Roles and Responsibilities of RWHAP Part A Planning Councils

Roles and Responsibilities of RWHAP Part A Planning Councils/Bodies (PC/PBs) and Recipients Slides for Module 2 Topic: Key Factors

Key Factors in PC/PB Community Planning PC/PB Responsibility for Establishing and Maintaining a Comprehensive System of HIV Care Service Categories Fundable under RWHAP Part A: Core Medical and Support Services Role of Data in Planning and Decision Making Role of PC/PBs in Addressing Health Disparities and Social Determinants of Health

Training Objectives Following the training, participants will be able to: Explain the concept of a comprehensive system of HIV care and how a Part A planning council or TGA planning body (PC/PB) helps to establish and maintain it Identify the 2 main types and the range of service categories that can be funded under RWHAP Part A Summarize the role of quantitative and qualitative data in RWHAP Part A planning and decision making Explain the concepts of HIV-related health disparities and social determinants of health Identify 3 ways in which the PC/PB can address HIV-related health disparities and social determinants of health

System of Care

Characteristics of a Comprehensive System of Care Includes core medical services as well as support services needed for retention and positive clinical outcomes Includes services supported by RWHAP and other funders, linked through referral agreements Provides equitable access to services in terms of location, hours, and physical access for all PLWH throughout the service area Enables diverse subpopulations to obtain services appropriate to their needs Links prevention and care, addressing all components of the HIV care continuum

Ensuring a System of Care PC/PB and recipient share responsibility for system of care HRSA/CDC Integrated HIV Prevention and Care Plan supports development of a comprehensive and responsive system of care that addresses service delivery gaps and resource needs PC/PB priorities, fund allocations, and directives help create and maintain a comprehensive system of HIV care RWHAP Part A-funded services must be coordinated with other RWHAP programs, prevention activities, and other HIV- related programs and services

Service Categories that Make Up the System of Care

Funding Services Core medical-related services: Listed in the legislation At least 75% of total service expenditures unless the program obtains a waiver from HRSA/HAB Support services requirements: Not more than 25% of total service expenditures Service categories specified by HHS Needed to achieve medical outcomes Medical outcomes = outcomes affecting the HIV-related clinical status of an individual with HIV/AIDS Planning councils need to know allowable service categories and service definitions

Service Categories that can be Funded under RWHAP Part A Support service categories and definitions of all services updated periodically by HRSA/HAB: Services described in Policy Clarification Notice (PCN) 16-02: Ryan White HIV/AIDS Program Services: Eligible Individuals & Allowable Uses of Funds Effective for awards made after October 1, 2016 Service definitions described in National Monitoring Standards (NMS) periodically updated to reflect the most recent applicable PCN

Core Medical Services 1. AIDS Drug Assistance Program (ADAP) Treatments Local AIDS Assistance Program (LPAP) Early Intervention Pharmaceutical Services (EIS) Health Insurance Premium and Cost Sharing Assistance for Low-Income Individuals Home and Community-Based Health Services Home Health Care 7. 8. Hospice Services Medical Case Management, including Treatment Adherence Services Medical Nutrition Therapy 10. Mental Health Services 11. Oral Health Care 12. Outpatient/Ambulatory Health Services (OAHS) 13. Substance Abuse Outpatient Care 2. 3. 9. 4. 5. 6.

Support Services 1. 2. Child Care Services Emergency Financial Assistance (EFA) Food Bank/Home Delivered Meals Health Education/Risk Reduction Housing Linguistic Services Medical Transportation Non-Medical Case Management Services 9. Other Professional Services [e.g., Legal Services and Permanency Planning] 10. Outreach Services 11. Psychosocial Support Services 12. Referral for Health Care and Support Services 13. Rehabilitation Services 14. Respite Care 15. Substance Abuse Services (residential) 3. 4. 5. 6. 7. 8.

Role of Data in Planning and Decision Making

Importance of Data-Based Decision Making Without data, all anyone has are opinions. Data elevates the probability that you ll make the right decision. W. Edwards Deming

Many Types of Data Needed for Decision Making Purpose of RWHAP is to improve the quality and availability of care for low-income, uninsured, and underinsured individuals and families affected by HIV disease [RWHAP Part A Manual, page 1] Data on how services are working for PLWH provide a sound basis for changes to improve them overall and for particular PLWH subpopulations and geographic areas HIV care continuum uses data to show performance at critical steps: diagnosis, linkage to care, retention in care, use of antiretroviral therapy (ART), and viral suppression overall and for specific subpopulations CQM, performance and outcome measures measure service quality and results

Data Needs for Ryan White Planning Note: Some data types overlap

Challenges of Using Data PC/PB needs many kinds of data from different sources Everyone uses data, but people new to community planning often need training in use of multiple types of data for decision making All members need to understand RWHAP data types and sources and to be able to assess data quality

Sound Practices for Data-Based Decision Making Agree annually on data needs Include in the PC/PB work plan how data will be obtained, analyzed, presented, and used Agree with the recipient on what data it will provide, when, and in what formats* Agree on a protocol for requesting additional data Train all PC/PB and committee members including community members Present data in user-friendly formats *Sound practice: include in a Memorandum of Understanding (MOU)

Sound Practices for Data-Based Decision Making (cont.) Develop a process to weigh, summarize, compare, and use data to reach decisions Conduct data presentations and discussions throughout the year Allow time for full discussion and review of data including comparing data from multiple sources Have a policy and process to manage conflict of interest Provide reminders to focus on reliable data and avoid impassioned pleas based on individual needs Use data to identify and address needs of subpopulations with HIV-related health disparities

Role of PC/PB in Addressing Health Disparities and Social Determinants of Health

HIV-related Health Disparities Disparities are avoidable differences in the burden of HIV disease for certain groups of people Disparities can put subpopulations at higher risk of becoming HIV-positive Inequities include being less likely to: Know their status Be linked to care soon after diagnosis Be retained in care Receive antiretroviral therapy Achieve viral suppression

Populations with HIV-related Health Disparities Racial and ethnic minorities especially African Americans and Latinos LGBT individuals especially transgender individuals Groups defined by multiple factors including race/ethnicity, gender, sexual orientation, age, and geographic location, such as: Young men of color who have sex with men African American women of childbearing age Homeless individuals

Expectations for Addressing Disparities One of the national goals for ending the epidemic: to reduce HIV-related health disparities and health inequities RWHAP Part A Manual (page 15): system of care should: Address the service needs of newly affected and underserved populations including disproportionately impacted communities of color and emerging populations Provide care consistent with goals of increasing access to services and decreasing HIV/AIDS health disparities among affected subpopulations and historically underserved communities

Minority AIDS Initiative Purpose: to evaluate and address the disproportionate impact of HIV/AIDS on, and the disparities in access, treatment, care, and outcomes for, racial and ethnic minorities (including African Americans, Alaska Natives, Latinos, American Indians, Asian Americans, Native Hawaiians, and Pacific Islanders) MAI funds allocated to RWHAP Part A as supplemental grants to improve HIV-related health outcomes to reduce existing racial and ethnic health disparities [2009 Legislation 2693(a)&(b)]

Social Determinants of Health Defined as: The circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness responsible for most health inequities [World Health Organization] Negative examples: poverty, homelessness, racism, unequal access to health care Linked to lack of opportunity and to a lack of resources to protect, improve, and maintain health [CDC White Paper on Social Determinants of Health 2010] Contribute to HIV infection and limit the ability to seek and obtain HIV services

PC/PB Actions to Address Disparities and Social Determinants of Health Structural approaches, like changes in programs and funding and adoption of new service models Use of HIV care continuum data to identify and target PLWH subpopulations with lower rates of linkage to care, retention, and viral suppression Use of funding and directives to refine service models and better serve these subpopulations Coordination with other services/funding streams Cultural competence training for PC/PB members, recipient staff, and providers

Sum-Up PC/PB plays a key role in ensuring a comprehensive system of care accessible to and appropriate for PLWH with varied characteristics and needs RWHAP Part A funds can be used to support 13 legislatively- specified core medical service categories and 15 HHS- approved support services Decisions about priorities, funding, and service models should be data-driven all PC/PB and recipient staff need to be comfortable using data PC/PB decisions should help reduce HIV-related health disparities and address social determinants of health

Optional Slides for Activity

Quick Scenarios to Apply Knowledge Following are 3 quick scenarios to increase interaction during your presentation/lecturette and help participants apply what they are learning to practical situations. Revise them if needed to fit your situation, and use them in small groups or pairs, or in the full group. Following is the title of each activity and where you may want to insert it: Insert Scenario A: Navigating the System of Care after slide 6 Insert Scenario B: Data Needs and Access after slide 18 Insert Scenario C: Addressing HIV-related Health Disparities after slide 25

Quick Scenario A: Navigating the System of Care Suppose you met a person with HIV who was getting HIV care through the RWHAP Part A program in another city but just moved here. That person says: Tell me about the system of HIV care, and how I can get access to medical care and support services. 1. What would you say if the question came from [Focus on one as assigned]: a. A young MSM of color? b. A woman with small children? c. A long-time HIV survivor aged 60+? 2. As a PC/PB member, how prepared are you to answer this question?

Quick Scenario B: Data Needs and Access Your PC/PB and recipient have a good relationship. About 6 years ago, following some tensions around access to data, a Memorandum of Understanding (MOU) was developed with a chart specifying what data would be provided and when. It has been very helpful. Since then, some additional data have become available like separate HIV care continuums for key target populations. The PSRA process and timing have also changed. The recipient provides the new data, but the MOU has not been updated to reflect these changes there are always other priorities for both the PC/PB and recipient. The Part A Director just announced that she will be retiring in 6 months. The Executive Committee thinks this is a good time to update the MOU. Do you agree? What are the benefits? What are the downsides, if any?

Quick Scenario C: Addressing HIV-related Health Disparities Your PC/PB and recipient carefully review data showing differences in linkage to care, retention in care, adherence to medications, and viral suppression for 3 key subpopulations: young African American men who have sex with men, immigrants from Latin America, and transgender people with HIV. This year, needs assessment included a special study of factors contributing to these disparities, and identified high levels of poverty, lack of health insurance, unstable housing, lack of services targeted to these populations, and transportation challenges as key factors for most of these populations. You are planning to hold 1 or more roundtables with key informants to discuss these issues. How can you make sure these discussions help you identify practical PC/PB actions to address these disparities?

Worksheet Activity on Key Factors in Planning Focus: Ways to address 3 key factors in HIV community planning in your work on the PC/PB 1. Ensuring a comprehensive system of care 2. Use of data in planning and decision making 3. Role of PC/PB in addressing health disparities and social determinants of health

Instructions Assume you are members of a committee or task force that will advise the PC/PB on how to successfully address your assigned key aspect of HIV community planning Choose a facilitator, recorder, and reporter Discuss your assigned key factor and complete the worksheet you have 30 minutes Prepare your reporter to present a 4-5 minute summary of your work to the full group