B. Gross, C. Moore, G. Plummer, D. Powell, L. Ruiz, V. Velazquez
Staff Present: DOHMH: D. Klotz, M. Lawrence, S. Macias, J. Colón-Berdecía, K. Mack, J. Acosta, D. Noble, G. Navoa, D. Ferdinand, R. James, S. Torho, M. Pathak; Public Health Solutions: G. Ashby-Barclay, A. Shahi, R. Santos; CHAIN: A. Aidala, PhD, M. Yomogida; J. Corbisiero (Parliamentarian)
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Ms. Walters and Mr. Harriman opened the meeting followed by a roll call and a moment of silence. The minutes from the March 24, 2022 meeting were approved with no changes.
Agenda Item #2: Recipient Report
Ms. Macias reported that HRSA observed National Transgender HIV Testing Day and National Youth HIV Awareness Day this month. Registration is now open for the virtual 2022 National Ryan White Conference on HIV Care & Treatment, which will take place August 23-26. The NY EMA will have seven presentations at the conference, including one from the Consumers on the Aging & HIV Service Directive. In policy news, a federal court struck down a Defense Department ban on PWH serving in the military.
With the federal budget approved, the final Ryan White Part A (RWPA) grant award is expected in mid-May. The Recipient is now in the GY 2021 subaward closeout period, which is key to fiscal compliance for RWPA subawards. During closeout, the recipient will ensure that all funds are liquidated within 90 days of the end of the budget period.
The NY EMA Quality Management Committee met on March 21st with over 20 stakeholders attending, including the Council and Consumer Committee. The committee reviewed the Council’s Framing Directive. They discussed the GY2022-23 priorities for the QM Program and brainstormed strategies to better engage consumers and providers of RWPA services in the QM Program. Priority areas include consumer engagement, collaboration and coordination, capacity building, service engagement, service quality, and health equity. The QM and Care and Treatment (CTP) Programs also offered technical assistance to the Dallas, TX EMA.
The Data to Suppression (D2S) project, funded by the National Institutes of Health since July 2021, began providing enhanced Ryan White Part A (RWPA) program resources to support viral suppression (VS) in late 2021. Targeting disparities in VS between RWPA clients and other PWH in New Yorkers, the D2S intervention includes delivery of reports on clients’ care and treatment status to their current behavioral health and housing services providers and capacity-building assistance for addressing barriers to ART adherence. The D2S project Advisory Board met on March 30 with about 25 participants to review the program.
CTP co-hosted a webinar with Public Health Solutions (PHS) for all RWPA providers on March 30. CTP reviewed HRSA Part A policy updates on client eligibility determination and recertification requirements, clinical quality management, 340b monitoring, and payor of last resort.
Proposals under the RWPA RFP for NYC Oral Health Services were due March 25th. Award status notifications will occur on June 15th with funded programs set to start on September 1st.
Agenda Item #3: GY 2022 Reprogramming Plan
Ms. Gilborn introduced the GY 2022 Reprogramming Plan approved last week by the Priority Setting & Resource Allocation (PSRA) Committee. The Council develops a reprogramming plan each year to spend funds that become uncommitted during the course of the year. We traditionally give the Recipient the latitude to shift funds between service categories in order to enhance overperforming contracts. No service category will be enhanced by more than 20% of its original allocation in the spending plan without Council approval. ADAP will be included as a category for enhancement after all other service categories have been considered, but will not be subject to the 20% cap. With programs reverting to fee-for-service reimbursement, the plan will allow the EMA to maximize spending during the year and reduce the levels of carryover seen during the two pandemic years.
Ms. Gilborn, on behalf of PSRA, moved to approve the Reprogramming Plan as presented. The motion was adopted 27Y-0N.
Agenda Item #4: Bylaws Amendment
Mr. Fields presented a draft amendment to Article VI of the Council’s bylaws to formalizes long-standing practices and eliminates uncertainty regarding how Council members serve on committees. It clarifies that Council members must serve on at least one committee, that Council member appointments to committees follow the same procedure as appointments for non-PC members, and that Council members only have voting rights on committees that they have been formally appointed to. In response to a question from Mr. Walker, it was clarified that the Bylaws still allow Council members to serve on multiple committees.
Mr. Fields, on behalf of the Rules & Membership Committee, moved to approve the bylaws amendment as presented. The motion was amended by unanimous consent to strike the word “during” and replace it with “throughout”. The amended motion was adopted 28Y-0N.
Mr. Fields also announced that the application process for Council membership is underway. Applications can be submitted through the website or on a form that can be emailed. There will be about 8 open seats this year, and members were encouraged to spread the word, especially to consumers and to underrepresented communities.
Agenda Item #5: Women with HIV in NYC: Service Needs and HIV Care Outcomes
Dr. Aidala presented CHAIN data women with HIV (WWH) in NYC. There are multiple social and clinical factors that create barriers for women to access and remain in HIV care and services. In addition to socioeconomic and structural barriers that affect all PWH, a number of factors are unique to women or more commonly experienced by them. This is the case both nationally and within New York City. Women at most risk or living with HIV are more economically disadvantaged than their male counterparts, and WWH experience disproportionate rates of trauma exposure and five times the rate of recent post-traumatic stress disorder (PTSD) compared to the female population nationally. Women are infected primarily via heterosexual sex, many within established relationships and with limited awareness of their risk status. The material conditions of their day-to-day lives, as well as unique psychological and emotional needs, have contributed gender-related HIV-related health disparities. Prior research, including CHAIN reports, has shown women are less likely than men to be routinely tested for HIV, enter HIV care later, and more often miss scheduled appointments, and have lower rates of sustained viral suppression. This report focuses on cisgender women, as there are too few transgender women in the CHAIN study sample for this report (n=14) for reliable estimates on what might be their specific needs or predictors of HIV care and outcomes.
After a brief description of the CHAIN study, there was a breakdown of background characteristics of the women in the sample. More than half are Black and 40% Latina, about 40% have children <18 in the home, and 20% are solo moms. Women more likely than men with HIV to have incomes below poverty level and have worse scores on standard measures of physical health functioning and quality of life. Over half of the women in the study had a mental health score indicating clinically significant mental health symptoms (a higher percentage than among all men but not among MSM).
Over 90% of women need housing assistance – 17% are unstably housed or homeless and others are severely rent burdened. Far more women (53%) concealed their status from household members compared to heterosexual men (33%), MSM (33%), and transgender PWH (25%). Fare more women than men have an experience of trauma or violence, both in childhood and adulthood. Over twice as many (almost half) have been assaulted by a partner.
Dr. Aidala reviewed the definition of service need and utilization for a range of services. For example, “Need Food Assistance” is defined as “not enough money for food that the individual or family needs, or self-report need for help with food, groceries, or meals”. “Received Food Assistance” is defined as “received SNAP or WIC, or respondent had group meals, home delivered meals, used a free food pantry, and/or received other food assistance.” 84% of women depended on housing assistance to pay rent or secure or maintain stable housing, and 12% need housing assistance but are receiving no assistance or housing services. 61% of women need and receive some type of financial assistance, and 11% need financial assistance but are not receiving any assistance. 45% of women need and receive some type of food or meal services, and 3% need food assistance but are not receiving any. The corresponding numbers for Mental Health are 57%/34%, Alcohol or Drug Treatment: 25%/21%; Medical Case Management: 27%/20%, Social Services Case Management: 96%/25%. Women’s need for housing assistance was consistently high while the need for financial and food assistance rose over the study period (2008-2020). Examples of the social and medical service barriers reported by study participants was given, with typical responses of women, heterosexual men and MSM compared. A common response for many services across populations was “I didn’t know where to go to get help.”
Definitions of HIV outcome measures were given (e.g., “adherent ARV use” is defined as Taking a recommended ARV regimen and report taking medications “exactly as prescribed, almost never missing a dose” and report not missing any medications in the two days preceding the interview). Compared to heterosexual men and MSM, women had the lowest rates of receiving appropriate care, ARV adherence, viral suppression. A comparison of medical care barriers was described (women are much more likely to cite child care). Other factors that contributed to poorer health outcomes include problem drinking, living alone, a child under 18 in the household, unstable housing, needing income assistance and needing medical case management.
Conclusions from the study are that, in addition to socioeconomic and structural barriers that affect all persons with HIV (PWH) there are multiple social and clinical factors that create barriers for women to access and remain in HIV care are unique to women or more commonly experienced by them. While rates of retention in care are similar to men, women face distinct barriers in sustaining ‘good care’ that meets clinical practice standards, adherence to ARV, and viral suppression. Women-centered, coordinated, comprehensive care is needed that addresses day-to-day life challenges as well as unique psychological and emotional needs.
A summary of the discussion follows:
- CHAIN participants were recruited through a random sampling of HIV health and support service providers from throughout the EMA.
- It is disturbing that so many people report not knowing where to get services as a barrier. This is an indication that agencies that are supposed to make referrals across the system are not doing their job effectively. Referral mechanisms need to be strengthened.
- The HIV care system has long failed cisgender women. There needs to be a reproductive justice lens in HIV care. Unmet child care needs are a major barrier to missed appointments. Family planning, the right to have or not have children and the right to terminate a pregnancy must be incorporated, as well as the right to parent a child and the issues around inappropriate involvement of child protective services. Women are not getting basic health needs met, including sexual health screenings (including PAP smears).
- There needs to be a change in the culture around women’s lives and health, including recognizing sexual health needs (e.g., increasing PrEP usage). Trauma-informed care needs to be incorporated systematically.
Agenda Item #5: Co-chairs Report
Ms. Walters and Mr. Harriman reported that that the Council’s contributions to the Integrated Plan discussion from the last meeting have been shared with the State. The Consumers Committee will continue to provide feedback on the Integrated Plan, which will also be shared with the State. A draft plan is expected in the fall.
A survey to enhance the Council’s Assessment of the Administrative Mechanism was sent out to all RWPA contractors. The survey will obtain input on payments, technical assistance and other aspects of their relationship with the Recipient and Master Contractor.
The chairs are also working with the Consumers Committee on a date for the Annual Council Picnic in July or August. Meetings are expected to remain virtual until the fall. Time will be needed for the procurement process to pay for meeting space, food, audio and other expenses for hybrid meetings. The Data Workgroup will need new chairs in the fall. Also, Nina Rothschild continues to improve and is expected to return to the office in mid-May.
Agenda Item #6: Public Comment
Ms. Lawrence announced an upcoming webinar on Embedding Equity with new NYS OASAS commissioner Dr. Chinazo Cunningham.
There being no further business, the meeting was adjourned.