Thursday, January 23, 2025
3:00-5:05 PM
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, P. Carr, L. Cyrus, V. Decamps, J. Dudley, J. Edwards, R. Ford, R. Fortunato, L. Francis, M. Gilborn, J. Goldenbridge, E. Kaywin, W. LaRock, M. Maia Soares, L. F. Molano, MD, B. Montes, J, Natt, C. Nuñez, J. Palmer, L. Richberg, M. Rodriguez, , J. Roman, L. Sabashvili, J. Schoepp, M. Sedlacek, S. Stallings, A. Tomlin, G. Ty
Members Absent: M. Bacon, M. Baney, G. Bruckno, M. Caponi, F. Laraque, S. Hemraj, R. Henderson, H. Martinez, N. Martin, S. Safo, MD, T. Troia
Staff Present: DOHMH: D. Saab, M. Navejas, A. Eppinger-Meiering, S. Kramer, J. Thomas, F. Abdelqader, D. Cilek, K. Mack, P. Padgen, A. Drab, F. Ahmed, H. K. Mok; Public Health Solutions: B. Silver, G. Barclay, A. Shahi, R. Santos
Agenda Item #1: Welcome/Introductions/Minutes/Announcements
Mr. Martin and Mr. Klotz opened the meeting followed by a roll call and a moment of silence. The minutes from the December 5, 2024 meeting were approved with no additional changes.
Agenda Item #2: Public Comment
Mr. Maia announced that the Consumers Committee’s planned Town Hall on Client Advisory Boards will take place in mid-April, with further details TBA.
Dr. Molano announced that Community Healthcare Network is sponsoring a conference next week on gender-affirming care.
Mr. Fields and Mr. Schoepp relayed concerns about the effects of the new administration’s recent executive orders on immigration and DEI, as well as proposed changes to Medicaid (work requirements, shifting costs of ACA expansion to states). Mr. Klotz reported that DOHMH BHHS Policy and External Affairs director Adrian Guzman is keeping track of developments and will keep the Council informed, including through a presentation at the February Council meeting.
Mr. Palmer raised the issue of how social service agencies should respond to possible encounters with immigration authorities. Also, he reported that a coalition in the Lower Hudson area is coordinating around the effects of the new Social Care Networks (funded through the State Medicaid 1115 waiver) and how they will impact RWPA services.
Mr. Martin discussed the importance of being safe on social media in the current climate.
Agenda Item #3: Recipient Report
Ms. Eppinger-Meiering reported news from HRSA and other federal partners, including Ryan White Program 2030 (RWP 2030) program letter, which details HRSA HAB’s vision to sustain high-quality care and treatment for people currently receiving services through the RWHAP while expanding efforts to identify and engage individuals with HIV who are undiagnosed or out-of-care. HRSA and CDC have released the guidance for the 2027-2031 statewide Integrated HIV Prevention and Care Plans. The NYS DOH will lead the development of the plan with input from the Council, DOHMH and stakeholders throughout NY State. HRSA released the 2023 Ryan White Data Report, with data on clients served by RW Parts A, B, C and D nationwide. A record-breaking 90.6% of people with HIV (PWH) receiving medical care through the RW programs are virally suppressed, exceeding the national viral suppression rate. CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) encouraged the public health and substance use disorder (SUD) treatment communities to increase the number of people with SUD who are tested and treated for HIV and viral hepatitis.
HRSA informed the Recipient that HRSA is in the process of issuing Notices of Award (NOA) for fiscal year (FY) 2025 RWHAP Part A grants. HRSA is currently operating under a Continuing Resolution; therefore, the upcoming NOA will provide partial funding (approximately 28% Formula and 18% MAI) based on the continuation of FY 2024 program requirements and funding levels. Final awards will be processed as soon as HRSA HAB receives the full FY 2025 appropriation amount for the program.
The CHAIN Study released two new reports, on HASA Utilization, and Incarceration among PWH enrolled in CHAIN. The Quality Management Program has finalized a series of trainings, forums, and workshops for RWHAP subrecipients, consumers, and recipient staff. The trainings will focus on utilization of quality improvement methods, developing quality management plans, and coaching for implementing and ensuring quality in the delivery and reporting of RWHAP services throughout the NY EMA. QMPI is also working with subrecipients transitioning to the new service model for behavioral health.
DOHMH BHHS released its 2023 STI Surveillance Report showing a decrease in syphilis cases but increases in chlamydia and gonorrhea. BHHS also released new images for its HIV Sure campaign. Two non-RWPA RFPs were also released.
Agenda Item #4: Recommendations for Providing Appropriate and Safe Care for
PWH Involved in Sex Work
Mx. Kaywin and Mr. Ford presented a set of recommendations developed by the Needs Assessment Committee (NAC) for delivering affirming, inclusive and culturally safe RWPA services to PWH involved in sex work. This topic was identified as an emerging issue during the development of the comprehensive needs assessment in 2023. NAC received presentations on sex work-related laws and policies and supporting care for sex workers from DOHMH, TransEquity Consultants, COIN Clinic, and National Harm Reduction Coalition. A summary of the compiled knowledge was described. A summary of the recommendations follows:
- The Recipient should emphasize to RWPA providers the importance of patient/client privacy, confidentiality, and informed consent and must never disclose information about a client’s profession.
- The Recipient should provide RWPA providers with the necessary resources and tools to deliver services in a way that protects and upholds the human rights of all sex workers.
- The Recipient should ensure that RWPA providers are trained on non-discrimination and the rights of sex workers to access high-quality, non-coercive care, while also guaranteeing confidentiality and informed consent.
- The Recipient should encourage RWPA providers to inform their clients about the anonymous reporting tool from the NYC Commission on Human Rights to report instances of discrimination.
- Assign a Recipient staff to regularly attend NYC Health Department Sex Work/er Workgroup (WG) meetings to stay informed on strategies, legal developments, and policy issues.
- Services must be accessible and provided in an equitable, stigma-free, welcoming, and culturally safe manner that respects and addresses each person’s unique needs.
- The Recipient should ensure RWPA providers coordinate real-time training calendars and resources focused on crisis counseling, psychological first aid, and trauma-informed care for all RWPA provider staff.
- RWPA providers should have free naloxone kits, drug testing strips and other drug checking reagents for Fentanyl or Xylazine available at their sites and provide clients with training on how to use harm reduction materials.
- RWPA providers should provide and make available safer sex and hygiene kits and materials to clients who express a desire or need for them.
- RWPA providers engage and consult with community-led sex work organizations and programs to gain insights, enhance engagement within this population.
- The Recipient should develop and distribute a comprehensive list of community-led sex worker advocacy groups, organizations and programs to connect clients seeking additional services and support within the community.
The Council commended the Needs Assessment Committee and its co-chairs for the thoughtful and comprehensive set of recommendations. Ms. Saab was thanked for her outstanding support of the NAC and its process for developing these recommendations.
Mr. Klotz reported that the Ending the HIV Epidemic (EHE) workplan will be presented at a future meeting, but noted that it includes a priority of the Consumers Committee to fund technical assistance for RWPA agencies to create and/or improve client advisory boards.
Agenda Item #5: Update on the Data Workgroup Presentations
Mr. Klotz noted that in 2023 the Council established an ad hoc Data Workgroup that developed recommendations to improve RWPA data collection. The goals of the recommendations were to increase user access to data for quality improvement, reduce required data collection, and increase capacity to share information across programs so that consumer and provider data collection burden will be reduced.
Ms. Cilek presented on eSHARE system enhancements to reduce data burden, including auto-population for intake assessment forms, multiple services forms, and expansion of the delete function to clean data. Upload module enhancements will include a bulk upload feature, and workflow and performance enhancements. User interface and experience enhancement include: improved search page, searchable dropdown, additional training materials and real-time processing when entering primary care status measures (PCSMs). DOHMH is still working on PSCM fillable PDF form uploads and auto-fill and -complete for form data.
Ms. Thomas presented a status update on Data Workgroup recommendations. The following questions were removed from intake and reassessment forms: 1) If AIDS diagnosis, AIDS diagnosis date; 2) Hospitalizations for year prior to program enrollment: counts and start date; 3) ED visits for year prior to program enrollment: counts and start date; 4) In the past 6 months, have you had sex with anyone? (anal or vaginal sex); 4) In the past 6 months, have you had any HIV-negative partners or partners whose HIV status you did not know?; 5) In the past 6 months, have you had sex in exchange for drugs, money, food, or shelter?; 5) Other assessment used? She noted that there is no clinical reason to differentiate between HIV and AIDS and that doing so can be stigmatizing. In addition, surveillance data will be used in lieu of lab test data in intake assessments and PCSM forms. All those data elements are no longer being collected for any new and revised service categories, except viral load test data. Only a few service categories still have those data elements as required, mostly because of competing priorities.
Ms. Eppinger-Meiering presented on collaboration with the Planning Council on data collection, including input from the Data Workgroup and IOC and Tri-County Steering Committees during development of new service directives. Per input from the Needs Assessment Committee, there are recommendations regarding special populations, including people with disabilities, new immigrants/migrant and people involved with sex work. Also, the Quality Management Committee, which includes Council members, provides input. Mr. Abdelqader presented on routine service category data reports to inform the Council’s planning process and to share with providers. Providers access “canned reports” within eSHARE and receive routine reports outside of eSHARE (e.g., the Agency-level Viral Suppression Report with breakdowns by service category and comparisons to RWPA overall). Evaluation projects using RWPA data are shared with providers and Council staff and members in the form of presentations and publications. Also, service category-specific fact sheets provide overviews of service goals, eligibility criteria, counts and descriptions of clients served, count of service types delivered, spending and systems-level considerations.
Finally, RWPA enrollment reports provide descriptive information on RWPA clients for the grant year by enrollment status (enrolled at all, new, reopened, closed, and active), by client demographics, by priority population (overlapping categories used in RWPA planning), and by service category.
A summary of the discussion follows:
- Fillable forms are not part of the system and must still be entered into eSHARE, but DOHMH is working toward being after to pre-enter data.
- The hope is that one day consumers can pre-enter data into the system to expedite intakes and reassessments.
- Sharing data between agencies (so that clients do not have to go through complete multiple intakes) will require legal consent from the clients in addition to inter-agency agreements and protocols.
- In general, sharing of medical information is done on a need-to-know basis and must be compliant with HIPAA rules.
- eSHARE is not an electronic medical record (EMR), thus cannot be used by clients like MyChart or other EMRs, but it can be used to help make care more seamless.
- It is important that the data collected be protected from inappropriate uses.
- There is no involvement yet of artificial intelligence in the system and DOHMH is very aware of the high levels of data security required.
Mr. Klotz thanked the presenters noting the progress toward many of the goals of the Data Workgroup, particularly lowering the burden of data collection and the elimination of intrusive intake questions.
Agenda Item #6: Other Business
Mr. Klotz announced that the February 27th Council meeting will be hybrid with the in-person component at Cicatelli Associates,505 8th Ave. 20th floor. The main agenda item will be the PSRA Committee’s GY 2025 spending scenario plan. Also, DOHMH Acting Commissioner of Health, Dr. Michelle Morse, will attend and address the Council.
There being no further business, the meeting was adjourned.
