Thursday, October 28, 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), A. Abdul-Haqq, S. Altaf, F. Alvelo, M. Bacon, M. Baney, L. Beal, A. Betancourt, R. Brown, M. Caponi, E. Casey, B. Cockrell, J. Dudley, B. Fields, R. Fortunato, M. Gilborn, C. Graham, E. Kaywin, M. Lesieur, A. Lugg, D. Martin, L. Freddy Molano, MD, C. Moore, J. Natt, J. Palmer, G. Plummer, D. Powell, M. Rifkin, L. Ruiz, F. Schubert, C. Simon, M. Thompson, V. Velazques, R. Walker, S. Wilcox
Members Absent: D. Beiling, R. Bruce, G. Bruckno, P. Canady, R. Chestnut, J. Edwards, B. Fenton, MD, J. Gomez, B. Gross, R. Henderson, H. Nguyen, T. Troia
Staff Present: DOHMH: C. Quinn, MD, D. Klotz, C. Rodriguez-Hart, J. Colón-Berdecía, K. Mack, S. Spiegler, R. Torres, G. Navoa, K. Miller, G. Yee, M. Pathak, J. Lawrence, J. Williams; Public Health Solutions: D. Ortiz, A.Shahi, A. Pelaez
Guests Present: C. Stein, K. Wunder (Bannon Consultants)
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. Mr. Harriman introduced the newly appointed members. The minutes from the July 29, 2021 meeting were approved with no changes.
Agenda Item #2: Welcome Remarks: Dr. Celia Quinn
Mr. Harriman introduced the new DOHMH Deputy Commissioner for Disease Control, Celia Quinn, MD. In her role, Dr. Quinn leads NYC’s management of and response to a range of infectious diseases (HIV, STIs, etc.), oversees the public health laboratory and DOHMH’s clinical services, and oversees clinical, epidemiologic, and laboratory science elements of the Health Department’s COVID-19 response. Dr. Quinn has served at the Centers for Disease Control and Prevention (CDC) as an Epidemic Intelligence Service Officer and is currently a CDC field assignee to DOHMH and is a Commander in the US Public Health Service.
Dr. Quinn presented on the current state of COVID-19 in NYC, noting that we are on the downward crest of the third wave of the pandemic. Hospitalizations are at one of their lowest points thanks to vaccines, but COVID-19 cases remain elevated, driven by the highly contagious Delta variant. COVID-19 has already caused more than 124,000 hospitalizations and 34,000 deaths in NYC since the beginning of the pandemic, and some neighborhoods have been harder hit than others. Low income neighborhoods have experienced the highest rates of illness, hospitalization, and death a result of higher rates of pre-existing conditions, difficulties in practicing physical distancing (smaller or more crowded apartments, need to take public transport, frontline jobs), healthcare access issues and structural racism. The importance of vaccines was stressed to move us closer to ending the COVID-19 public health emergency. About two thirds of all NYC residents are fully vaccinated. In response to a question, Dr. Quinn reported that studies on long COVID are ongoing and will hopefully contain data on long COVID and people with HIV (PWH).
Dr. Quinn also presented on the NYC Board of Health’s recent resolution declaring racism as a public health crisis, citing DOHMH’s focus on health and racial equity and incorporating anti-racism into DOHMH policies. She noted that several Council priorities align with this resolution, such as the Framing and Aging Directives. She expressed her enthusiasm for working with the Council on its initiatives.
Agenda Item #3: HIV & Aging Service Directive
Mr. Martin and Mr. Harriman presented the final text of the HIV & Aging Service Directive. On July 22nd, the Executive Committee approved the broad intent of the Directive, but sent the Directive back to the Consumer Committee in response to request for more details on consumer experience, better use of the Implementation Science Logic Model, and increased use of Peers in service delivery. The Consumer Committee met on August 17th to finalize edits and approve the full Directive, which has been shared with the meeting materials.
PWH over 50 represent a majority of the total PWH population (59% of PWH in NYC in 2019) and yet their intersectional needs are often unaddressed by HIV service organizations. To better understand the lives of PWH over 50 the NYC HIV Care and Treatment Program conducted focus groups the results of which underscore the need for improved resources for PWH over 50, including services to address social isolation, coordination between programs, benefits navigation, services offered in Spanish, and to address medical conditions of women with HIV over 50.
The Directive will Increase capacity to treat the complex needs of PWH over 50 mirroring aspects of the Golden Compass model through use of clinical staff (MD, RN, Pharmacist, Medical Assistant) to address comorbidities and to provide health education, geriatric, psychiatric, and cardiology consultation, and referrals to ongoing specialty care. Resources provided by RWPA will address gaps in current care provided at clinical sites, and funded services should support improved self-advocacy/self-management so that PWH can talk to their medical providers about broader health concerns.
The model will also increase the knowledge of resources available to support Aging PWH among RWPA funded providers; improve referral tracking to ensure Aging PWH are engaged in needed services; and adapt referral practices from the ARTAS model (i.e., the development of referral partnerships, communication /outreach/education, navigation and transportation if needed).
The Directive strengthens PWH networks and funds organizations that provide social support services for older people living with HIV. It will fund social support for exercise and set up buddy systems making contracts with others to complete specified levels of physical activity or set up walking groups and other groups to facilitate friendship and support. It will fund navigation, structured health education, and practical and emotional peer support services to increase engagement in care and promote self-care. It will identify how to leverage technology for social support and to overcome barriers that older people living with HIV face. The Directive calls for an increase in training of RWPA providers to ensure that providers effectively support Aging PWH through increased ability to identify comorbidities, link Aging PWH to needed resources, and that services are delivered equitably.
This program is designed to increase: 1) The number of HIV clinics providing screening/assessment for comorbid conditions; 2) Clinical capacity to provide services for common comorbidities for Aging PWH through an increase in knowledge and skills; 3) Attendance of Aging PWH at specialist appointments; 4) Consumer social support (peer delivered services, support groups, health education groups) activities ; 5) Consumer participation in fitness and exercise classes; and 6) Client perception of self-management skills when surveyed.
The next step after approval of the directive is for the Priority Setting & Resource Allocation (PSRA) Committee to plan for allocation of funding for Outpatient Medical Care and Referral for Medical and Support Services in the 2023 Application Spending Plan, after which the Recipient will work on an RFP for services to begin in GY2023-24.
A summary of the discussion follows:
- Non-medical providers will be able to bid for these programs with the exception Outpatient Medical Care (OMC) services.
- The HRSA-funded Project PROSPER is specific to four counties designated by CDC as ones that are driving the HIV epidemic nationally (Bronx, Manhattan, Brooklyn, Queens). There will be a presentation on it at next month’s meeting.
- The OMC services in the directive will be add-ons to existing clinical providers, allowing them to increase capacity to serve PWH in their practices, many of which currently are not able to address aging issues that are specific to PWH.
- The service will be cost-based so that, for example, a clinic can hire staff for training.
- The State DOH is also addressing aging and HIV and is compiling data from a recent survey. DOHMH should be encouraged to coordinate with any State recommendations and initiatives.
A motion was made and seconded that the Planning Council adopt the HIV & Aging Directive as amended. The motion was adopted 32Y-0N.
Agenda Item #4: GY2022 Ryan White Part A Grant Application
Ms. Stein presented on the Grant Year (GY) 2022 RWPA Application. The DOHMH HIV Care and Treatment Program leads the application process with support from Bannon Consulting and contributions from various elements of DOHMH and the Planning Council. For GY2022, the Eligible Metropolitan Area (EMA) requested $90,448,460 for HIV program services (the maximum allowed). This year, the RWPA application shifted to a three-year period of performance (instead of one-year) requiring a full application in GY22 and then less-intensive non-competitive continuation applications in GY23 and GY24. This is meant to reduce the administrative burden and costs on the Recipient and HRSA.
The first section of the application is an Epidemiological Overview of the EMA, which has 12% of all PWH in the US. As of the end of 2020, the EMA had over 132,000 PWH with Bronx and Manhattan having the highest per capita rate of HIV infection. Despite a 40% decrease in new diagnoses since 2016, there were still 1,452 newly diagnosed cases in 2020, 20% of whom were dually diagnosed with HIV and AIDS. 76% of all diagnosed PWH in the EMA are virally suppressed. Common co-occurring conditions were described that amplify the challenges that PWH face (hepatitis C, mental illness, STIs, homelessness, substance use, history of incarceration, COVID-19).
The EMA’s Early Identification of Individuals with HIV/AIDS (EIIHA) Plan was described, including testing, status-neutral navigation, the NY Knows campaign routine testing, etc. the application required that three sub-populations most disproportionately impacted by HIV be identified. Due to higher rates of late diagnosis lower rates of viral suppression, those populations are Black and Latino young MSM, Cisgender Black women, and Black and Hispanic older PWH.
Mr. Harriman described the section of the application that outlines the Planning Council’s work, which focused on the PSRA process, which resulted in a spending request that allocates 45% of funding to non-core support services, which necessitated a waiver of the Core Services Requirement, something the EMA can do, as NY State adequately covers medical services. The GY2022 plan also calls for newly funded Oral Health services in NYC.
Ms. Stein described the application section on unmet need (number of late diagnoses, the number of people aware of their HIV positive status with no CD4 or VL test in the most recent calendar year, and the number of people aware of their HIV positive status and in care that have a low viral load. The application describes the EMA’s approach to planning for services for those with unmet need, including sub-populations of focus. The Council and the CTP regularly use the HIV care continuum to understand gaps and identify new service models that might be able to meet those gaps. Specific interventions were identified, and the Application describes how activities related to re-engaging individuals with unmet need intersect with local and federal “Ending the Epidemic” initiatives.
The application describes the Quality Management programs and activities, such as provider capacity building, a value-based payments (VBP) pilot for Care Coordination programs and the annual Quality Improvement Conference. Finally, grant administration activities are described (e.g., fiscal and program oversight, reimbursement, compliance, staffing).
A summary of the discussion follows:
- The application was not able to include Black transgender women as a sub-population of focus because there is no data on that group in Tri-County. TC data is collected by the State Department of Health (NYC data is collected by DOHMH) and they are working on collecting that data for the future, but the application requires that the data be for the entire EMA.
- An age breakdown of epi data is available and can be requested for the Consumers Committee’s upcoming work on young PWH.
- The VBP pilot is only for NYC programs and the results will be reported back to the Council.
- There is a natural time lag for epi data as every diagnosis must be investigated to collect complete data and ensure that cases are not double counted. The next NYC HIV surveillance update will be release around World AIDS Day.
Ms. Plummer thanked everyone who contributed to the application, which is a very intense and arduous process.
Agenda Item #5: Recipient Update
Ms. Plummer reported that on October 5th, the U.S. Department of Health and Human Services (HHS) announced approximately $2.21 billion in Ryan White HIV/AIDS Program funding for cities, counties, states, and local community-based organizations was awarded in fiscal year (FY) 2021. HRSA also announced 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.”
On September 21st, the Recipient received the notice of award from HRSA authorizing the carryover of unobligated balance in the amount of $4,981,213. Amendments to contracts are currently in process. Carryover funds were approved by the NY Planning Council in July 2021.
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. The Consumers Committee has submitted an abstract to conduct a workshop on the HIV & Aging Service Directive.
On September 8th, Ms. Plummer was named the permanent Director of the HIV Care and Treatment Program. In this role, she will serve as Project Director for the Ryan White HIV/AIDS Program Part A NY EMA and as the Recipient representative on the Planning Council.
On October 6, Public Health Solutions (PHS), on behalf of the New York City Department of Health and Mental Hygiene (NYC DOHMH) Bureau of HIV (BHIV), released The Ending the Epidemic in New York City: The Undetectables Viral Load Suppression Program and Crystal Methamphetamine Harm Reduction Services concept paper.
DOHMH and CUNY were funded for the project “Strengthening the safety net: Testing a novel data-to-suppression (D2S) intervention strategy in the Ryan White HIV/AIDS Program” to implement and evaluate a novel ‘data-to-suppression’ intervention with RWPA support-service programs to address a viral suppression deficit among RWPA clients in HIV care.
Agenda Item #6: Planning Council Chairs Update
Mr. Harriman reported that the first meeting of the Joint HIV Planning Group/HIV Planning Council Policy Committee was held on Tuesday, co-chaired by Mr. Lesieur and an HPG representative. The Committee discussed its mission and began deliberations on which topics to delve into. Mr. Lesieur stated that the Committee will be working on targeted advocacy to educate the Council, governmental entities and the community on emerging federal, state and local policy issues that affect HIV service providers and consumers.
HRSA and CDC have issued their guidance for the Integrated HIV Prevention and Care Plan. The Council will be a key component of the plan. Also, further training and education on the use of implementation science will be provided.
Everyone was reminded to complete the survey on the Framing Directive so that feedback can be incorporated for a revised version that will be brought back to the Council for consideration. Ms. Plummer added that the directive is an important step in addressing the issues of racial and health equity addressed in the Board of Health resolution. Ms. Fortunato added that Council members who voted no or abstained are especially urged to provide specific comments on their concerns.
Agenda Item #7: Public Comment
Mr. Natt announced that NYU School of Medicine is offering a chronic disease self-management workshop for PWH.
There being no further business, the meeting was adjourned.
Minutes approved by the HIV Planning Council on November 18, 2021