Ryan White newsletter winter 2017

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December 2017



Ryan White Program;
Hennepin County Public Health; 525 Portland Ave., 3rd floor; Minneapolis, MN 55415 
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The Ryan White Provider Newsletter is issued semi-annually and provides information about HIV services planning, contract administration, quality management, CAREWare updates and training opportunities. Your feedback and suggestions for future issues are appreciated. 

Contact Ryann Freeman

Seasons greetings

As we approach the end of 2017, we have many things to be proud of. Between July 1, 2016 and June 30, 2017:

  • 89 percent of people served through Ryan White HIV/AIDS Program funding were retained in HIV medical care
  • 93 percent of people who received medical case management services were retained in care
  • 89 percent of people who received Part A funded outpatient health care services were virally suppressed

We are just shy of achieving the National HIV/AIDS Strategy Goals for retention in care (90%). To see how we compare with the overall national Ryan White HIV/AIDS Program retention and viral suppression rates in 2016, read the recently released Ryan White HIV/AIDS Program Services Report.  

Ryan White currently serves half of the Minnesota population diagnosed with HIV, yet we estimate that 75 percent of the population living with HIV in our 13-county Part A metro area are eligible for services. So how can we get more people engaged? We’d love to hear your ideas.

In this issue, you will learn about:

  • Progress in migrating HIV surveillance data into CAREWare to better monitor our performance
  • The Minnesota Council for HIV/AIDS Care and Prevention’s work in 2018
  • Community participatory approach efforts to engage disproportionately impacted people
  • An update on 2018 Part A and B contracts

Thank you for all that you do for people living with HIV in Minnesota and the Twin Cities. Happy holidays.  

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2018 Part A funding outlook

For the first time, we were given a ceiling amount of funding for our fiscal year (FY) 2018 Part A grant application ($6,198,211). If we receive this amount for FY2018, it will be a five percent increase from FY2017.

Whether we are awarded this amount is still uncertain; Congress has not passed the federal appropriations for FY2018. Based on news of current negotiations, it appears that FY2018 will be similar to 2017 and we are anticipating flat funding.

In 2017 we received a waiver of the requirement to expend 75 percent of our Part A funds on core medical services. (This allows us to spend more than 25 percent of our resources on support services.) We are currently in the process of applying for a core medical services expenditure waiver for 2018 so the Minnesota Council for HIV/AIDS Care and Prevention has more flexibility in meeting the needs of people living with HIV in our 13-county Part A grant area.  

Most FY2018 contract budgets will start at or near FY2017 amounts. Adjustments may be made based on FY2015 - 2017 spending and achievement of contractual performance goals.

Your Hennepin County contract manager will contact you in the coming weeks to begin work on your FY2018 contracts. 

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eHARS to CAREWare: an opportunity for more effective public health interventions

On October 6, 2017, the first full eHARS to CAREWare match occurred.* As of December 13, 79 percent of Ryan White clients (Part A, Part B, Rebate, and ADAP) had a viral load in CAREWare for July 1 – June 30, 2017. 

Our goal remains to reach 90 percent -- a goal that is achievable as the matching process continues to improve.

We want to thank the Minnesota Department of Health for their hard work on this effort. It has been (and will continue to be) a time intensive and technically challenging problem.

You might ask, if this project takes so much effort, why is it important? Retroactively adding viral loads allows us to answer many questions that we weren’t able to before, including:

  1. What populations** are most likely to be retained in care and virally suppressed?
  2. What services have the greatest impact on different populations** of Ryan White clients for retention in care and viral suppression?

With the paradigm shift of “treatment as prevention,” ending the epidemic is within reach. However, like all entities, we have limited capital (e.g., human, financial, knowledge). Answering the right questions in a scientific way will help us:

  • Improve our current inventions
  • Shape our future interventions
  • Work with our partnered providers, fellow government agencies, and community members to target our limited capital in the most effective way possible
  • End the HIV epidemic

* Our readers might find a refresher on eHARS and CAREWare helpful. We encourage you to view this link. Additionally, you can find the full presentation on the match on the Minnesota Department of Health’s website here.

** Populations can be sub-categorized in a variety of ways (e.g., race/ethnicity, age, gender, housing status, insurance status, date of HIV diagnosis, AIDS status, income, number of providers seen)

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Minnesota Council for HIV/AIDS Care and Prevention’s work in 2018

2018 is going to be a busy year for the Minnesota Council for HIV/AIDS Care and Prevention. Every year the council allocates Part A and Part B funding for the 13-county metropolitan area and Minnesota. And every two years, the council sets HIV-related service priorities.

Guiding the 2018 prioritization and allocation process are the four goals of the Minnesota and TGA Integrated HIV Prevention and Care Plan 2017-2021:

  1. Reduce new HIV infections
  2. Increase access to care and improve health outcomes for people living with HIV/AIDS
  3. Reduce HIV-related disparities and health inequities
  4. Achieve a more coordinated state and local response to the HIV epidemic to reduce the number of Minnesotans at risk of or living with HIV

One way the council impacts these goals is by allocating Ryan White funding to services that will reach Minnesotans, particularly populations experiencing disparities. The council’s Disparities Elimination Committee defined these populations as:

  • African Americans (including men who have sex with men, transgender individuals, and women)
  • African-born (including men who have sex with men, transgender individuals, and women)
  • Latinos (including men who have sex with men, transgender individuals, and women)

While race is not considered a biological reason for disparities in the occurrence of HIV/AIDS and the level of engagement in HIV care, racism is a social determinant of health. The associated discrimination that people of color experience can result in lower socioeconomic status, less education, less access to health care, greater prevalence of substance use disorder, and higher risk for HIV exposure.

The council will set HIV-related service priorities in June – July 2018 and allocate funding in August 2018. 

All council and committee meetings are open to the public and a schedule of meetings is located at http://www.mnhivcouncil.org/calendar.html. We welcome your attendance and participation at our meetings and we invite you to  join the council as a community member or submit an application for council membership.

We hope you will continue to inform your clients about the council and how they can be involved in our community HIV care and prevention planning process. Robust engagement of consumers, especially those from disproportionately impacted communities, ensures that we are meeting the needs of Minnesotans living with HIV and eliminating disparities. 

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Community engagement to eliminate HIV-related disparities

Despite tremendous advances in HIV/AIDS care, racial and sexual disparities persist in incidence, prevalence, and health outcomes. 

According to the Minnesota Department of Health’s (MDH) Annual HIV Data Release (2017), HIV disproportionately impacts people of color, most notably Blacks, both African American and African-born, and Latinos.” For instance, African Americans and African-born people comprised 47 percent of new diagnoses in 2016, but make up only 7.5 percent of the population in the Minneapolis-St. Paul transitional grant area. 

Similar trends are observed with sexual minorities. For instance, MDH (2017) reports that 48 percent of new diagnoses in 2016 were among MSM. And, among MSM, 45 percent of new infections were among men of color, with African American MSM accounting for 21 percent (MDH, 2017). According to the Centers for Disease Control, If current HIV diagnoses rates persist, about one in two black men who have sex with men (MSM) in the United States will be diagnosed with HIV during their lifetime,” (CDC, 2016).

Hennepin County’s Ryan White Program has implemented community engagement efforts to bridge our public health goals with community knowledge around the socio-cultural determinants of health. We have adopted the community based participatory research (CBPR) model as an evidence-based approach to establish trust and build lasting partnerships. “Community-based participatory research (CBPR) has emerged in the last decades as a transformative research paradigm that bridges the gap between science and practice through community engagement and social action to increase health equity,” (Wallerstein & Duran, 2010, p. 540).

We are currently supporting four community engagement efforts:

1) Black/African American Same Gender Loving Men’s Workgroup, now called The League of Extraordinary Black Men (The League)

After a year of monthly meetings, The League has developed a strategic plan, created and disseminated an HIV and League brochure, and increased the Minnesota Council for HIV/AIDS Care and Prevention’s awareness of the HIV prevention and care needs of Black same gender loving men.

The League now has three participants who are active on the council and/or council committees. In 2018, The League has planned activities, including: targeted community education to increase awareness of the importance of testing and PrEP; People of Color Pride outreach; and a summer community HIV awareness event. 

More details to come.

2) Partnerships with African faith leaders

Agness Mumba, a former Ryan White Program intern and a Humphrey Fellow at the U of M, adopted the CBPR approach and worked with local African faith leaders to develop a Faith Leaders’ HIV Education Curriculum. The curriculum was designed to address stigma related to culture, faith, HIV, gender, sex, and sexual identity. 

We partnered with Dr. Monica Yugu, Ryan White medical case manager, to implement this curriculum. In partnership with Tom Bichanga, The Aliveness Project’s director of care and prevention, the February 2017 training had 36 participants, 22 of whom were faith leaders. Part two of the training was held in April for 23 faith leaders, with nearly 100 percent of participants disclosing changes in knowledge and attitudes. Another training was offered in September for 16 Muslim faith leaders with similar results.

The efforts have expanded with leadership from Emma Boyce, Ryan White Program’s doctoral student intern. With Emma’s knowledge and community connections, over 120 people (20 of whom were faith leaders) showed up to the November 2017 training. An additional training was convened for 10 Liberian faith leaders.

Not only did pre- and post-tests demonstrate changes in knowledge and attitudes, but a large number of training participants received HIV tests offered by MDH and The Aliveness Project.

3) Latino MSM and Latina transgender community efforts

In an effort to better engage the target community, the Latino MSM and Latina Transgender workgroup partnered with Grindr, an online dating application. Two staff members from Red Door and Hennepin County’s Ryan White Program developed a survey that appeared on Grindr's pop-up advertisements. The survey engaged individuals around PrEP counseling, HIV testing, and linkage to care.

Eight hundred and eighty (880) Grindr users completed the survey, 36 of whom came in for testing or PrEP counseling/linkage, from which 22 were prescribed PrEP, while 23 individuals who self-reported as living with HIV came in for comprehensive one-on-one interviews. The interviews are currently undergoing qualitative analysis.

This innovative project proved to be a successful way to reach MSM of color, so Red Door is planning to administer the survey on similar dating applications.

4) Native American community efforts

The fourth community engagement effort is in the formative stage. Lenny Hayes, former council member, wanted to adopt the CBPR approach to a Native American HIV workgroup. The workgroup has now met for six months, and its core members (strong advocates, elders, and service providers) have had rich discussions around incorrect data reporting and culturally specific HIV-related needs. 

The workgroup is currently developing operational guidelines and a strategic plan – and planning a summer pow wow. Stay tuned for more insight and events.

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Cultural responsiveness standards development

In partnership with the Minnesota Department of Human Services (DHS), Hennepin County Ryan White Program’s rebate program planner convened a planning committee to develop cultural responsiveness standards of care. The development of these standards was motivated by a clear gap in the Ryan White Program Universal Standards around cultural responsiveness.

The vision for these standards aims to address health disparities and eliminate the gaps in access to and retention in care and prevention services. Four detailed standards around operation and structure, client rights, staff qualifications and training, and assessment and evaluation were developed and integrated into the Ryan White Program Universal Standards. Community input was gathered through five targeted focus groups and several one-on-one interviews, and provider input was gathered through a self-administered needs assessment. One of the biggest components of the standards is the required four hours of annual training around cultural responsiveness for provider staff.

Government staff, providers, and consumers are excited about the addition of these standards, and we look forward to officially adding them to next year’s contracts. Please reach out to Ryann Freeman (ryann.freeman@hennepin.us) to discuss this effort.

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Positively Hennepin update

It has been one year since Positively Hennepin launched, and its 2017 progress report is nearing completion. 

The report will highlight work that’s brought the county closer to having no new HIV infections by 2027 -- including HIV training with leaders and members of Liberian faith communities, a conference with PrEP clinics, and building a stronger partnership between county social services and HIV services. It will also include baseline data that measures the strategy’s ten milestones, including HIV testing, new infections, housing as a social determinant of health, PrEP use, and the care continuum. 

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New staff introductions

Emma Boyce

Emma Boyce joins Hennepin County’s Ryan White team as a doctoral level intern. With an undergraduate degree in human biology and chemistry, Emma worked with a toxicology company, MEDTOX, before continuing her education at the University of Minnesota in stem cell biology. After obtaining her first master’s degree, Emma worked as a researcher at the University of Minnesota until she went on to receive a second master’s degree in pharmacy from the University of Florida. 

After working in the pharmaceutical industry for nearly ten years, Emma decided to work to prevent the occurrence of diseases instead of developing drugs to treat disease conditions. She is currently enrolled as a doctorate student in epidemiology at Capella University and is working with the Ryan White team to increase HIV awareness among African-born populations, particularly Liberians. 


Mona Deoferio joins Hennepin County’s Ryan White Program as a senior contract manager. Prior to working at Hennepin County, Mona was a manager in the health care and senior living industry. During that time, she created home care agencies, mental health programs, and chemical health agencies to target underserved populations. Mona is also a Certified CPR instructor through the American Heart Association and teaches at local hospitals, clinics, and other community locations. 

Mona has a bachelor’s degree in child development, a master’s degree in business administration, and a passion for working in health care -- particularly with underserved populations.

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New contracting system

In fall 2017, Hennepin County rolled out a new contracting system. As a result, all Ryan White contracts have already been extended or will be extended through 2019. 

Beginning in late 2018, the new contracting system will allow contracts to be completed electronically. Until then, all Ryan White contracts will continue to be paper contracts and the process remains the same. 

More information regarding the new contracting process will be provided closer to the date of contract renewal.  

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2018 contract adjustments

Contract managers had been working on amendments to extend contract terms for another year beginning March 1, 2018 for Part A and April 1, 2018 for Part B. 

Considering that all Part A contracts would expire earlier than Part B contracts, contract managers prioritized Part A contract amendments and submitted these contracts to the Hennepin County Board of Commissioners for approval prior to year end. This effort will allow ample time for Part A contracts to go through the contracting process prior to the contract terms expiring.

Currently, contract managers have successfully amended to extend all Part A contracts to February 28, 2019. The amendment was intensive and we received lots of support from our providers, county attorney, and other managers. We enjoyed the team work and would like to extend our appreciation for your cooperation. 

With Part A contracts amended for an additional year, we know the service unit and budget allocations for each service area for fiscal year 2018-19 and will finalize contract agreements through ministerial adjustments.

In the meantime, contract managers are shifting their focus from Part A contracts to preparing an amendment to extend all Part B contracts for an additional one year while awaiting contractual 2018-19 Part A budget allocations. Based on current progress, we anticipate both Part A and Part B contracts to be completed earlier.

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