Monday, June 6, 2016

Big Picture - April & May

This post is part of a monthly series that summarizes what's been going on in the Ryan White Planning Council, HIV Prevention Planning Group, and their subcommittees. To view meeting materials and presentations, please visit www.hivphilly.org or check out our SlideShare account.

Spring has been busy here at the Office of HIV Planning! We moved to our new office on the 3rd floor of the building, in Suite 320. With all the difficulty of moving, we missed April’s Big Picture post, so we’ll cover both April and May here.

Finance Committee (May 12th):
The Philadelphia EMA received a $162,000 increase in their Ryan White Part A funding this year. The Finance Committee looked over and approved budgets for Philadelphia, the PA suburban counties, and NJ. Because of HRSA Policy Clarification 16-02, the EMA’s emergency medication program cannot be funded the same way anymore.  Money to support the program was moved from the Local Pharmaceutical Assistance Program (LPAP) to Direct Emergency Financial Assistance (DEFA). Representatives from the AIDS Activities Coordinating Office (AACO) also requested that the Planning Council move $84,000 from LPAP to referral for healthcare and supportive services.

Ryan White Part A grant allocations meetings for the fiscal year 2017 will be held in June. The Pennsylvania allocations meeting will be June 14th, Philadelphia will be on June 16th, and NJ on June 21st. The meetings will run from 1-4pm.

Needs Assessment Committee (April 11th):
The results of the Needs Assessment Committee’s transportation survey are in. Case managers who responded to the survey talked about common issues with getting clients to and from medical appointments. Logisticare and SEPTA tokens were mentioned in a lot of the responses. The committee plans to look into issues with Logisticare and will possibly write a transportation resource list for case managers.

New Member Orientation/Nominations Committee (April 14th & May 19th):
The Planning Council welcomed 4 new members in April. They were invited to attend an orientation, where they learned about their responsibilities as Planning Council members. Debbie also gave an overview of the Ryan White Part A planning process.

In May, the Nominations Committee looked over Planning Council attendance. They’ll follow up with members who have attendance issues. They also reviewed the attendance policy. Members who have 3 unexcused absences or miss 5 meetings in a calendar year may be removed from the Planning Council. Anyone with a circumstance that keeps them from coming to meetings (for instance, an illness) should contact the office. Members should also try to arrive to meetings on time.

Ryan White Planning Council (April 14th & May 19th):
April: Evelyn Torres and Sebastian Branca from AACO gave a presentation on AACO’s Client Services Unit (CSU) at a joint meeting with the HIV Prevention Planning Group. The CSU helps to get people with HIV into case management and other services. AACO’s Health Information Helpline (1-800-985-2437) also provides information to callers from 8am-6pm Monday through Friday. Sebastian talked about the ways AACO follows up with HIV service organizations to see well they’re doing.  AACO uses data to see which organizations need help to improve their performance, and then helps organizations make plans for how they’ll do better.

May: The Finance Committee presented the budget for this year’s Ryan White Part A grant. The Planning Council voted to approve the budget, along with the grantee’s request to move $84,000 from LPAP to referral for healthcare and supportive services.

Positive Committee (May 9th):
Antonio gave the Positive Committee a presentation on the 2015 Youth Risk Behavior Survey (YRBS). Philadelphia public high school students were asked about tobacco use, alcohol and drug use, body weight and activity, sex, and violence. You can see more information on Antonio’s slides here.

Nicole told the group about the OHP’s focus groups with high-risk heterosexuals. Participants in the focus groups talked about their experiences with healthcare in Philadelphia. You can read Nicole’s slides here. Also check out her full report along with her recent blog post, where she talks more about what she learned from the focus groups.

Comp Planning (April 21st & May 26th):
April: Nicole also gave her focus group presentation to the Comprehensive Planning Committee.

The Comprehensive Planning Committee looked over the Needs Assessment Committee’s transportation survey results. They agreed to brainstorm and work together with Needs Assessment on transportation issues.

The use of opioid medications and heroin is a huge problem in Philadelphia. Overdose deaths are on the rise. Hepatitis C rates among heroin users are also skyrocketing. The Comprehensive Planning Committee will continue to discuss the opioid epidemic at future meetings.

May: The Comprehensive Planning Committee has talked about a retention navigation program, transportation, housing, and health insurance premium cost-sharing over the last year. They asked AACO to look into a health insurance premium cost-sharing program for the Philadelphia EMA. The Positive Committee will address transportation at their next meeting. The Comprehensive Planning Committee will bring up the retention navigation model at this month’s Finance Committee and allocations meetings. The Planning Council will ultimately decide whether to fund the program.

HPG (April 27th):
Kathleen Brady, AACO’s medical director, gave her annual report on the HIV epidemic in Philadelphia. The National HIV/AIDS Strategy and the HIV Care Continuum were an important focus of her presentation. See Kathleen’s slides for more information.

We hope to see you all at June’s allocations meetings!


Want to get involved? To learn more, follow the links in this post, attend one of the meetings listed on our calendar, or email info@hivphilly.org. If you have questions, you can also call us at 215-574-6760.

Wednesday, May 25, 2016

8 ways to improve health care for adult heterosexuals

In November 2014, the Office of HIV Planning held focus groups with adult heterosexuals. The groups discussed the men’s and women’s experiences with health care, their ideal health care experience, and HIV testing in Philadelphia.  The full analysis and recommendations can be found here.

A low perception of HIV risk persists among heterosexuals in Philadelphia, despite the fact that there are almost equal numbers of heterosexuals living with HIV/AIDS (3,153) as men who have sex with men (3,140). However in recent years, diagnoses of HIV among heterosexuals have been decreasing in Philadelphia, from 316 in 2010 to 254 in 2014. Despite declining numbers of new infections in the overall heterosexual population, racial disparities among heterosexuals are stark. In 2014, there were 5,105 Black heterosexuals living with HIV/AIDS in Philly, 8 times as many as Whites (612) and 5 times as many as Hispanics (985). In 2014, there were 4,026 Black women living with HIV/AIDS, 7 times more than White women and 5 times more than Hispanic women.

According to the CDC, sexual risk among heterosexuals is quite common, including unprotected anal and vaginal intercourse and recent diagnosis of sexually transmitted infections. Many people have high-risk sex but do not recognize their own risk. In Philadelphia, 82% of men in the National HIV Behavioral Surveillance System sample had vaginal sex without a condom and 36% had anal sex without a condom in the previous year. For the women in the same sample, 86% had vaginal sex without a condom and 21% had anal sex without a condom in the previous year.

Racial disparities in HIV infection rates are not due to behavior alone. Powerful social factors like poverty, gender inequality, racial segregation and discrimination, and gender norms drive the epidemic in African American and other minority communities. Geography and racial segregation matter because people tend to socialize with people similar to themselves. This is a major factor in how HIV is concentrated in certain geographic and cultural communities. When examined geographically, areas with significant numbers of people living with HIV/AIDS are often areas with concentrated poverty and minority populations.

One of the major themes of the focus group discussions was how trauma impacts individual’s access to and comfort with medical care. Trauma is prevalent among many of the same communities that are most at risk for HIV including those in this report: women of color, African American men, especially those who have experienced homelessness and incarceration. The effects of trauma on health are varied. Trauma may cause healthcare avoidance, particularly for survivors of intimate partner violence. Health exams can be invasive and trigger traumatic responses, because of feeling a lack of control over one’s body. Evidence is growing that trauma negatively impacts immune function.  Trauma is associated with poorer metal health, substance abuse, ART adherence and immunologic outcomes.

 The following recommendations are based on the experiences and opinions of the focus group participants as well as the current literature and epidemiological data in Philadelphia (see full report for all references). These recommendations seek to address health disparities and decrease the number of new HIV cases in Philadelphia.

1. Trauma-informed care should be the standard of care. Considering the pervasive experiences of trauma for men and women of low socio-economic status (childhood and adult), all healthcare settings should work towards a trauma-informed culture.

2. Sexual and reproductive health care must be trauma-informed. All women should be screened for current intimate partner violence, as well as childhood and past sexual and emotional abuse. Appropriate referrals should be made for mental health and social support services.

3. Honor and maintain a patient’s dignity in all care settings. Patients who feel they are treated with dignity and are active participants in healthcare decision-making are more likely to adhere to treatment and trust their medical provider.

4. Holistic care that includes services for mental and physical health is essential for long-term health and continued engagement in primary and HIV care. Social support should be integrated into all health care settings, whether through case management, navigation services or peer support. Service providers should consider incorporation of childcare and respite services in services targeted to women, considering their caregiving responsibilities.

5. Continue and expand current efforts to make HIV testing routine in all primary care.  Efforts should ensure routine screenings are happening in communities where HIV is most prevalent. Routine testing doesn’t rely on patient disclosure or recognition of HIV risk behaviors and will increase the likelihood that individuals are diagnosed and linked to care in a timely matter.

6. Include information about PrEP during pre- and/or post- test HIV counseling services. Individuals who test HIV-negative (for whom PrEP is appropriate) should receive information about where and how to access PrEP and provided with relevant referrals.

7. Community-level campaigns to raise awareness about HIV risk and prevention in the Black and Latino communities are needed. The campaigns should be broadly marketed to all members of the Black and Latino communities, not just to individuals of a certain risk profile or class. Local community leaders should be the messengers of the campaign.

      8. Provide adult health education in community settings to improve health literacy to decrease health disparities. Programs should include information about sexual health and HIV/STI prevention, hygiene, nutrition, sleep, and the importance of health screenings. Specific interventions should focus on the health needs of Black men. 

Monday, April 11, 2016

Big Picture - March 2016

This post is part of a monthly series that summarizes what's been going on in the Ryan White Planning Council, HIV Prevention Planning Group, and their subcommittees. To view meeting materials and presentations, please visit www.hivphilly.org or check out our SlideShare account.

Finance Committee
HRSA’s Policy Clarification 16-02 sets rules about what can be funded by Ryan White. The clarification changes how the EMA can fund local AIDS pharmaceutical assistance. It also means the EMA can now fund syringe access programs.

The Finance Committee voted to approve a reallocation request from the AIDS Activities Coordinating Office (AACO). AACO representatives asked that money be moved from Medical Case Management to Information and Referral Services to support the Health Information Helpline. They said the change would not affect case management services.

Integrated Executive Committee
The Co-Chairs of the Planning Council, HPG, and their committees met to discuss areas where they can work together, including the Integrated Plan. They talked about HIV stigma and HIV testing. They also agreed to invite a presenter on trauma-informed care in the future. The Positive Committee will discuss Medicare/Medicaid and peer support programs.

Ryan White Planning Council
The Planning Council approved the Finance Committee’s request to reallocate money from Case Management to Information and Referral Services.

Positive Committee
David Griffith from the LGBT Elder Initiative discussed some upcoming events about HIV and Aging. You can find more information on the LGBTEI website.

The Positive Committee had a conversation about Medicare and Medicaid. They’re hoping to bring in a speaker to talk about Medicaid in the future. They’ll also be discussing Peer Support programs at their next meeting.

Comp Planning
The Comp Planning Committee looked through information about marketplace insurance programs. They also reviewed data on insured and uninsured people living with HIV and AIDS in Philadelphia. Updated insurance information will be available soon. The Committee is going to continue discussing a Health Insurance Premium Cost-Sharing program after they see more data.

They also finished their conversation on Housing as it affects health. Many people living with HIV and AIDS in Philadelphia need housing and can’t get it. Increased funding for housing may help shorten the waiting list for HIV/AIDS housing programs.

Needs Assessment Committee
The Needs Assessment Committee’s transportation survey got sent out to providers in early March. The survey has received a lot of responses already. Some providers said that they have issues with Logisticare. Some patients do not receive their day passes on time, or their rides do not arrive on schedule. Some people also have issues getting SEPTA tokens.

HPG
Dr. Anne Frankel from Temple University and Judith Peters from the Philadelphia School Board came to talk about last year’s Youth Risk Behavior Survey (YRBS). The survey asks high school students about smoking; drinking and drug use; weight, nutrition, and activity; sex; violence; and mental health. You can find slides from their presentation here.

Nominations Committee
The Nominations Committee reviewed applications for Planning Council membership. The Planning Council welcomes 4 new members! New Member Orientation will be held April 14th from 11am-2pm. Current Planning Council members can stop by orientation around 1pm to talk about their committees.


Want to get involved? To learn more, follow the links in this post, attend one of the meetings listed on our calendar, or email info@hivphilly.org. If you have questions, you can also call us at 215-574-6760.

Wednesday, March 30, 2016

Big Picture - February 2016

This post is part of a monthly series that summarizes what's been going on in the Ryan White Planning Council, HIV Prevention Planning Group, and their subcommittees. To view meeting materials and presentations, please visit www.hivphilly.org or check out our SlideShare account.

Finance Committee
The Finance Committee approved a request from the AIDS Activities Coordinating Office (AACO) to move $33,000 in the PA suburban counties from Mental Health and Transportation to Dental. This year’s Ryan White Part A grant award has not been received yet. However, the Finance Committee approved a temporary level funding budget.

Positive Committee
The Positive Committee watched a Vice Magazine documentary on PrEP. You can see it for yourself here

Needs Assessment Committee
The Needs Assessment Committee did a test run of their transportation survey. It will be distributed to providers in March.

Ryan White Planning Council
On behalf of AACO, the Finance Committee asked the Planning Council to approve the $33,000 shift to Dental in the PA counties. They also presented the level funding budget. The Planning Council voted to approve both.

Planning Council Social!
The Planning Council had their annual social after the February meeting. I hope everyone had a great time. We ate snacks, gave out some door prizes, and got to know each other better. Thanks to all the Planning Council members and guests who showed up. Here’s a few pictures from the event, courtesy of Planning Council member Ed Campbell.



Comp Planning
HRSA recently put out a Ryan White Policy Clarification. The document defines what can and can’t be funded under Ryan White. You can read it here.

The Comp Planning Committee talked about 5 categories that will be affected by the policy clarification: Local AIDS Pharmaceutical Assistance, Non-Medical Case Management, Housing Assistance, Health Insurance Premium Cost-Sharing, and Syringe Access. The committee is going to start working on a Health Insurance Premium Cost-Sharing assistance program over the next few months.

HPG
Nicole did a report on 2014’s focus groups for heterosexuals at high risk of HIV. The participants talked about their positive and negative experiences with health care. They also made recommendations for how health care could be improved. Nicole will release a full report on the focus groups in March.

Antonio gave a presentation on PrEP. He went through PrEP campaigns from across the country. The best PrEP marketing campaigns used pictures that people could relate to. Their websites were simple and avoided listing too much information.

The HPG did an activity where they brainstormed their ideal service system. Some topics they brought up were routine HIV testing, syringe exchange, and decriminalization of drug use and sex work. The Ryan White Planning Council and HPG Co-Chairs will talk about these topics at the Integrated Executive Committee meeting later this month.

Tiffany Dominique talked about the recent Bench to Bus Stop Conference, held at the Mutter Museum on January 26th. The conference promoted networking and encouraged health department representatives and researchers to work together on future projects.

Want to get involved? To learn more, follow the links in this post, attend one of the meetings listed on our calendar, or email info@hivphilly.org. If you have questions, you can also call us at 215-574-6760.

Monday, February 1, 2016

Big Picture - January 2016

Happy 2016! This post is part of a monthly series that summarizes what's been going on in the Ryan White Planning Council, HIV Prevention Planning Group, and their subcommittees. To view meeting materials and presentations, please visit www.hivphilly.org or check out our SlideShare account.

Finance Committee
Chris Chu from the AIDS Activities Coordinating Office (AACO) presented AACO’s quarterly underspending report to the Finance Committee. The EMA has spent 14% less than the Planning Council allocated for the past 9 months. Transportation in New Jersey had particularly low spending.

AACO requested that they be allowed to use the underspent funds for other services, like Food Bank and Medications. The Finance Committee approved the request.

Positive Committe
The Positive Committee will be inviting representatives from the LGBT Elder Initiative (LGBTEI) to their April meeting. They will discuss topics like mental health, nutrition, and exercise.

Briana gave a presentation about the National HIV/AIDS Strategy (NHAS) in Philadelphia. You can read more about the NHAS here. The new NHAS targets gay and bisexual men, Black women and men, Latino men and women, people who inject drugs, youth, and transgender women. These are the groups most affected by HIV and AIDS in the US. The Office of HIV Planning Epidemiologic Profile gives more information on all these groups in Philadelphia. You can find the Epi Profile on our website.

Needs Assessment Committee
The Needs Assessment Committee has been working on a transportation survey for the past several months. They’re putting some finishing touches on the survey and will be sending it out to local service providers soon.

Nominations Committee
The Nominations Committee is still looking for new Planning Council members. The Planning Council needs members from hospital or health care planning agencies, state Medicaid and Part B agencies, Part D grantees, Federally Recognized Indian Tribes, and people co-infected with Hepatitis B or C. If you are anyone you know is interested in applying to be a member, please visit our website for an application.

The Nominations Committee is hosting a Planning Council social after the meeting on February 11th. Please bring your friends! There will be food, activities, and a raffle for some awesome door prizes.

HPG/Planning Council combined meeting
The HPG and Planning Council combined their meetings this month. They had some guests talk about HIV and Aging (Terri Clark from ActionAIDS, and Kate Clark and Katie Young from the Philadelphia Corporation for Aging). Older people are too often left out when we talk about sexual health and risk. Many people living with HIV and AIDS in the US are over the age of 50. You can view the presentation here.

Dr. Robert Winn from the Mazzoni Center also came by to talk about their PrEP program. The Mazzoni Center had 500 patients taking PrEP in 2015. They’re working hard to get the word out about PrEP. They’ll be opening a free clinic at the Washington West Project in the future.

AACO presented their underspending report. The Planning Council voted to approve AACO’s request to use underspent funds for other categories.

Comp Planning
The Comp Planning Committee brainstormed their perfect HIV and AIDS service system. Some things they’d like to see are needle exchange programs, comprehensive sex education, and campaigns to reduce the stigma of HIV and AIDS. Co-chairs from the RWPC and the HPG will meet at an Integrated Executive Committee meeting to discuss these ideas.

Nicole gave the group some handouts about structural interventions (you can view meeting packets on our website). Structural interventions change the context in which people make choices about health behaviors. Providing people with food and housing are structural interventions. Many people living with HIV and AIDS in Philadelphia need housing, and there isn’t much available. The Comp Planning Committee is going to continue discussing this at their next meeting.

Want to get involved? To learn more, follow the links in this post, attend one of the meetings listed on our calendar, or email info@hivphilly.org. If you have questions, you can also call us at 215-574-6760.

Tuesday, January 5, 2016

Big Picture - December 2015

This post is part of a monthly series that summarizes what's been going on in the Ryan White Planning Council, HIV Prevention Planning Group, and their subcommittees. To view meeting materials and presentations, please visit www.hivphilly.org or check out our SlideShare account.

Hello all! Many of our committees didn’t meet this month given the upcoming holidays. Here’s the latest from those that did.

Nominations Committee
The Planning Council currently needs members from hospital or health care planning agencies, state Medicaid and Part B agencies, Part D grantees, Federally Recognized Indian Tribes, and people co-infected with Hepatitis B or C. The Planning Council is also seeking African American men from the Philadelphia and the PA counties. Anyone interested in applying for the Planning Council can print out an application from our website.

The Nominations Committee will host a social at the office after the Planning Council meeting on February 11th. Refreshments and entertainment will be provided.

RWPC
Antonio, our newest staff member, presented on PrEP. He summarized what the HPG and Planning Council have done about PrEP so far. The HPG and RWPC have heard several presentations on PrEP in the last year. There are still problems with getting PrEP to the people who need it most. For example, many people who need PrEP don’t know it exists. Primary care doctors also need more training about prescribing PrEP. The slides from Antonio’s presentation can be found here.

HPG
Co-Chairs Jen Chapman and Brad Shannon went to the National HIV Prevention Conference from December 6th-9th in Atlanta. PrEP, patient navigation, and transgender people were popular topics at the conference. There was a lot of talk about the National HIV/AIDS Strategy. The Federal Government released a community action plan. The CDC also launched a website about HIV testing  and an online tool that people can use to estimate their HIV risk. Jen’s slides can be found here.

Antonio went back over his PrEP presentation with the HPG.

The January HPG and Planning Council meetings will be combined (on January 14th). A doctor from a large PrEP program in Philadelphia is going to give a presentation. The HPG will continue to work with the RWPC on the Integrated Care and Prevention Plan, which will be submitted next year. At the February HPG meeting, the group will start talking about barriers to PrEP.

Want to get involved? To learn more, follow the links in this post, attend one of the meetings listed on our calendar, or email info@hivphilly.org. If you have questions, you can also call us at 215-574-6760.

Thursday, December 10, 2015

Big Picture - November 2015

The Big Picture is back! This post is part of a monthly series that summarizes what's been going on in the Ryan White Planning Council, HIV Prevention Planning Group, and their subcommittees. To view meeting materials and presentations, please visit www.hivphilly.org or check out our SlideShare account.

Positive Committee
The Positive Committee has been discussing transportation, along with their other healthcare needs. This month they reviewed the results of a survey they filled out at their last meeting. People who responded to the survey had few issues with transportation. The problems they did report were related to scheduling, delays with Medicaid transportation, tokens, and out of pocket costs.

The Positive Committee also did an interactive survey about medical care. They used clickers to answer questions about their satisfaction with doctors, clinical staff, and case managers. They talked about what kept them from getting to medical appointments or, on the other hand, what kept them in care.

Needs Assessment
The Needs Assessment Committee also reviewed the Positive Committee’s transportation survey. They brainstormed ways to resolve transportation issues. They’ve developed a transportation survey in their last few meetings, which they’ll be sending to HIV service providers in the near future.

Nominations Committee
The Nominations Committee discussed their agendas for the next year. Along with the usual membership recruitment activities, application review, and attendance review, they’ll host a Planning Council social on February 11th. The social will be held at the OHP after the Planning Council meeting. A meeting for all the subcommittee Co-Chairs is tentatively scheduled for June.

HPG/Planning Council Combined Meeting
Dr. Helena Kwakwa from the Health Department presented on the City Health Centers’ PrEP program. She pointed out that people often underestimate their risk for HIV. However, many people they surveyed were interested in PrEP. She said that doctors should bring up PrEP during primary care appointments in order to reach more people.

Dr. Kwakwa also reported on the Health Centers’ SHIPP (Sustainable Health Centers Implementation PrEP Pilot) study. People on PrEP through the Health Center program are asked if they want to participate in the study. A majority of participants are regularly taking their PrEP medications (they are adherent). Most referrals for the program are coming from HIV testers in the Health Centers.  Many people who are referred don’t end up going on PrEP. However, staff of the program do all they can to get people who are interested to appointments so they can get on PrEP. Dr. Kwakwa again recommended that primary care doctors start talking to patients about PrEP.

Briana read off the 4 major goals for the National HIV/AIDS Strategy (NHAS) for 2015-2020. The NHAS will guide the planning process over the next several years. The new target groups for the NHAS are gay, bisexual, and other MSM of all races and ethnicities, Black women and men, Latino men and women, people who inject drugs, youth aged 13-24, people in the Southern US, and transgender women. The Epi profile gives national and local statistics about HIV and AIDS for all these groups. You can read the full Epi Profile on our website.

Nicole reviewed the guidance for the Integrated Care and Prevention Plan. The HPG and Planning Council are going to work together on the Plan over the next year.

Comp Planning
The Comprehensive Planning Committee reviewed the Goals and Objectives they developed in 2011 to prepare for the upcoming Integrated Care and Prevention Plan. 

Want to get involved? To learn more, follow the links in this post, attend one of the meetings listed on our calendar, or email info@hivphilly.org. If you have questions, you can also call us at 215-574-6760.