Thursday, March 27, 2025
3:05-5:10 PM
By Zoom Videoconference
Members Present: D. Klotz (Governmental Co-chair), D. Martin (Community Co-chair), B. Fields (Finance Officer), R. Babakhanian, M. Baney, R. Brown, G. Bruckno, L. Cyrus, V. Decamps, J. Dudley, J. Edwards, R. Ford, R. Fortunato, L. Francis, M. Gilborn, S. Hemraj, R. Henderson, M. Maia Soares, N. Martin, L. F. Molano, MD, J, Natt, C. Nuñez, J. Palmer, G. Plummer (ex-officio), M. Rodriguez, L. Sabashvili, S. Safo, MD, J. Schoepp, M. Sedlacek, A. Tomlin, T. Troia, G. Ty
Members Absent: M. Bacon, M. Caponi, P. Carr, J. Goldenbridge, E. Kaywin, F. Laraque, W. LaRock, H. Martinez, B. Montes, L. Richberg, J. Roman, S. Stallings
Staff Present: DOHMH: C. Quinn, MD, MPH, S. Braunstein, PhD, M. Navejas, D. Saab, S. Spiegler, J. Acosta, A. Eppinger-Meiering, G. Gambone, R. James, G. Herndon, A. Guzman, T. Leong-Pelrine, S. Kramer, A. Omeyoma, C. Burt, E. Ramsdell, K. Mack, H. K. Mok; Public Health Solutions: A. Shahi, R. Santos; CHAIN Study: A. Aidala
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 February 27, 2025 meeting were approved with no changes.
Agenda Item #2: Public Comment, Part I
Mr. Natt and Mr. Maia promoted an ACT-UP protest against federal cuts to HIV prevention and other critical services. Mr. Maia also promoted the Consumers Committee’s Client Advisory Board Town Hall on April 15th.
Mr. Nuñez announced that Destination Tomorrow is holding a house ball to promote HIV prevention and awareness to youth.
Mr. Palmer raised questions about advance payments to Ryan White Part A (RWPA) subrecipients. Mr. Shahi responded that Public Health Solutions (PHS) notified them about getting advance funds to ensure continuity of services until the EMA receives its final notice of award. Mr. Klotz added that he just learned that HRSA submitted Ryan White program notices of award through the Congressional notification process, which means that final award notices should be going out to recipients soon.
Agenda Item #3: Recipient Report
Ms. Eppinger-Meiering reported on the observance of National Women and Girls HIV/AIDS Awareness Day and National Native HIV Awareness Day. HRSA announced that Thomas Engels is returning as
HRSA administrator. He was previously administrator from 2019-21.
On March 13th, PHS on behalf of the NYC DOHMH released the RWPA Care Coordination Services, Outpatient Ambulatory Services, and Emergency Financial Services in New York City Concept Paper, which outlines the basic intent of the forthcoming Request for Proposals (RFP). It is anticipated that awarded subrecipients will receive 36-month awards beginning on March 1, 2026.
On February 26th, the NYS DOH AIDS Institute held a final sharing session with RWPA subrecipients and consumers. Subrecipients discussed their experiences with implementing quality improvement projects, including findings on successful projects that led to new permanent initiatives and practices. Planning for the EMA’s 2025 Annual RWPA Provider Meeting has begun. The full-day event will take place on July 29, 2025. The planning committee has started developing workshops around various consumer engagement topics, resources for program implementation, and quality improvement practices.
On March 5th, BHHS and Planning Council staff joined the AIDS Institute and community partners from across the State at the first meeting of the work group charged with developing the next iteration of the Statewide Integrated HIV Prevention and Care Plan. On March 10th, BHHS joined the End AIDS NY Community Coalition’s briefing for New York City Council Members on ending the HIV epidemic in New York City. Mr. Guzman co-presented a historical overview of the ending the epidemic movement and Assistant Commissioner Sarah Bronstein shared 2023 HIV surveillance data and current HIV and sexual health programming and services. On March 11th, BHHS joined Hep Free NYC’s briefing for New York City Council Members on viral hepatitis elimination in New York City.
Agenda Item #4: Ending the HIV Epidemic Workplan
Mr. Spiegler and Ms. James presented the workplan for NY’s federal Ending the HIV Epidemic 063 grant, which covers Manhattan, Brooklyn, Bronx and Queens. The proposed services fill gaps in RWPA funding by paying for initiatives not reimbursable by RW. Highlights of the plan include: 1) support provision of clinical and psychosocial assessments for CCR clients who are ages 50+; 2) support provision of social and physical group activities for CCR clients who are ages 50+; 3) support establishment of CABs at CCR subrecipient sites; 4) develop a request for proposal (RFP) and execute contracts with at least 3 subrecipients to provide emergency, short-term financial assistance to EHE eligible populations of focus; and 5) develop and implement text messaging campaigns for EHE populations of focus. These initiatives are contingent on the funding being released by US HHS.
Agenda Item #5: Medical Case Management/Care Coordination Services (CCR) Directive
Mr. Hemraj and Ms. Fortunato introduced the revised CCR service directive, approved by the Integration of Care Committee, which will be rebid for services beginning March 1, 2026. HRSA defines CCR as a program to support retention in care by offering home-and field-based patient navigation focused on improving health outcomes in support of the HIV care continuum. Key activities were described (e.g., individualized care plan, treatment adherence support, coordinated access to services), and allowable services outlined (e.g., accompaniment, modified directly observed therapy). Service category goals remain the same, with the addition of increasing the use of immediate anti-retroviral therapy (iART) for the newly diagnosed.
Mr. Klotz outlined the goals and objectives aligned with the 2022-26 Statewide Integrated HIV Prevention and Care Plan (e.g., increasing the proportion of those linked to care and virally suppressed).
Ms. Saab described revisions to the service model. The main elements are:
- Strengthening the language around electronic (virtual) DOT, including promoting the use of existing interventions that have proven effective, such as “contingency management” through a smartphone-based app that uses incentive to reward VLS.
- Inclusion of a basic geriatric assessment (BGA) as a standard to screen for multimorbidity, polypharmacy, and cognitive impairments among older PWH, plus referrals to comprehensive services for aging PWH.
- Inclusion of iART as a bridge to regular treatment once clients are fully connected to clinical care.
The revised directive also encourages the Recipient to strengthen referral tracking through a closed-loop system or process to prevent gaps in care and enhance linkage to necessary services like specialty care, mental health, and harm reduction. In addition, minor tweaks were made to the eligibility section of the directive.
There was discussion of assessments, which are needed to determine the specific needs of the client. Mr. Fields commended the IOC Committee for their revisions to the directive, especially strengthening referral tracking.
Ms. Fortunato made a motion on behalf of the IOC Committee to accept the revised CCR service directive as presented. The motion was adopted 29Y-0N.
Mr. Klotz thanked the IOC Committee members and co-chairs for their work. He commended the extensive support of the Recipient staff and the outstanding work of Ms. Saab in support of the Committee’s work.
Agenda Item #6: Update on RWPA Ambulatory Outpatient (HIV & Aging) Services
Ms. Acosta and Ms. Herndon presented on the implementation of the AOS/HIV & Aging Service category. They reviewed the Council’s service directive for this category, which seeks to increase screening to support early detection and treatment for comorbidities (CVD, osteoporosis, social support, mental health, etc.) among aging PWH. Implementation strategies were listed (e.g., additional clinical capacity, screenings and assessments, prevention and wellness activities, trainings). The Council has allocated $1.3M, which funds three programs.
A description of the service model was provided. Services include care planning, case conferences with or without client, client assistance, linkage to services, STI screening/testing, hepatitis B & C screening/ testing, geriatric assessment/screening, cardiac screening, and other screenings/assessments. EHE funding to cover activities and services that are not payable under RWPA. The HRSA definition and allowable activities of AOS were listed. Program eligibility is standards RW criteria, plus individuals aged 50 years and older. AOS service activities were presented: outreach, service coordination, assessment, clinical services (geriatric assessment, STA screening, cardiac screening, behavioral health assessments). Also, EHE finds group physical and social sessions. Program staffing includes clinical social worker, registered nurse, pharmacist, HIV primary care provider, coordinator and data entry staff.
Programs, which started in March 2023, were piloted as a complementary program to existing RWPA CCR programs. The reimbursement structure is a combination of cost-based and deliverables to support the needs of clients beyond Medicaid reimbursables. Programs were procured as an interagency Memorandum of Understanding (MOU) with NYC Health + Hospitals (H+H) to leverage existing resources. There are three H+H sites: Jacobi Medical Center (Bronx); Elmhurst Hospital Center (Queens); and Kings County Hospital Center (Brooklyn). All have an established CCR program.
Challenges the program has faced included: Gaps in staff knowledge regarding specific care for aging people (specialize in HIV/primary care); implementing group activities; and contracting and data reporting. Successes have included: providers and staff willing to learn geriatric care best practices; good feedback from clients who say they like their providers and the ability to get care/referrals for all their needs; QI projects focusing on developing geriatric screeners for use in non-geriatric settings and dementia care training for nurses; and program directors have expressed interest in expanding the program to other sites and are exploring other means of funding. A summary of program enrollment broken down by various demographics and priority populations was given. Highlights include: 39% of clients are 60-69 and 47% 70-79; 55% are Black and 35% Hispanic; 52% are male and 48% female; 40% are from Brooklyn, 30% from Queens and 29% from the Bronx; 45% are cisgender women of color, 12% are MSM.
Ms. Burt and Ms. Ramsdell provided a summary of service utilization. There have been 1813 total services provided (1758 individual and 55 group). The most common service type is client assistance, followed by case conferencing. Half of client assistance was for social services and most of the rest for health care (there was some for entitlements and benefits). Coordination with providers included geriatric, cardiac and behavioral health services, but mostly other health and social services. Details on various assessments were given. For example, there were 218 geriatric assessments, and the highest proportion of issues identified was for social support and medication review. Other assessments included for vision, chronic disease and oral health. There were 173 cardiac assessments, of which only 6% resulted in referral to specialty care. There were 147 cancer screenings, many for cervical and prostate cancer. 64 STI tests were conducted, most commonly for syphilis. 60 hepatitis C tests were done. A review of client outcomes (based on viral load or CD4 tests and measures of maintenance in care) showed that 96% of clients were virally suppressed as of their most recent lab test and 97% maintained in care.
In response to questions, it was explained that all services are integrated into existing HIV clinics. Also, it is not clear why such a high proportion of clients are not MSM-identified.
A special session will be scheduled for Dr. Aidala to present the CHAIN report on HIV and aging. There being no further business, the meeting was adjourned.
