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 11^th. 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.

Big Picture - October 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.

Finance Committee: The Finance Committee voted to allocate MAI (Minority AIDS Initiative) funds to Case Management and Ambulatory/Outpatient Health programs that serve minorities in Philadelphia.

Visitors from the AIDS Activities Coordinating Office (AACO) presented their quarterly spending report. After 6 months, this year’s Ryan White Grant is underspent by about 9%. In other words, the EMA has spent 9% less than the Planning Council’s total allocations for the year. Underspending is expected to decrease over the next 6 months.

David Gana was elected as Finance Committee Co-Chair.

New Member Orientation: 5 new members were invited to attend a RWPC orientation session on October 8^th. At orientation, they learned about the roles and responsibilities of Planning Council members. They also got a rundown of what Ryan White is and how the Planning Council plays a role in the HIV planning process.

Planning Council: The Planning Council approved the MAI allocations presented by the Finance Committee. They also heard AACO’s underspending report, as presented at the Finance Committee meeting. The Planning Council approved the Retention Navigation Model developed by the Comprehensive Planning Committee, which is designed to keep people in medical care (see last month’s big picture post for more).

Tre Alexander was re-elected for a 2 year term as Planning Council Co-Chair.

Briana Morgan gave a brief overview of the OHP Epidemiologic Profile. You can find the Epi Profile, and an Executive Summary, on our website.

Comp Planning: The Comprehensive Planning Committee reviewed the guidance (instructions) for the next Integrated Care and Prevention Plan. The plan will describe the HIV epidemic in Philadelphia, what we’re doing about it, and our goals for the future. The Planning Council and HPG will be working together on the Integrated Plan throughout the next year.

Positive Committee: The Positive Committee elected Nancy Santiago as their new Co-Chair. Nancy leads a group called Huracán, which has brought Spanish-speakers to the last several Positive Committee meetings. Nancy hopes to represent the Latino community in Philadelphia.

The group brainstormed topics for future meetings. Some participants suggested HIV and aging, transportation, homelessness, and stress reduction, among other topics.

Nicole distributed a survey about transportation. The Planning Council is currently looking into issues that people are having with transportation so that these issues can be remedied in the future.

Needs Assessment: The Needs Assessment Committee reviewed a transportation survey they’ve been developing for providers. The survey will be distributed in the coming months. Together, the surveys of providers and consumers will allow the Planning Council to address common issues with transportation.

HPG: The HPG continued talking about PrEP and its future in Philadelphia. Co-Chair Jen Chapman spoke about a recent journal article published in Current Opinion on HIV and AIDS (abstract here). The article covers the role of healthcare providers in introducing PrEP into the community. It describes the way specialists (Infectious Disease/HIV doctors) and primary care physicians can help get PrEP to more people. Promoting PrEP to doctors and educating them is key to getting PrEP rolled out in places like Philadelphia.

Two young men who take PrEP visited the HPG to talk about their experiences. They described the process they went through to get on PrEP. They also brought up problems they’ve had with getting their medication. The young men said they’d gotten both positive and negative responses from friends, and they’d come across others who don’t know what PrEP is. The group wrapped up by discussing how the Health Department will market PrEP to people in Philadelphia. 

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.

Big Picture - September 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.

Nominations: The Nominations Committee approved 15 applications, including 5 new members.

RWPC:

Coleman Terrell, Director of the AIDS Activities Coordinating Office (AACO), reported on the MAI and the CoRECT program.

MAI

The Minority AIDS Initiative (MAI) is a federal program designed to meet the needs of minority individuals living with HIV and AIDS. The Philadelphia EMA currently receives around $2 million in MAI funding. This funds several Medical Case Management and Ambulatory (Outpatient) Health programs that serve minorities. AACO requested that funding for these programs continue at the same level.

CoRECT

The Co-operative RE-engagement Controlled Trial (CoRECT) is a project funded by the CDC through 2019. The program gets (links) and keeps (retains) people with HIV in care. The program targets patients who have never attended or who have stopped attending appointments. Health Department staff meet face-to-face with these patients to help them get in care.

NHAS

The National HIV/AIDS Strategy (NHAS) aims to reduce the impact of HIV nationwide. It encourages a wide variety of governmental bodies and organizations to work together toward common goals.

The first NHAS began in 2010, around the same time that the Affordable Care Act (ACA) was introduced, and ran for 5 years. The updated NHAS for 2015-2020 came out in August. Several changes have been made in the new NHAS; you can read about a few of them on this fact sheet. Here’s another infographic that reviews some key points about the update. We’ll post more about the NHAS in the future.

Positive

AACO’s Evelyn Torres presented on the Direct Emergency Financial Assistance program (DEFA), and Gary Tumolo of Philadelphia’s Office of Housing and Community Development (OHCD) presented on housing.

DEFA

The Direct Emergency Financial Assistance program offers emergency food, rent, utilities, transportation, and short-term medication assistance for people living with HIV and AIDS. You can read more about the DEFA program in this guide.

Housing

HOPWA is a national program providing housing for people with HIV and AIDS. In Philadelphia, 340 households are on the HOPWA waiting list, with an average wait time of 7 years. (People with AIDS who are street homeless wait about 1 year.) The Section 8 waiting list is closed. Project HOME is one alternative housing program. The PHFA website also lists some housing programs for seniors and people with disabilities, along with other affordable housing options.

Co-Chair Nominations

Dave Gana has reached the end of his two-year term as Positive Committee Co-Chair, so it’s time for the committee to elect a new Co-Chair. Several participants were nominated, and each nominee will give a short speech at the October Positive Committee meeting. Stay tuned for election results!

Needs Assessment

The Needs Assessment Committee reviewed the results of a recent provider survey on AACO’s local pharmaceutical program. They also created a transportation survey for providers, based on a request from the allocations meetings. Results of the survey will be available at next month’s meeting.

Comp Planning

Evelyn Torres shared further information about AACO’s linkage to care activities in Philadelphia with the Comprehensive Planning Committee (CPC). Philadelphia recently received a few CDC grants, which will fund general prevention efforts, patient navigation, and PrEP.

Based on previous conversations, Nicole Johns introduced a plan for a retention navigation model, designed to keep patients in medical care. The pilot program would occur at one-stop-shop medical clinics in the Philadelphia area.

HPG

PrEP

The HPG has been doing a lot of work around PrEP, a promising new method for preventing HIV transmission. PrEP has not yet been fully implemented in the Philadelphia area. The HPG hopes to help change that!

Dr. Helena Kwakwa of the City Health Center’s PrEP program gave the HPG some information about the program, which offers PrEP at all 8 of the city’s Health Centers. The program currently prescribes PrEP to 80 HIV-negative individuals.

The HPG is inviting young men with experience taking PrEP to their October HPG meeting.

Integrated Plan Guidance

The HPG discussed the federal government’s guidance for the Integrated Care and Prevention Plan, due in 2016. The plan will describe what Philadelphia has done and plans to do to address the HIV epidemic in our area. The HPG will hold several joint meetings with the Planning Council to prepare for the plan.

General: We would like to welcome our newest staff member, Antonio Boone. Antonio has a background in prevention education. He has worked with St. Christopher’s Hospital, Philadelphia FIGHT, and the Drexel University SWEAT program. Antonio will be working as a Health Planner, specializing in PrEP and other areas of HIV prevention.

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.

8 ways to improve health care for young gay and bi men

In June 2014, the Office of HIV Planning held focus groups with young men who have sex with men (YMSM) at three local organizations serving LGBTQ youth and young adults. The groups discussed the young men's experiences with health care, their ideal health care experience, and HIV testing in Philadelphia.  The full analysis and recommendations can be found here.

In order to decrease new cases of HIV and AIDS, we need to successfully engage young gay and bi men in primary care and address the fundamental social conditions contributing to their increased risk for HIV. Between 2006 and 2009, there was an estimated 54.5% increase in new infections among gay and bi men in Philadelphia. This increase was driven by new infections among African American men who have sex with men between the ages of 13-24. A paper by Stall et. al in 2009  estimated that if current trends continued half of the young black gay and bi men will have HIV by the age of 35. They also estimated that half of all men who have sex with men (MSM) would be HIV-positive by the age of 50. These numbers are dire. We must do a better job at meeting the medical and social needs of young gay and bi men. 

The following recommendations range from large systemic changes to improving interpersonal exchanges within health care settings. These recommendations are informed by both the analysis of the focus group discussions and the current literature (see report for a full list of the cited research). 

Increasing access to and engagement with primary care for YMSM is essential. Engagement in primary care is an especially important tool in the HIV prevention “toolbox” in this age of biomedical interventions like pre-exposure prophylaxis and “treatment as prevention”. HIV-negative YMSM should be linked to appropriate interventions and have regular sexual health screenings. YMSM who are regularly tested and engaged in health care will have a better chance of being linked to HIV care and treatment, should they acquire HIV. Programs that engage YMSM in health care should address their complex needs, including mental health, substance use, chronic health conditions, and social needs, in developmentally appropriate ways.

A combination of routine testing in all primary care settings and targeted community-based testing is necessary. Risk-based testing alone may miss high-risk individuals who are reluctant to disclose same-sex attraction and/or their sexual behaviors or substance use.

Comprehensive evidence-based sexual health education, inclusive of all gender identities and sexual orientations, is needed in the Philadelphia school district. Young people need sexual health education that promotes not only their health but their well-being.

HIV testing protocols should address concerns about confidentiality. HIV testing programs ought to consider who provides the counselling and testing, where testing occurs, and how to address concerns about confidentiality and privacy. It may be beneficial to include information about privacy protections and confidential testing protocols in outreach and marketing materials, in order to address those concerns before they can become barriers to testing.

Special attention should be paid to creating welcoming and accepting organizational cultures. Health care organizations need to prioritize the barriers, challenges and concerns of YMSM. YMSM want to go to providers who can relate to their experiences and accept them as they are.

Relevant information about local services, sexual health, and HIV/STD testing should be online in the places YMSM are likely to find it. Reliable online content will help many YMSM, especially those who are reluctant or unable to access services in the “gay” community. More local research is needed to better understand how Philadelphia’s youth access online health information.

Community level efforts are needed to address HIV stigma and discrimination of LGBTQ individuals, which persist and act as a barrier to open communication about the sexual health needs of YMSM.

Public health programs and health care organizations must be sensitive to the effects of stigma and discrimination on YMSM; especially minority YMSM who face not only stigma because of their sexuality and/or gender expression, but also live in a society with pervasive structural racism.  

Please share your ideas, insights and opinions about the recommendations and how we can better meet the needs of young gay and bi men in Philadelphia.

Now Recruiting for Healthcare Discussions

One of the roles of the Office of HIV Planning is to conduct local research to help determine the needs of the community; we call these studies "needs assessments".  The 2012 Ryan White Consumer Survey and the 2011 Geographic Risk Analysis are two of our past needs assessments. You can find past needs assessments and other local data on our Documents page.

Currently, we are working on a study for the Philadelphia HIV Prevention Planning Group (HPG) on healthcare experiences and HIV testing preferences of seven at-risk populations. The purpose of this study is to assess the individual-level, provider-level and system-level barriers to care experienced by the most at-risk populations; in order to better understand how these barriers affect at-risk individuals’ use of healthcare and HIV testing and prevention services. The study findings will inform the Philadelphia Department of Public Health’s planning and delivery of HIV prevention, testing, and treatment services.

We are holding one-time discussion groups (focus groups) with Philadelphians who identify as a member of one of the following groups:

• Young men who have sex with men (18-29)
• High risk heterosexuals (30-60)
• Black and Latino Men who have sex with men (30-60)
• High risk youth (18-29)
• Sexually active seniors (55+)
• Intravenous drug users (18+)

So far we have completed focus groups with young men who have sex with men (YMSM) and high risk heterosexuals in 2014. Blog posts will be posted when the YMSM and high risk heterosexual reports are up on the Documents page. The results from the YMSM discussions have been shared with the Ryan White Planning Council and the HPG, as well as various subcommittees. The analysis of the high risk heterosexual groups is underway and results will be shared with the community planning groups as soon as possible.

We are now recruiting black and Latino gay and bi men for focus groups in March and April 2015. If you or anyone you know is interested in participating, please contact Nicole at 215-574-6760 ext. 108. Participants receive a meal, tokens and a small thank you gift. Discussions take around one and a half hours (90 minutes). If an organization wants to have fliers to post or distribute, please contact Nicole. Any assistance in recruitment is greatly appreciated.

At this time we are only recruiting men who are proficient in English.  We are in discussion with community partners to develop a Spanish-language needs assessment to collect the barriers and experiences of Spanish-speaking Philadelphians at high-risk for HIV. Stay tuned for more information about that project.

Linking Clients to Care: A New Tool

It's a common enough story: someone is diagnosed with HIV. That person is told she needs to visit the doctor as soon as possible. Maybe that person calls for an appointment, and maybe she doesn't - but that person doesn't make it to the doctor that week. Or that month. It could be a child care problem, or a transportation problem, or an appointment availability problem.

But in some cases, it's just that people who were just diagnosed with HIV don't know that there is a system of care available to them -- even if they can't pay for services. In 2010, 18% of newly-diagnosed Philadelphians with HIV weren't linked to care within 90 days. We don't know each person's reasons for not getting medical care right away, but lack of knowledge of the care system is an obvious barrier for newly-diagnosed clients. In fact, through our local needs assessments, we've repeatedly found that many people living with HIV/AIDS report not accessing medical care because they couldn't afford it. We're lucky enough to have a comprehensive system of services available through Ryan White, but newly-diagnosed clients won't know about it if no one tells them it's there.



Here's a preview. Download a copy here.

At the same time, we know that it's not always easy for HIV testers to give consistent messaging while getting important information from their clients.  Enter, our new linkage to care tool. We hope that this tool will relieve some of the burden on HIV testers, increase access to care and other services for newly-diagnosed people with HIV, and improve linkage to care performance for our local provider sites.



We developed this tool after an extensive review of treatment readiness assessments in use across the country, and reduced the questions to the most relevant ones for helping clients with their initial linkage to care.  It was developed in partnership with the Points of Integration Workgroup, which spent a great deal of time honing both the language and the questions.  The tool was then presented to both the Philadelphia EMA Ryan White Part A Planning Council and the Philadelphia HIV Prevention Planning Group for additional feedback and adjustments.

We would like to note that we developed this tool as an aid for providers, and we designed it to help individual HIV testers improve access to services for their clients (and, by extension, to improve their own performance). This tool was not designed for data collection. Testers might decide to make copies and use a separate form for each client, in order to provide an “at a glance” summary of what is most needed to make that first linkage.  They might use pieces of this tool as a supplement to their own routines.  They might keep a copy with them to use as a discussion guide.  How they use the tool is up to them, but we do hope that it proves useful in their day-to-day work.

Of course, like all of our documents, this is free to distribute and reproduce.  We made it in black and white to be copier-friendly. We also included fainter lines in the notes section, allowing the neater testers among us to write along the lines and the more out-of-the-box testers to write willy-nilly in whatever direction they choose. We wanted this to be as user-friendly as possible. In that spirit, we welcome feedback and suggestions. Feel free to comment here, or use the contact information on the form to get in touch.

Download the linkage to care tool here - and share widely!
 

Quick Notes from the Federal AIDS Policy Partnership meeting

The Office of HIV Planning is a member of the Federal AIDS Policy Partnership (FAPP), a coalition of organizations from all over the country that advocate for people living with HIV and the organizations that serve them. You can learn more about FAPP and how to become a member organization here. Individuals living with HIV are also encouraged to join.  The group meets about four times a year, our last meeting was on February 12th. At that meeting we had some informative discussions with Dr. Jonathan Mermin, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention (CDC) and Dr. Laura Cheever, Associate Administrator for HRSA's HIV/AIDS Bureau.  We also discussed updates on implementation of the Affordable Care Act (ACA) and the reauthorization fo the Ryan White Program.

Dr. Mermin's presentation is well worth your time to review (slides here). He shared information on HIV prevention funding, national progress on the National HIV/AIDS Strategy (NHAS), and how the CDC is addressing HIV prevention in terms of the care continuum.  A few things really stuck with me. When talking about new HIV cases, Dr. Mermin mentioned that although incidence has been stable over all, there have been increases in the number of new HIV cases for men who have sex with men and young men who have sex with men, 12% and 22%, respectively. The CDC and it's partners are focusing on High Impact Prevention, as the future of HIV prevention. The keys to High Impact Prevention are aligning HIV prevention resources to the geographical areas and populations most affected by HIV, using cost-effective and evidence-based methods, maximizing the number of people living with HIV/AIDS with a suppressed viral load, and using data monitoring, dissemination and feedback to improve outcomes for organizations and jurisdictions.The CDC is also working closely with HRSA to align as much of the HIV care and prevention activities as possible; including community planning, data reporting, and policies.


A major topic of discussion with Dr. Cheever was the future of the Ryan White program, in the era of health reform (ACA). Much of the conversation was informed by the discussion  at the Ryan White Working Group meeting (the day before). That discussion focused mostly on when and how to advocate for the reauthorization of the law, and what it might include. Consensus from that discussion was it would be best for the community to wait until 2015 to push for reauthorization because so much is still unknown about how Ryan White programs will work in the context of expanded health coverage and other reforms of the ACA. The community of Ryan White providers and consumers need to collect stories of the successes of the program from the local levels: who is served, how their lives are improved, and what benefits and outcomes do we see on an aggregate level. There was also consensus that the next version of the Ryan White law will be transformative, in other words, it will include a lot of changes to how the program works, what services are provided and who is eligible.

Dr. Cheever also recommended that we need to focus our efforts to help people start and stay in HIV care. The local communities need to provide qualitative data (stories) about how and why people get lost and also linked to care. These qualitative data can work with the quantitative data (surveillance, program data) to develop effective plans for our HIV care systems, including Ryan White. Local communities, like the Philadelphia EMA, should focus on those who need the most help accessing and maintaining care and provide the supports they need. Those supports might include housing, mental health treatment, substance abuse treatment, child care, transportation or social support. The Ryan White program has the ability to meet these needs, but we have to direct resources to where they are most needed. We need to adapt the Ryan White system to work with the larger health care systems, not apart from them.

If I come away from these two meetings with any theme, it's "adapt or perish". We all need to become knowledgeable about the ACA and other changes in the science and policy world of HIV/AIDS. We have, as always, to do more with less. So we have to be informed, proactive, and deliberate.