Update: 2019 CDPH HIV Services Funding

Transcription

1 Update: 2019 CDPH HIV Services Funding Jorge Cestou Director of Community Health Services Division, HIV/STI Bureau Chicago Department of Public Health Nilsa Irizarry Director of HIV Housing Chicago Department of Public Health David Kern Deputy Commissioner of the HIV/STI Bureau Chicago Department of Public Health Patrick Stonehouse Director of HIV Prevention Chicago Department of Public Health Ayla Karamustafa Director of HIV Care and Essential Services Chicago Department of Public Health February 1, 2018

2 Goal for Today s Presentation Getting to Zero Illinois Current Data CDPH/CAHISC Planning Process 2019 HIV Services Funding 2018 Timeline

3 Illinois Getting To Zero Initiative What does getting to zero mean? Zero new HIV infections Zero people living with HIV who are not on treatment What are the goals? Increase by 20 percentage points the number of people living with HIV who are virally suppressed. Increase by 20 percentage points the number of people vulnerable to HIV infection who use pre exposure prophylaxis (PrEP). If successful, we could see fewer than 100 new cases by 2027.

4 Steps to Achieving GTZ Goals Folks have to understand their own healthcare needs. Folks have to know healthcare is accessible. Folks have to desire to engage in healthcare. Folks have to seek healthcare. Folks have to reach healthcare. Folks have to use healthcare.

5 Steps to GTZ Goals Desire Understand Seek Reach Use ARV ART use for for PrEP/HIV Treatment Successful PrEP Use*/ Viral Suppression

6 Current Data In 2016, the City of Chicago diagnosed 839 new HIV infections, the fewest since % linked to care within one month. >90% linked to care within one year. Disproportionate burden remains: Men, year olds, Non Hispanic Blacks, and Gay, bisexual, and other men who have sex with men (MSM).

7 Current Data We continue to face challenges keeping people in care and successfully using ARVs for treatment. In 2016, only 60% of people living with HIV accessed care. Only 40% were in care consistently. Less the 50% were virally suppressed. Only ~10% of individuals eligible for PrEP are using it.

8 CDPH/CAHISC Planning Process 2016 CDPH, with guidance from CAHISC, develops Centers of Excellence (COE) concept to promote ARV use toward viral suppression and PrEP. CDPH releases COE summary document. Honoring community feedback, CDPH and CAHISC agree to continue conversations about HIV service priorities through 2017 to seek and incorporate additional input. CDPH extends all 2016 HIV prevention, care, and housing contracts through 2017 to provide additional time for gathering and incorporating input.

9 CDPH/CAHISC Planning Process 2017 CDPH develops HIV Services Portfolio based on CAHISC guidance and community input. Portfolio includes 5 components: Community Development Housing Marketing Population Centered Health Homes Services for Persons who Use Drugs

10 CDPH/CAHISC Planning Process 2017 (continued) CAHISC conducts multiple community forums focused on Portfolio components to gather and incorporate additional input. CDPH conducts 5 focus groups with priority populations to inform Community Development initiatives. CDPH conducts numerous in person meetings with current delegates/sub recipients, provider groups, coalitions, and others to discuss portfolio (group and 1 1).

11 CDPH/CAHISC Planning Process 2017 (continued) Via CDPH, HealthHIV convenes Chicago HIV Institute: Collaborations to Enhance Comprehensive HIV Prevention, Care and Treatment Support to help prepare HIV partners for changes. CDPH conducts capacity building needs assessment with current delegates/sub recipients to identify areas for additional CBA support. CDPH provides infrastructure development funding to HIV prevention delegates to help prepare for changes. CAHISC examines health home models from other jurisdictions CDPH finalizes HIV Services Portfolio after 25 months of community input and CAHISC guidance.

12 Planning: Key Take Aways Ryan White services lead to positive health outcomes. Too few people living with HIV are enrolled in Ryan White. For persons vulnerable to infection, no similar system exists. We must increase access to both clinical and supportive services for more people. Benefits must be extended to persons vulnerable to HIV. HOPWA/housing services lead to positive health outcomes. Too few people living with and vulnerable to HIV have access to supportive housing services. We must increase access to housing for more people. Benefits must be extended to persons vulnerable to HIV.

13 Planning: Key Take Aways Often, individuals are on the own to navigate complicated systems of healthcare, supportive services, and housing, particularly if they do not receive Ryan White and/or HOPWA services. We must better coordinate delivery of comprehensive services to increase the likelihood people living with and vulnerable to HIV have every opportunity to benefit from these services. Individuals are complex and face many life circumstances that lead to poor health outcomes, including HIV infection. We must invest resources to address root causes of health disparity, including systemic racism. Resources must be invested in communities most impacted by HIV and must create opportunities and power in communities that are marginalized by prevailing systems.

14 Planning: Key Take Aways Smaller organizations are essential to reaching and serving marginalized populations. Future funding opportunities must embrace the value that smaller organizations contribute. Chicago has a long history of successfully implementing HIV services. Future funding opportunities must strive to preserve what is working, even as it moves to accelerate progress toward Getting to Zero. People living with HIV who are virally suppressed cannot transmit HIV to their sexual partners. Chicago must embrace Undetectable = Untransmittable, which means service providers must follow current science.

15 Final HIV Services Portfolio Community Development Housing Healthcare Access (expanded beyond Population Centered Health Homes) Marketing Services for Persons who Use Drugs (renamed) HIV Testing in Healthcare Settings (added) Resource Coordination (added) Evaluation and Quality Management (added)

16 IN THE FOLLOWING SLIDES, ANTICIPATED FUNDING OPPORTUNITY/IES REFER TO THE NUMBER OF REQUEST FOR PROPOSALS OR OTHER FUNDING MECHANISMS FOR EACH HIV SERVICES PORTFOLIO COMPONENT. THE TERM DOES NOT REFER TO THE NUMBER OF ANTICIPATED AWARDS FOR EACH FUNDING OPPORTUNITY.

17 Community Development Purpose: To address the intersections of HIV and social determinants of health, e.g., employment, housing, social exclusion/isolation Anticipated Funding Opportunities: 5 Description: Funds will support development and implementation of four initiatives, one each focused on: Black gay, bisexual, and other MSM; Latino gay, bisexual, and other MSM; Cisgender Black heterosexual women; and Transgender persons.

18 Community Development Description (continued): An additional funding opportunity will support comprehensive evaluation of these initiatives. Funded projects must include partnerships between communities, community organizations or coalitions, and evaluators.

19 Community Development Description (continued): Partnerships will: Assess root causes of HIV disparities caused by social determinants, Seek solutions from community members to address root causes, Develop systems level intervention(s) to reduce disparities at a population level, Implement intervention(s), Evaluate intervention(s), and Disseminate intervention and evaluation findings.

20 Healthcare Access Purpose: To support comprehensive, coordinated clinical and supportive services that promote the use of ARVs for HIV PrEP and HIV treatment Anticipated Funding Opportunities: 9(some opportunities will result in multiple funding awards)

21 Healthcare Access Description: 1. Population Centered Health Homes (PCHH) Funds will provide comprehensive clinical and essential support services for persons living with and vulnerable to HIV to promote ARV use for HIV PrEP and HIV treatment. PCHH can be implemented through partnership or by stand alone organizations. PCHH will be required to provide services in each of the following categories: outreach and recruitment, HIV testing, linkage to healthcare, engagement/retention in healthcare, primary care and/or HIV related medical care, medication adherence, STI screening and treatment, mental health services, substance use disorder services, and direct provision of or referral to employment assistance, nutrition services, vision services, oral healthcare, specialty medical care, and hormone therapy.

22 Healthcare Access Description: 2. PCHH for Persons Living with HIV who have Complex Medical/Behavioral Needs Funds will provide all services referenced under PCHH and services to enhance engagement of individuals living with HIV who are chronically disconnected from care and/or who have chronically high HIV viral loads.

23 Healthcare Access Description: 3. Highly Targeted HIV Testing and Linkage to Care Funds will provide highly targeted HIV testing and linkage to: HIV treatment via PCHH or other healthcare providers for newly diagnosed persons, Linkage to HIV PrEP via PCHH or other healthcare providers for vulnerable HIV negative persons, and Re engagement in HIV care/treatment via PCHH or other healthcare providers for persons previously diagnosed with HIV.

24 Healthcare Access Description: 4. Essential Supportive Services Funds will provide non clinical essential support services for persons living and vulnerable to HIV. Services will support successful ARV use by connecting individuals to HIV PrEP or HIV treatment via PCHH or other healthcare providers. Essential Supportive Services can be implemented through partnership or by stand alone organizations. Essential Supportive Services will be required to provide services in each of the following categories: outreach and recruitment, HIV testing, linkage to healthcare, engagement/retention in healthcare, and direct provision of or referral to other needed supportive services, including STI screening and treatment, mental health services, substance use disorder services, and employment assistance.

25 Healthcare Access Description: 5. HIV Primary Care Funds will provide primary care and/or HIV related medical care, medication adherence, and STI screening and treatment for persons living with and vulnerable to HIV. Services will support ARV by providing direct HIV PrEP medical care and HIV medical care and treatment.

26 Healthcare Access Description: 6. Legal Services Funds will provide legal services for persons living with and vulnerable to HIV to support successful ARV use for HIV PrEP and HIV treatment. 7. Foodbank Funds will provide food to persons living with and vulnerable to HIV in support of successful ARV use for HIV PrEP and HIV treatment. 8. Financial Assistance Funds will provide financial support (emergency, health insurance premiums, emergency housing, transportation) for persons living with and vulnerable to HIV to support successful use of ARVs for HIV PrEP and HIV treatment. 9. Medical Case Management Funds will provide system wide coordination of medical case management services for persons living with HIV. Services will support successful ARV use by connecting individuals to HIV treatment via PCHH or other healthcare providers and supporting medication adherence.

27 Housing Purpose: To provide housing for persons living with and vulnerable to HIV Anticipated Funding Opportunities: 2 Description: Housing for Persons Living with HIV Funds will provide housing for persons living with HIV to support successful ARV use for HIV treatment. Housing for Persons Vulnerable to HIV Funds will provide housing for persons vulnerable to HIV infection to support successful ARV use for HIV PrEP.

28 Marketing Purpose: To develop and deploy cohesive and consistent HIV/sexually transmitted infection (STI) health marketing campaigns Anticipated Funding Opportunities: 1 Description: Funds will support development of brand/identity for cohesive and consistent HIV/STI/health marketing campaigns. Funds will support deployment of 1 2 branded campaigns, annually, at least one of which will promote use of ARVs for HIV treatment and/or HIV PrEP.

29 Services for Persons who Use Drugs Purpose: To provide health and harm reduction services to persons who use drugs Anticipated Funding Opportunities: 1 Description: Funds will support the delivery of health and harm reduction services for persons who use drugs, including, but not limited to, needle/syringe exchange, HIV and HCV testing and linkage to care, overdose prevention, and direct provision of or referral to primary medical care and other substance use disorder services.

30 Evaluation and Quality Management Purpose: To ensure CDPH funded HIV services are implemented in a manner that leads to achievement of goals and provision of high quality services Anticipated Funding Opportunities: 2 Description: Funds will support evaluation and quality management of CDPH funded HIV services. HIV Testing in Healthcare Settings Purpose: To implement routine, opt out screening Anticipated Funding Opportunities: 1 Description: Funds will provide routine, opt out screening in healthcare institutions.

31 Resource Coordination Purpose: To link persons living with and vulnerable to HIV to needed HIV services Anticipated Funding Opportunities: 1 Description: Funds will create a comprehensive resource center that provides information about and direct linkage to HIV services for people living with and vulnerable to HIV.

32 Final Comments We recognize that many of our current services lead to positive outcomes. We preserve these services in the funding opportunities. Despite our success, we know current efforts alone are not sufficient to Get to Zero in the next 10 years. We must expand access to healthcare services and services that support healthcare for more people living with and vulnerable to HIV. Where beneficial, HIV prevention funds have been integrated with HIV care and housing funds in funding opportunities to expand access to persons vulnerable to HIV. Smaller organizations have a primary place in the funding opportunities.

33 Final Comments We continue to work with IDPH to explore opportunities to implement comprehensive programs throughout the Chicago EMA. Trans persons are explicitly included in funding opportunities. Medical Case Management, Housing, and Legal will be funded at the system level, rather than individual organization level. Employment support is explicitly referenced in the funding opportunities. Evaluation and quality management will be funded to support implementation of HIV services.

34 Final Comments We significantly expanded services funded under Healthcare Access. This means there will not be a wholesale reboot of the entire HIV services system, and we will ensure that effective services are preserved, while making room to accelerate progress through new ways of organizing services. This means we can test and demonstrate the impact of new approaches to delivering services through the portfolio.

35 Final Comments Population Centered Health Homes will be implemented as a part of the larger Healthcare Access umbrella. The underlying premise of Population Centered Health Homes is not new or unique. It s built on the success we ve seen in Ryan White programs (comprehensive, coordinated services). Many organizations are already using this model (or would choose to if barriers were reduced).

36 Final Comments Population Centered Health Homes have tangible benefits: Extend benefits to non Ryan White eligible persons living with HIV and persons vulnerable to HIV infection Incorporate the desire for and value of whole person approaches the healthcare Prioritize comprehensive approaches to healthcare engagement, instead of siloed approaches which can create barriers for customers

37 Final Comments Population Centered Health Homes have tangible benefits: Allow for partnerships and innovative models of care Minimize upfront bureaucratic barriers (e.g., developing siloed program plans/budgets that get stitched together at the program level post award) Promote patient choice and flexibility, in combination with other Healthcare Access and Resource Center funding opportunities

38 Timeline Week of January 15: Official communication to partners summarizing anticipated 2018 HIV funding categories and timeline Week of January 29: Official communication to partners detailing anticipated 2018 HIV funding opportunities February 1: CDPH webinar providing an overview of anticipated 2018 funding opportunities and timeline February March 2018: CDPH direct outreach and engagement of all current delegate agencies/sub recipients to discuss anticipated 2018 funding opportunities and timeline February March 2018: CDPH direct outreach and engagement of institutions and organizations that are not currently funded by CDPH to discuss anticipated 2018 funding opportunities and timeline TBD: Funding opportunity release dates

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