Thursday, December 22, 2022
By Zoom Videoconference
Members Present: G. Harriman (Governmental Co-chair), D. Walters (Community Co-chair), B. Fields (Finance Officer), S. Altaf, F. Alvelo, R. Babakhanian, M. Baney, K. Banks, A. Betancourt, R. Brown, M. Caponi, R. Chestnut, J. Dudley, J. Edwards, M. Gilborn, J. Gomez, C. Graham, B. Gross, S. Hemraj, B. Hribar, W. LaRock, M. Lesieur, D. Martin, N. Martin, H. Martinez, J. Natt, J. Palmer, G. Dominguez Plummer, J. Schoepp, M. Sedlacek, C. Simon, M. Thompson, S. Wilcox
Members Absent: M. Bacon, L. Beal, G. Bruckno, E. Casey, R. Fortunato, R. Henderson, E. Kaywin, F. Laraque, L. F. Molano, MD, H. Nguyen, M. Rifkin, M. Soares, T. Troia
Staff Present: DOHMH: D. Klotz, M. Lawrence, S. Spiegler J. Acosta, D. Noble, G. Navoa, J. Colón-Berdecía, K. Mack, I. Newman, A. Eppinger-Meiering, Monika Pathak, D. Bertolino, P. Parathi, MD, C. Hwang, S. Torho; Public Health Solutions: G. Ashby-Barclay, R. Santos, A. Shahi; Parliamentarian: J. Corbisiero
Agenda Item #1: Welcome/Introductions/Minutes/Public Comment
Mr. Harriman and Ms. Walters opened the meeting followed by a moment of silence. The minutes from the October 27, 2022 meeting were approved with no changes.
Agenda Item #2: Estimated Unobligated Balance Request
Mr. Natt explained that HRSA requires all EMAs to complete and submit by the end of this month an “estimated unobligated balance (UOB) request”. The document tells HRSA that the EMA will ask to use unspent funds from the current grant year (i.e., 2022 carryover) in the next grant year (2023). We will not know the actual amount of carryover until next spring after closeout of the grant year. The UOB request states that next spring we will ask to carry over as much as 5% (the maximum allowed with no penalty). The UOB request uses ADAP as a placeholder for the use of the carryover funds, but we are not required to spend the carryover for that purpose. In June 2023, PSRA will develop an actual carryover plan for submission to HRSA. GY 2022 carryover funds must be spent by the end of GY 2024 (Feb. 29, 2024).
A motion was made and seconded to approve the GY 2022 UOB request as presented. The motion was adopted by a roll call vote of 27Y-0N.
Agenda Item #3: GY 2022 2nd Quarter Expenditure Report
Mr. Fields introduced the GY 2022 2nd quarter expenditure report, which shows spending for the current grant year from March 1st through August 31st. As of mid-year, the grant award is 44% spent, which is the highest it has been since 2018. This means that the award is on track to come in well under the 5% maximum underspending by the end of the grant year, which is a big improvement over the two previous years, when spending was highly impacted by the COVID-19 pandemic. The improvement in spending is largely due to a return to in-person services and the resumption of performance-based reimbursement.
Mr. Spiegler presented the details of the spending report, focusing on areas of higher-than-average underspending. As noted, there is a big improvement in spending as of the end of the 2nd quarter from the previous two years, and even surpassed the two years prior to the pandemic. Non-medical Case Management reported being only 27% spent, mostly due to late invoices from the largest provider. Harm Reduction Programs have reported staff vacancies and a slower transition to in-person services. The Recipient’s Quality Management and Program Implementation (QMPI) team is working with them to improve this.
Low spending in Early Intervention Services is concentrated in programs funded under the PlaySure Network 2.0 program, which were in startup mode the first half of the year. Underspending in Emergency Financial Assistance is due to the large permanent enhancement the program received this year. They are working to increase outreach and client engagement to better promote the service EMA-wide. Supportive Counseling and Psychosocial Supportive Services for TIGNCNB programs have had difficulties with hiring, staff retention and client outreach and enrollment, affecting program performance. QMPI staff is working intensely with them on both administrative and programmatic issues. Health Education and Risk Reduction programs have had low recruitment, likely due to participants not wanting to attend in-person services and difficulty adapting the service model to virtual delivery. Several categories reporting underspending at this point, such as Housing, are projected to spend close to 100% of their allocations. This is due to factors such as late contract execution and adaptation to permanent enhancements. Tri-County Medical Transportation is underspent due to lower usage of the services due to COVID-19, but usage is picking up. TC Legal Services faced the same issue, as courts were still closed part of the year.
Agenda Item #4: 2021 NYC Epidemiology and Surveillance Updates: HIV, STIs, Hepatitis
Mr. Bertolino gave an overview of the recently released 2021 NYC HIV surveillance report. He explained how surveillance works and the limitations of the data and gave a broad history of HIV and AIDS incidence and prevalence throughout the HIV epidemic in NYC. In 2021, there were 1594 new HIV diagnoses and 2178 deaths among PWH. The number of new diagnoses continues its overall long-term trend downward in all groups (with 2020 an anomaly due to a decline in testing during COVID). Eight percent of new diagnoses were those with acute infection (76% of whom were MSM). Eighty-one percent of new infections were among Blacks and Hispanics. Most infections were among people who live in high poverty areas. Of the hundreds of children born to HIV-positive mothers, only one was confirmed to be HIV-positive.
The percentage of newly diagnosed people linked to care within 30 days continues to rise (80% in 2021, with 55% virally suppressed within three months). A total of 83% of PWH were virally suppressed (a slight increase since 2017). The care continuum was shown (95% of PWH diagnosed, 87% in care, 84% prescribed ART), in comparison with UNAIDS targets (90%) overall and by race/ethnicity. NYC exceeds UNAIDS targets for rates of diagnosis and viral suppression. In 2021 in NYC, most deaths among PWH were from non-HIV-related causes, although some non-HIV-related causes of death appear more frequently among PWH than the population at large (lung and colon cancer, liver disease). The rate of HIV-related deaths continues to decline. Higher death rates are seen among people who live in higher poverty ZIP codes.
A summary of the discussion follows:
- The percentage of new HIV diagnoses that are concurrent with an AIDS diagnosis has been relatively steady for some years.
- There was a huge drop in data points (e.g., lab results) in 2020 due to COVID, and the number of tests done in 2021 increased significantly from 2020.
- NYC would rank relatively low in HIV rates, but very high in absolute numbers due to the size of the population.
- Federal guidelines for breastfeeding have not been updated since 1985. Data indicates that it is safe for undetectable women, and it requires sensitive discussion.
- Home tests are not counted in routine reporting. Positive home tests are considered preliminary and must be confirmed by a health care provider (whose test is reportable).
- More detailed data is available in the full report, such as the number of COVID-19 deaths among PWH.
Dr. Paratha reported 2021 data on sexually transmitted infections (STIs) in NYC, specifically chlamydia, gonorrhea and syphilis. In 2021, there were 2230 cases of primary and secondary syphilis (no change from 2020), 7735 cases of latent syphilis (up 22%), 28,162 cases of gonorrhea (up13%) and 62,011 cases of chlamydia (up 10%). The increases were seen primarily among men and almost all syphilis cases are among men. Cases rates are highest in Chelsea/Hell’s Kitchen, Harlem, south and central Bronx and central Brooklyn. Among MSM diagnosed with syphilis in 2021, over 75% were HIV-positive.
Most gonorrhea cases are among men aged 20-44 and are concentrated in the same neighborhoods as above. Chlamydia rates among men and women are almost identical and are concentrated in people 15-34. Females are overrepresented among people ages 15-24 with chlamydia.
A summary of the discussion follows:
- Lab reports should be mandated to include additional fields for data collections (e.g., race/ethnicity).
- Syphilis interventions that helped bring down cases in the 1990s included extensive screening and treatment, particularly in correctional settings.
- DOHMH is working on getting more data on drug-resistant gonorrhea, which requires a culture be done. Some resistance to azithromycin is being seen, but ceftriaxone is still effective.
- Data on STIs among transgender people is not complete.
- There was a shortage of diagnostic testing supplies during the early part of the COVID pandemic, as the same ingredients are used in COVID testing.
Ms. Hwang reported that in NYC in 2021, 243,000 people had hepatitis B (5346 new diagnoses). Like HIV, there has been a long-term downward trend with an anomalous dip in 2020 due to fewer people accessing healthcare during COVID. Slightly more men were diagnosed and the diagnoses were spread out among age groups. Highest rates were seen among neighborhoods in northeast Queens and southern Brooklyn. There were 90 deaths with hepatitis B listed as the underlying cause (leading cause was cancer).
There were 86,000 cases of hepatitis C in NYC in 2021 (2832 new diagnoses). High caseloads were seen in south and central Bronx and central and southern Brooklyn. Cases were spread out among age groups (a change from patterns ten years earlier when cases were concentrated in baby boomers). Two-third of new cases were among men and almost half reported injection drug use. The hepatitis C treatment cascade shows that two-thirds of those diagnosed with hepatitis C have been treated and cured and 3% have persistent infection or reinfection. The rate of treatment (77%) was higher among people dually diagnosed with HIV. In 2021, there 263 deaths with hepatitis C listed as the underlying cause (leading causes were drug overdose and COVID-19).
Agenda Item #6 HIV (Prevention) Planning Group Update
Ms. Torho reported that the HPG launched its status neutral campaign to get providers to incorporate it into their practice. The HPG will hold its annual strategic planning meeting early next year and will look towards closer collaboration with the Council.
Agenda Item #7: Policy Committee Update
Mr. Lesieur reported that the Planning Council/HPG Joint Policy Committee is working on addressing the impending possible end of the 340b Medicaid carve out, which would result in the loss of millions of dollars for HIV service providers and safety net hospitals and clinics. The possible end of the program if it passes the governor’s budget, is the result of an erroneous cost savings during the Cuomo administration. A broad coalition of advocates is working to
Agenda Item #7: Public Comment, Part II
Mr. Schoepp reported that SNAP benefits accounts are being hacked and urged people to be cautious.
Ms. Simon reported that the Statewide Integrated HIV Prevention and Care Plan has been submitted to HRSA and CDC and is posted on the NYSDOH and Council websites. There being no further business, the meeting was adjourned.