CAHISC MEMBERSHIP RETREAT REPORT

Transcription

1 CAHISC MEMBERSHIP RETREAT REPORT January 29, 2014 Highlights of CAHISC 2014 Retreat CAHISC Unified Plan Planning Exercise Information Committee Retreat Vision Statements CAHISC Unified Plan (Table of Contents) Prepared by: Management Synergistics Inc Chicago, IL

2 CAHISC MEMBERSHIP RETREAT JANUARY 29, 2014 Welcome Purpose of Retreat To welcome and incorporate new members Nannette Benbow To review and define CAHISC mission and goals and provide a progress report and plan for future activities To review and refresh member knowledge of Council Committee structure and cascade model CAHISC Presentation Historical/Integration Perspective Initially, there were two planning bodies: the Ryan White Planning Council (EMA) and the HIV Prevention Planning Group (HPPG) (city). Previous Chicago planning bodies did not meet the desire to end siloed approach to efforts. CAHISC aims to support coordination to facilitate integrated services at the client level and achieve maximum impact. Challenges: Community Support Ryan White Part A/Prevention balance Integration of housing Integrated membership by-laws Synchronize planning cycles Prevention and Care planning guidance Management Synergistics Inc. pg. 1

3 Respectful transition of current members Level of Support HIV Stakeholders: Planning Council, HPPG, and others Federal Partners (HRSA and CDC) Community Co-Chair Leadership CDPH Leadership: STI/HIV Division and staff commitment Integration Process (2 phases) May 2011: Convene integration workgroup December 2011: Interim bylaws, call for application, and new name of CAHISC given February 2012: Joint Meeting between the Council and HPPG March 2012: Select Applicants April/May 2012: First CAHISC planning body/strategic planning meeting January 2013: CAHISC steering committee held a two-day strategic planning meeting to review integration progress Reviewed epidemiological data Membership survey results on integration process Compared HRSA and CDC community planning requirements Serveral new models were considered HIV Cascade Model Overview The Cascade/Continuum Model is a model that is used to identify issues and opportunities related to improving the delivery of services to people living with HIV across the entire continuum of care. Management Synergistics Inc. pg. 2

4 The continuum shows proportions of individuals living with HIV/AIDS who are engaged at each stage of HIV care, as well as where there are gaps and where people living with HIV (PLWHA) are dropping off. Seeing this helps in implementing system improvements and service enhancements to better support individuals, and ultimately increases the proportion of PLWHA who have achieved viral suppression. CAHISC committees are designed around the bars of the cascade. Primary Prevention/Early Intervention: HIV-infected and HIV-diagnosed (bars 1 and 2) Linkage and Retention: Accessed Care and Retained in HIV Care (bars 3 and 4) ART and Viral Suppression: On ART and Suppressed Viral Load (bars 5 and 6) Five main stages HIV Diagnosis Getting linked to care Staying in care Getting antiretroviral therapy (ART) Achieving a low amount of HIV virus in the body (viral suppression) Program Highlights Introduction of CDPH and the Division of HIV/STD Services Mission: To make Chicago a safer and healthier place by working with community partners to promote health, prevent disease, reduce environmental hazards and ensure access to health care for all Chicagoans. Provides leadership for Public Health Management Synergistics Inc. pg. 3

5 Identifies, analyzes and tracks issues Delivers services either directly or through delegate agencies STI/HIV Division Deals with prevention, housing, and care and support services including Quality Management Surveillance, epidemiology and research, as well as administrative/fiscal and capacity building services. Services (Surveillance Prevention, Care, Housing, Quality Management) CDPH currently funds many HIV Prevention Services 28 Community-Based Organizations (CBOs) Over $6.6 million Ryan White Program Ryan White Program is administered by the US Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB). The Chicago Eligible Metropolitan Area (EMA) for Ryan White funding is comprised of 9 counties: Cook, DeKalb, DuPage, Grundy, Kane, Kendall, Lake, McHenry, and Will counties. Ryan White Part A (RW) Part A funds may be used to provide a continuum of care (i.e. medical and support, aka essential, services) for PLWHA. Chicago also has separate funding called the Minority AIDS Initiative (MAI) funding. This legislation requires CAHISC conducts a Needs Assessment, Priority Setting and Resource Allocation activities, requires funding for Core Medical Services, and a Comprehensive Plan. Role of Quality Management (QM) Assesses, evaluates, and monitors the extent and quality of HIV services provided to ensure that services adhere to DHHS guidelines and established clinical practices. Identifies practice areas in need of improvement. Oversees the development of Ryan White Part A standards of care. Conducts clinical quality site visits. Analyzes and utilizes data to guide and improve performance of internal and external partners. Conducts coordinated technical assistance (TA) and support to delegate agencies based on data submission and site visit findings. Changing Landscape The ACA Affordable Care Act Marketplaces and Private Insurance Pros: More HIV+ people access insurance. ADAP and RW still there to complete coverage. Concerns: Affordability, in-network providers available, out-of-pocket costs. Medicaid and Managed Care Management Synergistics Inc. pg. 4

6 Pros: Medicaid expansion for PLWHA (12k or more), Concerns: PLWHA lost in system, no HIV QM Prevention Pros: PrEP coverage through Medicaid and private insurance, insurance payment for HIV testing, Medicaid payment for non-med providers to offer services Concerns: Billing for services, how will CBO build connections with HC providers, time for medical providers to focus on prevention. People with HIV Pros: More access to care, PLWHA more assistance to afford marketplace insurance. Concerns: is care affordable, shifting mindset from emergency room to primary care FYI - ADVOCACY DAYS in Springfield: Tentatively April 9 and May 21 Epidemiology (Epi) Presentation Be aware that an Epi team member will be assigned to each CAHISC committee for questions, etc. New members should download and review the 2013 HIV/STI Surveillance Report from the CDPH website. Why is data from 2011?: Surveillance is a process of collection and validation which is a challenging process. The CDC recommendation is to wait 18 months after collection to present the data and create reports. In the spring, Epi will present 2012 numbers. Trends: Steep decline in new HIV diagnoses. This is a concrete example of how the city of Chicago has been helping the HIV community. 10 years ago about 1/3 of new HIV diagnoses were an AIDs diagnoses within the same year. This number is improving, but still need to eradicate concurrent HIV/AIDS diagnosis. New HIV diagnoses occurring mostly in the high MSM north area, Westside and Southside. New inclusion of transgender individuals in the data collection process. Still working out how to best collect this data. Most HIV diagnoses occurring in the African American (AA) community, although there is a recent decrease in new diagnoses among AA women. Still a large disparity among racial groups of women. No decline of HIV diagnoses among young people under 30. In some cases, this remained the same and increased. MSM continue to bear more of HIV diagnosis burden. Consistent and dramatic decline in number of diagnoses among injection drug users (IDUs). This is the majority of the reason for the decrease in the city of Chicago overall. Little decrease in MSM and heterosexual individuals. Increases in diagnoses of HIV in young MSM (13-29 year olds) YOUTH are driving the GAP IN RETENTION. Little change in late stage dx amongst Hispanics Management Synergistics Inc. pg. 5

7 EW continuum (aka cascade) uses a new denominator, and removes the number of people who are assumed to have HIV but do not know their status. Important for Early Intervention committee work. STAY TUNED FOR WEBINAR looking at the Continuum to help understand where we are in different demographics later this year. Decision Making Process and Parliamentary Procedure Any method of decision making requires: An agenda Ground rules or Respectful Engagement Practices Quorum of Membership Listening to all concerns What is a consensus? Cooperative effort to find a solution that is acceptable and supportable. Everyone buys in at least 70% Consensus is NOT a unanimous or majority vote, everyone 100% satisfied, or group think Voting Each voting member has the right to vote. Abstentions are usually stated...appearance of conflict of interest and/or voting member is not present for motion and/or discussion. Management Synergistics Inc. pg. 6

8 Parliasensus A hybrid of consensus and parliamentary procedure. It is a term to reflect the idea that meetings often consist of flow of ideas. Questions on Decision Making What is reserving the rights of others? Reserving rights of others implies that you want to hear what the minority and the majority have to say and maintain balance. Do all of these rules need to be followed at each committee meeting? It is expected that all committees adhere to some of these things. The committee decides how we want to flow, i.e. consensus building, etc. Parliamentary procedures are mostly done with the larger body, but can be instated at the committee level if it is desired. Do non-voting members still get to speak and participate at committee meetings? Non-voting members are still expected to fully participate, but at this time do not have the power to vote. Committee Co-Chair Presentations Each committee given a few minutes to explain past committee work and visions for the upcoming year. Unified Plan 2014 Planning Exercise Committees were asked to brainstorm in individual groups to put forth bullet statements identifying problems, priority populations and best practices. These would form the basis of a unified vision for the ideal continuum of care. The committees were asked to respond to the following questions What are the major problems/ overarching Community Concerns in the Chicago Area as pertains to your cascade area problem statements What are a few best practices, solutions for the identified problems What priority populations should we pay close attention (include racial, ethnic, sexual orientation, geographic. area stages of infection etc.,) Formulate a brief statement about what an ideal continuum of services would look like in your cascade area. See Matrix ---CAHISC Unified Planning Exercise See Vision Statement Planning Exercise Management Synergistics Inc. pg. 7

9 Relevant Community Planning (How CAHISC Operates) Community Planning is a process in which people from different lifestyles, occupations different interests, responsibilities, expertise, and involvement in HIV come together as a group to plan efforts to prevent, and care for HIV infection. Hat Exercise: Must take off whatever hat one wears outside of CAHISC, and look at efforts from a planner's perspective. Shared CAHISC and Grantee (CDPH) Responsibilities Carry out needs assessment Develop a Unified Plan Coordinate with other programs and services Strategy on mutual interest Membership and Bylaws The Bylaws are almost completed. Remember to declare conflicts of interest at the beginning of any relevant discussions. Travel Reimbursements available for unaligned consumers. For new members be aware that it may take a month or so for initial check to be processed, be aware. Brenda Fair is the contact for reimbursements. Attend meetings! Attendance is tracked at full body and committee meetings. Unified Comprehensive Plan, CAHISC Information/Documents, and Going Forward What CAHISC wants to do is develop a plan that documents the work we are doing in terms of looking at HIV from the Management Synergistics Inc. pg. 8

10 perspective of the cascade/continuum. The plan will be developed through the work done in CAHISC committees and will describe the committees participation in the process of needs assessment, gap analysis and formulation of planning priorities and strategies. Members are encouraged to bring their binders to meetings and add to them as presented with additional documents. HRSA Ryan White Primer, and revised CDC comprehensive plan will be given to members. Peter McLoyd will get this document out to full body for review. The plan is not just a requirement for funders. It also becomes a useful resource for all CBOs, hospitals, clinics, PLWHA in Chicago, etc. Ask questions when necessary. Voting and non-voting members share in the workloads. New members partner with seasoned members when necessary. Plans that are signed off by CAHISC co-chairs are always brought through the steering committee. Next Steps Committees get to work! Keep in mind that the work that is done informs $40 million of funding in the Chicago area. Feedback/Comments o Retreat was very good o One day was enough, facilitated well o Enjoyed teambuilding exercise o A lot of material o Planning exercise was very knowledgeable Questions and Answers from Retreat CAHISC Presentation Q&A Suppressed Viral Load Why is it indicated at 200 or less? The way it is defined is that a viral load less than 200 is the standard, based on lab work. It varies, but most importantly this is a CDC definition uses and CAHISC wants to be comparable. Question regarding retained in care: Numbers in CDPH were for 3 months, is number actually lower than that?: Retained in care is defined as 2-3 viral load visits, and those who we have data to look at. It is being determined if that lab proxy is good enough. What does ART stand for? Anti-retroviral therapy, the HIV medication regimen. It used to be called HART. GREAT QUESTIONS! KEEP THEM COMING IN COMMITTEE These are the type of questions that are important and should be asked during sessions Management Synergistics Inc. pg. 9

11 Program Highlights Q&A It was mentioned that CAHISC should get handouts of delegate agencies funded through CDPH. Housing Funding question: Is it at the same funding level from the previous year? With federal changes, there have been fluctuations, but thanks to being able to move money around CDPH has been able to keep funding level. RW Part A: what does that cover? Part A covers specific core and essential services. Whereas Part B is the state of Illinois, that also provide medication (ADAP) as a part of the state program. Part A and Part B work hand-in-hand. Prevention question: When funding is allotted, is there a system in place to ensure work is being done with the CBOs, and evaluated? Agencies submit quarterly data based on what they are funded for, i.e. client level data, etc. There are many different data points. There are also site visits, QM, and checks and balances in place. One thing that is looked at is new tests and re-testing, as well. RW Part A CDPH staff encourages partnership with different agencies. One of the service categories funded is medical case management (MCM)...so, an MCM can help to link, as well as a non-medical case manager, to support services. Also do site visits, and QM strategies. 75% of funding goes to Core Services With the ACA will we lose money or will money be transferred? This is a year of a lot of data gathering, since it is up in the air how the ACA will affect patients under RW. Many will move out of RW since they are a payer of last resort. Need to be able to shift allocations to other service categories if necessary. Each year, CAHISC takes part in priority setting and resource allocation, and will have about a quarter's-worth of data to extrapolate out. From this, it can be determined if a shift of the 75/25% allocation is necessary. Is there a way that Part A could provide high-risk negative services? Look to the cascade, and how they interact. It most likely will not come from RW due to legislation language stating HIV+ only. ACA Q&A: What is considered routine HIV testing that will be covered? Everyone between the age of at least once, and anyone else who is at risk. No standard on how often people should be tested. Perhaps HIV testing will be integrated in primary care. What is being done to educate providers on PrEP? Should be done at the agency level, meaning we need to be providing that. MAJOR CONCERN: What are the incentives of Medicaid to monitor outcomes and get PLWHA to undetectable viral load? Costs money. Do managed care companies have that system built in? No, there is no system at this time, and no HIV Management Synergistics Inc. pg. 10

12 outcome built into the managed care system. Need to focus on healthcare outcomes for PLWHA. Epi Q&A In terms of MSM, is there an under reporting new diagnoses in primary care as opposed to other programs? Answer: no. Delayed testers: Latinos have the highest number of late testers, and there is data on that. Commonalities among PLWHA who pass away? An analysis on that should be done. From national data it is known that late testers and poverty are correlations to death. Death data is more challenging to work with, but it is a great idea to pursue. Management Synergistics Inc. pg. 11

13 CAHISC UNIFIED PLAN 2014 PLANNING EXERCISE The following matrix was developed to present the bulleted statements brought forth and recorded by each committee in the planning exercise CAHISC COMMITTEE/CASCADE AREA PRIMARY PREVENTION -EARLY INTERVENTION PRIOTY POPULATIONS - Sex Workers - Youth (13-19, 20-29) - MSM/Trans - Latino -Non-identified MSM Neighborhoods - Hetero Females LINKAGE AND RETENTION - Young MSM (13-30) - Transgender - Senior Citizens - Newly Released Inmates - Prenatal Care - Women and Children - Undocumented Minorities - Sex Workers OVERARCHING PROBLEMS PERTAINING TO CASCADE AREA - Transportation - Faith-based community - Lack of resources - Stigma - Economics - Poverty - Housing - Program Referrals - Cultural Security - Getting people to test - Domestic Violence - Latin/Asian Cultural Divide - MSM Insensitivity/Cultural - Finance, Housing, Transportation, Food - Support Group/New Method - CBO Follow Up/Scope - Mental Health - HIV/AIDS Education - Mentoring -N.A./A.A., etc. BEST PRACTICES AND SOLUTIONS - Community Map - Intensive Case Management - Patient Navigation - Early Intervention - Partner Services - TA and Capacity Building with Community - PrEP and PeP - Routine Testing - Cultural Competence Clinic Environment: Age, Sexual Orientation - Benefits: ACA, Medicare/Medicaid - Secondary Education/GED - Job Training - Dept of Voc. Rehab: W.I.P.A., P.A.S.S. - Map of Clinics (private doctors, as well as public health clinics) - Implementing Intervention: Willow, MISSION STATEMENT/IDEAL CONTINUUM OF SERVICES - Broad based culturally sensitive community prevention programs that include social determinants, biomedical and EIS, CB, TA targeting HR priority populations in HR com allocating funds to best practices. - Develop system of care that meets the needs of clients to link them and retain them in care. Management Synergistics Inc. pg. 12

14 CAHISC COMMITTEE/CASCADE AREA PRIOTY POPULATIONS OVERARCHING PROBLEMS PERTAINING TO CASCADE AREA BEST PRACTICES AND SOLUTIONS Artist, SISFA - Undocumented Immigrants - Outreach Method - Inclusive Access - M.O.U.: List - Policy and Procedure in Place - Incentives and Accountability - Affordable Housing: HASA - Electronic Medical Records System MISSION STATEMENT/IDEAL CONTINUUM OF SERVICES ART AND VIRAL SUPPRESSION - Youth (18-29) - Females - Heterosexuals - African Americans - HIV Care in South, Far South, West, Central - Individuals born in Spanish speaking country, PR, or Asia - Providers unaware of Rx Guidance for HIV+ (specifically non-hiv providers) - More non-hiv providers treating HIV - Health illiteracy of client and providers - Occurrence of med holidays - Young people and willingness for meds, but inconsistent appointments - Various definitions of adherence (relates back - Peer navigators, counselors, groups - Provider education for Tx standards and referrals (mirroring Ryan White -> Medicaid) - Co-pay assistance - True Tx adherence counselors - Patient education (web) - HIV classes for people (similar to pregnancy classes) - Collect all on-line resources - Assess barriers to - Every person retained in care is served by system that fully supports informed, easy, affordable access to medications, and are educated on proper adherence and strategies to combat stigma. Management Synergistics Inc. pg. 13

15 CAHISC COMMITTEE/CASCADE AREA MEMBERSHIP PRIOTY POPULATIONS - Youth - High risk negatives - Transgender - Homeless - Aging population - Incarcerated -IDUs - Applicants who meet multiple categories OVERARCHING PROBLEMS PERTAINING TO CASCADE AREA to health illiteracy) - Inconsistent provision of Tx adherence counseling - Lack of peer support (especially in newly dx) - Non-HIV providers unaware of referral network for HIV - Co-pay burdens - Stigma - Housing, mental health, and substance abuse - Lack of outside knowledge of CAHISC - HIV status stigma - Youth, for example social determinants - Language - Lack of incentives - Social media presence increase that is culturally appropriate - Transportation - Planning Body burnout - BEST PRACTICES AND SOLUTIONS getting and staying on ART - Ongoing outreach - Going beyond HIV funded agencies with CAHISC information for recruitment and our purpose MISSION STATEMENT/IDEAL CONTINUUM OF SERVICES Status Stigma - Social assumptions regarding HIV - Discuss how to address fear - Get involved with community leaders - Openness Management Synergistics Inc. pg. 14

16 Committee Retreat Vision Statements The following is a narrative summary composed from the matrix above: PPEI: Broad based culturally sensitive community prevention programs that include social determinants, biomedical and EIS, CB, TA targeting HR priority populations in HR com allocating funds to best practices. L&R: Develop system of care that meets the needs of clients to link them and retain them in care. AVS: Every person retained in care is served by a system that fully supports informed, easy, affordable access to medications, and is educated on proper adherence and strategies to combat stigma. Drafted Vision Statement from Committee Vision Statements and Best Practices CAHISC and CDPH envision an ideal continuum of prevention and care that will decrease community viral load by providing broad based culturally sensitive community prevention programs and a system of care that meets the needs of clients to link and retain them in care. This integrated continuum of prevention and care will assure that every person retained in care will have informed affordable access to medications and is educated on proper adherence and strategies to combat stigma and assure that all at risk and in need of care have stable housing. To improve and move our current system of prevention, care and housing toward our ideal vision we have established the following goals: 1. Expand awareness in the Greater Chicago Community of HIV services and broaden the participation of stakeholders in the activities of CAHISC to develop an integrated system of care. 2. Develop a community map that identifies community levels of infection, linkage and retention and prescription and adherence to ART and Viral Suppression 3. Target high risk community areas and priority populations with high impact prevention activities that are culturally sensitive and address the social determinants of health 4. Develop a system of Early Intervention Services that includes early identification of high risk individuals, accessible, capable community sensitive testing and services supporting linkage to medical (including access to PreP and PeP) and essential services (Housing, patient navigation, intensive case management, partner services) for positive and high risk clients 5. Develop a seamless system of linkage and retention that educates and supports clients from initial diagnosis to full engagement in care 6. Provide training and capacity building to assure that all HIV medical providers follow consistent treatment standards, provide adherence counseling and support and understand the needs of priority populations and issues of stigma 7. Enhance the integration of affordable housing resources with HIV prevention and care services Management Synergistics Inc. pg. 15

17 8. Enhance the integration of substance abuse and mental health services into the continuum of HIV care 9. Strengthen data and quality management system Vision of Ideal Continuum Comprehensive Plan CDPH and CAHISC envision an ideal continuum of care that, in collaboration with multiple funding streams and health system partners, will achieve the following: Make a seamless transition from the time of diagnosis to entry into care Reduce HIV transmission in all communities Increase the availability of testing services so that all individuals can know their HIV status Create a system of care in which all HIV positive individuals can have a suppressed viral load throughout their lifetime Reduce the number and severity of complications and episodes of serious illness Lengthen the time between diagnosis and death from the virus Priority Populations In the Chicago Area, HIV infection continues to occur disproportionately in certain population groups and geographic communities. The continuum of care must ensure the service needs of those who are most impacted. The following priority populations and communities have been identified by CAHISC committees during their retreat. See Matrix Overarching Problems The committees listed the following overarching problems and barriers to care. (See matrix) Priority Populations Overarching Problems Priority Populations Youth (13-19) Youth (20-29) Young MSM Women (heterosexual) Women and Children Women in Prenatal Care Transgender Individuals born in Spanish Speaking Countries and Puerto Rico Individuals born in Asia Undocumented residents Incarcerated Newly released from incarceration HIV Related Stigma Fear of others knowing HIV status Cultural Insensitivity Latin/Asian cultural divide Beliefs of Faith Based Communities Transportation Housing Getting people to test HIV status Program referrals Scope of CBO follow-up Lack of peer support for newly diagnosed Lack of Mentoring by experienced peers Increase in Non-HIV specialist providers treating HIV Non-HIV providers are unaware of referral network for HIV Management Synergistics Inc. pg. 16

18 Transgender MSM African Americans Latinos Sex workers Aging population/seniors IDUs High risk negatives Lack of HIV prevention and care services in communities: South Far South West Central Food Poverty/lack of financial resources Co pay burdens Domestic Violence Substance Abuse Support groups NA/AA Mental Heath HIV/AIDS Education Need to increase culturally appropriate social media presence Language services Health illiteracy of clients and providers Providers not aware of prescription guidance for HIV (specifically non-hiv providers) Inconsistent definitions of Adherence Occurrence of Medication Holidays Inconsistent provision of treatment adherence counseling Young people engage in tx and medication but are inconsistent in keeping appointments Lack of Outside Knowledge of CAHISC Lack of incentives for participation Stigma of HIV Status Planning body burn out Chicago Area HIV Unified Plan for Prevention, Care, Management Synergistics Inc. pg. 17

19 Housing and Essential Services Table of Contents Introduction This section describes the Chicago Area community as a whole, including the history of the response to the local HIV epidemic and the new approach to comprehensive HIV planning. Description of Chicago Area History of Response to HIV epidemic Description of the Use of the Chicago HIV Cascade in the Planning Process Engagement Plan: Developing the Comprehensive Plan for 2014 This section describes the process used to develop this document, including methods to ensure collaboration with people living with HIV/AIDS and engagement with previous and new partners. The Development of CAHISC and the Cascade Model Collaboration of People Living with HIV/AIDS: Inclusion of HIV Providers and other Stakeholders Executive Summary This section provides a statement of the purpose, mission and vision of the plan and summarizes the Goals, Strategies, Activities and Quality Measures by cascade area. It also provides a statement of how the plan addresses federal and regional formed guidelines and systemic issues like the ACA Section I: Where are we Now? This section describes the current state of HIV/AIDS in Chicago Area. It provides an overview of the current system of HIV prevention and care services and summarizes progress made since the last comprehensive HIV plan was developed. Epidemiological Profile of Current HIV/AIDS Epidemic in Chicago The profile is depicted by cascade area, PPEI, LTC, AVS and has been reviewed and developed through the committee structure. Management Synergistics Inc. pg. 18

20 Trend, unmet need and characteristic data have been summarized and integrated by CDPH HIV surveillance and presented to the Council for final review. HIV/AIDS Cases by Demographic Characteristics and Exposure Category Trends and Changes in the Chicago EMA Early Identification of Individuals with HIV/AIDS (EIIHA) Geographic Mapping Disparities Disproportionate Impact: Populations of Special Concern Co Morbid Factors Unmet Need Integrated Summary of Trends and Unmet Need Resource Inventory: The Chicago Area Continuum of HIV/AIDS Services and Interventions The committees reviewed existing inventories of services and resources identified and added new ones that addressed their area of the cascade. Gap Analysis: Services, Interventions and Service Delivery Environments Needed by Cascade Continuum Area This section describes gaps is services and resources. Each committee upon analysis of epi. data, resource inventory, community engagement and survey activity have submitted a gap analysis for their cascade area. It also describes how Federal and State financial and legislative changes have impacted the Continuum of Care Section II: Where do we need to go? Designing an Improved Continuum of HIV/AIDS Services and Interventions This section describes the community s vision for an ideal system of HIV prevention and care services for the Chicago Area and outlines the overarching issues, opportunities, goals, and objectives that shape this ideal system. Each committee was asked to provide recommendations for an ideal continuum of care from the perspective of their area of the cascade and how this impacts priorities and resource allocations. An Ideal Continuum of HIV Services and Interventions Review of 2013 Priority Setting and Resource Allocation Process Section III: How Will We Get There? This section outlines the specific strategies and activities needed to make progress toward an ideal system of HIV prevention and Management Synergistics Inc. pg. 19

21 care services in the Chicago Area. The Committees have formulated strategies, activities and bench marks into their work plans that have been incorporated into the Comprehensive plan. Review of Progress re: 2012 Comprehensive and Jurisdictional Plan Goals Bridging the Ideal and Current Continuums of Care 2014 Proposed Goals, Strategies, Activities and Quality Measures Section IV: How Will We Monitor Progress? This section describes how progress on objectives, strategies, and activities will be measured. It outlines plans for improved data collection and for using data to monitor services and outcomes. It also describes how the plan is aligned with other local, state, and national initiatives. Management Synergistics Inc. pg. 20