Tri-County Steering Committee Minutes March 8, 2023



March 8, 2023, 10:05-11:15am

By Zoom Videoconference

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

Members Absent:        M. Acevedo, L. Beal, L. Best, L. Bucknor, M. Diaz, L. Hakim, A. Hardman, K. Mandel, A. Ruggiero, K. Scott, S. Thomas

Staff Present:              NYC DOHMH: J. Acosta, D. Saab

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 January 11, 2023 meeting were approved with no changes.  Mr. Oldi announced that he is relocating and that this will be his final Committee meeting.  He thanked the Committee for their hard work and dedication, and will use the knowledge he gained here in his new job as executive director of a legal services organization in Massachusetts.  Long-time member Danielle Ahmed is also retiring from the Committee after many years of service in the housing arena in Westchester.  Finally, Ginny Schneider has stepped down from the Committee.  Both were thanked for their service.

Agenda Item #2: Updates

Consumer Update

Mr. Alvarez reported that many consumers are facing co-morbidities, including heart disease and cancers, and initiatives at HRSA and HHS to monitor these trends.  Many consumers are also worried about potential budget cuts that may impact HIV services.  Mr. Harriman affirmed that the Ryan White program is not in any imminent danger of being eliminated.

Planning Council Update

Mr. Harriman reported that at the March Council meeting, there will be a presentation on the EMA’s draft Quality Management Plan.  The Consumers Committee had a session on improving consumer engagement in the QM plan.  The Integration of Care Committee is continuing review of a draft of the new Behavioral Health service directive.  The Needs Assessment Committee continues to work on the draft comprehensive Needs Assessment, with the goal of presenting the final draft during the HRSA site visit in May.  

Mr. Palmer thanked the Policy Committee for an excellent letter to State legislators to educate them about the importance of the 340B program. 

Recipient Report

Mr. Spiegler reported on federal updates, including the end of the COVID-29 public health emergency, and HRSA’s newly issued oral health and behavioral health reports.  Mr. Spiegler discussed a long-standing policy for Ryan White Part A (RWPA) providers on client eligibility requirements for services include HIV status, as well as certain income and residency criteria that must be verified by program staff within 90 days of enrollment. In support of best public health practices and to ensure that PWH who receive care in NYC and Tri-County can fully engage in primary HIV medical care, income and residency requirements may be waived under certain circumstances. However, HIV status must always be confirmed and documented.

The NYC DOHMH HIV Care and Treatment Program has a new webpage that includes a list of all RWPA providers.  The QM plan revision is under way, and the QM committee is identifying QM training needs, creating opportunities for subrecipient engagement, and finalizing methods to elevate QM/QI practices within subrecipient programs.  Finally, New York State has created a Medicaid recertification communications toolkit to help inform New Yorkers about renewing their coverage, which will be required for all enrollees.  Mr. Piazza reported that the Medicaid recertification process will be difficult, and clients can reach out to the Department of Social Services.  Also, SNAP benefits are losing their COVID enhancements, which will have a negative impact.

Agenda Item #3: Tri-County HIV Epidemiology and Surveillance Report

Ms. Patterson provided the annual HIV surveillance update for Tri-County (TC), with data as of December 31, 2021.  She noted that many definitions are standardized, but to remember that all the numbers represent real people.  She explained that HIV data collection procedures (through lab and provider reporting, medical record reviews, etc.).  After dropping continuously since 2012, the number of people newly diagnosed with HIV ticked up slightly from 2020 to 2021, but this is believed to be due to a big dip in testing during the first year of COVID (testing levels have almost returned to pre-COVID levels).  When taking the COVID year into account, the drop continued.  The numbers match national trends.  TC had 73 new HIV diagnoses in 2021, the vast majority in lower Westchester.  Overall, since 2017, the number of new infections has dropped by almost 50%.  All racial groups have seen decreases, but Blacks, MSM and people in their 20s still have the highest numbers of new diagnoses.  The number of concurrent HIV/AIDS diagnoses (a sign of people who were not tested early or received treatment) has dropped by half since 2017.  Westchester has the highest total number of people with HIV in TC, concentrated in the parts of the county close to NYC.  Of the regions in the State outside of NYC, TC has the second highest number of PWH (after Nassau-Suffolk), but the highest rate.  There are 32 transgender PWH in TC. 

The Ending the Epidemic metrics were described.  TC is doing well linking people to care within 30 days, exceeding other regions in NYS.  Viral suppression rates in TC are on par with the rest of the State (81% of those diagnosed, slightly lower than the 85% ETE target).  The treatment cascade for TC was described.  Additional data is available on the NYS ETE dashboard. 

A summary of the ensuing discussion follows:

  • It’s great that the new data collection on sex at birth and current gender captures the picture of HIV among trans people, instead of lumping them in with MSM or other groups.
  • Further information about gender breakdown is available and can be requested.
  • NYSDOH does have NYC data, which is reported to the State from the NYC DOHMH.  The incidence rate in NYC is significantly higher than TC.
  • While racial disparities are still significant, some have decreased over the years and the State is working to eliminate those disparities.
  • It would be interesting to know if higher linkage to care rates are related to where diagnoses are made (e.g., medical facilities).

The next meeting will be on Wednesday, April 12th @10am. 

There being no further business, the meeting was adjourned.