State Fiscal Year 2019 HIV Funding Peter DeMartino Prevention and Health Promotion Administration Center for HIV Prevention and Health Services June 19, 2018
PHPA MISSION AND VISION MISSION • The mission of the Prevention and Health Promotion Administration is to protect, promote and improve the health and well-being of all Marylanders and their families through provision of public health leadership and through community- based public health efforts in partnership with local health departments, providers, community based organizations, and public and private sector agencies, giving special attention to at-risk and vulnerable populations. VISION • The Prevention and Health Promotion Administration envisions a future in which all Marylanders and their families enjoy optimal health and well-being.
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Resource Inventory Baltimore City Baltimore MSA MADAP $ 13,270,490 $ 23,937,037 Care Services $ 46,378,796 $ 50,346,252 HIV Prevention $ 15,044,412 $ 16,552,044 Total $ 61,909,251 $ 78,050,886 PLWH 12,384 17,307 $ per PLWH $ 4,999 $ 4,510 4
Core Services - $8,383,806 (2018) - $20,973,331 (2019) Service Category Number of Number of SFY 2018 Award SFY 2019 Percent Providers Providers Award Change 2018 2019 Outpatient/Ambulatory Health 8 10 1,737,751 2,654,853 153% Services Oral Health 8 8 1,597,777 1,294,890 81% Early Intervention Services 5 15 468,799 12,467,612 2659% Medical Nutrition Therapy 3 3 183,074 195,524 107% Home and Community-Based 1 1 60,135 83,797 139% Services MCM 14 13 2,962,851 2,897,097 98% Mental Health 6 6 1,210,450 1,186,829 98% Substance Abuse Outpatient Care 2 3 162,969 192,729 118%
Support Services - $7,262,480 (2018) - 7,457,402 (2019) Service Category Number of Number of SFY 2018 Award SFY 2019 Percent Providers Providers Award Change 2018 2019 Non-Medical Case Management 12 8 1,702,146 1,186,612 70% Emergency Financial Assistance 1 1 1,722 1,723 100% Food Bank/Home Delivered Meals 7 8 92,966 89,063 96% HE/RR 13 9 1,621,317 1,556,034 96% Housing 11 11 1,531,090 3,174,797 207% Linguistic Services 1 2 50,000 10,833 22% Medical Transportation 12 14 263,135 274,554 104% Outreach 13 5 1,388,697 484,325 35% Psychosocial Support 10 9 611,407 679,461 111%
Minority AIDS Initiative • Ryan White Part B is limited in use of MAI funds • Outreach Only • $386,638 • Three Providers • Decrease from 2018
Housing • Ryan Part B is one of many housing models • What models are we using in Maryland?
Housing First
Upstream Outreach Early Intervention Services Health Education/Risk Reduction
Funding Streams • Upstream directs RWHAP Part B grant dollars under: » Outreach » Early Intervention Services (EIS) » Health Education/Risk Reduction (HERR) • Ideally, funded entities will implement a full Upstream program including all three categories of activities.
Um. Yeah, so we don’t do that… • HRSA/HAB PCN 16-02 and Treatment Adherence Program Guidance: HERR Treatment Adherence services provided during an Outpatient/Ambulatory Health Service visit should be reported under the Outpatient/Ambulatory Health Not Everything Services category whereas Treatment Adherence services provided during a Medical Case Management visit should be reported in the Medical Case is Upstream Management service category. MAI Outreach and Traditional Outreach 12
Funding Streams • Upstream directs RWHAP Part B grant dollars under: » Outreach » Early Intervention Services (EIS) » Health Education/Risk Reduction (HERR) • Ideally, funded entities will implement a full Upstream program including all three categories of activities.
Making Strategic Investments: EIS DIS Surveillance Case Finding HCV Housing 14
+ Magnetic - Continuum 16
Maryland Five-Year Integrated Plan General Vulnerable Full Care Viral Load Population Population Diagnosis Engagement Suppression Linkage to Care/Data to Care PrEP and nPEP Routine Testing Community Medication Expanded HIV Mobilization Adherence Provider Network Syringe Services Care Coordination Behavioral Risk Peer Support Reduction Partner Services Networks HIV-informed Culturally Systems Integration Responsive and Marketing to a Access to Flexible Workforce general audience Medications Condom Distribution Targeted Testing Health Literacy and Promotion
fix systems not people • “Your answer is not my solution” – A huge dose of humility • We all do incredible work; even when we’re wrong • And doing the wrong thing better and better doesn’t make it right 18
contracting as intervention: • Address network impoverishment • Move the burden from the consumer and acknowledge the privileged system • Develop infrastructure for key activities as markers of system production rather than intervention specific outcomes 19
WE HAVE A GOAL: 5,692 37,200 X .153 5,692 20
Core Elements: RWHAP funding dictates the core elements of Upstream . • MANDATORY ELEMENTS: – Upstream must target a vulnerable population as identified in the National HIV/AIDS Strategy (NHAS); NHAS 2020; or the State Integrated HIV Plan – Upstream must be a significant enhancement to existing HIV or Health Services within a funding program. RWHAP Upstream must not supplant existing funding.
Vulnerable Populations – NHAS 2020 - defined as any population where the prevalence of HIV is much higher than the general population - • Gay, bisexual, and other men who have sex with men of all races and ethnicities (noting the particularly high burden of HIV among Black gay and bisexual men) • Black women and men • Latino men and women • People who inject drugs • Youth aged 13 to 24 years (noting the particularly high burden of HIV among young Black gay and bisexual men) • People in the Southern United States • Transgender women (noting the particularly high burden of HIV among Black transgender women)
Upstream Priority EIS Population Outreach HERR TESTING LINKAGE 23
Upstream: PrEP Priority Population Outreach Testing HERR 24
Upstream: STI Priority Population Outreach Testing HERR 25
Upstream: HCV Priority Population Outreach Testing HERR 26
Upstream: SSP Priority Population Outreach Testing HERR 27
Maryland Department of Health Prevention and Health Promotion Administration 28
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