Planning Council Meeting Minutes October 31, 2019

Meeting of the

HIV HEALTH AND HUMAN SERVICES PLANNING COUNCIL OF NEW YORK
Thursday, October 31, 2019
3:05-5:00 PM
LGBT Center, New York, NY
MINUTES

Members Present: J. C. Park (Governmental Co-chair), M. Lesieur (Community Co-chair),S. Hemraj (Finance Officer), A. Abdul-Haqq,F. Barrett,A. Betancourt,R. Bruce, P. Canady,P. Carr, E. Casey,B. Cockrell, M. Diaz,M. Domingo, J. Dudley, J. Edwards, T. Frasca, C. Graham,G. Harriman,C. Kunzel, Ph.D. (by phone), J. LiGreci,O. Lopez (by phone),J. Maldonado (by phone)J. Natt, J. Reveil, C. Reyes, M. Rifkin, L. Ruiz, J. Schoepp, F. Schubert, C. Simon (by phone),M. Singh,A. Straus (by phone), M. Thompson, T. Troia, R. Walker, D. Walters (by phone), B. Zingman, MD (by phone)

Members Absent: M. Bacon, D. Beiling, L. Best, R. Chestnut, B. Fenton, MD, R. Fortunato, B. Gross, A. Lugg,M. Mackey, M. Mañacop, D. Powell, A. Roque

Staff Present: DOHMH:D. Daskalakis, MD, O. Blackstock, MD, D. Klotz, M. Lawrence, J. Colón-Berdecía, A. Guzman, C. Rodriguez-Hart,K. Mack, J. Lawrence; Public Health Solutions:G. Kaloo, E. York-Lewis;J. Corbisiero(Parliamentarian)

Guests Present: A. Humm, A. Northrop

Mr. Park and Mr. Lesieur opened the meeting followed by introductions and a moment of silence. New members introduced themselves and talked about why they wanted to be involved with the Council. The minutes of the July 25, 2019 meeting were approved with no corrections.

Mr.Harriman reported that HRSA released a Notice of Funding Opportunity (NOFO) for Ending the HIV Epidemic-Primary Care HIV Prevention.  Funding will support the Health Center Program in expanding HIV prevention services that decrease the risk of HIV transmission, focusing on supporting access to and use of pre-exposure prophylaxis (PrEP).  HRSA will invest approximately $50 million in HRSA-funded health centers located in geographic locations identified by the Ending the HIV Epidemic: A Plan for America. The funding opportunity also emphasizes that HRSA-funded health centers partner with: health departments, Ryan White-funded organizations, and community and faith-based organizations.  Partnership activities include identifying at-risk individuals, testing for HIV, and linking patients to care.

HRSA’s HIV/AIDS Bureau released its 2019 biennial report highlighting five Ryan White HIV/AIDS Program recipients who implemented successful strategies and models of HIV care and treatment —including practice transformation, public-private partnerships, rapid entry to HIV care and delivery of ART, the use of telehealth/telemedicine, and a jurisdictional approach to providing treatment and care.  The 2019 Report theme is “Advancing Innovation to End the HIV Epidemic.”

On August 8^th, Public Health Solutions (PHS), on behalf of the New York City Department of Health and Mental Hygiene (NYC DOHMH), Bureau of HIV (BHIV), announced the release of a Request for Proposals (RFP) for Ryan White Part A Food and Nutrition Services in New York City. NYC DOHMH is soliciting proposals to deliver Nutrition Services and Food/Meal Services including home-delivered meals, congregate meals, pantry bags, and vouchers.

Over the summer, the Grantee, DOHMH staff and their grant writer worked to craft a responsive and thorough application to the GY2020 funding opportunity announcement for Ryan White Part A. The application was submitted on September 24^th.  Key elements of the grant application will be presented to the Planning Council at a future meeting.  As part of the application, the Grantee submitted a waiver application for FY2020 to the Core Medical Services (CMS) requirement, which requires that at least 75% of the services allocation be spent on HRSA-defined Core Medical Services.  The Planning Council’s Application Spending plan necessitates a waiver as only 56% of the service allocation was allocated to the Core Medical Services —such as ADAP, Oral Health Care, Early Intervention Services, Mental Health, Medical Case Management, and Harm Reduction services — and 44% were allocated to Supportive Services — including Housing,Food and Nutrition, Emergency Financial Assistance, and Psychosocial Support Services.

The sixth annual Part A Power of Quality Improvement (QI) Conference will be held on Monday, November 25^that the Kimmel Center at New York University. The conference theme for this year is “Using Unexpected Results to Improve Performance”. This is an all-day conference focusing on what has been learned during the process of improving and ways to share those lessons with colleagues. Mr. Carr added that the Consumers Committee has been working hard on a session for the conference on “Meeting Client Needs for Oral Health Services”.  Consisting of a panel and workshop, the session will help Ryan White Part A providersaddress their clients’ Oral Health needs, leading to improved health outcomes and quality of life.

Mr. Harriman continued, that BHIV engaged in a cross-program collaboration, including both the Planning Council and HIV Planning Group, to submit a proposal to support strategic partnerships, communication, peer-to-peer technical assistance (TA), jurisdictional planning efforts to address emerging needs of targeted jurisdictions through CDC-funded state and local health departments and their ability to end the HIV epidemic in the U.S. The Bureau outlined in their proposal efforts to enhance the existing jurisdictional epidemiological profile and develop a situational analysis at the beginning of the project and will use this tool to engage existing community bodies, consumers, and providers, and host listening sessions and conduct other engagement activities to solicit feedback to inform the development of a draft plan by June 2020. A draft situational analysis is due to the CDC by December 30, 2019. The Situational analysis and the accompanying plan will be presented to community stakeholders starting in January 2020.

The Clinical Operations and Technical Assistance (COTA) Program with the support of the Care and Treatment Program, has submitted a proposal to implement a work plan on activities, innovative approaches, and interventions to reduce new HIV infections. This funding is meant to be used in conjunction with the RWHAP and is not bound by the RWHAP legislative requirements, therefore, funded activities can have a broader approach to addressing HIV. Proposed activities may include, but are not limited to: increasing organizational capacity; information dissemination and public outreach; community engagement; implementation of emerging practices; evidence-informed and/or evidence-based interventions, particularly around linkage to care; retention in care, reengagement in care, and adherence counseling; the provision of needed client services; and data infrastructure development and systems linkages.

On Wednesday, September 18^th, BHIV and National Working Positive Coalition co-hosted Career Power Source: Getting Work You Want on Wednesday, September 18, 2019, at Baruch College. The event consisted of three core activities: 1) The Lab, where participants received individual career support from experts, including resume development, job search strategies, interview preparation, and professional development coaching; 2) workshops by experts on employment options, services, and resources in New York City; and 3) a tabling session featuring employment, training, education, benefits advisement, legal, and other service providers. Over 30 agencies led presentations and provided information and personalized support to participants, who received 150 clothing vouchers for professional attire and headshots for LinkedIn profiles. Career Power Source events are part of BHIV’s work to address economic stability through workforce development as a social determinant of health. The initiative focuses on improving access to employment opportunities for people living with or affected by HIV in New York City, particularly LGBTQ people of color. Approximately 150 community members attended the event.

Ms. Thompson introduced the recommendations for improving access to Part A services for PLWH with disabilities.  The Needs Assessment Committee (NAC) undertook a rigorous process, including delving in to numerous data sources, conducting a well-attended public forum, and holding extensive consultation (including with the NYC Commission on Human Rights) and community input.  The recommendations will go a long way towards ensuring that barriers to services are lowered for PLWH with disabilities.  Mr. Park added that this work was partially impelled by his own experience with hearing loss and stressed the importance of making all services as accessible as possible to people with sensory, mobility, cognitive and other disabilities. Ms. M. Lawrence was thanked for her work supporting this process.

Ms. Lawrencedescribed the background data that the NAC used to create the recommendations.Disability refers to people who report that they are deaf, blind, have serious hearing or vision impairment, have difficulties with cognition, mobility or self-care.  According to eShare data, at their most assessment visit, 6,156 (45%) out of 13,819 clients reported having at least one disability.  In NYS 21.1% of adults have some type of disability.  Disabilities are more prevalent among Black and Hispanic people, as well as older adults.  RWPA service categories with the largest number of disabled clients are: Food & Nutrition (29%), Medical Case Management (19%) and Mental Health Services (6%).  An overview of disabilities in NY from CDC data and the NYC Office on People with Disabilities was presented. 

Ms.Thompsonpresented the set of recommendations: 1) Improve and enhance data collection on disabilities (including hidden disabilities) in general throughout the Ryan White Part A (RWPA) portfolio, including all future information systems and validated screening tools. 2) Ensure that client disabilities are addressed in service plans.  3) The Recipient will ensure RWPA providers are trained on what reasonable accommodations are, and how to provide such accommodations.  4) The Recipient will provide guidance to help ensure compliance with all relevant local, state and federal laws governing access for people with disabilities, strengthen their ability to oversee and ensure compliance and develop a directory/map of RWPA services that lists accessibility for all service sites.  5) Accessibility shall be included in the Part A Quality Management Program to increase access to care for consumers with disabilities.  For agencies with websites, recommend agency websites are fully accessible and provide guidance on where to access technical assistance.  Work with the Mayor’s Office on Disabilities to continually update literature, recommendations and guidelines for working with people with disabilities.  6) Identify funding resources, support and advocacy organizations, checklists, and guidance that providers can use to ensure ADA compliance.  7) The Recipient will identify gaps in access for individual assistive technologies and determine mechanisms for assistance (including RWPA) in the acquirement of such technologies, such as hearing aids, wheelchairs, etc. for those who need them.  8) Improve engagement, including with the Council and consumers.  The Consumers Committee will take the lead on hosting periodic events with consumers, particularly vulnerable consumers such as those with disabilities, in order to collect feedback on access and other barriers to care.

Ms. Thompson made a motion on behalf of NAC to accept the recommendations as presented. 

In the ensuing discussion it was clarified that due to restrictions on the use of Ryan White funds (e.g., for capital improvement), the intent of the resource guide and training is to help organizations leverage other resources to make their facilities accessible.

Ms. Casey noted that hospitals already collect data from their patients on their disabilities, and that a second, Part A-mandated collection would be redundant and burdensome. 

Ms. Casey moved to amend the first recommendation to read “Establish a standard for data collection on disabilities in general throughout the Ryan White Part A (RWPA) portfolio, including all future information systems and screening tools.  A. Grantee will identify a data set, and provide guidance to improve the identification of disabilities among RWPA clients…”The motionto amend was approved 30Y-0N.

The motion to accept the amended recommendations was approved 30Y-0N.

Mr. Park introduced journalists and activists Andy Humm and Ann Northrop, who have been reporting on the HIV epidemic since the beginning.  They conducted a dialogue with NYC DOHMH Deputy Commissioner for Disease Control Dr. Demetre Daskalakis and Assistant Commissioner for HIV Dr. Oni Blackstock on “The Future of HIV”.  Highlights of the discussion include:

• Trends are heading in the right direction, but disparities remain, particularly among people of color, young gay men of color, the transgender community.  Stigma, homophobia and transphobia remain obstacles to closing gaps in health disparities.
• Without a preventive vaccine and a cure, the work will always entail maintaining treatment and prevention regimens and improving on them to reduce new infections and improve health outcomes.
• The federal Ending the HIV Epidemic initiative is being undermined by the administration’s other actions around the Affordable Care Act, erasing trans people. 
• Standardized HIV education in public schools has run up against the increased autonomy of school principals.  DOHMH works with the Dept. of Education through school-based clinics and is revising the HIV curriculum, but due to resource constraints cannot be everywhere.  Peer education can supplement the work of governmental agencies.
• There is a reported spike in the use of injection drugs among young people, but we are not seeing a spike in hepatitis C, which is a sentinel marker.  The City is waiting for the State to give the green light on safe injection (aka overdose prevention) facilities.  A new initiative is the addition of syringe exchanges at all the NYC sexual health clinics.
• NY State law requires HIV testing as part of routine medical care, but it is difficult to enforce.  Incentives can help.  At least NY does not have criminalization laws that discourage people from testing.
• There are record levels of STIs being reported, some of which is ascribed to the use of PrEP and the diminishment of condom use.  DOHMH takes a harm reduction approach –PrEP and the U=U message cannot be held hostage to the fact that some people will not use condoms consistently (which has always been an issue in prevention).  DOHMH is lowering access to STI screening and treatment (e.g., accelerating results from gonorrhea and chlamydia tests with new technology).  Also, promoting oral and rectal STI tests and offering PrEP to all who test positive.  Better testing (not just urine, but oral and rectal swabs, etc.) is catching STI at a higher rate, but the success of PrEP is reducing HIV infection is undeniable.  Also, the NIH has to be held accountable to conduct more STI research.
• Homelessness, especially among youth, will continue to be a driver of the epidemic and requires more resources.

Mr. Frasca announced an upcoming town hall on the proposed NY State version of Medicare for All. 

There being no further business the meeting was adjourned.

Minutes approved by the HIV Planning Council on November 21, 2019