The Chair, Sarah Kenneally, called the meeting to order at 10:04 a.m. She welcomed everyone and asked for introductions.

Transcription

1 Strategic Planning Committee and Prevention Committee Joint Integrated Plan (IP) for HIV/AIDS Prevention & Care Review Team Meeting United Way Ansin Building, 3250 SW 3 rd Avenue, Ryder Conference Room, Miami, FL May 14, 2018 Approved August 1, 2018 # Members Present Absent Guests 1 Bannister, Christina x Branch, Rodney 2 Bennett, Brady x Coello, Erika 3 Castellanos, Lina x Erbstein, Silvana 4 Conyers, Tamar x Estevez, Sandra 5 Duberli, Francesco x Jackson, Richardo 6 Engram, Steven x Jordahl, Lori 7 Ferrer, Luigi x Munoz, Virginia 8 Forrest, David x Persaud, Camille 9 Gallo, Giselle x Renaud, Florianne 10 Goldberg, David x Saxeena, Praveena 11 Hess, Amaris x Wynn, Joey 12 Hilton, Karen x 13 Howard, Alexis x 14 Hunter, Tabitha x 15 Ibanez, Gladys x 16 Jefferson, Shayna x 17 Kemmerer, Nicola x 18 Kenneally, Sarah x 19 Kubilus, Barbara x 20 Lee, Aquilla x 21 Messick, Barbara x 22 Moore, James x 23 Mooss, Angela x Staff 24 Munoz, Doralba x Bontempo, Christina 25 Neff, Travis x Brock-Getz, Petra 26 Nelson, Takisha x Ladner, Robert 27 Orozco, Eddie Otway, Kevin 28 Powell, James x 29 Puente, Miguel x 30 Quintero, Samuel x 31 Reynolds, Brandon x 32 Rodriguez, Belissa x 33 Siclari, Rick x 34 Troy, Robert x 35 Valle-Schwenk, Carla x 36 Zayas, Matilde x Quorum = 15 I. Call to Order/Introductions The Chair, Sarah Kenneally, called the meeting to order at 10:04 a.m. She welcomed everyone and asked for introductions. May 14, 2018 Minutes Page 1 of 6

2 II. Resource Persons Ms. Kenneally asked Behavioral Science Research (BSR) staff to identify themselves as resource individuals. III. Floor Open to the Public Ms. Kenneally opened the floor to the public with the following statement: During the 2013 session, the Florida Legislature passed Senate Bill 50, which requires states, county and municipal boards to provide members of the public a reasonable opportunity to be heard on items and matters before the board. On items that are on today s agenda, members of the public have an opportunity to be heard concerning each of the items. If there is anyone who wishes to be heard, I invite you to speak now. Each person will be given three minutes to speak. Please begin by stating your name and address for the record before you talk about your concerns. There were no comments or questions and the floor was subsequently closed. IV. Review/Approve Agenda Members reviewed the agenda. Motion to approve the agenda as presented. Moved: Miguel Puente Seconded: James Powell Motion: Passed V. Review/Approve February 12, 2018 Minutes Members reviewed the meeting minutes from the February 12, 2018 meeting. Motion to approve the February 12, 2018 minutes as presented. Moved: Miguel Puente Seconded: James Powell Motion: Passed VI. Reports A. Part A/MAI Grantee Report Carla Valle-Schwenk Carla Valle-Schwenk, Office of Management and Budget Grants Coordination (OMB), reviewed the Ryan White Part A/MAI Expenditure Report for Fiscal Year (FY) 2017 dated May 1, 2018 (copy on file). Ryan White Program (RWP) Part A has spent about 98% of the direct service dollars. A response from the Health Resources and Services Administration (HRSA) is pending a response for the RWP carryover request from FY Approximately 97% of RWP Minority AIDS Initiatives (MAI) direct service dollars have been spent to date. Billing will be closed out by the end of the month in preparation for a Federal report filing which is due by the end of May. The total number of clients served to date was 9,887. RWP service definitions were revised and ed to subrecipients with a highlighted summary of changes. These will be posted to the County s website and the Partnership website. Medical case management, system-wide standards, and primary medical care standards were also updated and are available online. HRSA advised that nutritional supplements Ultra Meal Advanced Protein and IGG Pure could not be part of the Local Pharmaceutical Assistance (LPA) program. HRSA advised that the supplements did not fall under the guidelines of the LPA, regardless of the County s required Letter of Medical Necessity for nutritional supplements. The service category Nutritional Counseling is not a prioritized service and the number of clients and cost are both low enough that a work-around is expected to be found. The County is working with May 14, 2018 Minutes Page 2 of 6

3 the Florida Department of Health in Miami-Dade County (FDOH) on finding a supplier and getting the supplements to the pharmacy. The final RWP award is still pending and is expected by the end of the week. A partial award of $11,816,877 was received in March. Regarding Affordable Care Act (ACA) clients, Part A payed insurance premiums for about 520 clients through December 2017 with FDOH dollars of about $4.5M. The state AIDS Drug Assistance Program (ADAP) is paying for about 1,200 clients. The 520 clients should be transitioned to ADAP for the 2019 calendar year. Revised paperwork for the Out-of-Network (OON) referral process has been sent to agencies where PAC Waiver clients have transitioned. OON self-referral is also available; clients must still have all the required paperwork. The Test and Treat/Rapid Access (TTRA) program is on hold pending process revision and contracts between subrecipients and FDOH to distribute prescription drugs. A new start date in June is expected. B. Partnership Report Christina Bontempo Ms. Bontempo announced the Partnership Report for April was in the meeting materials (copy on file) and noted the motions of both the Prevention and Strategic Planning Committees were passed by the Partnership. The 2018 Assessment of Administration surveys have been distributed; four subrecipient surveys and 12 Partnership surveys have been received. Members who are responsible for completing the survey(s) are asked to do so as soon as possible and those who have not received the survey are asked to contact Ms. Bontempo. VII. Standing Business A. Membership Report Christina Bontempo Ms. Bontempo noted the Vacancy Report for May 2018 (copy on file) and noted there are three new Partnership members pending appointment by the Mayor s office. Members were reminded that the Joint Integrated Plan meeting counts toward regular Prevention and/or Strategic Planning meeting attendance. VIII. New Business A. Integrated Plan Workbook Christina Bontempo Ms. Bontempo detailed the committee binder materials and reminded members to bring the binder to their committee and joint review team meetings as these are the working documents that will be referenced throughout the year. B. Integrated Plan Activities Review (FDOH-MDC) Sarah Kenneally Condom Distribution Update Erika Coello Ms. Coello presented a Power Point on the FDOH Condom Distribution Program (copy on file). The presentation detailed updates since 2016; condom distribution activities, program measures, quality control, and marketing campaign, including pictures of the Getting 2 Zero condom wrapper, Government Center take-over, and buses and billboards advertising the campaign. Approximately three million condoms have been distributed to date since the program started. May 14, 2018 Minutes Page 3 of 6

4 Metrix for measuring the success of the program include tracking social media hits and tracking the number of condoms and education sessions requested. Getting condoms into schools is still a challenge due to public school policies. It was suggested that posters for the Test Miami locator tool/website may be able to be brought into schools so that students can easily find condom distribution and testing sites. Ms. Kenneally presented the FDOH Power Point Miami-Dade County Integrated HIV/AIDS Prevention and Care Plan, st Quarter, January 1-March 31st, (copy on file). The presentation highlighted the prevention plan activities to reduce health disparities, increase access to care, and prevent new infections. Following are highlights: 2018 Quarter 1 Review. 38.2% of goals are met the target for completion; 41.2% are in progress; 5.8% are behind schedule; 11.7% are lacking necessary data; and 11.7% have not been started either due to lack of data or because they have a later start date in the Plan. P1.1 Increase access to and use of condoms by HIV positive persons and HIV-vulnerable populations, including but not limited to injection drug users (IDU), Trans-identified persons, gay and bisexual men. 911,469 condoms were distributed by FDOH in the first quarter of P1.2a Create a process for PrEP external referral system (PrEPLink). Thrity-two testing sites are anticipated to become part of the referral system pending receipt of Memorandum of Understanding. PrEP usage among women was noted as lacking however distribution is believed to be underreported. Targeting PrEP to high-risk women is a priority however qualifying women as high-risk has been difficult. P1.2d Establish new Pre-exposure Prophylaxis (PrEP)/ Post-exposure Prophylaxis (PEP) medical providers. There is a concern for how to get PrEP to the undocumented population who may not seek help from a government agency. New FDOH PrEP centers are being established in West Perrine, the Refugee Help Center in Little Havana, and in a University of Miami mobile unit. Non- Occupational Post-Exposure Prophylaxis (npep) is generally administered in hospital settings; FDOH focus is on PrEP and PEP P1.2c Create a local directory of providers prescribing PrEP/nPEP. 20,000 PrEP palm cards have been printed and were available at the meeting for subrecipient agencies. Non-Occupational Post- Exposure Prophylaxis (npep) is being administered in hospital settings but it is unclear how this affects minors. PrEP billboards are being installed throughout the county. P1.2e Explore creating a PrEP Ambassador Program. The PrEP Speakers Bureau is launching in July and interested persons should contact Karen Iglesias at FDOH for more information. P1.3 Implement combined STD/HIV education and testing to raise HIV prevention awareness among HIV-vulnerable populations, including but not limited to injection drug users (IDU), Trans-identified persons, gay and bisexual men. Training is ongoing through FDOH workgroups, including the MSM, PrEP, Hispanic Initiative, and Black Initiative workgroups. P1.3c Rebrand the STD Clinic name. The STD Clinic has been rebranded as the Sexual Health and Wellness Clinic. P2.1 Increase number of OB/GYN healthcare providers engaging in HIV prevention activities with pregnant women. FDOH is working with the Healthy Babies Task Force. D1.1a Partner with healthcare settings (e.g. hospitals, health centers, emergency departments), to May 14, 2018 Minutes Page 4 of 6

5 increase the provision of routine HIV testing as part of medical care. Six community partners, including three RWP subrecipients are partnering with FDOH. DP Enhance HIV prevention, testing, communication and community mobilization efforts in Miami-Dade County towards MSM, Hispanics and Black/African-Americans. Workgroups meet monthly; a calendar of workgroup meetings was available at the meeting (copy on file). Outcome Evaluation and Challenges in completing goals. An Integrated Plan Logic Model (copy on file) was presented and reviewed. The logic model details measurable evaluation outputs which are not currently part of the Plan and are intended to measure how well we are implementing IP activities and to assist with better coordination between Prevention and Strategic Planning goals and objectives. A motion to adopt the Logic Model was put forward. Motion to begin the process to make the Integrated Plan activities more reflective of the outputs as referenced in the Integrated HIV Prevention Logic Model. Moved: James Moore Seconded: David Goldberg Motion: Passed Opposed: Lena Castellanos and Miguel Puente C. Integrated Plan Activities Review (RWP Part A/MAI) Robert Ladner/Petra Brock Robert Ladner and Petra Brock-Getz presented on the Linkage, Retention and Viral Load Suppression activities (copy on file). Following are highlights: L1.1a Create an FDOH-MDC / RWP Linkage to Care team (LTC team), meeting at least every two months, to identify and address areas of improvement in FDOH-MDC and RWP newly-diagnosed linkage cooperation. Second Year efforts are directed at implementation of activities to improve linkage process. The Director of Health for the Department of Corrections (DOC) has left so the process to establish a DOC linkage program is starting over; ideally recently released persons will leave prison with a 7-day or 30-day supply of medication. The RWP has added a form for correctional facilities to document linkage of newly-released PLWH. L1.1b Create a comprehensive outreach linkage resource directory, mapping outreach service providers by area within Miami-Dade County, and ensuring that at least one outreach provider in each area provides outreach/ linkage services outside normal business hours and on weekends. The directory is under revision. L1.1c Identify agency best practices in linkage of newly-diagnosed PLWHA, and recommend dissemination to testing/outreach/medical subrecipients to increase the percentage of newlydiagnosed who are linked to care (began 01/01/18). TTRA continues to be the protocol for linking newly-diagnosed and lost-to-care clients. L1.1e Guarantee flexible after-hours and weekend availability at RWP MCM, OAHS and OHC subrecipients, ensuring that at least one (1) MCM subrecipient, one (1) OAHS subrecipient and one (1) OHC subrecipient will offer after-hours service five (5) weeknights per week and will offer four (4) hours of service availability one (1) weekend day, to reduce or eliminate barriers to RWP linkage once a PLWHA has been diagnosed at an FDOH-MDC site. Self-reported data have been collected; revision of the goal should be considered following the full TTRA implementation. L1.3a Provide linkage to, re-engagement in, and retention in RWP HIV medical services using DTC activities (see also R.2 et seq.). Data sharing between RWP and FDOH is necessary to differentiate between clients lost to care and clients who have passed away, left the service area, or are no longer RWP-eligible. A pilot program is under development. R1.3a Assess measurement systems for measuring lagtime, wait time and hold time among RWP May 14, 2018 Minutes Page 5 of 6

6 OAHS, OHC and MCM subrecipients, and track subrecipients thereafter (began 01/01/18). It is not clear what or who defines lag/wait/hold times or how to define reasonable time. Factors in wait time are also linked to clients having multiple appointments in a day and client knowledge (or lack thereof) of how to navigate the service system. Subrecipients written protocols should be collected and reviewed. R1.4a Monitor quality and appropriateness of OAHS clinical care through client satisfaction surveys, focus groups, targeted reviews of SDIS data and clinical record reviews and improve through various technical assistance methods (on site QM TA, AETC, etc.). Require corrective actions for subrecipients with identified deficiencies. Client Satisfaction survey conducted by BSR will be prepared in August. Review of frontline staff interactions with clients as relates to clients experiences is also being reviewed. R2.1a The joint FDOH/RWP Linkage to Care team will determine criteria for "truly lost to care" case closures and develop an "early warning system" to identify RWP clients at risk for being lost to care (began 01/01/18); and R2.1b FDOH and RWP will develop data-sharing protocols and feedback mechanisms to provide updated contact information to RWP on clients who are flagged by the "early warning system" as at risk for being lost to care, as well as provide case closure data to FDOH for clients with 6, 9 and 12 months since the most recent VL measurement or on-site RWP OAHS contact. Collaboration between FDOH-MDC, OMB and RWP CQM is ongoing. V1.1a Develop capacity for increased Test and Treat sites, setting a goal of one (1) new site identified and in development every 18 months, including: (1) identifying potential new Test and Treat sites; (2) determining what the sites need to become Test and Treat-ready; and (3) provide technical assistance to the sites to assure Test and Treat readiness and success. TTRA is intended to be the standard for newto-care and returned-to-care clients; system-wide implementation is pending review of how to provide medication to clients, particularly those entering the system through non-clinical points of service. V1.3a On a monthly basis, detect PLWHA with persistently high viremia (high VL loads over two consecutive semi-annual measurements) and notify RWP OAHS and MCM subrecipients to enable their targeted response. Monitor improvement in VL levels to ensure efficacy of subrecipient response. CQM advises subrecipients of clients identified as having persistent high viremia; in February, 45 clients (5.5% of all RWP clients) were identified as persistently not suppressed. IX. Meeting Evaluation Attendees were reminded to return their completed evaluation forms to staff following the meeting. X. Announcements Staff announced the next Partnership meeting is May 21; the third meeting of the Annual Needs Assessment is June 13; and members are reminded to complete their Assessment of the Administrative Mechanism surveys. XI. Next Meeting The next Review Team meeting is August 13, 2018 beginning at 10:00 a.m., at the United Way Ansin Building. XII. Adjournment Motion to adjourn the meeting. Moved: Miguel Puente Seconded: Christina Bannister Motion: Passed The meeting was adjourned at 1:54 p.m. May 14, 2018 Minutes Page 6 of 6