SUBJECT
Title
AUTHORIZATION TO ACCEPT HIV/AIDS SERVICES GRANT FUNDING AND AUTHORIZATION TO PURSUE FUTURE FUNDING OPPORTUNITIES FOR HIV/AIDS SERVICES (DISTRICTS: ALL)
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OVERVIEW
For 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 to provide a variety of care and treatment services to persons living with HIV. These funding sources include the Ryan White HIV/AIDS Treatment Extension Act of 2009 (RWTEA) Part A and the RWTEA Part A Minority AIDS Initiative (MAI).
The RWTEA Part A and RWTEA Part A MAI comprise the single largest federal funding source for HIV services received by the County of San Diego (County). The one-year grant term is March 1, 2021 through February 28, 2022. The RWTEA Part A funding is $10,594,101, and the RWTEA Part A MAI funding is $742,177, for a total of $11,336,278. 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.
Today’s action requests that the Board accept this ongoing source of grant funding for HIV/AIDS services. Additionally, if approved, today’s actions would authorize the application for any additional funds to be used to address testing, prevention and care, and treatment needs of individuals and families in San Diego County who are impacted by HIV/AIDS and/or STDs.
This item supports the County’s Getting to Zero initiative by funding services that help people living with HIV remain in care and achieve viral suppression. Research has demonstrated that persons who have achieved viral suppression are not able to transmit HIV to others sexually. This item also supports the Live Well San Diego vision by building better health through providing access to high quality HIV care and treatment services that lead to improved physical and behavioral health which promotes a healthy, safe, and thriving region.
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 $10,594,101 and $742,177 in grant funds from the Health Resources and Services Administration for the period of March 1, 2021 through February 28, 2022, for Ryan White Part A and Part A Minority AIDS Initiative respectively 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 any additional funding opportunity announcements, if available, to address the prevention, testing, care, and treatment needs of those impacted by HIV/AIDS and other sexually transmitted diseases.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year 2020-22 Operational Plan in the Health and Human Services Agency. If approved, this request will result in estimated costs of $3,835,000 and revenue of $3,778,759 in Fiscal Year 2020-21 and estimated costs of $7,670,000 and revenue of $7,557,519 in Fiscal Year 2021-22. The funding sources are Ryan White Part A and Part A Minority AIDS Initiative revenue from the Health Resources and Services Administration. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These costs are estimated at $56,241 for Fiscal Year 2020-21 and $112,481 for Fiscal Year 2021-22. 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 costs and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
The HIV Planning Group reviewed this item and voted to accept the recommendations on March 24, 2021.
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, such as medical case management and mental health 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, such as pre-exposure prophylaxis, that provides 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, 2019, an estimated 13,996 people were living with HIV in San Diego County. In 2019, there were 368 newly diagnosed HIV cases in San Diego County, which is a decrease of 26% from the 499 diagnosed cases in 2016. 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.
The County of San Diego (County) has received Ryan White Part A funds since 1991. Services funded by Ryan White Treatment Extension Act (RWTEA) Part A and RWTEA Part A Minority AIDS Initiative (MAI) revenue play a vital role in the County’s Getting to Zero initiative. RWTEA Part A funding currently provides services for people living with HIV with no other payer source for services. Funded service categories include HIV primary medical and dental care, case management, emergency and temporary housing assistance, mental health services, substance use disorder treatment services, and other supportive services. Currently, in San Diego County, almost 4,000 persons living with HIV receive at least one of these services funded by RWTEA Part A.
The goal of the RWTEA is to ensure all people living with HIV are linked to and are retained in HIV primary medical care. The key measure of success is the rate of viral suppression. 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. However, when treated, the number can drop below 200, at which point the virus is deemed “suppressed.” When that happens, 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 2019, 59% 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 2020, patients receiving RWTEA Part A services in San Diego County, who had a recorded viral load test, showed a suppression rate of 91%, (2,566 of 2,815). San Diego County continues to have one of the highest viral suppression rates of the 52 Ryan White jurisdictions funded in the United States and Puerto Rico according to U.S. Department of Health and Human Resources and Services Administration (HRSA).
RWTEA Part A MAI was established in 1999 to improve access to HIV care and health outcomes for persons of color. Services funded by MAI include outreach, medical case management, non-medical case management, mental health counseling, outpatient substance use disorder treatment, and medical transportation services. In calendar year 2020, there were 330 clients served in Part A MAI. Of those, 93% were virally suppressed (278 of 300).
On October 7, 2020, the County Health and Human Services Agency submitted the annual RWTEA Part A funding application to HRSA. On March 23, 2021, HRSA notified the County of an award of $11,336,278 for the term of March 1, 2021 through February 28, 2022. This Board request is occurring later than usual due to the HRSA award notification timeline. Funding awarded includes $10,594,101 in RWTEA Part A revenue, and $742,177 in RWTEA Part A MAI revenue. In comparison, funding for RWTEA Part A and funding for RWTEA Part A MAI were $78,319 less than funding received in the prior period. The RWTEA Part A funding formula is based on the number of people living with HIV within the jurisdiction and the competitiveness of the County’s annual application for funding. The RWTEA Part A MAI funding formula is based on the number of persons of color living with HIV within the jurisdiction. The HIV, STD, and Hepatitis Branch of Public Health Services received a score of 99 out of 100 on the RWTEA 2021 application. This is the highest score received on the application in the past ten years. The review committee cited all strengths and no weaknesses.
A waiver of Board Policy B-29 is requested because the funding does not offset all costs. Unrecovered costs are estimated at $55,829 for Fiscal Year 2020-21, and $111,658 for Fiscal Year 2021-22. The funding source for these unrecovered costs will be existing Health Realignment allocated for these programs. The public benefit for providing these services far outweighs these costs. RWTEA Part A fills an important gap in the local HIV service delivery system by ensuring individuals with HIV have access to high quality HIV primary care. It is important for persons living with HIV be linked to and retained in HIV primary medical care. The key measure of success is the rate of viral suppression. When HIV is suppressed, HIV does no further damage to the immune system, and if someone has been virally suppressed for six months or longer, they cannot transmit HIV sexually to anyone else. These aspects are keys to advancing the Getting to Zero initiative, which is an overwhelming benefit to the public. The Agency Director, Health and Human Services Agency, certifies that these activities would be worthy of funding with County resources if external financing were unavailable.
Today’s action seeks authorization to accept $10,594,101 in RWTEA Part A funding and $742,177 in RWTEA Part A MAI funding from HRSA for the period of March 1, 2021 through February 28, 2022, and to authorize the Clerk of the Board to execute all required grant documents, upon receipt. Today’s request would also authorize the application for any additional funds to be used to address testing, prevention and care, and treatment needs of individuals and families in San Diego County who are impacted by HIV/AIDS and/or STDs.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed action supports the Building Better Health and Living Safely initiatives in the County of San Diego’s 2021-2026 Strategic Plan as well as the Live Well San Diego vision 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)
N/A
AGENDA ITEM INFORMATION SHEET
REQUIRES FOUR VOTES: ☐ Yes ☒ No
WRITTEN DISCLOSURE PER COUNTY CHARTER SECTION 1000.1 REQUIRED
☐ Yes ☒ No
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PREVIOUS RELEVANT BOARD ACTIONS: June 23, 2020 (7), Accept HIV/AIDS Services Grant Funding Agreement; May 21, 2019 (9), Accept HIV/AIDS Services Grant Funding Agreement; September 11, 2018 (8), HIV/AIDS Services Grant Funding Agreement; September 26, 2017 (3), HIV/AIDS Services Grant and Approve Increased Funding for HIV Emergency Pooled Services; June 28, 2016 (9), HIV/AIDS Services Revenue Agreement; March 17, 2015 (5), HIV/AIDS Revenue Agreements and Sole Source Procurement; March 1, 2016 (25), Getting to Zero Initiative; April 15, 2014 (6), HIV/AIDS Revenue and Services; and May 14, 2013 (7), HIV/AIDS Revenue and Services. |
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BOARD POLICIES APPLICABLE: B-29 Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery |
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BOARD POLICY STATEMENTS: Waiver of Board Policy B-29 is requested because the Health Resources and Services Administration revenues do not fully offset all costs. Costs to be waived for Ryan White Treatment Extension Act (RWTEA) Part A and Part A Minority AIDS Initiative are estimated to be $56,241 for Fiscal Year 2020-2021 and $112,481 for Fiscal Year 2021-2022 for the term of the grant. The public benefit for providing these services far outweighs these costs. RWTEA Part A fills an important gap in the local HIV service delivery system by ensuring individuals with HIV have access to high quality HIV primary care. The Agency Director, Health and Human Services Agency, certifies that these activities would be worthy of funding with County resources if external financing were unavailable. |
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MANDATORY COMPLIANCE: N/A |
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ORACLE AWARD NUMBER(S) AND CONTRACT AND/OR REQUISITION NUMBER(S): 114618, 125795 |
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ORIGINATING DEPARTMENT: Health and Human Services Agency |
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OTHER CONCURRENCE(S): |
N/A |
CONTACT PERSON(S):
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Wilma J. Wooten, M.D., M.P.H. |
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Patrick Loose |
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Name |
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Name |
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(619) 542-4177 |
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(619) 293-4709 |
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Phone |
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Phone |
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Wilma.Wooten@sdcounty.ca.gov |
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Patrick.Loose@sdcounty.ca.gov |
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E-mail |
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E-mail |