Thursday, May 26, 2022
By Zoom Videoconference
M I N U T E S
Members Present: G. Harriman (Governmental Co-chair), D. Walters (Community Co-chair), A. Abdul-Haqq, F. Alvelo, S. Altaf, A. Betancourt, R. Brown, M. Caponi, R. Chestnut, B. Cockrell, J. Dudley, J. Edwards, B. Fields, R. Fortunato, M. Gilborn, C. Graham, R. Henderson, E. Kaywin, M. Lesieur, D. Martin, C. Moore, J. Natt, H. Nguyen, J. Palmer, G. Plummer, M. Rifkin, L. Ruiz, F. Schubert, C. Simon, M. Thompson, T. Troia, V. Velazquez, R. Walker, S. Wilcox
Members Absent: M. Bacon, M. Baney, L. Beal, G. Bruckno, P. Canady, P. Carr, E. Casey, J. Gomez, B. Gross, L. F. Molano, D. Powell
Staff Present: DOHMH: D. Klotz, M. Lawrence, G. Gambone, B. Tsoi, MD, J. Acosta, J. Colón-Berdecía, D. Noble, G. Navoa, R. James, I. Newman, K. Miller, P. Chan, F. Silva, B. Meisel, G. Herndon, J. Williams, C. Rodriguez-Hart, S. Torho, 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 April 28, 2022 meeting were approved with no changes. Mr. Harriman reviewed the agenda, noting that the June and July Council meetings will be three hours in order to complete the year’s planning tasks (carryover and spending plans, directives, etc.).
Ms. Lawrence, Ms. Graham and Ms. Walters were congratulated on the success of the “Embedding Equity” webinar.
Agenda Item #2: NY EMA RWPA Quality Management Update
Ms. Plummer introduced Ms. Gambone, Acting Director for the Quality Management Program. Ms. Gambone presented an update on the New York EMA’s Ryan White Part A (RWPA) Quality Management program. The Ryan White legislation requires the establishment of a clinical quality management program to “assess the extent to which [RW] services are consistent with the most recent HIV treatment guidelines; and develop strategies for ensuring that services are consistent with the guidelines for improvement in the access to, and quality of HIV services”. The Recipient works directly with subrecipients (RWPA providers) to give overall direction and to implement, monitor and exchange data for performance measures and/or quality improvement activities. The program implements quality improvement (QI) activities aimed at improving patient care, health outcomes, and patient satisfaction. The QM program is a partnership between NYC DOHMH and the NYS DOH AIDS Institute and includes stakeholders such as the Planning Council, Consumers, Public Health Solutions and the RWPA providers. Ms. Gambone discussed the guiding principles to a trauma-informed approach and the need to be transparent, collaborative, empowering and driven by equity.
The QM program is developing a new 2022-25 QM Plan to replace the current plan. The timeline for the plan’s development was described, with a new plan due to HRSA on December 1, 2022. The initial team strategic planning meetings will review the scope of work (e.g., QM/QI capacity building trainings and coaching). The QM Plan will also focus on implementing the Council’s Framing Directive, translating that into a usable assessment and planning tool. The program has already added a new Crisis Intervention/De-Escalation Training requirement as a paid deliverable, requires subrecipients to have formal commitments with medical and social service providers to conduct warm-hand-off referrals, and requires subrecipients to develop and maintain emergency preparedness plans. Also, the QM program is providing technical assistance (TA) to enhance uptake of current and emerging technologies that reduce client and staff burden, conducting ongoing training on harm reduction and trauma-informed care rooted in supporting health needs of patients and staff, and conducting training on how to help clients achieve self-management and empowerment. Other QM program plans to implement the Framing Directive include requiring subrecipients to complete stigma reduction organizational readiness tool, and requiring them to use findings from the assessment to inform the development of an organizational stigma, implicit bias and racism reduction plan.
Activities within the QM Program include: informal self-assessment, team strategic planning, new policies and procedures, identifying staff training needs, and strengthening relationships. Activities with RWPA programs include training and capacity development in the areas of trauma-informed care, Seeking Safety, Healthy Conversations, Integrated Harm Reduction, clinical supervision, mental health training, person-centered documentation, and coordinated care. There is also the ongoing Positive Life Workshop for consumers. Peer learning opportunities were outlined, as well as materials and resource development (e.g., Patient Navigation Guide, Resource Guide for Programs Serving People with Disabilities). The program is developing curricula on racial equity, intimate partner violence awareness, aging & HIV and Care Coordination e-Learning. There will be no QI conference this year, but instead the program will conduct informal peer learning sessions.
QM activities with PHS were described, such as setting expectations for program design and implementation, developing and refining scopes of work and deliverables, and jointly monitor compliance with contract terms and expectations for quality. Program development (new models and revisions of current models), and policies and procedures were described. The DOHMH HIV Care and Treatment Program’s Research and Evaluation Unit will lead performance measurement, develop quality indicators and design eSHARE reports for QM. Lessons learned will be disseminated through conferences, journals and other forums.
QM Program priorities for 2022-23 include: health equity, consumer engagement, capacity building and service quality. Efforts to increase consumer engagement include focus groups, consumer representation on the EMA’s QM Committee, client satisfaction surveys, town halls, and QM Program staff attending subrecipients’ CAB meetings. In recent years, consumer engagement has resulted in the HIV & Aging Directive, expanding telehealth, Incentivizing consumers for achieving or maintaining VLS, and Consumers Committee’s workshops at the Power of QI Conference.
A summary of the ensuing discussion follows:
- There are non-RWPA funded self-management programs that do work similar to the Positive Life Workshop, including one at NYU/Bellevue.
- The program is still brainstorming how to envision “QI champions”.
- The QM allocation is capped by HRSA at $3M or 5% of the total award, whichever is less, thus no enhancement funds can be made available.
- Long-term injectables are new and the program is trying to figure out how to integrate and learn more about what clients and consumers need.
Ms. Gambone solicited feedback on the QM program, with the following responses provided:
- More direct, confidential feedback from consumers is needed, such as through comment boxes at providers.
- Funds for improving access to telehealth services, as well as an app that can ease access to information. (There were funds for telehealth access through the GY 2021 carryover plan, but there were challenges implementing it due to the time frame).
- NYU and other providers have conducted instant client surveys at the agency sites using tablets, which can provide instant feedback.
- QI forms and processes should be standardized across programs to reduce burden on providers.
Agenda Item #4: EIIHA Update
Dr. Tsoi presented on the EMA’s Early Identification of Individuals with HIV/AIDS (EIIHA) Plan, which grow out of the goals of the National HIV/AIDS Strategy, the federal Ending the HIV Epidemic (EHE) Plan and the NYS Ending the Epidemic (ETE) Plan, all of which call for diagnosing people with HIV as early as possible in order to get them into effective treatment and sustained viral suppression. The NY EMA’s EIIHA Plan has three target populations with higher rates of undiagnosed HIV: Black and Latino MSM, Transgender and gender non-conforming people, and Black and Latina women living in neighborhoods with high HIV prevalence. The EIIHA Plan’s primary activities are: promote and increase HIV testing; improve timely linkage of people newly diagnosed with HIV to medical care; and increase awareness of and referral to HIV prevention services, including PrEP, PEP, treatment as prevention, and condoms. EIIHA activities are funding through RWPA Early Intervention Services (EIS) funds, CDC funds, EHE funds and City Tax Levy funds.
There is a two-tier approach to increasing HIV testing. Tier One promotes routine HIV screening in healthcare facilities through guidance to clinicians, a public health detailing campaign, the New York Knows initiative, and social marketing. Tier Two aims to decrease inequities in health outcomes by targeting HIV testing services in non-clinical settings through making HIV self-tests available, contracts with community organizations and NY Knows.
The EIIHA Plan also includes activities to promotes and supports linkage to medical services and immediate initiation of HIV treatment (iART) for people who have diagnosed HIV infections. Contracted agencies are expected to link people who test HIV positive to medical care within four days of diagnosis and be offered HIV treatment on the first medical visit. City Sexual Health Clinics offer HIV treatment to clients on the day of diagnosis and to PWH who have never engaged in HIV treatment. There are also training and TA. Other activities in the EIIHA Plan support expansion and improved implementation of safe, effective prevention interventions, including treatment as prevention, PrEP and PEP.
A summary of the ensuing discussion follows:
- HIV testing is available at urgent care centers, but they do not always offer them as part of routine care. The EIIHA program is concentrating on larger clinical settings.
- Social marketing campaigns have a diverse set of images, including with older PWH.
- There is an emphasis on using peers to promote testing, as well professional development for those peers so that they can move up in their organizations.
Agenda Item #5: Planning Council Co-chairs Report
Mr. Harriman reported that a new chair for the Data Workgroup will be needed. Mr. Lesieur reported that a letter in support of the Safer Consumption Services Act, which would expand overdose prevention sites, was sent to the NYS legislature. The letter was developed by the Joint Policy Committee, written by Adrian Guzman and approved by the Executive Committees of the Planning Council and HPG.
Ms. Simon reported on the Integrated HIV Prevention and Care Plan. Proposed strategies were received through various feedback mechanisms (including the Council and Consumers Committee) for the four areas of focus (Prevent, Diagnose, Respond, Treat). The process for prioritizing those strategies was explained, based on magnitude of impact, alignment with the ETE plan, sustainability and ease of implementation. Council. Members will be provided with an online tool to prioritize proposed strategies. In addition, two “community convenings” will be held in June to get additional feedback.
Ms. Simon also announced a new NYSDOH AIDS Institute request for applications to support innovative program models that address barriers and needs of older adults living with HIV.
There being no further business, the meeting was adjourned.