Tri-County Steering Committee Minutes February 9, 2022



December 8, 2021, 10:05-11:05am

By Zoom Videoconference


Members Present:       S. Altaf (Co-chair), J. Palmer (Co-chair), D. Ahmed, V. Alvarez, L. Bucknor, A. Contreras, J. Gago, B. Malloy, C. Oldi, M. Piazza, A. Pizarro, S. Spiegler, (for G. Plummer), S. Richmond, A. Ruggiero, S. Thomas

Members Absent:        M. Acevedo, L. Beal, L. Best, M. Diaz, D. Dominguez, M. G. Ferone, L. Hakim, A. Hardman, G. Harriman, K. Mandel, L. Reid, V. Schneider, D. Scholar, K. Scott, A. Simmons

Staff Present:              NYC DOHMH: D. Klotz, J. Acosta, M. Lawrence, D. Ferdinand; Public Health Solutions: D. Ortiz; CHAIN: M. Yomogida

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

Mr. Altaf and Mr. Palmer opened the meeting followed by introductions and a moment of silence.  The minutes of the December 8, 2021 meeting were approved with no changes. 

Agenda Item #2: Updates

Consumer Update

Mr. Alvarez reported that consumers continue to experience difficulties accessing Westchester County Dept. of Social Services, as well as Medicaid-funded medical transportation.  He added that several newly diagnosed people have recently joined Living Together.

Planning Council Update

Mr. Klotz reported that the next full Council meeting will be held on February 24th and will include a third quarter expenditure report.  Underspending continues to be higher than normal due to COVID-related issues.  There will also be an introduction to Implementation Science, which is the new framework for developing service directives and was used for the new Framing and Aging Directives. 

On Monday, the Priority Setting & Resource Allocation Committee will vote on the Tri-County Steering Committee’s request for flat funding in GY 2022.  They are also examining Care Coordination (Medical Case Management) and Harm Reduction Programs for payer of last resort issues for making decisions on allocations for NYC programs in the GY 2023 grant application.

The Consumers Committee is developing its process and timeline to review the unique needs of youth and young adults ages 13-29 with HIV in the NY EMA, which will result in a set of recommendations by July 2022.  The Integration of Care Committee is working on a new service directive that bundles three current NYC categories (Mental Health Services, Harm Reduction, and Supportive Counseling) into one large Behavioral Health category.

Council co-chair Graham Harriman is spearheading a new Data Collection Workgroup made up of Council members and representatives from the Recipient to address data collection challenges the RWPA program has had over the years, including barriers to provider data access, inefficient data entry including processes, and significant data collection burden on consumers and providers.  The Committee will develop recommendations that will be shared with the Recipient, others in DOHMH, and HRSA to improve data collection through improved database technology that will increase user access to data for quality improvement, reduce required data collection, and increase capacity to share information across programs so that consumer and provider data collection burden will be reduced.    

Recipient Update

Mr. Spiegler reported that the White House Releases the National HIV/AIDS Strategy for 2022-2025 on December 1st.  The Strategy will accelerate the nation’s work to end the HIV epidemic in the U.S. by 2030, re-energizing and strengthening a whole-of-society response to the epidemic.  The Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB) 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 01/12/2022, the Recipient received the Partial Notice of Award for the FY 2022 Ryan White HIV/AIDS Program (RWHAP) Part A grant in the amount of $29,005,692 (approximately 49% of Formula and 32% of MAI).  HRSA continues to operate under a Congressional Continuing Resolution and the award provides partial funding based on the continuation of GY 2021 funding levels.  Final awards will be processed as soon as HRSA/HAB receives the full GY 2022 appropriation amount for this program.

HAB released a Policy Clarification Notice on Determining Client Eligibility and Payor of Last Resort in the RWHAP. The updated guidance eliminates the six-month client eligibility recertification requirement for RWHAP programs, instead allowing recipients and subrecipients to conduct timely eligibility confirmation in accordance with their policies and procedures.  The notice also states affirmatively that immigration status is irrelevant for the purposes of eligibility for RWHAP services.

Gina Gambone has been named as the Acting Director of the HIV Care & Treatment Program’s Quality Management (QM) unit.  Ms. Gambone will be attending future Council and committee meetings. 

In December, Public Health Solutions (PHS), on behalf of DOHMH, released the Ryan White Part A Services in the Tri-County Region Rental Assistance Program RFP, with programs starting June 1, 2022. PHS will soon release the Oral Health Care Services in New York City concept paper, with the RFP set to be released on February 2, 2022 for programs starting September 1, 2022. 

Agenda Item #3: CHAIN Report: COVID-19, Service Needs and Telehealth in Tri-County

Ms. Yomogida presented a COVID-19 Check In based on interviews with CHAIN participants in the Tri-County region.  She gave a brief overview of the CHAIN study, a cohort of representative PWH from the EMA.  When the pandemic halted regular, in-person interviews, CHAIN staff called participants to check in, offer information on available services, and confirm contact information.  Common participant feedback led to the development of a longer, more structured questionnaire asking about service needs, information received, and telehealth use.  Interviews were conducted from March 2020 to April 2021 with 51 TC participants interviewed.  A longer, more detailed survey was employed from April 2020 onward. 

Questions asked includes: 1) How are PWH in NYC and the Tri-County dealing with the threats, stresses, and restrictions associated with the COVID-19 pandemic?  2) What are their informational, medical, behavioral health, and supportive service needs during the COVID-19 social and economic disruption?  3)

Have PWH’s needs changed over the course of the pandemic?  The respondents were 55% make and 45% female, the largest age cohort was over 55 (46%), and 92% were Black or Hispanic.  The vast majority reported a good quality of life and health, but a majority were worried about getting sick from COVID or being at risk from having to go to work.  About a third of respondents had symptoms of anxiety or depression, but almost half felt hopeful about the future. 

Twenty-nine percent reported need for Food & nutrition Services, and 18% reported a need for Financial Assistance.  Almost half reported that they had experienced financial hardship, and a quarter said they were unable to get cleaning supplies or hand sanitizer.  Smaller numbers reported inability to get food or were laid off.  Ninety-four percent reported contact with a service provider.  Only small numbers did not have enough information about preventing COVID.  Thirty-seven percent lacked telehealth knowledge or resources, particularly not knowing how to use a phone or computer for video conferencing. 

A summary of conclusions is: 1) PWH, especially younger PWH, faced greater financial hardship as the pandemic dragged on.  2) As their resources depleted, women became more stressed, especially about money.  3) Supportive services targeting PWH should prioritize women’s subsistence needs (food, housing, and financial assistance) given their outsize effect on health and well-being. The provision of assistance should not be limited to the immediate aftermath of an emergency.

Recommendations include: 1) Service providers should reach out early and often to PWH to ensure they understand where and how to receive care as well as how their health may be affected during a rapid-onset emergency.  2) Providers utilizing telehealth should dedicate extra time or staff to orient clients to new methods of connecting, especially older PWH or those with lower levels of digital literacy.

A summary of the ensuing discussion follows:

  • Providers’ experiences with increased demand for food services confirms the study’s findings.  The demand at TOUCH as continued to the current day at twice the pre-pandemic level.
  • Tri-County respondents experienced more transportation issues that NYC respondents.  Otherwise, responses were very similar.
  • CHAIN is about to start a new wave of interviews, which should provide some insight into whether the trends seen in this report are continuing.
  • Providers could use a centralized resource to assist with technology issues to improve remote services and connectivity with clients.  (Open Door Family Medical Center has a training program – information will be shared with the Committee.)
  • There have been discussions in the AIDS Institute for a number of years about telehealth, and it is important to note that many services cannot be delivered remotely, including examinations (e.g., taking blood).  This is especially important for aging PWH.

Mr. Klotz added that at the April meeting there will be a presentation on the impact of COVID-19 on RWPA enrolment and service utilization in Tri-County.

The next Committee meeting will be held on March 9th, 10am.

There being no further business, the meeting was adjourned.