Thursday, November 18, 2021
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), S. Altaf, F. Alvelo, M. Baney, A. Betancourt, E. Casey, R. Chestnut, B. Cockrell, J. Edwards, B. Fields, R. Fortunato, M. Gilborn, C. Graham, E. Kaywin, M. Lesieur, D. Martin, L. Freddy Molano, MD, C. Moore, J. Natt, H. Nguyen, J. Palmer, G. Plummer, D. Powell, M. Rifkin, C. Simon, M. Thompson, T. Troia, V. Velazquez, R. Walker
Members Absent: A. Abdul-Haqq, M. Bacon, L. Beal, D. Beiling, R. Brown, R. Bruce, G. Bruckno, P. Canady, M. Caponi, J. Dudley, B. Fenton, MD, J. Gomez, B. Gross, R. Henderson A. Lugg, L. Ruiz, F. Schubert, S. Wilcox
Staff Present: DOHMH: C. Quinn, MD, D. Klotz, M. Lawrence, C. Rodriguez-Hart, J. Colón-Berdecía, K. Mack, F. Abdelqader, S. Winant, J. Bell, S. Torho, J. Thomas, G. Navoa, D. Ferdinand, K. Miller, G. Yee, M. Pathak, E. Rossi; Public Health Solutions: B. Silver; NYS DOH: D. Rajulu, W. Patterson
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 October 28, 2021 meeting were approved with no changes. Mr. Powell announced that Exponents will be hosting an event next week in honor of Transgender Day of Remembrance.
Agenda Item #2: Impact of COVID-19 on Ryan White Part A Programs
Mr. Abdelqader presented on the impact of COVID-19 on Ryan White Part A (RWPA) programs, which faced challenges in enrolling new clients and delivering services during the pandemic. To assess the impact of COVID-19 on client access to RWPA programs and services, the HIV Care & Treatment Program’s Research and Evaluation Unit analyzed new enrollments and service utilization data for Housing (HOU), Harm Reduction (HR), Mental Health (MH), Food and Nutrition (FNS), and Emergency Financial Assistance (EFA) services. Programs were selected based on expected increase in demand for services to address behavioral and basic needs given the stresses the pandemic put on people’s abilities to cope and cover essential costs for rent and food. With COVID-related exposures to job losses, fear/anxiety, bereavement, illness, and loss of human contact and access to social support networks, we expected clients might be turning to RWPA in the service areas represented by these programs. The Recipient put in place changes to minimize the effect of COVID-19 restrictions on access to services (e.g. permitting telephone/videoconferencing for broader array of reportable services, reimbursing for costs instead of fee-for-service).
The report used eShare data to examine new enrollments and service utilization for March-September 2020 compared to the same period in 2019. There was a description of the service types in each category. From 2019 to 2020, new enrollments increased for EFA, and decreased for HR, MH, and FNS. EFA was a new service category that started on March 1, 2019 in Tri-County and in summer 2020 was expanded to NYC clients in order to cover the entire EMA (all under one provider in Westchester). Between 2019 and 2020, the number of clients served decreased for all programs, except EFA. For EFA, the number of clients served likely increased because the program was expanded to serve NYC clients. The decrease was greatest for FNS (which was rebid and undergoing its deliverable period from March 2020) and least for MH and HOU. Between 2019 and 2020, the number of service units increased for HOU and MH services, but decreased for HR, FNS, and EFA.
Compared to 2019, the decrease in client enrollments in 2020 may have been due to difficulties in conducting work remotely and conducting in-person outreach to enroll new clients by providers. From 2019 to 2020, while the number of clients served decreased, service unit increases in programs like mental health and housing suggest a higher need for those services. With the decrease in clients served, there may be potentially less access to services, however, the increase in service units suggests a greater demand among clients already accessing services in those programs.
RWPA providers faced numerous obstacles during the pandemic, and the extent of these obstacles will never be fully detailed by the numbers provided from this analysis. This includes a lack of technology (e.g., some providers and clients might not have had access to phone/internet to conduct and receive remote services), loss of clients and employees due to COVID-related morbidities/mortalities, and lack of privacy in terms of delivering services to clients in shared living spaces. The needs for services may have been the same, but enrolling and accessing those services may have been impossible for clients whose status is not known by the people living with them in close quarters. The NY EMA encompasses a very large area and COVID-19 effects have varied by geographical location, and so clients might be less inclined to seek services depending on how they were affected. Data entry may also have been depressed by the pandemic due to factors such as lack of access to eSHARE/ forms, lack of personnel or time to handle data entry while grappling with staff attrition or other pressing priorities, and separation of reimbursement from data entry (with the shift to cost-based vs. performance-based reimbursement).
Feedback from providers also found that use of telehealth services facilitated the delivery of services during the pandemic, especially with clients (or staff) who are worried about contracting COVID-19. Services like accompaniment and group health education were challenging to provide virtually and delivering them in-person was very limited due to COVID-19 restrictions. Some clients were turning to services provided to all NYC residents, instead of RWPA programs, which impacted service delivery (e.g. food and nutrition, harm reduction). Mental health clients preferred one-on-one, in-person service delivery, especially those who had to juggle other personal priorities/problems in addition to their own health. Certain services, like video directly observed therapy (DOT), were negatively impacted because not all clients have access to a smartphone. Some providers also reported that staff burnout, time off, and turnover affected the delivery of services during the pandemic.
The next steps after this analysis are to: 1) Provide RWPA service providers with programmatic support and technical assistance that is specific to the challenges presented by the pandemic; 2) Assess the impact of data entry lags on data completeness due to the pandemic; 3) Investigate the effect of mortality on our RWPA clients to give further context on any loss of clients due to COVID-19; and 4) Continue to monitor how the pandemic affects RWPA enrollments and service delivery.
A summary of the discussion follows:
- Provider feedback was obtained verbally at meetings, and not through a formal survey.
- During the first 6-month period of the new FNS contracts, contractors were not required to enter data into eShare, which may account for the large drop in reported units of service. Ms. Fortunato and Mr. Palmer reported that their agencies continued to provide high or higher levels of food services during the pandemic.
- Congregate meal programs need to be reopened for vaccinated clients. This is an essential service, not just for food, but to counter social isolation.
- There could be a spike in utilization as agencies resume in-person services.
- While this study did not obtain data directly from consumers, there have been two CHAIN reports so far with data on the impact of COVID-19.
- Many staff, particularly at clinical sites, were redeployed during the pandemic, leading to staff shortages in RWPA programs.
- Infection control protocols for home visits were an issue for provider staff.
- In a cost-based environment, most under-spending has been from staff vacancies.
- The effect of recent price increases in groceries can be monitored.
Agenda Item #3: Follow-up: NYS Data Collection
As a follow-up to questions raised at the previous meeting concerning data on transgender women in Tri-County, Ms. Rajulu and Ms. Patterson from the State Department of Health explained that the AIDS Institute is revising its data collection system to collect information on this population, while continuing to protect confidentiality. There have already been new tables added to recent surveillance reports.
Agenda Item #4: Project PROSPER Update
Ms. Winant and Ms. Bell presented an update on Project PROSPER (Planned Resources for an Organized and Specific Population-level Equitable Response), NYC’s initiative using federal Ending the HIV Epidemic funding, which provides funds to 48 jurisdictions identified by the CDC as having a substantial HIV burden. Those jurisdictions include Bronx, Manhattan, Brooklyn and Queens. The EHE goal is to reach a 75% reduction in new HIV infections by 2025 and a 90% reduction by 2030. The initiative includes various projects. PROSPER is the HRSA initiative for RW Parts A and B and runs from March 2020 through February 2025.
The four main PROSPER activities are: 1) Increase organizational capacity to deliver high quality HIV services; 2) Implement evidence-based interventions; 3) Expand implementation of emerging practices (Be InTo Health intervention and Enhanced Data-to-Care/eD2C); and 4) Develop data infrastructure and systems linkages. The main goals for all activities are to increase retention in care and viral suppression (VS), particularly among priority populations. The elements of each activity were described (e.g., for activity #1, build capacity among DOHMH Bureau of Hepatitis, HIV and STI staff to incorporate racial equity frameworks into all activities). Progress to date was outlined (e.g., e-learning on using a trauma-informed approach to improve health outcomes for Black MSM), as well as future steps (e.g., immediate ART/iART). Be InTo Health has awarded 9 contractsto agencies to implement evidence-based interventions to improve engagement and retention in care among Black and/or Hispanic/Latino priority populations. eD2C has awarded 5 contracts to increase the capacity of the HIV workforce to utilize data to strengthen and improve care for PWH.
iART provider detailing kits have been completed and visits with providers at priority clinics are underway. Long-acting injectables formative work was completed (data collection, stakeholder meetings), as well as technical assistance to providers on hepatitis C. There have also been eShare enhancements. The Be InTo Health programs serving Black and Hispanic Older PWH were outlined, with goals around increasing linkage to and retention in medical care, increasing VS, addressing age-related needs and decreasing symptoms of depression. Specific activities were described (e.g., iART, case conferencing, client-centered social activities). The original evidence-based program used as a model is the Golden Compass Program, a comprehensive care program for people living with HIV ages 50+ that was also used for the Council’s new Aging & HIV service directive. Be InTo Health subrecipients, funding amounts and catchment areas were described. Start dates were either March 1, 2021 or August 1, 2021. Preliminary successes and lessons learned were explained, and next steps described (e.g., support for programs with a focus on client-centered and culturally responsive approaches).
In response to questions, Ms. Winant reported that certified peer workers are included in the recommended staffing plan, and that eShare improvements are meant to reduce data burden on providers.
Agenda Item #5: HIV Planning Group (HPG) Update
Ms. Torho gave an update on the activities of the HIV Planning Group, a DOHMH community planning body that advises DOHMH on HIV prevention issues and the City’s CDC-mandated HIV prevention plan. The HPG is in the final stages of recruiting and interviewing new members. Officers were elected for the new term, which will start in January with a virtual strategic planning meeting. the HPS is also creating an ad-hoc advisory group for recipients of a CDC high-impact prevention grant (grant awards were made by the CDC).
Agenda Item #6: Recipient Update
Ms. Plummer reported that the 2022 National Ryan White Conference on HIV Care & Treatment will take place August 23-26, 2022 with the theme “The Time Is Now: Harnessing the Power of Innovation, Health Equity, and Community to End the HIV Epidemic.” Last month HRSA updated guidance to eliminate the six-month client eligibility recertification requirement for RW programs, instead allowing recipients and subrecipients (providers) to conduct timely eligibility confirmation in accordance with their policies and procedures. The notice also states that immigration status is irrelevant for the purposes of eligibility for RW services. The policy was issued in response to recipient requests to reduce administrative and client burden while enhancing continuity of care to ensure that clients have access to medical and support services in order to achieve viral suppression.
The 8th annual Ryan White Part A (RWPA) Power of Quality Improvement Conference will be held virtually this year on December 14 from 9:00 AM to 4:00 PM. This year’s conference theme is “Building Resilience, Actualizing Equity, and Ending the Epidemic” which will demonstrate the efforts of RWPA programs to manage services throughout the COVID-19 pandemics by providing continuity of care with resiliency and perseverance. On November 8th, DOHMH received an acceptance letter from NMAC to participate in the ESCALATE Technical Assistance cohort, which trains and empowers participants to recognize and address HIV stigma across the Ryan White HIV/AIDS Program nationally. ESCALATE will engage recipients and subrecipients in Parts A, B, C, and D, which includes health departments and planning councils.
NYS DOH and NYC DOHMH invite everyone to join this year’s 23rd Annual World AIDS Day (WAD) Event and the 2021 Ending the Epidemic (ETE) Summit on December 1st. The theme for this year’s ETE Summit and WAD events is “Overcoming Pandemics ETE and COVID-19” and “From the Group Up: Over 40 years of Public Health”.
Agenda Item #7: Planning Council Chairs Update
Mr. Harriman stated that the Council seeks to create an inclusive environment, and to help ensure that, people should consistently share their preferred gender pronouns. Mx. Kaywin added that being misgendered can be traumatic, and it is important for the Council to be a model, starting with putting pronouns alongside names in people’s Zoom panels. Ms. Simon added that NYSDOH has piloted a trans allyship training, which can be shared widely.
Mr. Harriman also reported that the Joint Planning Council/HPG Policy Committee meets next Tuesday to prioritize issues to focus on. Also, HRSA just announced that the requirement for an annual Estimated Unobligated Balance Request, which the Council usually approves in December, have been waived. This request allowed the Council to apply in the following spring to use unspent funds after year-end close out (the 5% maximum allowed carryover for GY 2021 would have been about $4.5M).
There being no further business, the meeting was adjourned.