 In this newsletter, you will find updates from the Division of HIV and STI Programs (DHSP). If you have any questions or feedback about the newsletter, please reach out to us at: MDHHS-SHOARS-Support@Michigan.gov.
Since the U.S. monkeypox (MPV) outbreak began and cases were discovered in Michigan, the Division of HIV and STI Programs (DHSP) has been collaborating with others across MDHHS to support communication, testing, vaccination, case investigation, and contact tracing across the state. Michigan case counts and more information can be found at Michigan.gov/MPV. If your agency would like support in MPV response (including planning outreach, communication, vaccine events, etc.), please contact Katie Macomber at macomberk@michigan.gov.
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Open Enrollment is the dedicated time of year where clients on Premium Assistance can enroll in a new health insurance plan, or review and continue their current health insurance plan if available. This is a critical step to ensure that our clients have health insurance coverage during the following calendar year. The Michigan Drug Assistance Program (MIDAP) recommends that clients check with their current insurance provider to confirm if their plan is still available for the following calendar year. If the plan is still available, we ask that they carefully review the plan to ensure that it still meets their needs as some plans may change. If they are not happy with their current plan, this is the opportunity to choose a new plan that meets their needs.
Premium Assistance mails out Open Enrollment Response forms with prepaid return envelopes to all of our current clients, as well as all MIDAP clients who are eligible but not yet enrolled in the Premium Assistance program. The Open Enrollment Response Form may be used to make the first month’s binder payment to insurance companies, on the client’s behalf, to allow for additional time for invoices to be received. If a client chooses to submit the response form, they will still be required to submit an invoice from the insurance company within 30 days. A detailed invoice from the insurance company, which includes the client’s Member ID, address to remit payment, and premium amount, is required within 30 days of when the client’s insurance policy becomes active to continue making premium payments. In addition to a detailed invoice, Marketplace (ACA) clients are required to submit the Marketplace Eligibility Letter showing that they have taken the full amount of the Advanced Premium Tax Credit (APTC), and Medicare Part D clients are required to submit an approval (showing the percentage covered) or denial letter from the Low-Income Subsidy (LIS) program.
Open Enrollment 2023 Dates:
Medicare Part D: October 15, 2022 – December 7, 2022
Medicare Part C (Advantage Plans): January 1, 2023 – March 31, 2023
Marketplace (ACA): November 1, 2022 – January 15, 2023
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For MIDAP Case Managers: The Michigan Drug Assistance Program (MIDAP) is interested in learning more about your client’s satisfaction with the quality of MIDAP service. This week the MIDAP program began sending out its annual client satisfaction survey via US Mail and email to your clients. The survey is optional and there are no consequences for clients who choose not to participate. However, it is still important to MIDAP to collect as much client feedback as possible. As you communicate with your clients over the next few weeks, please take a moment to remind them about this opportunity to share their thoughts about the program and the service they receive. This short survey is an excellent way for clients to anonymously raise any concerns they might have with MIDAP.
Clients without a valid email on file will get a physical copy of the survey in the mail but it can also be accessed online via Qualtrics. The MIDAP program would be grateful for any effort you can give to help your clients complete the survey by the first Friday in November (11/4/2022).
The survey is available on Qualtrics, if your client needs help taking the survey you can fill it out with them over the phone by copying and pasting this link in your browser: https://mdhhssurveys.michigan.gov/jfe/form/SV_bNlW78MkWfndBwq?Distribution=URL .
The onset of the COVID-19 pandemic forced a lot of STI services to pause. As a result of school closures and limited STI test kit availability, MDHHS was not able to conduct school wide STI screening events, as it has been doing for years. In response to this, MDHHS explored alternative options to ensure school aged adolescents had access to STI screening services and information during the pandemic.
The MDHHS Priority Populations Coordinator, Johnnie Green III remained in communication with schools throughout the state and offered suggestions to shift the focus from the large-scale screening events, to activities that would help clinics to remain visible in the community. In 2021, as schools began to offer a hybrid education option of virtual and in-person learning, school-based clinics were able to increase STI screening services by offering virtual STI education, hosting low volume pop-up events for small numbers of students, and collaborating with community organizations to ensure students and parents could still access testing services when needed.
After lots of planning and dedication, MDHHS was able to host a total of eight school screening events for the 2021-2022 school year. These testing events yielded 1084 screenings and resulted in 70 positive tests of which all were treated in the school-based health centers. Planning for the 2022-2023 school year is well under way and we are looking forward to expanding school screening events and reaching pre-pandemic screening goals. If you would like additional information or would like to coordinate a school wide STI screening event at your school, contact Johnnie Green III at greenj13@michigan.gov.
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Over the past year, DHSP Prevention staff have been working with Medicaid to develop a LGBTQ+ reporting template for the Medicaid health plans. This template was developed to improve policies, service delivery, and reporting across the plans. This reporting requirement includes: updating LGBTQ+ nondiscrimination policies for beneficiaries and employees, assessing provision of gender affirming care, and improving PrEP reporting and uptake. Along with the reporting template, DHSP and Medicaid are developing a capacity building and technical assistance plan in collaboration with Ruth Ellis and other DHSP supported capacity building agencies. Next steps for this project include addressing SOGIE, incorporating STI activities and measures, and establishing clinical quality measures.
Did you know that the Cancer Screening Project (CaSPr) talked to providers and people living with HIV (PLWH) to hear their thoughts on cancer screenings?
Results from interviews say these things get in the way of PLWH knowing about, deciding to get, and following through with Cancer screening:
- Providers not having time to support patients through the entire process
- Fear of the screening procedures
- Avoiding a diagnosis, and not “wanting to know” if they had cancer or not
- Cost of services and lack of insurance coverage
Here’s how CaSPr can help with these barriers:
- Provide HIV sensitivity training to providers in screening locations
- Provide emotional support to patients who may be afraid or avoidant
- Reduce fear of the screenings by providing education on what the procedures will entail
- Help patients determine if they are eligible for co-pay assistance or other programs that can reduce out of pocket costs.
But we can’t do this work without you! If you have any patients living with HIV who might be at risk for certain cancers or eligible for a screening, refer them to CaSPr via fax. You can find the form here.
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 Many HIV prevention experts believe that a status neutral approach can improve service delivery, eliminate stigma, and reduce health disparities. Read this brief from the CDC for more information about a status neutral approach.
The Division of HIV/STI has been awarded a new grant to monitor the impact of syphilis on mothers and babies. This grant is part of the CDC SET NET Project. The purpose of the grant is to investigate past cases (2020-2021) of syphilis to understand the underlying causes for the increased rate among women and infants. This will be accomplished through medical record abstraction and working with community partners. Medical record abstraction will focus on reviewing medical records to find patterns, underlying causes, and missed opportunities and will include reviewing OBGYN, primary care, and delivery records. All data will be presented to internal and external stakeholders, and the Surveillance Unit will work with the community (doctors, CBOs, CABs, etc.) to address the issue and develop solutions while also strengthening current relationships and creating new partnerships with the community. If you currently have internal workgroups or meetings related to mothers/perinatal care or would like to create a group at your agency, please contact Genna Owens, HIV/STI Surveillance Manager, at owensg1@michigan.gov, 517.245.3300.
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MDHHS DHSP will be piloting a new supplemental HIV surveillance project starting July 2023. This project is aimed at understanding more about individual and systemic factors that contribute to recent and ongoing gaps in HIV testing and prevention. We are seeking input from 4-5 individuals, including newly diagnosed people living with HIV (PWLH), to provide input on recruitment strategies and community engagement for this project. If you are interested or would like to refer someone to join this committee, please contact Jamilah Drakeford, Special Studies Unit Manager, at DrakefordJ@michigan.gov.
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Please join us on November 1st from 2:00pm to 3:00pm for our next Continuum of Care (CoC) Quarterly Open Office Hours. The topic for this session is the Michigan Drug Assistance Program (MIDAP) – We’ve Got You Covered! We are privileged and excited to have Dana Vigas from the MIDAP Unit presenting. Dana will explain and outline additional resources available to better serve our clients.
Our Quarterly Open Office Hours is also an opportunity for Ryan White Subrecipients to learn more about the various services offered, in addition to asking questions to the presenters and the CoC unit staff. If you have not yet received an invite for this meeting, please contact Tammy Spitzley, SpitzleyT8@michigan.gov, or any of the CoC unit staff.
Latest updates from the HIV/STI Epidemiologists:
STI Reports
STI Annual Diagnoses and Trends, 2021 is a slide deck of data highlights for cases through calendar year 2021. These data show priority populations, trends over time, and areas of concern or areas for action. The slide deck format is meant to be accessible for individual viewing, as well as for presenting in group settings as a basic overview of the state of the STI epidemics in Michigan today.
STI Diagnoses, 2021 provides tables of total diagnoses and rates for chlamydia, gonorrhea, primary & secondary syphilis, and latent syphilis. Re-infection rates for chlamydia and gonorrhea are also shown. All data are broken down by patient characteristics of age, race and sex assigned at birth, transmission risk, county of residence, and local health jurisdiction of residence.
STI Diagnosis Trends, 2012-2021 includes 10-year trend analyses for Michigan residents diagnosed with an STI (syphilis, chlamydia, or gonorrhea). Trends are standardized for changing population, and diagnosis rate changes are evaluated for statistical significance using negative binomial regression. Breakdowns are geographic and demographic.
STI-HIV Coinfections, 2021 looks at HIV prevalence among people diagnosed with new syphilis, gonorrhea, or chlamydia infections during 2019, as well as the rate of STI diagnoses among all people living with HIV in Michigan. The slides highlight the priority populations who are disproportionately affected by coinfection, while the tables show details by race and sex, age, transmission risk, and local health department. These data are available as tables with highlights in slide deck format.
HIV Trends and Prevalence Reports
HIV Diagnosis Trends, 2012-2021 includes geographic, demographic, and linkage to care trends. It also contains minimal HIV testing information. As this is the first Trends Report published in full since COVID, there are a few important notes to keep in mind:
- COVID-19 affected many aspects of HIV testing and care. During 2020, new HIV diagnoses were significantly lower than expected, likely to due to an interruption of testing. Therefore, 2020 was excluded from the statistical calculations. In 2021, new diagnoses remained low, but fell within the normal limits. Therefore this Trends report was deemed worthwhile to update this year, however interpret significantly declining trends with caution. Artificially low diagnoses in some populations during 2021 may be amplifying modest declines.
- Trends are a measure of new diagnoses, not new infections. Historically new diagnoses were a consistent proxy for new infections. This may still be the case, but the drop in testing during 2020 and the lack of a full recovery in 2021 has made the relationship questionable.
- Partner Services (PS)/contact tracing fatigue is having an impact. Transmission risk and testing history are frequently only obtained by PS. Since 2020, the public appears to be less inclined to speak with PS staff resulting in low risk and testing history ascertainment. For this reason, this slide deck does not include either of these topics.
The slides highlight important information found in the tables. The tables include analyses of Michigan as a whole, the Detroit Metro Area (DMA), and the Detroit Local Health Department (LHD) jurisdiction.
HIV Prevalence Report, 2021 focuses on people living with HIV December 31, 2021. It includes geographic and demographic breakdowns, information regarding HIV Stage 3 (previously known as AIDS), HIV transmission rates, STI coinfections, and historic prevalence estimates. The slides highlight important information found in the tables. The tables include assessments of Michigan as a whole, as well as of the Detroit Metro Area (DMA) and the Detroit Local Health Department (LHD) jurisdiction.
Thank you for reading our newsletter!
Michigan.gov/HIVSTI
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