SUBJECT
Title
AUTHORIZE THE APPLICATION FOR AND THE ACCEPTANCE OF GRANT AGREEMENT FOR HIV SURVEILLANCE PROGRAM (DISTRICTS: ALL)
Body
OVERVIEW
The County of San Diego (County) Getting to Zero initiative seeks to end the HIV epidemic locally through focused efforts related to testing, treatment, and prevention. This item supports the Getting to Zero initiative by providing surveillance information to measure outcomes and identifying subpopulations of individuals living with HIV disease who are in need of medical care and treatment and support services. These support services include case management, mental health treatment, and substance-use treatment to help them remain in medical care over time.
For the past 25 years, the San Diego County Board of Supervisors (Board) has authorized agreements with the California Department of Public Health (CDPH) to accept Integrated HIV Surveillance and Prevention Funding for Health Departments. This agreement provides services to reduce transmission of HIV disease in San Diego County and to improve health outcomes for people living with or newly diagnosed with HIV/AIDS. On July 23, 2019 (8), the Board authorized a five-year agreement for HIV/AIDS Surveillance services through June 30, 2024, for an approximate amount of $3,500,000.
Pending release of the 2024-29 HIV Surveillance Program grant application and award notification, today’s action requests the Board approve and authorize the Clerk of the Board to execute a new 2024-29 HIV Surveillance Program agreement with CDPH, from July 1, 2024, through June 30, 2029, for an anticipated five-year total of approximately $3,300,000. Additionally, today’s action also requests the Board authorize future funding opportunities to enhance surveillance to improve data-driven decision management in support of individuals and families who are impacted by HIV disease in San Diego County. These actions also support the Live Well San Diego vision of healthy, safe, and thriving communities by enabling ongoing surveillance activities to improve the treatment and health of persons with HIV disease in San Diego County. This will be accomplished through enhancing identification of reportable health conditions and improving access to prevention, testing, and high-quality medical care that lead to improved health.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Waive Board Policy B-29, Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery, which requires prior approval of grant applications and full cost recovery of grants.
2. Authorize the application for and the acceptance of approximately $3,300,000 in grant funds from the California Department of Public Health for the period of July 1, 2024 through June 30, 2029, for HIV disease related surveillance under the 2024-29 HIV Surveillance Program.
3. Authorize the Clerk of the Board to execute all required grant documents, including any extensions, amendments and/or revisions thereto that do not materially impact or alter the services or funding level.
4. Authorize the Agency Director, Health and Human Services Agency, to pursue future funding opportunities related to enhancing surveillance to improve data-driven decision management in support of those impacted by HIV disease.
EQUITY IMPACT STATEMENT
HIV has disproportionately impacted some of our most vulnerable residents who include Black and Hispanic communities, gay, bisexual, and other men who have sex with men. According to the Gallup.com article “LGBTQ+ Identification Rises to 5.6% in Latest U.S. Estimate” (2021), gay, bisexual, and other men who have sex with men currently comprise of approximately 2.5% of the adult population. However, in San Diego County, gay, bisexual, and other men who have sex with men comprise 62% of recent HIV diagnoses and 71% of persons living with HIV. Moreover, in San Diego County, like much of the rest of the United States, HIV has disproportionately impacted Black and Hispanic communities. Blacks comprise less than 5% of the county population but comprise 14% of recent HIV diagnoses. Hispanics comprise 34% of the county population yet comprise 49% of recent HIV diagnoses. The County of San Diego (County) local Getting to Zero initiative places a priority on reaching residents and communities most disproportionately impacted by HIV by identifying everyone living with HIV in San Diego County and linking them to HIV treatment services and support. By utilizing the information collected from the HIV Surveillance Program and by engaging in continuous quality improvement activities to achieve the objectives of the Getting to Zero initiative, those disproportionately impacted by HIV can be reached to achieve collective impact and improve outcomes along the HIV care continuum.
SUSTAINABILITY IMPACT STATEMENT
The proposed actions align with the County of San Diego Sustainability Goal #2 to provide just and equitable access to County services and resources, and Sustainability Goal #4 to protect the health and well-being of San Diegans. Ongoing surveillance activities and efforts are designed to improve the overall health and well-being for individuals living with HIV disease while supporting the Getting to Zero initiative. These activities and efforts include 1) identifying subpopulations of individuals living with HIV disease who need medical care and treatment, and 2) providing additional support through services, such as case management, mental health treatment, and substance-use treatment to help individuals remain in medical care.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year (FY) 2024-26 CAO Recommended Operational Plan in the Health and Human Services Agency. If approved, today’s actions will result in estimated costs of $759,816 and approximate revenue of $660,768 in FY 2024-25 and estimated costs of $759,816 and approximate revenue of $660,768 in FY 2025-26. The funding source is the California Department of Public Health. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. Unrecovered costs are estimated at $99,048 for FY 2024-25 and $99,048 for FY 2025-26. The funding source for these costs is Realignment. The public benefit of providing these services far outweighs these costs. There will be no change in net General Fund costs and no additional staff years.
BUSINESS IMPACT STATEMENT
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Details
ADVISORY BOARD STATEMENT
The Health Services Advisory Board reviewed this item on March 5, 2024, and recommended approval of the recommendations.
BACKGROUND
On March 1, 2016 (25), the San Diego County Board of Supervisors (Board) adopted the Getting to Zero initiative, which seeks to end the HIV epidemic by 2026. Since its adoption, the Getting to Zero initiative has evolved into a comprehensive approach to ending the HIV epidemic, with five core strategies:
1. Test: Identify everyone living with HIV in San Diego County and link them to HIV treatment and other services that provide support for remaining in treatment.
2. Treat: Ensure that everyone living with HIV in San Diego County has access to HIV treatment services so that persons living with HIV can achieve viral suppression.
3. Prevent: Identify everyone at risk for HIV infection in San Diego County and link them to HIV prevention resources and other services that provide support for remaining HIV negative.
4. Engage: Continue partnering with communities disproportionately impacted by HIV to achieve collective impact and improve outcomes along the HIV care continuum.
5. Improve: Engage in continuous quality improvement activities to achieve the objectives of the Getting to Zero plan.
As of December 31, 2023, there were 14,489 people living with HIV disease in San Diego County. This estimate represents an increase from approximately 14,000 cases reported to the Board in 2018. In 2023, there were approximately 393 newly diagnosed cases of HIV in the county, similar to the number of cases seen each year since 2018. In addition to monitoring new diagnoses in county residents, the HIV Surveillance Program also processes and investigates reports of persons previously diagnosed and living with HIV disease who have relocated to the county, and 200 of these cases were investigated in 2023. HIV continues to be a major public health concern in San Diego County, and on average, there is more than one new HIV diagnosis every day.
Recommendation #1: Waive Board Policy B-29, Fees, Grants, Revenue Contracts
A waiver of Board Policy B-29 is requested because the approximate $3,300,000 funding does not offset all costs, as County of San Diego (County) Health and Human Services Agency (HHSA), Public Health Services (PHS) Epidemiology and Immunization Services Branch (EISB) and California Department of Public Health (CDPH) have different Indirect Cost Rates, which are calculated based on salaries, wages, and fringe benefits.
Unrecovered costs are estimated at $99,048 for Fiscal Year (FY) 2024-25 and $99,048 for FY 2025-26. The services funded by this grant support essential care and treatment, prevention, and surveillance services for people living with or at risk of acquiring HIV disease in San Diego County. These services would be required to control the transmission of HIV within the county even if outside funding were not available. The funding source for these unrecovered costs will be existing Health Realignment.
Recommendations #2 and #3: Apply for and Accept 2024-29 HIV Surveillance Program grant
For the past 25 years, the County has received AIDS Master Grant Agreement funding from CDPH (now called 2024-29 HIV Surveillance Program grant). This funding provides services to reduce the transmission of HIV disease in San Diego County and to improve health outcomes for people living with HIV disease. These funds also support the local HIV Surveillance Program, which maintains the County’s active HIV disease case surveillance efforts in hospitals, clinics, private physician offices, immunology laboratories, and other medical/social service settings.
The primary objective of this program is to ensure a minimum of 85% of unduplicated newly identified HIV disease cases are reported to the CDPH Office of AIDS within 45 days of diagnosis. As of FY 2023-24 Quarter 2, the program reported 84% (142/169) of newly identified cases of HIV within 45 days and expects to meet the 85% goal going forward. To achieve this objective, the program continues to 1) develop and enhance reporting relationships, 2) improve timeliness and reliability of local HIV disease case data, 3) investigate cases of epidemiological interest, and 4) investigate reported HIV disease cases to establish accurate information on modes of transmission.
Historically, the 2019-20 HIV Surveillance Program application and grant award notification were released after the start date of the grant. In addition, grant funds were awarded retroactively. In addition, CDPH previously awarded EISB $3,303,840 for the term of July 1, 2019, through June 30, 2024. EISB anticipates an award in the amount of approximately $3,300,000 for the term of July 1, 2024, through June 30, 2029. Pending release of the grant application and award notification, today’s action requests the Board approve and authorize a new five-year HIV Surveillance Program agreement with CDPH.
Recommendation #4: Authorization to pursue future funding
In addition, today’s action would authorize future funding opportunities to enhance HIV disease-related services and programs already provided. These services and programs enhance surveillance to improve data-driven decision management in support of individuals impacted by HIV disease and contribute to the County PHS mission to promote health and improve quality of life by preventing diseases, injury and disability.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the County of San Diego 2024-2029 Strategic Plan Initiatives of Sustainability (Resiliency) and Equity (Health), and the regional Live Well San Diego vision by supporting access to prevention, testing, and high-quality medical care that results in improved physical health.
Respectfully submitted,
SARAH E. AGHASSI
Interim Chief Administrative Officer
ATTACHMENT(S)
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