San Francisco Ryan White Part D Women, Infants, Children, and Youth with HIV/AIDS ( HIV + WICY) Bill Blum Chief Operating Officer, Community Oriented Primary Care Director, HIV Health Services
Federal Ryan White Funding Categories The Ryan White legislation created a number of programs, called Parts, to meet needs for different communities and populations affected by HIV/AIDS. Each is described below: Part A provides emergency assistance to Eligible Metropolitan Areas and Transitional Grant Areas that are most severely affected by the HIV/AIDS epidemic. Within Part A, Minority AIDS Initiative (MAI) provide core medical and related support services to improve access and reduce disparities in health outcomes in metropolitan areas hardest hit by the epidemic. Part B provides grants to all 50 States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and 5 U.S. Pacific Territories or Associated Jurisdictions. Additional Part B funds are "earmarked" for State AIDS Drug Assistance Programs (ADAP), which primarily provide medications. Under Part B, MAI fund outreach and education services designed to increase minority access to ADAP. Part C provides comprehensive primary health care in an outpatient setting for people living with HIV disease. Under Part C, MAI funds are used by community health centers and other service providers to improve access to early intervention HIV/AIDS services. Part D provides family-centered care involving outpatient or ambulatory care for women, infants, children, and youth with HIV/AIDS ( HIV + WICY) Part F provides funds for a variety of programs: The Special Projects of National Significance Program grants fund innovative models of care and supports the development of effective delivery systems for HIV care. The AIDS Education and Training Centers Program supports a network of 11 regional centers and several National centers that conduct targeted, multidisciplinary education and training programs for health care providers treating people living with HIV/AIDS. The Dental Programs provide additional funding for oral health care for people with HIV. 2
Ryan White Part C & D Consolidation Proposal Health Resources & Services Administration (HRSA) is currently soliciting feedback on the proposed 2015 consolidation of the RW Parts C & D. Rationale is to lessen administrative burden. However will result in less protection for HIV+ WICY specific funding and service levels. Proposing an additional $4 Million funding level. May or may not be off set by expanded eligible applicant pool. Final budget appropriation awaiting Congressional approval. Final Funding Announcement not expected before the fall of 2014, but HRSA/HAB doing concurrent RFP planning. 3
HIV in SF WICY Population Women 25+ Transgender Women Youth 13-24 Children 2-12* ‘08 ‘09 ‘10 ‘08 ‘09 ‘10 ‘08 ‘09 ‘10 ‘08 ‘09 ‘10 Living w/ AIDS 504 539 546 192 195 202 38 34 93** 2 2 2 Living w/ HIV non-AIDS 386 360 365 149 148 151 161 178 n.a. 4 0 3 Living w/ HIV/AIDS 890 899 911 341 343 353 199 212 202 6 2 5 Newly reported HIV non- 37 28 29 10 12 10 43 52 53 0 0 0 AIDS Newly reported AIDS 40 23 15 9 9 10 13 n.a. n.a. 0 0 0 Sources: SF Department of Public Health HIV/AIDS Epidemiology Annual Reports, 2008-2010 • Because of the zero-prevalence of infant infection in SF over the past three years, infants and children under the age of 12 were not included in the above table. • n.a. = statistics for this age range not available **For this cell, youth aged 13-29 were used, as that was the available number for the time period 4
Social Context of SF: In HIV+ WICY Compared with Overall HIV+ and General Population General HIV + WICY HIV+ Pop. 59% 37% 58% Racial/ethnic minorities 7% 2% 13%* Adolescents (ages 13 to 24) 35% 8% 2% Homeless 40% 25% 8% Uninsured 51% 46% 23% Underinsured 73% n.a. 10% Illegal drugs and/or alcohol abuse 78%** n.a. 9% Unemployed 12% 22% 35% Primary language (non-English) 72% 17% 11% Live below 100% of the FPL Source: SFDPH - HIV/AIDS Epidemiology Annual Report, 2010, *Approximated based on 2010 census data—broken down 10-14, 15-19, 20-24. **Rates only available for youth. 5
San Francisco RW Part C Grantee San Francisco Community Clinic Consortium (SFCCC) HIV/AIDS program is operated in RW Part C Grantee: SFCCC partnership with SFCCC health Subcontractors: (7) clinics and SFDPH clinics. Tom Waddell Urban Health A continuum of services is Center (SFDPH) provided including primary South of Market Health medical care, medication Center adherence support, dental/oral health care, nutritional HealthRight 360 assessments and counseling, Larkin Street Youth Services substance abuse and mental health Lyon-Martin Clinic assessments and referrals. Mission Neighborhood Health Calendar year 2013 served 600 Center UDC Native American Health Funding level of $820,000/year Center 6
San Francisco RW Part D Grantee Family Service Network (FSN) Members RW Part D Grantee: UCSF Positive Health Program (PHP/Ward 86) @ SFGH Subcontractors: (7) Family HIV Clinic (FHC) @ SFGH South Van Ness Adult Behavioral Health Services (SVNABHS)/SFDPH Bay Area Perinatal AIDS Center (BAPAC)/UCSF UCSF Women's HIV Program (WHP) Larkin Street Youth Services Aftercare Program (LSYS) Catholic Charities Catholic Youth Organization Rita da Cascia Program (RdC) Substance Abuse Outpatient Program(STOP)/SFAF 7
FSN – Service Provision PHP/Ward 86: Primary & specialty medical care with onsite case management, social work, treatment adherence, psychiatry and clinical trials. BAPAC : Comprehensive preconception counseling and prenatal care for HIV+ women. FHC : Primary & specialty medical care for HIV+ people and their affected family members with on-site nutritionist, social worker and pharmacist. LSYS : Comprehensive on-site medical care, case management, peer advocacy and housing for HIV+ youth (18-24 years of age). RdC : Case management, housing, support groups for families and community building activities. SVNABHS : Individual, group and couples psychotherapy, psychiatric services, and clinical case management for those living with HIV. STOP : Outpatient substance abuse treatment for HIV+ individuals. WHP : Primary & specialty medical care with onsite case management, social work, treatment adherence and psychiatry. 8
FSN – Target Populations The targeted population is San Francisco HIV-positive WICY. The population includes increasing numbers of women of color, particularly African-Americans and Latinas. Transgender and older women across all racial and ethnic groups. Homeless youth, and gay and bisexual young men. The vast majority of these individuals live in poverty, are homeless or in marginal housing, have experienced trauma, and face complex substance use and mental health issues. The Network expects to serve 400 WICY utilizing Part D funds. 9
FSN – RW Part D Funding Levels FY 13-14 FY 14-15* PHP $103,803 $95,498 BAPAC $16,757 $15,416 FHC $50,323 $46,297 LSYS $22,979 $21,141 RdC $110,929 $102,055 SVNABHS $97,531 $89,729 STOP $20,399 $18,767 WHP $72,811 $66,986 Total Grant Amount $495,532 $455,889 *11 month contracts that end June 30, 2015 10
Next Steps for 2015 Pending Consolidation of RW Part D Funding Into RW Part C SFDPH - HHS maintains service continuum for HIV+ WICY services potentially utilizing RW Part A & B and General Funds to wrap around RW Part C funding shortages. SFDPH in conjunction with SFCCC, UCSF and community partners determine best strategies for SF application for RW Part C funding. 11
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