Tri-County Steering Committee Minutes April 10, 2024



April 10, 2024, 10:05-11:30am

By Zoom Videoconference

Members Present:          J. Palmer (Co-chair), S. Altaf (Co-chair), V. Alvarez, L, Bucknor, A. Contreras L., Cyrus, M. Diaz., J. Gago L. Hakim,  , K. Mandel, L. Reid, K. Scott, A. Pizarro,  S.Thomas, L. Francis

Members Absent:           L. Best, L M. Acevedo, A. Desir, B. Malloy, A. Hardman, A. Ruggiero, J. Gobler, A. Milian

Guest Present:                  E.Pradhan, M. Yomogida

Other PC Members

Present:                               B. Fields

Staff Present:                    NYC DOHMH: D. Klotz, D. Saab, J. Acosta, S., Spiegler., S. Kramer

Agenda Item 1: Opening/Moment of Silence/Minutes/Announcements/Public Comment

Saqib A. and Julian P. opened the meeting followed by introductions and a moment of silence. The minutes of March 13, 2024 meeting were approved with minimal changes. Doienne S. announced that the HIV Planning Council is hosting its first Brown Bag session on April 19th at 1pm. This an informal and optional meeting to discuss various topics of interest. The meeting invitation was sent via email to all TCSC members.

Agenda Item #2: Updates

Consumer Update

Maria D. reported that arranging consumer transportation for medical appointments is still a long-standing concern following the disenrollment of Medicaid beneficiaries. Doienne S.reported that she has elevated the consumer concerns to the contracting company providing Medicaid transportation services, Med Answering (the) and she will share their response in an upcoming meeting. Victor R. also shared that many consumers are struggling with co-morbidities and dying from conditions such as cancer. He also shared that it is important for the Department of Health’s data reporting system to collect information that matches the realities of challenges being faced by PWH. He also reported that the HRSA requirement for RWPA providers to submit proof of HIV status every 6 months for every client continues to be a burden and inconvenience to consumers and providers.

Planning Council Update

David K.  announced retirement of the Planning Council’s Community Coordinator, Jose Colon-Berdecia and the vacancy for the backfill position. He also announced that second Community Planner position is now filled but awaits a start date. The Consumer Committee is presenting Best Practices Guidelines for Client Advisory Boards, at the annual RWPA Provider meeting on July 16th.  The Needs Assessment Committee completed its recommendations for providing RWPA support to newly arrived asylum and immigrant communities in the NY EMA. The Rules & Membership Committee will begin the process of recruiting new Council members. Council members are encouraged to help spread the word about recruiting potential members. April’s Planning Council meeting will include a review of the yearly reprogramming plan and updates on the Quality Management implementation plan and the Medicaid 1115 waiver.

Recipient Report

Johanna A. reported news from HRSA and other federal agencies, including commemorating National Women and Girls and Native HIV/AIDS Awareness Days. The federal FY 2024 budget was finalized, with Ryan White appropriations mostly flat funded. There was a report on data recently released at the annual Conference on Retrovirus and Opportunistic Infections (CROI) on the efficacy of long-acting injectable ART. Registration is open for the National Ryan White Conference in August. Virtual attendance is unlimited. On March 14th, Public Health Solutions, on behalf of NYC DOHMH, released the concept paper for the forthcoming RFPs for Behavioral Health and Non-medical Case Management/ Inmates & Releasees. A timeline of the RFP was reported, with programs to start March 1, 2025. The Recipient also released an updated RWPA Referral Directory, which will be posted on the Council website and includes newly funded Housing programs. The Quality Management (QM) Committee for the NY EMA continues to meet to discuss updates and feedback on subrecipient quality management trainings. The QM Program is also collaborating with the Consumers Committee to deliver a consumer-led session on client advisory boards (CABs) at the 2024 RWPA Provider Meeting on July 16th. Along with CABs, topics will include using eSHARE data to improve service delivery, resources for immigrants and migrants, and engaging consumers in various methods of collaboration to provide feedback on service delivery and quality improvement. In February and March 2024, a collaborative DOHMH-CUNY study team hosted two half-day 5 community participatory “Developing Information Sharing Standards through Community” (DISCO) events. DISCO is a supplemental grant attached to the ongoing “Data-to-Suppression” (D2S) project, which offers reporting and capacity-building resources to promote viral suppression in RWPA housing and behavioral health programs. Other policy news was reported, including about an initiative to advocate to repeal laws that criminalize HIV transmission, and a NY State application to expand income eligibility for the NYS Essential Health Plan.

Agenda Item #3: Needs Assessment Committee – Recommendations for Supporting the NY EMA’s Asylum Seeker and Newly Arrived Immigrant Communities

Doienne S. presented the Needs Assessment Committee (NAC) emerging issues identified in the Comprehensive Needs Assessment and the set of recommendations to improve access to care and support services for immigrants/migrants/newly arrived PWH in the EMA.

Doienne S. gave an overview and context for the recommendations, including the NAC’s role in selecting topics to investigate through quantitative and qualitative data collection and analysis. The EMA’s 2023Comprehensive Needs Assessment included a wide range of data and recommendations, as well as additional topics for future research in a “parking lot” of emerging issues. Such as people of trans experience, people involved in sex work, and HIV workforce challenges. The first topic to be completed looks at newly arrived PWH (migrants, asylum seekers, and immigrants generally). Since Spring 2022, there have been more than 180,000 newly arrived immigrants entering the City shelter sites, mostly from Spanish-speaking countries, but also many from African, Asian and Caribbean countries. Many have experienced trauma and are in need of extensive support. From October 2023 to January 2024, NAC received a series of presentations and reports to inform the development of recommendations for improved and enhanced service delivery for HIV-positive newly arrived immigrants who seek care in the Ryan White Part A (RWPA) system. Broad themes and goals were developed and recommendations for each goal. A summary of the themes, goals and recommendations follows:  

Theme #1: Language Barriers. Goal: Strengthen RWPA provider capacity to provide high-quality, diverse easy to access and linguistically affirming language written or oral interpretation and translation services in the languages spoken by newly arrived immigrants being served in the NY EMA. Recommendations: assess and enhance provider capacity to provide interpretation and translation language services; provide resources and guidance to sub-recipients for staff trainings that address the cultural and linguistic needs specific to immigrant communities.

Theme #2: Service Demand Increase/Navigation Challenges. Goal: help RWPA providers accommodate and manage the increase in service needs of newly arrived clients. Recommendations: RWPA providers improve and expand upon existing case management services that focus on immigrant communities; Recipient should regularly identify providers that have a focus on immigrant services who have the capacity to receive client referrals to mitigate high client volume.

Theme #3: Mental Health Concerns for Clients. Goal: address the mental health concerns and the high level of trauma among newly arrived clients. Recommendations: providers should train their staff on understanding the specific behavioral and mental health needs of newly arrived immigrant clients using a trauma-informed approach; the Recipient should develop a list of crisis intervention providers.

Theme #4: Mental Health/Staff. Goal: build staff and peer worker resiliency, support, and organizational capacity to enhance emotional and psychological wellness in the workplace. Recommendation: providers should develop and implement wellness models, self-care plans and mental health toolkit for staff and peer workers needing support.

Theme #5: LGBTQ+ Asylum Seekers. Goal: provide the guidance and resources to help providers with treating LGBTQ+ clients with sensitivity and competence. Recommendations: providers should provide educational orientation to all staff and peer workers to improve LGBTQ+ competency (including SOGI training); RWPA providers should offer relatable materials, guidelines, and resources on LGBTQ+ affirming services.

Theme #6: Stakeholder and Community Engagement. Goal: build the capacity of RWPA providers to navigate the evolving policy and service system as it relates to immigrant health and social services access. Recommendation: the Recipient should provide information about changes to the immigration policy and protections, and the health care and social support service landscape to RWPA providers to maximize service provision and referrals. 

Doienne S. acknowledged the contributors to these recommendations, including the NAC members and co-chairs, the Council and Recipient staff and outside presenters who contributed on this important issue.

A summary of the ensuing discussion follows:

  • Some agencies are reporting an increase of clients from South/Central American and African countries, but some are unsure if new clients are newly arrived immigrants or existing (however it is presumed that they could be newly arrived).
  • Two agencies reported that a few, newly diagnosed and recently enrolled clients are entering their programs very sick or with a high viral load count. One patient needed to be hospitalized for HIV care. 
  • While no Tri-County providers presented to the NAC, the recommendations should include additional and specific resources to serve immigrant/migrant issues in the region.
  • Seeking HIV testing and treatment is an issue for immigrant arrivals who fear a potential/existing HIV disclosure.
  • Members provided Doienne S. with contacts to outside agencies in the region that could serve as a point of reference for specific immigrant resources.

Doienne S. to follow up with NYS contacts providing immigrant/migrant services in the region. She will develop a comprehensive referral directory of NYS/NYS resources and share with the Committee.  

The next meeting will be the second Wednesday of May.    There being no further business, the meeting was adjourned.