Thursday, December 5, 2024
3:05-5:15 PM
In-person at Cicatelli Associates, 505 Eighth Ave., and by Zoom Videoconference
Members Present: D. Klotz (Governmental Co-chair), D. Martin (Community Co-chair), B. Fields (Finance Officer), J. Acosta (for G. Plummer, ex-officio), R. Babakhanian, R. Brown, G. Bruckno, M. Caponi, P. Carr, L. Cyrus, V. Decamps, J. Edwards, R. Ford, R. Fortunato, L. Francis, M. Gilborn, S. Hemraj, R. Henderson, M. Maia Soares, L. F. Molano, MD, B. Montes, J, Natt, C. Nuñez, J. Palmer, L. Richberg, M. Rodriguez, L. Sabashvili, S. Safo, MD, J. Schoepp, M. Sedlacek, A. Tomlin, T. Troia, G. Ty
Members Absent: M. Bacon, M. Baney, K. Banks, J. Dudley, J. Goldenbridge, E. Kaywin, F. Laraque, W. LaRock, H. Martinez, N. Martin, J. Roman, S. Stallings
Staff Present: DOHMH: C. Quinn, MD, D. Saab, A. Eppinger-Meiering, S. Kramer, Z. Edelstein, D. Bertolino, D. Bickram, K. Mack, P. Padgen, H. K. Mok; Public Health Solutions: A. Shahi, R. Santos
Agenda Item #1: Welcome/Introductions/Minutes/Announcements
Mr. Martin and Mr. Klotz opened the meeting followed by introductions and a moment of silence. The minutes from the October 24, 2024 meeting were approved with no additional changes.
Agenda Item #2: Public Comment
Rachel Warshaw (NYU School of Global Public Health) announced a research study called “MOST QUITS”, a community-engaged study for PWH who are struggling to quit cigarette smoking. She encouraged those interested in enrolling or who need further information to contact mostquits@nyu.edu
Mr. Maia inquired lauded Tom Viola, retiring Executive Director of Broadway Cares/Equity Fights AIDS, who raised over $300M for HIV treatment, care and services during his tenure. He also praised his long-time primary care physician, Dr. Mary Vogler, who is also retiring after many years of distinguished service caring for PWH.
Agenda Item #3: Recipient Report
Ms. Eppinger-Meiering reported news from HRSA and other federal partners, including commemorating World AIDS Day and Homelessness Awareness Month. Changes in Medicare Part D will significantly reduce prescription costs, including those paid for by ADAP and other Ryan White programs. HRSA HAB launched a new webpage dedicated to information about the Ryan White Program 2030, which prioritize efforts to reach PWH who are out of care and not virally suppressed by leveraging partnerships, focusing interventions, and engaging community to end the HIV epidemic. Sessions and materials from the August National Ryan White Conference have been posted online.
DOHMH has made 27 awards under the Behavioral Health request for proposals (RFP) for programs beginning March 1, 2025. The Behavioral Health service categories are Mental Health Services, Supportive Counseling Services, and Harm Reduction Services, funded at a total of $13,203,171 annually. One award was also made for Non-Medical Case Management Services for Currently and Recently Incarcerated PWH at a total of $1,436,644 annually (the rest of the service category allocation goes to H+H Correctional Health for services on Riker’s Island). A list of the awardees was provided.
On October 22, the DOHMH HIV Care and Treatment Program (CTP) successfully submitted the HRSA Ending the HIV Epidemic (EHE) in the U.S. – Ryan White HIV/AIDS Program Parts A and B grant application. CTP applied for the ceiling amount totaling $16,700,000for year one (effective March 1, 2025) and a total of $112,311,308for the five-year period of performance for the grant. Final allocations are dependent on appropriations and grant application scoring. the EHE initiative expands the program’s ability to meet the needs of clients, specifically focusing on linking PWH who are either newly diagnosed, diagnosed but currently not in care, or are diagnosed and in care but not yet virally suppressed, to the essential HIV care, treatment, and support services needed to help them reach viral suppression in the four boroughs of Brooklyn, Bronx, Manhattan, and Queens.
From October 21-24, 2024, CTP delivered a four-day training with RWHAP Part A Care Coordination subrecipients throughout the Lower Hudson Valley (Tri-County) region. The NY EMA Quality Management (QM) Program delivered a new quality improvement training on October 11 entitled, Addressing Stigmatizing Language in Healthcare Settings and Care Services Documentation.
On December 4, DOHMH hosted its World AIDS Day 2024 citywide event at Brooklyn Public Library. On December 4, the New York City Health Department released new user’s guides on HIV testing, daily PrEP, injectable PrEP, PrEP on demand, and emergency PEP, and two new infographics: A Snapshot of HIV Among Women in New York City, 2023, and A Snapshot of HIV Among People Ages 50 and Older in New York City, 2023. These new materials join the new PrEP Prevents HIV pocket guide in multiple languages. DOHMH also released data on drug overdose deaths. On October 21, Dr. Michelle Morse became Acting Health Commissioner for the New York City Health Department following Dr. Ashwin Vasan’s departure. Dr. Morse also serves as the agency’s inaugural Chief Medical Officer.
In a response to Mr. Babakhanian, Ms. Eppinger-Meiering explained that use of peers is part of the recommended staffing plan for programs, although certain positions require, per NY State and HRSA, specific licensure (e.g., mental health clinicians). Also, while funding is divided according to separate line items, as HRSA has no “behavioral health” category, funded agencies provide multiple service models, and there will be one intake for all programs. A single, integrated Behavioral Health team at CTP and the QM program supports all providers.
Agenda Item #4: GY 2024 Estimated Unobligated Balance Request
Ms. Gilborn presented the estimated unobligated balance request” (UOB), a HRSA requirement that all EMAs submit by the end of December an. The document tells HRSA that the EMA will ask to use unspent funds from the current grant year (i.e., 2024 carryover) in the next grant year (2025). 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 uses ADAP as a placeholder for the use of the carryover funds, but we are not required to spend the carryover for that purpose. The Council will know the actual amount of carryover next spring after closeout of the grant year, after which the PSRA Committee will develop an actual carryover plan for submission to HRSA.
A motion was made and seconded to approve the GY 2024 estimated unobligated balance request. The motion was adopted 29Y-0N.
Agenda Item #5: Emergency Financial Assistance (EFA) Directive
Mr. Hemraj presentedthe revised directive for Emergency Financial Services category. The HRSA definition of the service was provided: limited one-time or short-term payments to assist clients with an urgent need for essential items or services necessary to improve health outcomes, including: utilities, housing, food (including groceries and food vouchers), transportation, medication not covered by ADAP, or another HRSA-allowable cost needed to improve health outcomes. A timeline of the service category was described. The category started in the Tri-County region in 2018 with an allocation of $250,000 and has increased to its current $1.6M to serve the entire EMA. The cap on assistance was raised in 2021 from $2000 per client/year to $5000. Only one organization, located in Westchester, has been the sole service provider since 2018. The Council has long expressed the need to allow for the inclusion of a service provider within NYC to enhance reach and maintain efficiency of service spending.
Mr. Klotz reviewed the revisions to the existing directive. Goals were updated to reflect language in NYS Integrated HIV Prevention and Care Plan 2022-2026. The boilerplate statement preceding the service model was removed as it is now part of the framing directive overarching all directives. A new agency eligibility provision was added: “At least one (1) funded agency service site must be geographically located within the five (5) boroughs of New York City and have the capacity and reach to serve clients from New York City and their specific needs.” Also, language of the existing provision regarding Tri-county provider was updated to mirror language of the new provision: “At least one (1) funded agency service site must be geographically located within the Tri-county region with the capacity and reach to serve clients from Tri-county region and their specific needs.” The directive also encourages the Recipient to leverage other resources to promote the use of peers to conduct outreach and to create an online portal for direct application for services.
A summary of the key points in the ensuing discussion follows:
- Recipient staff clarified that EFA pays for emergency financial needs (e.g., an urgent rent payment, utility bill, groceries) as needed, with documentation and fulfillment of payor of last resort requirements. The total amount of assistance over the course of a year can be up to $5000 per client (as per the Council’s directive). The time from requesting assistance to when a payment is made (directly to a vendor, not the client) depends on the request and the completeness of required documentation, but can be as short as one week.
- Mr. Carr raised concerns about the efficiency of having two programs requiring two separate staffs to provide the service.
- The amounts of the allocations for NYC and Tri-County will be determined next year by PSRA after reviewing data on enrollment, utilization and need in each geographic area.
- New providers for the service (starting March 2026) would be determined through a competitive bidding process through an RFP.
- The Council will monitor the implementation of the NYS Social Care Networks (Medicaid 1115 waiver), which will fund many of the same services as RWPA.
A motion was made and seconded to approve the revised EFA directive as presented. The motion was adopted 29Y-0N.
Agenda Item #6: 2023 NYC HIV Surveillance Report
Ms. Edelman presented the 2023 NYC HIV epidemiology and surveillance report. Data comes from HIV-related lab tests ordered by NYC-based providers and DOHMH-led investigations to confirm diagnose and determine whether they are new or previously reported. Data help us understand and evaluate progress toward reducing disparities in HIV prevention, diagnosis, and outcomes by demographic groups. In 2023, 1686 people were diagnosed with HIV (1149 were newly diagnosed and 328 or 19.5% were concurrently diagnosed with AIDS). There are about 88,5000 PWH in NYC and in 2023 there were 1538 deaths among PWH. Divergence in new diagnoses and estimated new infections suggests that more people with existing infections were diagnosed for the first time.
A history of the HIV epidemic in NYC was provided, along with trend lined for 2019-2023. Seventy-nine percent of new diagnoses were men, 18% women, 3% transgender women and <1% transgender men. Forty-two percent were Latino/a and 41% Black, 67% were ages 20-39 years and 14% over 50. Sixty-nine percent were MSM. While rates of new diagnoses have ticked up slightly among most groups since 2022, they remain considerably lower than 2019. Rates of new diagnoses remain persistently high among Blacks and Latinos, MSM and people living in high poverty ZIP codes.
Progress on improving HIV care outcomes among people with HIV in NYC remained flat, with stable trends or small improvements over the past five years. The percentage of timely initiation into care after diagnosis increased slightly to 80%, and viral suppression (VS) within three months of diagnosis increased slightly to 52%. Rates are slightly lower among some groups (Black, ages 49+). Total VS among PWH is 84%. The proportion of people in each stage of the HIV care continuum was provided by race/ethnicity. While no population has reached the UN 95% target for PWH to be on anti-retroviral treatment (ART), there are no disparities among PWH on ART who have reached VS, with all meeting the UN 95% target. The age-adjusted death rate for PWH fell from 9.6 in 2019 to 7.5 in 2023. The rate is higher among Black and transgender people. The proportion of deaths attributed to HIV is 19%.
A summary of the discussion follows:
- DOHMH uses genomic sequencing to determine if an infection is recent.
- Knowing whether a recent arrival to NYC was infected here or came already infected is important data to have.
- Many cardiac and other co-morbidities are exacerbated by HIV infection and may have earlier onset due to HIV, which would not necessarily show up in the data on cause of death.
- The age-adjusted death rate for all New Yorkers is 6.1/1000 (compared to 7.5 for PWH). While still higher for PWH, it is a vast improvement over time.
- The increase in the number of new infections of unknown transmission category is likely due to not being able to do as many in-person interviews and medical chart reviews as pre-pandemic.
- The presentation of the data is easier to digest in the current report.
- DOHMH should consider getting more consumer input into the data analysis.
Agenda Item #7: Public Comment, Part II
Heather Anderson (Gilead Sciences) introduced herself, noting that Gilead supports over 35 health systems in NYC. She expressed the hope to tell Council members and the community more about the work.
Mr. Maia stated that he looks forward to having the same open dialogue with Dr. Morse that the community did with Dr. Vasan.
There being no further business, the meeting was adjourned.
