Thursday, February 24, 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, A. Betancourt, S. Altaf, M. Baney, R. Brown, M. Caponi, B. Cockrell, J. Dudley, J. Edwards, B. Fields, R. Fortunato, M. Gilborn, C. Graham, B. Gross, R. Henderson, E. Kaywin, M. Lesieur, D. Martin, J. Natt, H. Nguyen, J. Palmer, G. Plummer, D. Powell, M. Rifkin, F. Schubert, C. Simon, M. Thompson, T. Troia, V. Velazquez, S. Wilcox
Members Absent: F. Alvelo, M. Bacon, L. Beal, D. Beiling, G. Bruckno, P. Canady, E. Casey, R. Chestnut, B. Fenton, MD, J. Gomez, A. Lugg, L. F. Molano, MD, C. Moore, L. Ruiz, R. Walker
Staff Present: DOHMH: M. Lawrence, C. Rodriguez-Hart, PhD, J. Colón-Berdecía, K. Miller, R. Torres, M. Pathak; Public Health Solutions: A. Shahi
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 January 27, 2022 meeting were approved with no changes. Mr. Fields paid tribute to Michael Anderson, a community advocate who passed away recently.
Agenda Item #2: Public Comment
Mr. Palmer and Mr. Altaf reported that when agencies received GY 2020 carryover funds for professional development, they were told that the funds only had to be committed by the end of the fiscal year (Feb. 28), but agencies were just informed that the money had to be actually spent and any training completed by this Monday, which would be impossible. Mr. Shahi responded that Public Health Solutions will provide a deliverable opportunity for activities done this year that will be used to provide coverage of costs made to identify trainings, register staff, etc. Mr. Harriman explained the timeline of carryover, from the plan approved by the Council, HRSA giving its approval of the plan, contract amendments, executing amendments, etc. Ms. Thompson added that providers should be consulted about the use of future carryover. Mr. Harriman added that a question about carryover can be added to the assessment of the administrative mechanism survey.
Agenda Item #3: Recipient Report
Ms. Plummer introduced Ms. Macias, who has joined the HIV Care & Treatment and will be working on RWPA and will be presenting the Recipient report in the future. On February 7, the HRSA HIV/AIDS Bureau (HAB) observed National Black HIV/AIDS Awareness Day with the goal of closing health inequities. 2022 National Ryan White Conference on HIV Care & Treatment will take place August 23-26, with limited in-person attendance and open virtual participation. The HRSA RWHAP has a new website: https://ryanwhite.hrsa.gov/. The EMA has a new Project Officer, Axel Reyes, starting on March 1st. He has over 25 years of professional and volunteer experience in HIV prevention and care services domestically and internationally.
The NY EMA Quality Management Committee reconvened on February 10th co-facilitated by the HIV Care and Treatment Program (CTP) Quality Management (QM) Unit and the NY State Department of Health AIDS Institute (AI) Quality Management Program. Over 25 stakeholders attended.
On December 20th, PHS, on behalf of the CTP, released the RWPA Services in the Tri-County Region Rental Assistance Program RFP, with programs starting June 1st. PHS also released the Oral Health Care Services in New York City RFP on February 7th and funded programs are set to start on September 1st. Five organizations were awarded with the EIS funding released through the Playsure network 2.0. Programs start on 3/1/2022.
On January 12th, PHS released the Ending the Epidemic in New York City: The Undetectables Viral Load Suppression Program and Crystal Methamphetamine Harm Reduction Services RFP, with programs starting July 1st.
Agenda Item #4: GY 2020 into GY 2021 Carryover Expenditure Report
Ms. Plummer reported that as of the end of November 2021 (end of the third quarter), $47.7M (60%) of the total GY 2021 award is spent, which is lower than the expected 75%, largely due to the use of cost-based reimbursement. About $1.8M will be reprogrammed to ADAP. Actual carryover amount from GY 2021 into GY 2022 may be lower as funds are spent between December 2021 through end of the grant year on February 28, 2022. Mr. Shahi explained that with a cost-based reimbursement structure (in place for two years), a large portion of funding is spent in the final months of the contract year. Ms. Plummer reviewed the Council’s GY 2020 into GY 2021 carryover plan. Of the $4.9M in carryover, from HRSA approval of the carryover plan to this meeting, 63% has been spent. A breakdown by line item was provided: $204K for Care Coordination Value-based Payments, $492K to Emergency Financial Assistance, $2.5M to ADAP. Mr. Shahi explained that there is no data available yet for expenditure on Food & Nutrition, staff development and training, or technological devices because PHS is currently in the process of finalizing amended budgets to allow for these expenditures. Ms. Plummer added that she and her staff are working with PHS to address issues that have presented problems around contractor payments and expenditure reporting. Also, the program is moving back to performance-based (aka fee-for-service) reimbursement in GY 2022. Ms. Silver added that other EMAs and other federal grants across the country are experiencing the same issues. Mr. Harriman added that HRSA has waived the 5% cap on underspending of formula funds again this year, which will help. Most importantly, it is essential to spend all the carryover in the subsequent year, otherwise those funds are returned to HRSA and the unspent amount deducted from future grant awards.
There is no updated data on the spending of the carryover from GY 2020 due to late reporting by contractors. Complete data will not be available until early March. The Recipient has urged contractors to spend quickly to ensure that all carryover is spent, as any unspent carryover must be returned to HRSA. The Recipient is also communicating with the AIDS Institute to ensure that ADAP can absorb any left over after the other priorities. Also, HRSA has issued another waiver this year allowing EMAs to carryover more than usual without penalty.
A summary of the discussion follows:
- FNS providers are struggling with higher food costs, so there should be consideration of adjusting voucher amounts which would both address higher costs and increase the spending rate.
- Agencies are given two opportunities to amend their contracts, including near the end of the year, so that they can recoup unexpected costs. Programs will also be going back to performance-based reimbursement, which will help with spending.
- Client retention can be a challenge in some FNS programs due to recertification barriers. The Recipient is about to implement a reduction in certification of eligibility due to new HRSA regulations.
Agenda Item #5: Implementation Science Primer
Dr. Rodriguez-Hart presented on evidence-based (aka evidence-informed) practices, which are interventions that we know through trials and evaluations work to improve health outcomes at the individual level, but often are not used in the real world of public health practice and healthcare settings. On average it takes 17 years to go from the discovery of a new intervention to its routine use in practice, and less than half of evidence-based practices even make it into routine healthcare use. Implementation Science (IS) is a type of research that studies methods to promote the uptake or integration of research findings into routine practice. Traditional HIV research is usually focused on health outcomes at the level of the patient or individual (e.g., timely linkage to care, and viral load). In contrast, IS focuses on strategies that target health systems and providers so that we can get the best evidence to the patient or community. IS is primarily concerned with how interventions get used in real world settings. IS can also help address health equity, for example by paying attention to the context in which healthcare occurs (e.g., stigma, poverty). Federal funders, including HRSA, are focusing on defining and standardizing the use IS across programs.
Context includes factors that influence implementation of interventions (also called determinants). When the context is not taken into account, we might use approaches that are inappropriate to the setting, leading to unsuccessful interventions. The HIV context was thought out, discussed, and included in the recently-approved Planning Council Framing Directive. A “Consolidated Framework for Implementation Research” (CFIR) is one of the most widely used determinants framework that helps to understand implementation context. The framework has five domains: Intervention characteristics, outer setting (broader context), inner setting, characteristics of the individuals involved, and process of implementation. For RWPA, the outer setting is the characteristics of the HIV epidemic, structural determinants of health, the social services system. The inner setting is a wealth of data on the system of care.
Implementation strategies are methods or techniques used to enhance the adoption, implementation, and sustainability of a public health/clinical program or practice (the intervention). We can select from many types of strategies, but those we choose need to reduce barriers and leverage facilitators that we identified in the context. IS researchers say we know what the EBPs to eliminate HIV are (treatment, PrEP/PEP, syringe exchange, condoms, etc.), so, what remains to be investigated is how we get these interventions to the populations that need them. Strategies are specified, and an example was provided related to stigma. IS separates out different types of outcomes and collects a broader diversity of outcomes. Traditionally, our focus has been on measuring client outcomes, largely ignoring the health system and provider actions. A formula was described for measuring how an effective outcome may benefit a smaller number of people based on how and how well providers choose to deliver it. A method for choosing a model and implementation was described. An IS logic model template was described showing determinants, implementation strategies, mechanisms and outcomes.
Agenda Item #6: Planning Council Chairs Update
Mr. Harriman and Ms. Walters reported that they represented the Council on a State effort around the new Integrated HIV Prevention and Care Plan, which will be due December 2022. Along with planning bodies across the State, they are working on how to complete the Plan within the plan guidance. It will reflect all the work already done in the State, including the ETE plan. A high-level timeline was shared including Council feedback, community input, and a Council letter of concurrence.
The Data Workgroup will meet on Monday at 10am. The first meeting will go over the workgroup’s charge and introduce the concepts that they will need to work with. Mr. Carr and Mr. Schubert have agreed to chair the workgroup.
There being no further business, the meeting was adjourned.
Minutes approved by the HIV Planning Council on March 24, 2022
Graham Harriman, MA