HIVAIDS Bureau Division of State HIVAIDS Programs DSHAP

HIV/AIDS Bureau Division of State HIV/AIDS Programs (DSHAP) Ryan White HIV/AIDS Program Part B Technical Assistance Webinar Increasing Access to HIV Medications: Models that Work February 26, 2014

DSHAP Mission To provide leadership and support to States/Territories for developing and ensuring access to quality HIV prevention, health care and support services. 2

Agenda Opening Remarks/ Announcements Harold Phillips Question and Answer A Report on the Minority AIDS Initiative (MAI) Anita Edwards Maryland MAI Program Jami Stockdale Durkia Hudson Care Linkage Challenge Kevin Coger Questions and Answer Closing Remarks Harold Phillips 3

Presenter Harold Phillips Deputy Director Division of State HIV/AIDS Programs 4

Announcements & Updates 5

Announcements • “Tell One” Project • Tell One Person about the Health Insurance Marketplace! • CMS FAQ on Third Party Payment of Premiums • All Grantees Meeting/Clinical Update Meeting • ADAP Data Report System Shutdown Notification • Grantees will be notified prior to shutdown • RSR Browser Compatibility Issues • See tips from the DART Team on TARGET Center Data. TA@caiglobal. org 6

Announcements Important Deadlines: • 340 -B Recertification Deadline March 14 th : • RSR Provider Reports Deadline March 10 th • All RSRs must be in submitted status Deadline March 31 st Upcoming Webinars: • “Tools for Creating ADR XML Client Report” March 5 • To register look under "Events" on the TARGET Center • “Adapting HIV Providers' Fiscal Management in a Changing Financing Landscape”: March 6 • To participate contact Jacqueline@healthiv. org 7

Questions 8

Presenter A Report on the Minority AIDS Initiative (MAI) Anita Edwards, Lieutenant Commander Senior Program Advisor Division of State HIV/AIDS Programs 9

RWHAP Part B MAI • RWHAP Part B MAI Legislative requirements • Section 2693(b)(2)(B) - For grants used for supplemental support education and outreach services to increase the number of eligible racial and ethnic minorities who have access to treatment through the program under section 2616 for therapeutics…, 10

RWHAP MAI Differences • RWHAP Part A: MAI formula grants provide core medical and related support services to improve access and reduce disparities in health outcomes in metropolitan areas hardest hit by the epidemic • RWHAP Part B: MAI formula grants fund outreach and education services designed to increase minority access to needed HIV/AIDS medications through state Part B AIDS Drug Assistance Programs (ADAP) and other medication assistance programs. 11

Reporting Requirements

Reporting Requirements 13

MAI Funding FY 2012 • $10, 234, 501 allocated for FY 2012 MAI services • $9, 949, 406 total service expenditures for FY 2012 MAI • $3, 278, 242 Education • $6, 671, 164 Outreach • Total Clients Served • 18, 469 Education • 30, 601 Outreach 14

MAI Clients served by Service Category Education Outreach • Black/African American 11, 283 • Hispanic 5, 989 • Asian 531 • Other Minority 91 • Unknown 686 • Black/African American 17, 841 • Hispanic 8, 773 • Asian 880 • Other Minority 242 • Unknown 2, 892 15

Increasing Access to HIV Care: Models That Work Maryland MAI Program February 26, 2014 Durkia Hudson, MSW Jami Stockdale, MA Maryland Department of Health and Mental Hygiene Prevention and Health Promotion Administration http: //phpa. maryland. gov

Maryland MAI Overview Service Goals- To provide increased access for disproportionately impacted low-income minority individuals with HIV disease to HIV/AIDS treatment/medications available through the Part B Maryland AIDS Drug Assistance Program (MADAP). Objective 1 -Through targeted outreach to racial and ethnic minority communities, the program will identify persons who are HIV positive and out-of-care. Objective 2 - Provide education through focused outreach activities and advertising that target African American and Latino persons living with HIV/AIDS to increase their participation in the Maryland AIDS Drug Assistance Program. Prevention and Health Promotion Administration [Date] 17

Maryland MAI Overview Funding HRSA has awarded the Center for HIV Prevention and Health Services between $415, 000 -$466, 000 annually since FY 2011. – ½ of the funding designated to outreach – ½ of the funding designated to education l Funding was first distributed through an RFP process and has been distributed on a 3 year continuation grant since then. Sub-Grantees l Aids Interfaith Residential Services (AIRS) l Total Health Care, Inc. l Chase Brexton Health Services l Baltimore City Health Dept. Clinical Services l Baltimore City Health Department STD Prevention l Health Care for the Homeless l University of Maryland at Baltimore Institute for Human Virology ( Jacques Initiative) l Prevention and Health Promotion Administration [Date] 18

Maryland MAI Overview Types of Organizations: • • FQHC’s City Health Department Nonprofit Organization University Based Health Clinic Types of Outreach: • Street Outreach • Prison/Jail Outreach • Support Groups Types of Education: • One-on-One • Groups (curriculum & non-curriculum based) • Workshops Prevention and Health Promotion Administration [Date] 19

Sub-Grantee Overview Agency Target Population Program Description AIRS HIV+ person who are receiving primary care services Engages HIV infected persons in educational sessions that focus on services that are readily available to them. AIRS uses both group and one-on -one curriculum based interventions to educate clients about health & wellness, pharmacy assistance, housing, and other social service programs. Total Health Care, HIV+ persons who Inc. & Chase will soon be released Brexton Health from incarceration Services Both sub-grantees engage HIV positive persons while in prison/jail. While in prison outreach workers work with soon to be released persons to identify and address any barriers to care that may limit their ability to reengage in care. Upon release they are linked to care at their clinic where they are connected to primary medical care, as well as, linked to pharmacy assistance. Health Care for The Homeless Targets persons experiencing homelessness through street outreach and groups to engage newly diagnosed and HIV positive persons who may have fallen out of or are not in care. The outreach worker and case manager assists clients with barriers to Prevention and Health Promotion Administration care and pharmacy assistance applications. [Date] Homeless 20

Sub-Grantee Overview Agency Target Population Program Description Baltimore City Health Department Clinical Services Latino Provides street outreach services that target and engage HIV positive Latinos into primary care and pharmacy assistance services. Baltimore City Health Department STD Prevention HIV+ persons who have fallen out of care Engages clients that have been out of care for 6 months or more in direct linkage to care. The outreach worker will assist in scheduling the first medical appointment, as well as, transporting clients to their first appointment. UMB IHV (Jacques Initiative) HIV+ persons and/or high risk groups Engages clients at outreach sites that serve populations that are actual or disproportionately at risk for HIV. These clients are engaged in treatment preparedness workshops with a medical professional and an HIV person living well with the disease. The outreach worker is there Prevention the and Health Promotion Administration to assist in connecting clients to their clinic [Date] 21 and pharmacy assistance.

Evaluation l Education and outreach activities are tracked through client tracking forms and includes: – Medical care referrals (healthcare providers, HIV primary care, CTR, and Case Managers) – Education sessions – Completion and submission of applications for pharmacy assistance programs – Demographics Prevention and Health Promotion Administration [Date] 22

Client Tracking Form Prevention and Health Promotion Administration [Date] 23

Client Tracking Form Prevention and Health Promotion Administration [Date] 24

Program Reach l Over 2, 000 forms are submitted a year for approx. 1, 500 encounters with HIV+ clients. l 700 referrals are made to HIV primary medical care providers. l 400 unduplicated HIV+ clients based on Social Security Number (SSN) are served. l 220 received emergency, temporary, or full access to the Maryland AIDS Drug Assistance Program. Prevention and Health Promotion Administration [Date] 25

Enhanced Linkages l. A cross reference of the client’s SSN and the Maryland AIDS Drug Assistance Program (MADAP) client database shows that approx. 400 were able to receive emergency, temporary, or full access to the program. Prevention and Health Promotion Administration [Date] 26

Data Collection Tips l Keep the form brief l Train program staff to complete the form l Share data with program staff to convey that the numbers demonstrate success of the program Prevention and Health Promotion Administration [Date] 27

Challenges l l l l l Reaching the target population Staff turnover Collecting SSN Completion of the form – Skip patterns When to complete the form: During encounter vs. after the encounter Saturation of outreach venues Estimating goals Separating RW Part B MAI from RW Part A MAI Access to other databases Prevention and Health Promotion Administration [Date] 28

Best Practices OUTREACH l Be open to diverse models and venues for Outreach COORDINATION l Designate someone with primary responsibility for coordination VERIFICATION l Establish partnerships within the State Health Department Prevention and Health Promotion Administration [Date] 29

Care Linkage Outreach Challenge: How to Reduce the Number of HIV-Positive Persons Who Test Repeatedly Without Disclosing Their Positive or HIV Care Status Kevin Coger Care Linkage Investigator STD/HIV Prevention Program Baltimore City Health Department

The Issue BCHD STD/HIV Prevention Program provides 12, 000 to 14, 000 HIV conventional tests per year on street corners and fixed site locations. l Some of the clients seen, who tested HIVpositive previously, test again for HIV without disclosing their positive or HIV care status. l This has caused lost opportunities to immediately assess each client’s HIV care status. l Prevention and Health Promotion Administration [Date] 31

Setting The Program offers STD/HIV testing via mobile units. l Testing in neighborhoods & fixed site locations through street outreach services. l When HIV-positive persons are identified through these efforts: * We assess their HIV care status * Partner services are offered l Prevention and Health Promotion Administration [Date] 32

The Solution l “ Do Not Test List” (DNT) l Same-day appointments. l Provide Incentives l Clients already in care identify their primary medical care provider and the date of their last kept appointment. l The HIV Reactor Coordinator verifies this information. Prevention and Health Promotion Administration [Date] 33

Questions 34

Contact Information • • Anita Edwards, AEdwards@hrsa. gov Durkia Hudson, durkia. hudson@maryland. gov Jami Stockdale, jami. stockdale@maryland. gov Kevin Coger, Kevin. Coger@baltimorecity. gov 35

2014 Webinar Evaluation Option 1 Option 2 Kpatterson@hrsa. gov mazuine@hrsa. gov 36

Thank You 37