TRI-COUNTY STEERING COMMITTEE MEETING
July 8, 2020, 10:10am-11:45am
By Zoom Videoconference
Members Present: M. Diaz (Co-chair), A. Straus (Co-chair), D. Ahmed, S. Altaf, V. Alvarez, L. Best, L. Bucknor, D. Dominguez, G. Dominguez Plummer (for G. Harriman), L. Hakim, D. Klotz, K. Mandel, C. Oldi, J. Palmer, M. Piazza, L. Reid, S. Richmond, A. Ruggiero, K. Scott, A. Simmons, S. Thomas
Members Absent: M. Acevedo, A. Contreras, M. G. Ferone, J. Gago, A. Hardman, P. Laqueur, A. Pizarro, D. Scholar, T. Seabrook
Staff: NYC DOHMH: J. Acosta, A. Guzman, J. Colon-Berdecia; CHAIN: A. Aidala, PhD, D. Norman
Agenda Item 1: Opening/Moment of Silence/Minutes/Announcements
Ms. Diaz and Ms. Straus opened the meeting followed by introductions and a moment of silence. The minutes of the June 10, 2020 meeting were approved with no changes.
In response to an inquiry from Mr. Palmer, Ms. Dominguez Plummer will provide data from the CHORDS study, which examines outcomes for medical case management programs.
Agenda Item #2: Updates
Mr. Alvarez and Ms. Diaz reported that consumers in Tri-County are keeping in touch despite the technical challenges. The Women’s Group met outdoors with social distancing, which was important to address the social isolation that many members have experienced during the COVID-19 pandemic. Generally, Living Together members are maintaining their treatment adherence, although issues arising from aging are being seen more and more. Also, some have had family members who have become ill from COVID-19 but are recovering.
Planning Council Update
Mr. Klotz reported that the Priority Setting & Resource Allocation Committee approved the Steering Committee’s FY 2021 Application Spending Plan, which next goes to the Executive Committee and full Council. The next Consumers Committee virtual Town Hall on COVID-19 and HIV is tentatively scheduled for August 18th. The Rules & Membership Committee has completed candidate interviews for the next round of Council appointments. There were a number of excellent candidates, including two from Tri-County.
The next Planning Council meeting, scheduled for July 30th, will conclude this year’s planning cycle. There will be votes on the FY 2021 Base, MAI and TC application spending plans, the assessment of the administrative mechanism (a review of how well the Grantee did implementing the Council’s priorities), and an Oral Health Services directive for NYC. There will also be elections for community co-chair and finance officer.
Recipient (Grantee) Report
Ms. Dominguez Plummer reported that the 2020 National Ryan White conference will be held virtually from August 11-14. Due to its virtual platform, the conference is open to all (to register click on: https://ryanwhiteconference.hrsa.gov/register/ Recipient and PC staff will be attending and presenting at this year’s conference, presenting on the important work being done through the NY EMA.
The Recipient will submit the RWHAP Part A Progress Report and Expenditures next week. The Report documents the successes and challenges to address the National Goals to End the HIV Epidemic and HIV care continuum outcomes, changes to the healthcare landscape, planning council activities, and final FY19 expenditures to HRSA/HAB. The 2020 RWHAP Part A Program Terms Report (PTR) and Program Submission is now open via the HRSA Electronic Handbook site. The Part A PTR deadline is July 9, 2020, and the Program Submission is due July 30, 2020. The PTR is comprised of the Consolidated List of Contracts (CLC) and Allocation Table, identifying all service and non-service contracts being funded for the current grant year and reports PC allocations of funds in accordance with the Notice of Award (NoA) reporting requirements; and the Program Submission is comprised of the PC Chair(s) letter, PC membership roster and reflectiveness, demonstrating the PC’s endorsement of the FY2020 priorities and allocations and the PC’s membership is in compliance with legislative reflectiveness and representation requirements.
On June 10, the NY EMA’s Care and Treatment Program hosted an abbreviated webinar for program staff from Ryan White Part A funded organizations throughout the NY EMA. Over 140 people were in attendance. Mr. Harriman reported on recent developments in the RWPA program at the local and national level. Dr. Oni Blackstock, MD, MHS, Assistant Commissioner for the Bureau of HIV (BHIV) reported on the intersection of COVID-19 and HIV, and the Health Department’s and BHIV’s responses to the pandemic. Meeting participants reported that their clients’ greatest challenge amid COVID-19 concerned dealing with loneliness and isolation, keeping with rent and housing costs, and food security.
Finally, Dr. Oni Blackstock will be resigning from her position as the NYC DOHMH Assistant Commissioner for the Bureau of HIV, effective July 17th. A transition plan is being developed. During her time with BHIV, Dr. Blackstock has led the bureau in achieving a historic low in the annual number of people newly diagnosed with HIV in New York City, and in becoming the first large U.S. city to achieve the 90-90-90 goals. She also led the bureau’s efforts in advancing racial equity
Agenda Item #3: CHAIN Report
Dr. Aidala presented a report on Housing, Transportation and HIV Care Continuum Outcomes. NYS Continuum of HIV Care in the Tri-County Region shows that: 86% of the 4,420 PLWH in 2018 received HIV care; 54% were retained in continuous care; and 62% were virally suppressed. Affordable housing and HIV-specific housing resources are limited in the Tri-County region and comprehensive public transportation systems are absent. This report examines housing and transportation needs, services received, and HIV Care Continuum Outcomes. An overview of the CHAIN study and its methodology were described.
Safe and affordable housing allows people to access and stay in care, and transportation barriers lead to missed appointments, delayed care. Housing status for three waves of interviews from 2008 through 2017 was reviewed. 11% of the cohort was unstably housed or homeless. Around a third have some self-reported housing issue. 16% report having transportation needs. Up to 51% received housing services only, up to 6% receive transportation services only, and up to 17% received both. 60% of younger (<35 years) have one or both needs compared to 44% among older PLWH. Latinx and Asian, other and mixed ethnic groups have higher needs compared to others. Participants with lowest incomes (<$7500/yr) are less likely to report current need for either service than their higher income counterparts – perhaps due to increased income-based eligibility. Rates of need for one or both services are highest among current drug users and persons scoring low on a measure of mental health functioning.
Definitions of “consistent care”, “appropriate care”, “adherent ARV use” and “viral suppression” were described. Generally, people who have both housing and transportation needs have lower rates of all those markers on the continuum of care. Using statistical analysis, people who receive both services are more likely to meet the outcome indicators on the continuum. Current drug use was also an indicator for not meeting the continuum’s markers. Users of Medical Case Management services are also more likely to meet the markers. Details were provided for each specific marker by service need and utilization.
In summary, unstable housing, rent burden, and other housing challenges have a significant impact on connection to medical care, adherence and viral load outcomes among persons living with HIV/AIDS in the Tri-County Region, especially when combined with transportation needs. Receipt of housing and/or transportation services is associated with receiving appropriate care, and PLWH receiving housing and/or transportation assistance continue to have multiple behavioral health and supportive service needs that are associated with lack of consistent care, medication nonadherence, and unsuppressed viral load.
In response to a question from Ms. Straus, Dr. Aidala reported that due to IRB constraints as a research project, they can’t directly intervene in someone’s care, but they can provide resources and referrals, as well as notify a provider that there is an issue generally, without providing any names.
Dr. Aidala then presented preliminary findings from a brief COVID-19 check-in phone interview with NYC CHAIN study participants. Due to the pandemic, in early March, CHAIN implemented a modified protocol for outreach to study participants via telephone to maintain inter-wave contact during this time. The initial effort during March and April was designed as a brief check-in to see how participants were doing, whether they had any medical or social service needs, and confirming contact information for their next in-person interview. Beginning late April we expanded the phone survey instrument to additional questions, focused specifically on COVID-19 issues.
Results of the interviews are: Almost all received information about coronavirus; 15%: did not get enough or did not understand information about how coronavirus might affect their health; 15%: did not get enough or did not understand information about how to get medical or other services while offices were closed; the need for food was described often with grave concern; 31%: unable to get food, groceries, or meals; and 47%: experienced financial hardship, were struggling to make ends meet. An important concern continuing into June was the inability to get cleaning supplies or hand sanitizer.
13% were unable to get medical care not related to COVID-19; 21% did not have capacity or weren’t sure of capacity for videoconferencing (e.g., their phone had limited minutes, internet was not broadband, the computer may not have been theirs but someone else’s in the household); a bigger barrier seems to be digital literacy; and almost 40% did not know how to use their phone or a computer to participate in a video conference for a medical or other appointment.
Mr. Palmer said that a full study of the impact of COVID-19 on the Tri-County cohort would be very welcome. Mr. Klotz said that the CHAIN Technical Review Team will bring this up for review.
Agenda Item #4: Policy Update
Mr. Guzman presented on current topics in law and policy. On July 7th, the Mid-Hudson region (Duchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester Counties) entered phase 4 of the statewide COVID-19 reopening plan. Various local responses were described (e.g., Putnam Area Rapid Transit restored public transit service), as well as local COVID-related issues (e.g., Rockland County issued subpoenasto eight individuals they believed attended a party in West Nyack last month, and who failed to cooperate with contact tracing efforts). Westchester County is also cracking down on businesses that charge hidden COVID-related fees. Finally, the US House of Representatives’ second COVID-19 relief bill is still not being considered by the Senate.
Ms. Straus reported that New York State has not reimbursed their contractors for some services (including HIV prevention and syringe exchange) since the beginning of the pandemic. Mr. Guzman noted that NYC DOHMH has been adapting reimbursement mechanisms to pay providers, but had no information on what the State is doing.
The next meeting will be held on Wednesday, October 14th by Zoom videoconference.
There being no further business, the meeting was adjourned.