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DATE: |
November 15, 2022 |
07 |
SUBJECT
Title
AUTHORIZATION TO ACCEPT ADDITIONAL HIV/AIDS GRANT FUNDING AND APPLY FOR FUTURE FUNDING OPPORTUNITIES (DISTRICTS: ALL)
Body
OVERVIEW
For over 30 years, the San Diego County Board of Supervisors (Board) has authorized grants and agreements with the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) to provide a variety of care and treatment services to persons living with HIV. Today’s action requests Board authorization to accept additional funding from HRSA awarded under Ending the HIV Epidemic: A Plan for America - Ryan White HIV/AIDS Program Parts A and B, in the amount of $1,667,400 for period of March 1, 2020 through February 28, 2025.
Ending the HIV Epidemic: A Plan for America - Ryan White HIV/AIDS Program Parts A and B was a new funding source in 2020 created by HRSA in response to the introduction of the federal End the HIV Epidemic initiative. The County of San Diego (County) was initially awarded a total of $5,000,000 on April 7, 2020 (6). The County has received notice of increases totaling $1,667,400 bringing the award to $6,667,400 for the life of the grant. This funding supports and is utilized for programs and services related to community engagement and leadership development for persons living with HIV, linkage to and retention in HIV care, low barrier medical care and HIV molecular epidemiology, also known as Enhanced Data to Care.
This item supports the County’s 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 by providing access to high-quality HIV care and treatment services that lead to improved physical and behavioral health. In addition, this item supports the County’s Getting to Zero initiative by funding services that will help people living with HIV remain in care and achieve important health outcomes, including viral suppression. Research has demonstrated that persons living with HIV who have achieved viral suppression cannot transmit HIV to others sexually.
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 acceptance of an additional $1,667,400 in grant funds from the Health Resources and Services Administration for the period of March 1, 2020 through February 28, 2025, for Ending the HIV Epidemic: A Plan for America - Ryan White HIV/AIDS Program Parts A and B, and authorize the Clerk of the Board 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 Agency Director, Health and Human Services Agency, to apply for additional funding opportunity announcements, if available, for HIV service-related resources.
EQUITY IMPACT STATEMENT
Since the beginning of the epidemic, HIV has disproportionately impacted the most vulnerable residents. Gay, bisexual, and other men who have sex with men, for instance, are currently estimated to comprise less than 2% (LGBTQ+ Identification Rises to 5.6% in Latest U.S. Estimate, gallup.com) of the adult population, and yet they 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’s population but comprise 12% of recent HIV diagnoses. Hispanics comprise 34% of the population of the county yet comprise 48% of recent HIV diagnoses.
Since its inception in 1990, the Ryan White HIV/AIDS Treatment Extension Act (formerly the Ryan White CARE Act) has focused on ensuring access to treatment and support services for the most vulnerable residents. Thus far during the last grant period (March 1, 2021- February 28, 2022), a total of 3,313 clients received services funded by Ryan White Part A in San Diego County. Of those clients, 54% (1,786) were Hispanic and 13% (423) were Black.
The success in reaching residents and communities most disproportionately impacted by HIV is due in large part to the HIV Planning Group, an official advisory board to the San Diego County Board of Supervisors that also has the legislative authority to allocate Ryan White Part A funding to respond to local needs as determined by review of epidemiologic data and extensive engagement to communities. In partnership with the HIV Planning Group, the County of San Diego Health and Human Services Agency (HHSA) conducts needs assessments every three years among persons living with or those vulnerable to HIV, assessments of system capacity and capabilities every three years, and focus groups with different communities annually. During Fiscal Years 2019-20 and 2020-21, the HIV Planning Group engaged a consultant to conduct a community engagement process to identify how policy, planning, and funding changes could further close the disproportionalities among Black, Hispanic, and transgender communities. The HIV Planning Group and HHSA are currently implementing the recommendations from the final report.
SUSTAINABILITY IMPACT STATEMENT
The proposed actions align with the County of San Diego’s (County) Sustainability Goal #2 to provide just and equitable access and Sustainability Goal #4 to protect health and wellbeing. HIV Epidemic: A Plan for America - Ryan White HIV/AIDS Program Parts A and B funding will provide support to the HIV, STD and Hepatitis Branch of County Health and Human Services Agency, Public Health Services by increasing capacity and services aimed to prevent, identify, and treat HIV. Testing, identification, and treatment will improve the overall health of communities, reduce the demand of associated care services, while increasing effectiveness of care providers and lowering operating costs of facilities, thus reducing greenhouse gas emissions and waste generated within the care sector.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year 2022-24 Operational Plan in the Health and Human Services Agency. If approved, today’s actions will result in estimated costs of $1,713,800 and revenue of $1,667,400 in Fiscal Year 2022-23. The funding source is the federal Ending the HIV Epidemic: A Plan for America - Ryan White HIV/AIDS Program Parts A and B, and Health Realignment. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These costs are estimated at $46,400 for Fiscal Year 2022-23. The funding source for these costs will be existing Health Realignment allocated for these programs. The public benefit for providing these services far outweighs these 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 San Diego HIV Planning Group recommended approval of the recommendations on October 26, 2022.
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: provide HIV testing to those vulnerable to HIV, and link 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 and other services so that persons living with HIV can achieve viral suppression.
3. Prevent: Link those at risk for HIV infection in San Diego County 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, 2020, an estimated 14,237 people were living with HIV in San Diego County. In 2020, there were 302 newly diagnosed HIV cases in San Diego County, which is a decrease of 39% from the 502 diagnosed cases in 2016 when the Getting to Zero initiative began. Despite the reduction, HIV continues to be a major public health concern in San Diego County, with an average of one new HIV diagnosis every day. In 2019, following the leadership demonstrated by several jurisdictions throughout the United States, including the County of San Diego (County), the U.S. Department of Health and Human Services announced a new initiative, Ending the HIV Epidemic: A Plan for America. The 10-year initiative seeks to achieve the goal of reducing 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 (PrEP); and
• Pillar Four: Respond quickly to potential HIV outbreaks to get needed prevention and treatment services to people who need them.
The first major funding opportunity related to the Ending the HIV Epidemic initiative was titled Ending the HIV Epidemic: A Plan for America. In our application for this funding, the County proposed the following ambitious goals:
• Reduce new HIV diagnoses by 75% by December 31, 2024 (from 369 new HIV diagnoses in 2018 to 92 in 2024);
• Increase proportion of persons living with diagnosed HIV who receive care to 95% by December 31, 2024 (from 74% in 2018 to 95% in 2024); and
• Increase proportion of persons living with diagnosed HIV who are virally suppressed to 90% by 2024 (from 63% in 2018 to 90% in 2024).
On October 15, 2019, the County Health and Human Services Agency (HHSA) submitted the grant application to U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA). On February 26, 2020, HRSA notified the County of an award of $5,000,000 total for the term of March 1, 2020 through February 28, 2025. In Fiscal Year 2021-22 HHSA was notified of an increase of $667,000, and in Fiscal Year 2022-23 HHSA was notified of an additional increase of $1,000,400, bringing the total to $6,667,400 for the life of the grant.
In Fiscal Year 2019-20 and Fiscal Year 2020-21, a community engagement project occurred that focused on the needs of Black and Latino gay and bisexual men and other men who have sex with men, and transgender individuals. This project resulted in a three-year action plan that includes recommendations for addressing stigma and medical mistrust. A community engagement project is underway to engage women and youth of all race/ethnicities and develop an action plan for services going forward. Ending the HIV Epidemic: A Plan for America - Ryan White HIV/AIDS Program Parts A and B funds will be used to support future community engagement projects to address needs of persons over the age of 50 living with HIV, currently the largest population of those living with HIV, and Indigenous populations.
In addition to community engagement, funds will be used for leadership development, low-barrier medical care, re-engagement in HIV care (for those who have fallen out of care) and community-informed molecular epidemiology. Leadership development is being conducted to train people living with HIV to serve in leadership roles in community planning on the San Diego HIV Planning Group and the California HIV Planning Group. Low barrier medical care is being implemented as an alternative to traditional medical care that may not work for clients who have difficulty with retention in medical care. Services include drop-in medical visits, incentive-based services, and intensive case management. The ultimate goal of this service is to help this population achieve the best health outcome of viral suppression. Re-engagement in HIV care is utilized to re-engage people living with HIV who have fallen out of care. These services use a rapid linkage model to help people return to care as quickly as possible. Lastly, community informed molecular epidemiology uses gene sequences to identify and respond to clusters of HIV. When a cluster is identified, County Communicable Disease Investigators will contact people in the cluster to ensure linkage to HIV testing, linkage to prevention services and linkage to treatment as needed. The County will also work with persons identified in a cluster to inform any sexual or needle-sharing partners.
A waiver of Board Policy B-29 is requested because the funding detailed below does not offset all costs. Unrecovered costs are estimated at $46,400 for Fiscal Year 2022-23. The funding source for these costs will be Health Realignment. The public benefit for providing these services far outweighs these costs, as the Ending the HIV Epidemic: A Plan for America - Ryan White HIV/AIDS Program Parts A and B funding fills an important gap in the local HIV service delivery system by ensuring individuals with HIV have access to high quality HIV primary care. There will be no change in net General Fund costs and no additional staff years.
Today’s action seeks authorization to accept $1,667,400 in grant funds from HRSA for the period of March 1, 2020 through February 28, 2025, for Ending the HIV Epidemic: A Plan for America - Ryan White HIV/AIDS Program Parts A and B and authorize the Clerk of the Board to execute all required grant documents, upon receipt. Additionally, today’s action requests authorization for the Agency Director, Health and Human Services Agency, to apply for additional funding opportunity announcements, if available, for HIV service-related resources.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed action supports the County of San Diego’s 2022-2027 Strategic Plan Initiatives of Equity (Health) and Community (Quality of Life) by improving access to high-quality and efficient medical care and support services that contribute to improved physical and behavioral health.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Chief Administrative Officer
ATTACHMENT(S)
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