Tri-County Steering Committee Minutes March 13, 2019



March 13, 2019, 10:05am-11:45pm
Westchester County Department of Social Services 6 10 County Center Road, White Plains, NY

Members Present:      A. Straus (Co-chair), M. Diaz (Co-chair, by phone), D. Ahmed, S. Altaf, V. Alvarez, L. Bucknor, S. Spiegler (for G. Harriman), B. Catena, A. Contreras, D. Dominguez, M. G. Ferone, J. Gago, J. Gressel, P. Laqueur, C. Oldi, J. Palmer, A. Pizarro, L. Reid, S. Richmond, A. Ruggiero, K. Scott, T. Seabrook, A. Simmons, S. Thomas  

Members Absent:    M. Acevedo, D. Bartolini, L. Best, L. Hakim, A. Hardman, J. Page, J.C. Park, M. Piazza, D. Scholar, C. Watkins

Staff:                          NYC DOHMH: D. Klotz, J. Colón-Berdecía 

Guest:                         W. Patterson (NYSDOH AIDS Institute)

Agenda Item 1: Opening/Moment of Silence/Minutes  

Ms. Straus and Ms. Diaz opened the meeting followed by a moment of silence and introductions.  The minutes of the January 9, 2019 meeting were approved with no changes.  

Mr. Altaf announced that Hudson Valley Community Services’ Mt. Vernon office has moved to a new, more private location.  An open house will be scheduled this spring.  Also, HVCS is in the process of staffing up two new programs, Psychosocial Support, and Emergency Financial Assistance (Mr. Alvarez will be staffing the Psychosocial Support program beginning in April), as well as continuing existing Housing, Medical Transportation and Food & Nutrition programs.  Information will be distributed soon for providers who want to make referrals to these programs. 

Ms. Contreras reported that Putman County is holding a health fair that will include HIV testing.

Agenda Item #2: Updates  

Living Together

Mr. Alvarez reported that Living Together transitioned to a new provider agency (Hudson Valley Community Services) and will resume monthly meetings in April.  There will be a benefit to having the program co-located with a number of other Ryan White-funded services, including Medical Transportation, Food and Nutrition and case management.  Also, smoking cessation efforts are making progress, with several members quitting, changing to vaping or reducing use.  A long term member recently passed away and was mourned by the members.  It’s a reminder of the on-going challenges on an aging PLWH population.  Finally, reports of MSM who are becoming re-infected with hepatitis C are raising concerns.

Policy Report

Mr. Klotz reported that there will be a report at an upcoming meeting on the proposed federal Ending the Epidemic 2030 proposal, which may result in a modest amount of additional Ryan White funding in the NY EMA, as four of the 48 counties targeted nationwide are in the EMA (Bronx, Brooklyn, Manhattan, Queens).  There is also the danger that any progress from that initiative might be offset by proposed budget cuts to other federal programs including Medicaid and Medicare.

Ending the Epidemic Report

Mr. Laqueur reported that the local EtE committee is developing a PowerPoint that explains the four major areas of focus (testing, PrEP/PEP, stigma, cultural competence).  The presentation will be used to educate the community, do outreach and recruit new participants. 

Grantee Report

Mr. Spiegler reported that the one provider of Ryan White Part A Early Intervention Services (EIS)/HIV

Testing (Rockland Dept. of Health) has decided to discontinue their contract, which means that about $134K in Ryan White Part A funding is now unobligated.  The Steering Committee has several options about reallocating the funds.  Given the low positivity rate and the fact that testing is now widespread and part of routine medical care, the funds can be reallocated to another service category where there is need.  There are unfunded proposals in Housing and Medical Case Management from the recent RFP.  Questions were raised about unmet need in other areas, such as Food & Nutrition and Legal where funds can be shifted to existing providers to enhance capacity. 

If the Committee decides to maintain funding in the EIS category, another provider would have to be found (an RFP process would mean a gap as a solicitation takes up to a year).  In NYC, Ryan White programs have moved away from testing due to the availability of other resources.  The Committee requested information about whether there are any special populations that were being reached by the terminated program that could justify keeping the funding in EIS.  

If the funds remain unobligated, then they are reprogrammed as per the Council’s plan to enhance overperforming contracts.  With the newly rebid contracts, most Tri-County programs have shifted from costbased to fee-for-service, which means enhancements will be possible to do.  As programs are new, there will not be any meaningful performance data for a while.  Any funds left over after program enhancements are shifted to the ADAP Program, which uses them to pay for medications for the uninsured in the EMA. 

Additional information will be provided for the next meeting on the above issues in order for the Committee to make a funding recommendation.

Agenda Item #3: Standards of Care  

Mr. Klotz led the Committee through the final two draft standards of care (SOCs).  SOCs are used to establish minimum expectations for the delivery of services, help define how services are structured and delivered, and guide quality management and contracting.  The elements of the SOCs reviewed were: definition of services (from the HRSA monitoring standards); purpose of services (i.e., why the service is important); service goals (taken from the directives and RFP); client characteristics and needs; service activities and standards, staff qualifications, case closure, and grievance procedures.  

The elements of the Housing SOC were described, taken from the Committee’s Service Directive, HRSA Monitoring Standards, and the RFP.

A motion was made, seconded and approved unanimously to accept the Housing Services Standard of Care as presented.

The elements of the Medical Case Management (MCM) SOC were described, taken from the Committee’s Service Directive, HRSA Monitoring Standards, and the RFP.

A question arose concerning one line on page 1, first paragraph, where it says “In order to enroll in a Medical Case Management program, PLWHA have to be – or become – patients of the clinic with which the program is associated”.  Mr. Alvarez was concerned that someone who already has a doctor they like but wants MCM services would need to change providers.   Mr. Spiegler explained the program targets the out of care and that linkage agreements ensure that people will be able to keep their preferred provider, but Committee members asked for additional assurance.  The issue will be discussed at the next meeting before a vote on final approval of this SOC.

Agenda Item #4: Tri-County HIV Epidemiology Presentation  

Ms. Patterson presented on the state of HIV in the Tri-County region, based on the most recent NY State surveillance report, which was released at the end of last year and has complete data for 2017.  There was an overview of how data is collected (from laboratory reporting, medical records, providers and DOH partner services).  Diagnoses in prisons are counted in the region, even if the person originally comes from outside of the area.  In 2017, 146 people in TC were diagnosed with HIV (117 in Westchester, 25 in Rockland, 4 in Putnam).  TC accounted for 20% of HIV diagnoses in NYS not including NYC (which had 2,157).  This is the second highest region outside NYC after Long Island.  New diagnoses were concentrated in lower Westchester and Spring Valley (Rockland), a pattern that has persisted for many years.  107 were male and 39 were female at birth (2 were born male but female identified at diagnosis).  42% were Hispanic/Latinx, 42% African-American/Black, 10% White, 6% multi-race (a large disparity with the percentage of Black and Hispanic people in the general population).  There was 1 Asian person in TC diagnosed.  48% were men who have sex with men (MSM), 30% heterosexual, 16% intravenous drug users (IDU), 3% MSM/IDU, and 2% unknown.  36% were aged 20-29 (with a spike in the number of those 20-24), 22% were 30-39, 18% 40-49, 18% 50-59.  84% of the newly diagnosed in TC entered into care within 30 days of diagnosis, 89% within 90 days (of those 62% received genotype testing).  The rate of new infections among younger males (20-24) has increased since 2015.  Young Black and Latinx MSM account for most of this increase.  

The number of people with a concurrent HIV and AIDS diagnosis (a sign that they have been infected for years without being tested or seeking treatment) was close to 30% (a slight increase in 2017 after dipping for several years).  There are a total of 3,844 people living with HIV in the TC region (16% of the State not including NYC, which has 125,884).  64% are male and 36% female.  34% are Black, 34% Hispanic/Latinx, 19% White, 13 multi-race and Asian/Pacific Islander.  This compares to the demographics of the general population of 58% white, 23% Hispanic/Latinx, 13% Black, 6% multi-race and Asian/PI.  The largest age group among those living with HIV are people in their 50s, followed by the 40s and 60s, which shows the aging of the epidemic.  

In the TC region, 86% of PLWH have been diagnosed, 67% are in care, and 61% are virally suppressed.  71% of people in care are virally suppressed, which is close to the 73% average of the State (outside of NYC where 85% of people in care are suppressed), but below the Ending the Epidemic target of 85%.  

A summary of the ensuing discussion follows:

  • All positive test results are reported, regardless of whether or not the person is an undocumented immigrant.  Those who are tested are not asked their immigration status, in order to not discourage people from entering into care.
  • It is important to remember that there are people behind the statistics, and that each number represents a real person.
  • The State is aware that the regions outside of NYC are lagging in their EtE indicators (especially rates of people in care and virally suppressed) and are looking at additional efforts to bring those numbers up.
  • Some areas have enhanced partner notification services that can help identify people who have not tested yet. A presentation to the Committee on these services would be welcome.

Any questions on the epi stats will be submitted to Mr. Klotz, who will compile them and forward them to Ms. Patterson.

There being no further business, the meeting was adjourned.