Planning Council Meeting Minutes November 30, 2023

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Thursday, November 30, 2023

3:00-5:00 PM

By Zoom Videoconference

Members Present: D. Klotz (Governmental Co-chair), D. Martin (Community Co-chair), B. Fields (Finance Officer), S. Altaf, R. Babakhanian, K. Banks, R. Brown, P. Carr, V. Decamps, J. Edwards, R. Ford, R. Fortunato, M. Gilborn, J. Goldenbridge, C. Graham, S. Hemraj, R. Henderson, B. Hribar, E. Kaywin, M. Lesieur, M. Maia Soares, J. Palmer, G. D. Plummer, M. Rodriguez, L. Sabashvili, J. Schoepp, M. Sedlacek, C. Simon, M. Thompson, T. Troia, G. Ty, S. Wilcox

Members Absent: F. Alvelo, M. Bacon, M. Baney, G. Bruckno, M. Caponi, J. Dudley, J. Gomez, J. Henson, F. Laraque, W. LaRock, N. Martin, H. Martinez, L. F. Molano, MD, J. Roman

Staff Present: DOHMH: D. Saab, D. Bertolino, S. Spiegler, J. Acosta, A. Eppinger-Meiering, S. Kramer, M. Pathak, R. James, M. Dorsheimer, J. Jaramillo; Public Health Solutions: G. Ashby Barclay, A. Shahi, R. Santos

Agenda Item #1: Welcome/Introductions/Minutes

Mr. Klotz and Mr. Martin opened the meeting followed by a roll call and a moment of silence.  The minutes from the October 26, 2023 meeting were approved with no changes.  

Mr. Martin reported that the Council lapel pins have been delivered and will be distributed at the next meeting or by mail.  He thanked the Consumers Committee subcommittee and staff who worked on it, as well as the Pratt student who did the design.  The pin will be a tool to bring greater visibility to the Council and its work. 

Agenda Item #2: Second Quarter Expenditure Report

Mr. Fields introduced the 2nd quarter expenditure report, noting that as part of the Council’s mandate to assess the efficiency of the administrative mechanism, we receive quarterly expenditure reports from the Recipient.  The 2nd quarter report covers the grant year from March 1 to August 31, 2023.  The third quarter report, which we will receive in February, will tell us more about the spending picture for the year, but as of the end of the 2nd quarter, overall spending is close to the target of 50%.

Ms. Plummer reported that overall spending as of the end of the 2nd quarter was 46%, within the range of the target amount for the year.  Areas with notable underspending include: Non-Medical Case Management/Incarcerated (NYC), Early Intervention Services (NYC and Tri-county), Psychosocial Support for TIGNCNB (NYC) and Legal Services (Tri-County).  Reasons for underspending vary, such as reduced demand for Transportation with some services still virtual; underperformance in PSS TIGNBNC; and contract terminations in Health Education, Harm Reduction, Short-term Housing, Supportive Counseling and Legal (TC).  The Quality Management program is also underspent due to staff vacancies and invoices yet to be submitted.

A summary of the discussion follows:

  • Some of the providers who terminated contracts cited the administrative burden of RWPA requirements.  DOHMH has worked to lessen the burden, but HRSA has a number of requirements that must be fulfilled. 
  • Ongoing staffing problems have also been cited as an issue in underspending.
  • Tri-County Medical Case Management programs took a reduction this year and some are struggling to maintain their level or service.  Reprogramming funds can be used this year to enhance programs, and the TC Steering Committee can consider adjusting the ongoing allocation for this category.
  • The other-than-personnel services part of the Council support budget (vendors, consultants, etc.) is a very small part of the overall administrative budget, so the delay in approvals for these items does not have a material effect on overall expenditures.

Agenda Item #3: Estimated Unobligated Balance (UOB) Request

Ms. Gilborn explained that HRSA requires all EMAs to complete and submit by the end of December an “estimated unobligated balance request”.  The document tells HRSA that the EMA will ask to use unspent funds from the current grant year (i.e., 2023 carryover) in the next grant year (2024).  We will not know the actual amount of carryover until next spring after closeout of the grant year.  The UOB request states that next spring we will ask to carry over as much as 5% (the maximum allowed with no penalty).  The UOB request uses ADAP as a placeholder for the use of the carryover funds, but we are not required to spend the carryover for that purpose.  In June 2024, PSRA will develop an actual carryover plan for submission to HRSA.

Ms. Gilborn, on behalf of the PSRA Committee moved to approve the GY 2023 unobligated balance request as presented.  The motion was adopted 27Y-0N.

Agenda Item #4: Recipient Report

Ms. Eppinger-Meiering reported news from HRSA and other federal agencies, including a new report on EHE strategies to address health disparities, grants for behavioral health services for HIV prevention, and a CDC recommendation for routine Mpox vaccines for people at risk. 

The Recipient announced the awards under the Ryan White Part A (RWPA) NYC Housing RFP for programs beginning March 1, 2024.  Two programs were funded for Short-term Rental Assistance, 7 for Short-term Housing, and 4 for Housing Placement Assistance.  The agencies and amounts were provided in the written report.  On November 1, the Recipient released a revised Referral Directory for RWPA programs in the NY EMA.  The Directory aims to serve as a resource to help agencies and PWH in the EMA identify and connect with the various RWHAP Part A services that are available in the EMA.  DOHMH also released a HOPWA RFP to fund 5 programs to provide permanent supportive housing in New York City to very low-income PWH and their families for a period of nine years (July 1, 2024, to June 30, 2033). 

On November 20th, the Quality Management and Program Implementation (QMPI) Unit, along with partners from NYS Department of Health’s AIDS Institute, hosted a peer learning session entitled “Quality Improvement Sharing Session for RWHAP Part A Providers and People with Lived Experience.” Both RWPA subrecipients and consumers were invited to join in the discussion, where programs presented QI projects and received feedback on implementation.  The NY EMA Quality Management Committee met on October 24th, 2023, to discuss progress on quality improvement trainings as well other initiatives for determining and defining quality for the CQM program.

Information was provided on the upcoming DOHMH World AIDS Day event, the Medicare open enrollment period, and an expanded hospital based DOHMH overdose prevention program. 

Agenda Item #5: NYC HIV Epidemiology and Surveillance Update

Mr. Bertolino presented the latest NYC HIV surveillance data for the year ending December 31, 2022.  He provided a brief overview of HIV surveillance and data collected (positive tests, viral load tests, CD4 results, genotypes), how the HIV registry works, and the limitations of the data.  In 2022, the year for which new surveillance data are publicly available, In 2022, 1,624 people were newly diagnosed with HIV, a 1.3% decrease in the annual number of new HIV diagnoses compared with 2021. The relatively stable number of new HIV diagnoses from 2021 to 2022, compared with the marked one-year declines seen in previous recent years, may reflect ongoing “catch-up” of HIV diagnoses not made as readily during the height of the COVID-19 pandemic.  There were an estimated 87,000 people with HIV in New York City and 1,603 deaths occurred among people diagnosed with HIV.  There were declines in new HIV diagnoses and estimated incident HIV infections from 2018 to 2022.  Declines were seen across all groups in estimated incident HIV infections, and men who have sex with men experienced the greatest estimated decline, although numbers among this group remain higher than other transmission categories.  Disparities in HIV diagnoses by race or ethnicity continue, with Black and Latino/Hispanic people disproportionately affected.  People 20-39 years old, and those living in low-income areas of Brooklyn and the Bronx continue to have the highest number of new diagnoses. 

From 2018 to 2022, timely initiation of care (defined as within 30 days of a new HIV diagnosis) remained relatively flat in NYC, but inequities continue among women, Black, white and Asian/PI people, people with injection drug history, and younger and older groups.  viral suppression, or a viral load test with fewer than 200 copies per mL, within three months among people newly diagnosed with HIV in New York City from 2018 to 2022.  Viral suppression among all people newly diagnosed with HIV remained relatively flat, with ongoing disparities among Black, white, and Asian/Pacific Islanders, and people aged 60 or more years, and people residing in Queens or Staten Island.  The care continuum among various groups was described.  Age-adjusted death rates among people with HIV (for all causes of death) peaked in 2020, and has since declined by 39%.  There are higher rates among Black or multiracial people, people living in the Bronx and people living in areas with high and very high poverty.  There have been huge declines in HIV-related death, as well as declines in non-HIV-related deaths, and that 79% of deaths among PWH were due to non-HIV-related causes. 

Highlights of the ensuing discussion follows:

  • While there has been a decline in the number of genotype tests, DOHMH still keeps track of them.
  • DOHMH investigates new diagnoses to see if they are really new or if they may have been diagnosed previously outside of NYC.
  •  DOHMH uses CDC codes regarding sex by birth.  Gender identity is separately reported.
  • The breakdown by age includes people who were perinatally infected.  The number of new perinatally infected cases has been t or close to zero for many years.
  • The number of those who report an unknown mode of transmission increased during the COVID pandemic due to lack of complete access to electronic medical records.
  • Despite the steep declines in new IDU cases, the number should be lower given the wide availability of clean syringes.
  • While the rates for Black people in the care continuum are similar to other groups for those diagnosed, in care and on ART, the number of those who are virally suppressed is lower.  This may be due to issues that affect treatment adherence, such as unstable housing. 
  • Cause of death is based on what is reported on death certificates.  When looking at death by causes other than HIV, it should be kept in mind that PWH may experience cardiovascular disease and cancer on the whole earlier than HIV-negative people.

Agenda Item #6: Council Co-chairs Report

Mr. Klotz reported that on November 15th there was an all-day retreat that included Council and Recipient staffs and the Council’s Executive Committee.  Conducted by an outside facilitator, the retreat built on the recently approved Memorandum of Agreement to promote a collaborative working relationship and clearer understanding of each party’s roles and responsibilities.  The participants developed a set of shared values and next steps.  The retreat facilitator is writing a report that will be shared with the full Council at the December meeting, along with a plan for building on the success of the retreat.

Mr. Martin added that the work done at the retreat in the small groups needed to be shared with the larger group.  Also, in the process of developing shared values, some people may have felt left out if they had a different opinion.  The retreat was still successful and we look forward to sharing the results and next steps with the full Council.

Agenda Item #7: Public Comment, Part II

Ms. James announced that Ending the HIV Epidemic (EHE) Project PROSPER is sponsoring a women’s sexual health event on December 7th

Mr. Martin acknowledged World AIDS Day and everyone who does the work of fighting HIV and building on the work of those who have gone before. There being no further business, the meeting was adjourned.