SUBJECT
Title
AUTHORIZE ACCEPTANCE OF HIV SERVICES GRANT FUNDING AND APPLICATIONS FOR FUTURE FUNDING OPPORTUNITIES (DISTRICTS: ALL)
Body
OVERVIEW
The San Diego County Board of Supervisors (Board) has authorized grants and agreements with the United States Health Resources and Services Administration (HRSA) to provide care and treatment services to persons living with HIV for over three decades. These funding sources include the Ryan White HIV/AIDS Treatment Extension Act of 2009 (RWTEA) Part A, the RWTEA Part A Minority AIDS Initiative, and the Ending the HIV Epidemic: A plan for America- Ryan White HIV/ AIDS Program Parts A and B.
Ryan White HIV/ AIDS Treatment Extension Act (RWTEA) Part A and RWTEA Part A Minority AIDS Initiative Funding
Awarded annually, the RWTEA Part A and the RWTEA Part A Minority AIDS Initiative comprise the single largest federal funding source for HIV services received by the County of San Diego (County). The County received notice of a grant award on May 15, 2024, by HRSA. The RWTEA Part A funding is $11,313,642 and the RWTEA Part A Minority AIDS Initiative funding is $784,859, for a total of $12,098,501 for the period of March 1, 2024, through February 28, 2025. This funding will continue to support medical treatment, mental health treatment, substance use disorder treatment, temporary housing assistance, and other critical services for persons living with HIV.
Ending the HIV Epidemic Funding
In 2020, HRSA created a new funding source, Ending the HIV Epidemic: A Plan for America - Ryan White HIV/AIDS Program Parts A and B, in response to the introduction of the federal Ending the HIV Epidemic initiative. Initial Board action, April 7, 2020 (6), authorized the acceptance of $5,000,000 in grant funds and subsequent Board action, November 15, 2022 (7), authorized the acceptance of an additional $1,667,400 in grant funds. Both initial and subsequent Board action authorized funding through February 28, 2025. On May 14, 2024, the County received notice from HRSA that an additional $2,559,215 was awarded for the period of March 1, 2024 through February 28, 2025 and the County has exceeded the amount authorized in prior Board Actions. This funding supports and is utilized for programs and services related to community engagement and leadership development for persons living with HIV, linkage and retention in HIV care, low barrier medical care, and housing supports.
Today’s action requests the Board to approve and authorize acceptance of $11,313,642, $784,859, and $2,559,215, respectively in RWTEA Part A, RWTEA Part A Minority AIDS Initiative, and Ending the HIV Epidemic funding to support HIV care and treatment activities.
This item supports the County vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished through education, prevention, and intervention to interrupt transmission of disease in the region. This item also supports the County Getting to Zero initiative by planning and allocating resources dedicated to services for residents who are vulnerable to or living with HIV.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Waive Board Policy B-29, Fees, Grant, Revenue Contracts - Department Responsibility for Cost Recovery, which requires prior approval of grant applications and full-cost recovery of grants.
2. Authorize the acceptance of $11,313,642 and $784,859 in grant funds from the United States Health Resources and Services Administration for the period of March 1, 2024 through February 28, 2025 for Ryan White Part A and Ryan White Part A Minority AIDS Initiative respectively, and authorize the Agency Director, Health and Human Services Agency or designee, to execute all required grant documents, upon receipt, including any annual extensions, amendments and/or revisions thereto that do not materially impact or alter the services or funding level.
3. Authorize the acceptance of an additional $2,559,215 in grant funds from the United States Health Resources and Services Administration for the period of March 1, 2024 through February 28, 2025 for Ending the HIV Epidemic, and authorize the Agency Director Health and Human Services Agency or designee, to execute all required grant documents, upon receipt, including any annual 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, or designee, to apply for any additional funding opportunity announcements, if available, to address the prevention, testing, care and treatment needs of those impacted by HIV.
EQUITY IMPACT STATEMENT
In San Diego County in 2023, gay, bisexual, and other men who have sex with men comprise 48% of recent HIV diagnoses and 70% of persons living with HIV. HIV has disproportionately impacted some of San Diego County’s most vulnerable residents, who include Black and Hispanic communities, gay, bisexual, and other men who have sex with men. Local surveillance data from 2023 demonstrated that Blacks comprise less than 6% of the county population but comprise 13% of recent HIV diagnoses. Hispanics comprise 35% of the county population yet comprise 53% of recent HIV diagnoses. Because of the disproportionate impacts of HIV among communities of color, community engagement efforts have been utilized to plan and provide services that address issues such as stigma, medical mistrust and access to care.
The County of San Diego Health and Human Services Agency, Public Health Services works in partnership with the HIV Planning Group, an official advisory board to the San Diego County Board of Supervisors to address the needs of persons living with HIV, particularly those with disproportionate impact, as described above. The HIV Planning Group is comprised of people living with HIV, service providers, subject matter experts, HHSA designees, community members and designees from each supervisorial district. The HIV Planning Group conducts needs assessments of system capacity and capabilities every three years. This includes engaging with different impacted communities through focus groups. These engagement efforts play an impactful role in informing decisions and ensuring resources are effectively and equitably distributed to serve the needs of those most impacted by HIV in San Diego County. The last needs assessment was conducted in 2021 and the results led to service changes as a result of COVID-19, including temporary housing, transportation and food services. The next needs assessment is currently being conducted.
SUSTAINABILITY IMPACT STATEMENT
By increasing capacity and services aimed to prevent, identify, and treat HIV, the proposed action aligns with the County of San Diego (County) 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 Diego residents. Testing and identification of those unaware of their HIV status, and treatment of HIV will improve the overall health of communities and reduce the demand of associated care services, while increasing effectiveness of care providers and lowering operating costs.
FISCAL IMPACT
Recommendation #2: Authorize acceptance of Ryan White Treatment Extension Act (RWTEA) Part A and RWTEA Part A Minority AIDS Initiative funding
Funds for this request are included in the Fiscal Year (FY) 2024-26 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated costs of $12,268,293 and revenue of $12,098,501 in FY 2024-25. The funding source for this grant is the United States Health Resources and Services Administration. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These unrecovered costs are estimated to be $169,792. The funding source for these costs will be existing Realignment. The public benefit for providing these services far outweighs the costs. There will be no change in net General Fund cost and no additional staff years.
Recommendation #3: Authorize acceptance of Ending the HIV Epidemic funding
Funds for this request are partially included in the Fiscal Year (FY) 2024-26 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated costs of $2,650,793 and revenue of $2,559,215. The funding source for this grant is the United States Health Resources and Services Administration. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These unrecovered costs are estimated to be $91,578. The funding source for these costs will be existing Realignment. The public benefit for providing these services far outweighs the costs. There will be no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
The HIV Planning Group reviewed this item at its meeting on July 24, 2024, and recommended approval.
BACKGROUND
The County of San Diego (County) Health and Human Services Agency, Public Health Services leverages various resources to effectively support the needs of individuals vulnerable to or living with HIV, including ensuring the availability of testing, prevention, and treatment services.
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 in San Diego County. 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 nearly 15,000 people living with HIV in San Diego County and an estimated 1,300 persons living with but unaware of their HIV status.
Recommendation #2: Authorize acceptance of Ryan White Treatment Extension Act (RWTEA) Part A and RWTEA Part A Minority AIDS Initiative funds
The Board has authorized grants and agreements with the United States Health Resources and Services Administration (HRSA) to provide care and treatment services to persons living with HIV for over three decades. Established in 1990, services funded by the Ryan White Treatment Extension Act (RWTEA) Part A and RWTEA Part A Minority AIDS Initiative revenue play a vital role in supporting the County efforts to end the HIV epidemic in San Diego County. RWTEA Part A services fill gaps in the local HIV service delivery system by ensuring individuals living with HIV have access to high quality HIV primary care and additional support services. Funded services include HIV primary medical and dental care, case management, mental health services, substance use disorder treatment services, emergency financial assistance, emergency and temporary housing assistance, and other supportive services. Currently, in San Diego County, over 3,300 persons living with HIV receive at least one of these services funded by RWTEA each year.
The goal of the RWTEA is to ensure all persons living with HIV are linked to and are retained in HIV primary medical care. The key measure of success is to achieve viral suppression. Viral suppression occurs when a person living with HIV has 200 or less copies of HIV in a millimeter of blood, at which point the virus is deemed “suppressed.” A person living with HIV who is not virally suppressed would expect to have 50,000 or more copies of HIV in a milliliter of blood. When viral suppression occurs, HIV can no longer do any further damage to the immune system. When a person living with HIV has been virally suppressed for six months or longer, they cannot transmit HIV sexually to anyone else. In 2022, 57% of people living with diagnosed HIV achieved viral suppression in San Diego County. Patients in the RWTEA Part A system of care have even better rates of viral suppression. In Ryan White fiscal year 2022-23 (March - February), patients receiving RWTEA Part A services in San Diego County, who had a recorded viral load test, showed a suppression rate of 92%. Additional data from HRSA, which oversees the Ryan White program, shows that in 2022 San Diego County had one of the highest viral suppression rates of the 52 jurisdictions funded in the United States and Puerto Rico at 92.8%.
RWTEA Part A Minority AIDS Initiative was established in 1999 to improve access to HIV care and health outcomes for persons of color. Services funded by the RWTEA Part A Minority AIDS Initiative include outreach, medical case management, non-medical case management, mental health counseling, outpatient substance use disorder treatment, and medical transportation services. In Ryan White fiscal year 2022-23, there were 326 clients served in Part A Minority AIDS Initiative, of whom 92% were virally suppressed.
Recommendation #3: Authorize acceptance of Ending the HIV Epidemic funding
The Ending the HIV Epidemic initiative seeks to reduce new HIV infections in the United States to less than 3,000 per year by 2030. The initiative has four pillars and closely aligns with the local Getting to Zero initiative:
• Pillar One: Diagnose all people with HIV as early as possible.
• Pillar Two: Treat people with HIV rapidly and effectively to reach sustained viral suppression.
• Pillar Three: Prevent new HIV transmissions by using proven interventions, including pre-exposure prophylaxis; and
• Pillar Four: Respond quickly to potential HIV outbreaks to get needed prevention and treatment service to people who need them.
Funding from the Ending the HIV Epidemic initiative enhances and supports the efforts of Ryan White services. Since the inception of this funding in 2020, the County has largely focused its efforts on community engagement and community leadership training and development, and re-engagement in medical care for persons living with HIV who have fallen out of medical care. A three-year community engagement project that ended in early 2024 focused on women and youth. Over 300 women and youth were reached through outreach, community forums, and support groups. Leadership training and development have prepared emerging leaders in community planning efforts for HIV. Each year, three training cohorts are implemented and are comprised of 8-10 individuals per cohort. Four graduates of leadership training and development are currently serving on the HIV Planning Group. Re-engagement efforts have been successful with 70% of people who had fallen out of HIV primary care, relinking through efforts of these services. Future plans for this funding include implementation of comprehensive low barrier medical care, housing supports, and medical advocacy.
Today’s action requests the Board to approve and authorize acceptance of $11,313,642, $784,859, and $2,559,215, respectively in Ryan White Part A, Ryan White Part A Minority AIDS Initiative, and Ending the HIV Epidemic funding to support HIV care and treatment activities.
A waiver of Board Policy B-29 is requested because the funding does not offset all costs. Recommendation #2: Unrecovered costs are estimated at $169,792 for FY 2024-25, for Ryan White Part A and Ryan White Part A Minority AIDS Initiative funding. The funding source for these unrecovered costs will be existing Realignment. Recommendation #3: Unrecovered costs are estimated at $91,578 for FY 2024-25, for Ending the HIV Epidemic funding. The funding source for these unrecovered costs will be existing Realignment. The public benefit for providing these services far outweighs these costs filling an important gap in the local HIV service delivery system and ensuring individuals with HIV have access to high quality HIV primary care.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed action supports 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,
EBONY N. SHELTON
Chief Administrative Officer
ATTACHMENT(S)
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