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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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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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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:
- What populations** are most likely to be
retained in care and virally suppressed?
- 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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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:
- Reduce new HIV infections
- Increase access to care and improve health
outcomes for people living with HIV/AIDS
- Reduce HIV-related disparities and health
inequities
- 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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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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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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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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 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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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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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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