Broward County HIV Health Services Planning Council. Joint Planning Committee Meeting Agenda May 14, 2012 at 1:00 P.M.

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1 Committed to delivering health and human services innovations at the national, state and local level through planning, direct services, evaluation and organizational capacity building. Broward County Health Services Planning Council Broward Regional Health Planning Council, Inc. 200 Oakwood Lane, Suite 100 Hollywood, Florida T (954) F (954) Joint Planning Committee Meeting Agenda May 14, 2012 at 1:00 P.M. Karlene Tomlinson, Part A Co-Chair Kim Saiswick, Part B Co-Chair 1. Call to Order (Please sign-in) 2. Moment of Silence 3. Welcome and Introductions a. Review Meeting Ground Rules, Sunshine b. Review Public Comment (Sign-in at Front of Room) c. Committee Member Introductions d. Guest Introductions e. Excused Absences f. Approve Today s Agenda g. Approve 04/09/12 Meeting Minutes 4. Public Comment 5. Surveillance and Epidemiology Three-year EPI Trend Presentation 6. Prevention Update 7. Comprehensive Plan Discussion Client Survey Input PE Training Follow up 8. Unfinished Business 9. Business 10. Grantee Reports a. Part A b. Part B c. ADAP 11. Reminder: - Meeting Attendance Confirmation Required at least 48 Hours Prior to Meeting Date - Request Comments on Ryan White /AIDS Program 2013 Reauthorization (See below) 12. Request for Information/Directives 13. Agenda Items for Next Meeting 14. Next Meeting Date: Thursday, 6/11/12 at 1:00 p.m. 15. Adjournment NOTICE Please be aware this meeting and all information stated thereof is a matter of public record under FL s Government in the Sunshine Law (FL Statute, Chapter ). Acknowledgement of status is not required, and if disclosed becomes a part of the public record.

2 Committed to delivering health and human services innovations at the national, state and local level through planning, direct services, evaluation and organizational capacity building. Broward Regional Health Planning Council, Inc. 200 Oakwood Lane, Suite 100 Hollywood, Florida Ryan White /AIDS Program 2013 Reauthorization: Comments Requested HRSA/HAB is requesting comments regarding reauthorization of the Ryan White legislation, which will take place in The Ryan White /AIDS Program is the largest Federal program specifically dedicated to providing care and treatment. It funds heavily impacted metropolitan areas, States, and local community-based organizations to provide medical care, medications, and support services to more than half a million people each year. Currently authorized by the Ryan White /AIDS Treatment Extension Act of 2009, the program will be up for reauthorization by the U.S. Congress in To inform that reauthorization, HRSA encourages stakeholders, including grantees, advocacy organizations, State and local administrators, and other members of the Ryan White and /AIDS communities to provide comments on all aspects of the program. Comments should be organized under headings that clearly indicate which Part (Part A, B, C, D or F) the comment addresses. HRSA has established a web page with details on how to submit comments. Comments are due July 31, 2012 HRSA will hold at least four webinar or teleconference listening sessions over the next few months, each focused on a different geographic region. Dates, times and other details will be available in near future. In addition to the resources listed above, don t forget to check out these other HAB resources, which are updated regularly. HAB Web site TARGET Center, Central Source for Ryan White TA (Not a US Government Web site) Twitter, Sign up using ryanwhitecare (Not a US Government Website) The HAB Information is distributed biweekly by the HRSA/HAB Division of Training and Technical Assistance (DTTA). To subscribe or unsubscribe contact Paula Jones. NOTICE Please be aware this meeting and all information stated thereof is a matter of public record under FL s Government in the Sunshine Law (FL Statute, Chapter ). Acknowledgement of status is not required, and if disclosed becomes a part of the public record.

3 Joint Planning Committee Monday, April 9, Oakwood Lane, Suite 100, Hollywood FL Meeting Minutes Attendance # Members Present Absent Guests Grantee Staff 1 Tomlinson, K. Part A Co-Chair X Bowen, S. DeGraffenreidt, S. (Part A) 2 Saiswick, K. Part B Co-Chair X Doe, P. Jones, L. (Part A) 3 Gammell, B. X Jackson, R. 4 Katz, H. B. X Kenny, K. 5 Mercer, A. X PC Support Staff 6 Moragne, T. X Hosein, F. 7 Shirley, J. X Rosiere, M. Quorum = Call to Order (Government and Sunshine) The Part B Co-Chair called the meeting to order at 1:04 p.m. 2. Moment of Silence A moment of silence was observed. 3. Welcome and Introductions The Part B Co-Chair welcomed everyone and introductions were made. Attendees were notified of information regarding Government in the Sunshine Law and meeting reporting requirements, which includes the recording of minutes. In addition, they were advised that the acknowledgement of status is not required but is subject to public record if it is disclosed. Approval of 04/09/12 Meeting Agenda Motion #1 To approve the 04/09/12 Agenda as amended Proposed by: H. Bradley Katz Seconded by: Brad Gammell Action: Passed Amendment: To allow the Community Viral Load Presentation to be conducted before the Grantee Reports. Approval of 02/13/12 and 03/12/12 Minutes Motion #2 To approve meeting minutes of 02/13/12 and 03/12/12 Proposed by: Timothy Moragne Seconded by: Brad Gammell Action: Passed 4. Public Comment There was no public comment. 5. Community Viral Load in Florida - Presentation Senior Epidemiologist from the Bureau of /AIDS, Florida Department of Health presented on Community Viral Load (CVL) in Florida via video conference. Questions posed to Ms. Goodin after the presentation were as follows: (i) Q: How is homelessness established and recorded? A: On the case report forms there are fields that indicate homelessness at time of initial reporting and future updates on address status usually reports the client as homeless or includes the address of a homeless shelter where they may reside for some time. Therefore the initial record of homelessness is referred to along with subsequent mapping to homeless shelters. (ii) Q: What is the difference between median or mean when referring to CVL and what is done when people in care have a higher percentage of undetectable viral load (VL)? A: There are two ways to measure any value to compare over time: (a) the mean value which is the average or (b) the median value which is the middle range where half the values are above and half are above. When a median value for the distribution of VL is examined, it is apparent that a vast majority of the community is Joint Planning Minutes 04/09/12 1

4 an undetectable level and over this time will be consistently undetectable and this would not change over time. Thus the mean value is better suited for this. (iii) Q: Do all of the ehars (Enhanced /AIDS Reporting System) data have both viral load and CD4 at initial diagnosis (and reported later)? A: The case definition for initially reporting a case does not require a viral load but a Western Blot confirmation and the EIA test. A person can therefore be initially reported without a viral load. When they are linked to care their physician will order routine CD4 and detectable VL testing for monitoring purposes and these results are VL reportable. (iv) Q: How are other EMAs incorporating this CVL information? A: There is currently strong interest but no community has been able to successfully move forward with calculating this measure. The greater areas of interest are the large, metropolitan areas. (v) Q: Do you think that these calculations can be done on a tri-county basis? A: If infectiousness is being looked at it will be better to start out with a larger area, but if expended funds or the sphere of control in Broward County need to be tracked, it would be recommended to shrink the population (data). For further questions Ms. Goodin has asked that she be contacted at Kate_Goodin@doh.state.fl.us. The presentation is available at the following link: %20Florida.pdf The committee discussed investigating this CVL further and noted it will require VL numbers from various sources. A guest from the BCHD noted there are current discussions with the DOH in order to get the data that will be needed to even start calculations such as for a CVL and it is the intent of the health department to attempt to get ehars data from local laboratories and other sites from at least 75% of persons in the area. Retrieving VL numbers from the ADAP Wait List was also discussed and the request will be forwarded to the BCHD along with percent undetectable which is reported by providers. There will be an update from BCHD as to when this report can be put together. 6. Grantee Reports A. Part A Grantee Report The Part A Grantee reported the final expenditures from providers are being wrapped up by 4/13/12. There is a carryover of $300,000 - $500,000 as a result of the late Notice of Grant Award. There was no downturn in services which had to be stretched out. It is hoped that the grant would be as favorable next fiscal year. B. Part B Grantee Report The Part B Grantee report was provided on expenditures up to February 2012: Non Medical Case Management conducted 448 eligibility interviews in February of which 101 were new clients. Medication co-payment served 307 clients in which 7 were new to the program. There were 298 clients served in February for Med Co-Pay and 9 clients served for mail orders. Cost avoidance for Med Co-Pay program is $39,655. Total cost avoidance from April-February is $213,732. Bus passes are being distributed for both Part A and Part B (Medical Transportation) and this is being closely monitored and information is being tracked and put into CAREWARE. When Part A bus passes have been depleted, Part B bus passes will begin being distributed. Any remaining funds must be returned to the state. Several clients with insurance through the AICP program have been calling into the health department. These clients are unhappy as effective June 2012, if clients are eligible for Medicaid/Medicare they must be enrolled and will no longer be served through the AICP program. Many clients are stating they are unable to afford their copays and deductible for their medications which Part B had been covering under Med Co-Pay if they had private insurance. ADAP Report The ADAP report through March 30, 2012 was provided: The total ADAP "open" enrollment was 2,312 with 1,525 total ADAP clients being served in the last 30 days. The ADAP Waitlist enrolled 171 clients and the total ADAP/Medicare Part D Enrollment was 187. There were 771 appointments of which 272 (35%) were missed. Client(s) Served is defined as having at least one "pickup" in the period. The category definitions and the clients served by category are as follows: Joint Planning Minutes 04/09/12 2

5 Category A Clients Served = 8 (CD4 < 200 cells/mm3 and/or CD4% < 14%: A diagnosis of AIDS and/or diagnosis of active opportunistic infection and/or diagnosis of -associated nephropathy.) Category B Clients Served = 64 (CD4 cell count between cells/ mm3: Persons currently on ARV therapy, persons previously on ARV therapy but therapy was interrupted and treatment naïve clients) Category C Clients Served = 97 (Treatment naïve clients with CD4 cell count > 350 cells/mm3) Category D Clients Served = 9 (Unknown/Other) Clients are removed from the Wait List by medical category in the order of earliest enrollment. This serves as a reminder that clients MUST recertify every 6 months or they will lose their position on the Wait List. 7. Annual Surveillance & Epidemiology Presentation The BCHD representative presented the monthly Surveillance Report and the National Report Card During the discussion it was noted that No Indicate Risk (NIR) category that was down last month has spiked this month along with black male category. The BCHD representative clarified that with the NIR category, when Broward County residents are tested in other counties and other states it goes onto the NIR category. This NIR category fluctuates a lot as cases come from other states and counties and cases go to other states and counties. This is compared to the previous year. The NIR category is reclassified yearly with a goal reclassification rate of 85%. Joint Planning Minutes 04/09/12 3

6 Prevention Update The following report (three year EPI trend) was provided. The presentation will be made at the next meeting (05/14/12). EXECUTIVE INFORMATION REPORT FOR SURVEILLANCE: January-December 2009, 2010, & 2011 Infection Cases, BROWARD COUNTY YTD YTD 2011 YTD All Cases White % % -24% % 10% 45% Black % % -20% % -17% 4% Hispanic % % -6% % 39% 48% Other 13 1% 8 1% -38% 18 2% 38% 125% Total 1, % % -19% 1, % 0% 25% Western Blot (WB) Recorded White % % -16% % 19% 43% Black % % -14% % -14% 0% Hispanic % % -3% % 34% 39% Other 7 1% 7 1% 0% 15 2% 114% 114% Total % % -13% % 4% 20% Infection Cases, by Type of Confirmatory Test, Florida, 2011 Virologic Only Western Blot All Cases Percent Percent YTD % of Total YTD % of Total YTD % of Total Virologic WB White 61 41% % % 17% 83% Black 53 36% % % 12% 88% Hispanic 30 20% % % 15% 85% Other 3 2% 15 2% 18 2% 17% 83% Total % % 1, % 14% 86% Note: Whites predominate among the virologically diagnosed cases. AIDS Cases, Florida YTD YTD 2011 YTD White % % -30% % -24% 8% Black % % -21% % -19% 3% Hispanic 87 12% 79 14% -9% 94 15% 8% 19% Other 23 3% 15 3% -35% 18 3% -22% 20% Total % % -22% % -17% 7% borns (Perinatal, Born in Broward County Percent 2011 YTD No. % of exposed No. % of exposed Change No. % of exposed % Change % Change No. Exposed/Seroreverter % % -5% % -40% -37% No. Infected (not AIDS) 2 2% 1 1% -50% 0 0% -100% -100% No. Infected AIDS 0 0% 0 0% 0% 0 0% 0% 0% TOTAL BORN An Important Note on Reporting Changes and Their Effect on /AIDS Trends, Current Infection data reflects any case meeting the CDC definition of infection which includes all newly reported cases and newly reported AIDS cases. with no previous report of. Previous reports of data reflected only newly reported cases, which were (not AIDS) at the time of report. ly reported Infection cases do not imply they are all newly diagnosed cases. * Note: DOC cases are excluded from the county totals of and AIDS cases. The following Counseling and Testing Sites Report in Broward County January 2012 was presented. County BROWARD Sex N P Total P% Risk N P Total P% Female MSM/IDU Male MSM Transgender IDU Missing Data Sex with Grand Total Sex with MSM Sex with IDU Race N P Total P% Sex with Other Asian Perinatal Black STD Diagnosis Hispanic Sex for Drugs/Money Amer Indian/Alaskan Sexual Assault Native Hawaiian/ Pac Isle Heterosexual White Other Risk Mixed No Identifiable Risk Refused Refused Missing Data Missing Data Grand Total Grand Total Site Type N P Total P% Age Group N P Total P% 01-Anonymous < STD Drug Treatment Family Planning Prenatal/OB TB Adult Health Prison/Jails College Missing Data Private/MD Grand Total Special Projects CBO CHD FieldVisit Other-Missing **Indeterminate test results are not shown, but are included in the total tested.** Joint Planning Minutes 04/09/12 4

7 The committee will continue on a monthly basis to look at unfunded mandates of post-test counseling. It was recognized that the tracking of linkage from testing sites be an on-going dialogue along with ADAP viral load measures. 8. Comprehensive Plan Discussion Client Survey Input The motion that was not made at last meeting due to lack of quorum was formally proposed as follows: Motion # 3 To recommend that a Client Survey be completed by December 31, 2012 the data to be used at next fiscal year s PSRA process Proposed by: Brad Gammell Seconded by: Timothy Moragne Action: Passed 9. Old Business/ Business Announcement: On April 25, 2012 the BCHD will be conduction a Grand Rounds on routinizing testing, inclusive of ER-based testing. 10. Agenda items for next meeting Standing Agenda Items Three Year EPI Trend Presentation Comprehensive Plan Discussion 11. Next meeting date Monday, May 14, 2012 at 1:00 p.m. Venue: BRHPC 12. Adjournment: Meeting was adjourned at 3:26 p.m. Joint Planning Minutes 04/09/12 5

8 January -April, 2012 Broward /AIDS Surveillance Report AIDS Living AIDS Living AIDS Living AIDS Living TOTAL BLACK ,358 TOTAL HISPANIC ,325 TOTAL WHITE ,764 TOTAL ,447 Adult Male sex w/male (MSM) ,351 Adult Male sex w/male (MSM) ,368 Adult Male sex w/male (MSM) ,328 Adult Male sex w/male (MSM) ,047 Adult heterosexual contact ,443 Adult heterosexual contact Adult heterosexual contact Adult heterosexual contact ,319 Adult IDU Adult IDU Adult IDU Adult IDU Adult MSM & IDU Adult MSM & IDU Adult MSM & IDU Adult MSM & IDU Adult NIR (no identified risk) ,665 Adult NIR (no identified risk) Adult NIR (no identified risk) Adult NIR (no identified risk) ,464 Perinatal Exposure Perinatal Exposure Perinatal Exposure Perinatal Exposure Other Other Other Other , , , , , , , , , BLACK FEMALE ,907 HISPANIC FEMALE WHITE FEMALE FEMALE ,815 Adult Heterosexual Contact ,807 Adult Heterosexual Contact Adult Heterosexual Contact Heterosexual Contact ,352 Adult IDU Adult IDU Adult IDU IDU Adult NIR (no identified risk) Adult NIR (no identified risk) Adult NIR (no identified risk) NIR (no identified risk) Perinatal Exposure Perinatal Exposure Perinatal Exposure Perinatal Exposure Other Other Other Other , , , , BLACK MALE ,451 HISPANIC MALE ,944 WHITE MALE ,237 MALE ,632 Adult Male sex w/male (MSM) ,351 Adult Male sex w/male (MSM) ,368 Adult Male sex w/male (MSM) ,328 Male sex w/male (MSM) ,047 Adult Injection Drug Use (IDU) Adult Injection Drug Use (IDU) Adult Injection Drug Use (IDU) IDU Adult MSM & IDU Adult MSM & IDU Adult MSM & IDU MSM & IDU Adult heterosexual contact ,636 Adult heterosexual contact Adult heterosexual contact Heterosexual contact ,967 Adult NIR (no identified risk) Adult NIR (no identified risk) Adult NIR (no identified risk) NIR (no identified risk) ,538 Perinatal Exposure Perinatal Exposure Perinatal Exposure Perinatal Exposure Other Other Other Other , , , , , , , Source: FL DOH Bureau of, data as of 5/3/2012. Notes: Data are for persons over the age of 13 years old for all categories. This table does not include Department of Corrections cases. The age groups for people living with are for current age. Table does not include numbers for racial category Other. Living data represent a snapshot of all living cases reported through 5/3/12.

9 EXECUTIVE INFORMATION REPORT FOR SURVEILLANCE: January-March 2011, 2012 & 2012 Infection Cases, Broward County* YTD YTD 2011 YTD 2012 YTD All Cases White 59 29% 63 29% 7% 90 35% 53% 43% Black % % -8% % -5% 4% Hispanic 37 18% 50 23% 35% 56 22% 51% 12% Other 2 1% 1 0% -50% 4 2% 100% 300% Total % % 3% % 23% 19% Western Blot (WB) Recorded White 48 26% 54 28% 13% 69 32% 44% 28% Black % 91 48% -10% 95 45% -6% 4% Hispanic 32 18% 44 23% 38% 46 22% 44% 5% Other 1 1% 1 1% 0% 3 1% 200% 200% Total % % 4% % 17% 12% Infection Cases, by Type of Confirmatory Test, Broward County, 2012 Virologic Only Western Blot All Cases Percent Percent YTD % of Total YTD % of Total YTD % of Total Virologic WB White 21 51% 69 32% 90 35% 23% 77% Black 9 22% 95 45% % 9% 91% Hispanic 10 24% 46 22% 56 22% 18% 82% Other 1 2% 3 1% 4 2% 25% 75% Total % % % 16% 84% Note: Whites predominate among the virologically diagnosed cases. AIDS Cases, Broward County YTD YTD 2011 YTD 2012 YTD White 41 24% 41 26% 0% 22 20% -46% -46% Black % 92 59% -12% 62 57% -40% -33% Hispanic 20 12% 20 13% 0% 22 20% 10% 10% Other 3 2% 3 2% 0% 3 3% 0% 0% Total % % -7% % -35% -30% borns (Perinatal, Born in Broward County) 2011 YTD Percent 2012 YTD No. % of exposed No. % of exposed Change No. % of exposed % Change % Change No. Exposed/Seroreverter % % -54% % -42% 25% No. Infected (not AIDS) 0% 0% #DIV/0! 0% #DIV/0! #DIV/0! No. Infected AIDS 0% 0% #DIV/0! 0% #DIV/0! #DIV/0! TOTAL BORN An Important Note on Reporting Changes and Their Effect on /AIDS Trends, Current Infection data reflects any case meeting the CDC definition of infection which includes all newly reported cases and newly reported AIDS cases. with no previous report of. Previous reports of data reflected only newly reported cases, which were (not AIDS) at the time of report. ly reported Infection cases do not imply they are all newly diagnosed cases. * Note: DOC cases are excluded from the county totals of and AIDS cases. 5/9/2012

10 EXECUTIVE INFORMATION REPORT FOR SURVEILLANCE: January-December 2009, 2010, & 2011 Infection Cases, BROWARD COUNTY YTD YTD 2011 YTD All Cases White % % -24% % 10% 45% Black % % -20% % -17% 4% Hispanic % % -6% % 39% 48% Other 13 1% 8 1% -38% 18 2% 38% 125% Total 1, % % -19% 1, % 0% 25% Western Blot (WB) Recorded White % % -16% % 19% 43% Black % % -14% % -14% 0% Hispanic % % -3% % 34% 39% Other 7 1% 7 1% 0% 15 2% 114% 114% Total % % -13% % 4% 20% Infection Cases, by Type of Confirmatory Test, Florida, 2011 Virologic Only Western Blot All Cases Percent Percent YTD % of Total YTD % of Total YTD % of Total Virologic WB White 61 41% % % 17% 83% Black 53 36% % % 12% 88% Hispanic 30 20% % % 15% 85% Other 3 2% 15 2% 18 2% 17% 83% Total % % 1, % 14% 86% Note: Whites predominate among the virologically diagnosed cases. AIDS Cases, Florida YTD YTD 2011 YTD White % % -30% % -24% 8% Black % % -21% % -19% 3% Hispanic 87 12% 79 14% -9% 94 15% 8% 19% Other 23 3% 15 3% -35% 18 3% -22% 20% Total % % -22% % -17% 7% borns (Perinatal, Born in Broward County Percent 2011 YTD No. % of exposed No. % of exposed Change No. % of exposed % Change % Change No. Exposed/Seroreverter % % -5% % -40% -37% No. Infected (not AIDS) 2 2% 1 1% -50% 0 0% -100% -100% No. Infected AIDS 0 0% 0 0% 0% 0 0% 0% 0% TOTAL BORN An Important Note on Reporting Changes and Their Effect on /AIDS Trends, Current Infection data reflects any case meeting the CDC definition of infection which includes all newly reported cases and newly reported AIDS cases. with no previous report of. Previous reports of data reflected only newly reported cases, which were (not AIDS) at the time of report. ly reported Infection cases do not imply they are all newly diagnosed cases. * Note: DOC cases are excluded from the county totals of and AIDS cases. 5/9/2012

11 Ryan White Part B Final Year End Report March 2012 Service Category Allocated (Final March Spent/ Encumbered) Monthly Average Left ( YTD Spent/ Encumbered) (% Left) Final Year End (Balance) Home Delivered Meals Home Health Care Services Medication Co Pay Case Management (non-medical) Medical Transportation Administration $ 2,479 $ 13,018 $ 647,318 $ 179,001 $ 149,930 $ 110,192 $ 315 $ 3,360 $ 116,396 $ 23,309 $ $ 6,455 $ 1,050 $ 6,550 $ 621,548 $ 143,681 $ 149,930 $ 110,192 58% 50% 4% 20% 0% 0% $ 1,429 $ 6,468 $ 25,770 $ 35,320 $ $ TOTALS $ 1,101,938 $ 149,836 Non-Medical Case Management conducted 521 interviews from March of which 130 were new. Medication Co Payment served 340 clients in March in which 17 were new to the program. 333 Clients served in March Med Co Pay 7 Clients served in Mail Order $ 1,032,951 6% 94% $ 68,987 Cost Avoidance for Medication Co Payment Program for March $41,259. Total for April-March is $254,991. Part B Budget March 2012 Final Year End Balance 6% $68,987 Expenditures 94% $1,032,951 This report reflects all invoices received and paid to close out fiscal year /10/2012