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DATE: |
October 22, 2024 |
07 |
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 California Department of Public Health Office of AIDS (CDPH-OA) to reduce transmission of HIV in San Diego County for almost three decades.
Today’s action requests the Board to authorize the acceptance of $7,592,529 in grant funds for High Impact Prevention and Surveillance Programs for Health Departments and $8,879,370 in grant funds for High Impact Prevention and Surveillance Programs for Health Departments - Ending the HIV Epidemic. Both grants are from the CDPH-OA and are for the period of August 1, 2024, through May 31, 2029. Lastly, today’s action requests the Board authorize applications for future funding opportunities to support the prevention, testing, care, and treatment needs of those impacted by HIV.
This item supports the County of San Diego (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 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 living with or vulnerable to HIV.
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 $7,592,529 in grant funds for High Impact Prevention and Surveillance Programs for Health Departments from the California Department of Public Health, Office of AIDS for the period of August 1, 2024 through May 31, 2029, for HIV services related to prevention, and authorize the Deputy Chief Administrative Officer, 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 $8,879,370 in grant funds for High Impact Prevention and Surveillance Programs for Health Departments - Ending the HIV Epidemic from the California Department of Public Health, Office of AIDS for the period of August 1, 2024 through May 31, 2029, for Ending the HIV Epidemic services related to prevention, and authorize the Deputy Chief Administrative Officer, 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 Deputy Chief Administrative Officer, 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
HIV has disproportionately impacted some of San Diego county’s most vulnerable residents, which includes Black and Hispanic communities and 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. 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.
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. The HIV Planning Group is comprised of people living with HIV, service providers, subject matter experts, HHSA representatives, 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.
SUSTAINABILITY IMPACT STATEMENT
The proposed actions align with the County of San Diego Sustainability Goal #2 to provide just and equitable access and Sustainability Goal #4 to protect health and well-being. This will be accomplished by increasing capacity and services aimed to prevent, identify, and treat HIV. Testing, identification, and treatment of HIV will improve the overall health of communities, reduce the demand of associated care services, while increasing effectiveness of care providers and lowering operating costs.
FISCAL IMPACT
Recommendation #2: High Impact Prevention and Surveillance Programs for Health Departments
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 $1,248,573 and revenue of $1,199,969 in FY 2024-25, and estimated costs of $1,611,794 and revenue of $1,549,050 in FY 2025-26, for an estimated total of $7,900,062 in costs and $7,592,529 in revenue through FY 2029-30. The funding source for this grant is the California Department of Public Health Office of AIDS (CDPH-OA). A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These unrecovered costs are estimated to be $48,604 for FY 2024-25, and $62,744 for FY 2025-26. The total unrecovered costs are estimated to be $307,533 through FY 2029-30. 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: High Impact Prevention and Surveillance Programs for Health Departments - Ending the HIV Epidemic
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 $1,433,097 and revenue of $1,398,700 in FY 2024-25, and estimated costs of $1,856,905 and revenue of $1,812,335 in FY 2025-26, for an estimated total of $9,097,734 in costs and $8,879,370 in revenue through FY 2029-30. The funding source for this grant is the California Department of Public Health Office of AIDS (CDPH-OA). A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These unrecovered costs are estimated to be $34,397 for FY 2024-25, and $44,570 for FY 2025-26. The total unrecovered costs are estimated to be $218,364 through FY 2029-30. 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 September 25, 2024, and recommended approval of the recommendations.
BACKGROUND
The County of San Diego (County) Health and Human Services Agency, Public Health Services (PHS) leverages various resources to effectively support the needs of individuals vulnerable to or living with HIV, including ensuring 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.
According to County HIV surveillance data, as of December 31, 2023, there were nearly 15,000 people living with HIV in the county and an estimated 1,300 persons living with HIV who are unaware of their HIV status. In 2016, at the beginning of Getting to Zero, there were 538 newly reported cases of HIV in San Diego County. In 2023, there were 409, indicating a 25% decrease since 2016. Despite this decrease in 2023, on average, every day in San Diego County a new case of HIV was diagnosed, indicating that HIV continues to be a major public health concern in the region.
Ending the HIV epidemic is possible due to substantial advances in HIV treatment and HIV prevention. Treatment for persons living with HIV, known as anti-retroviral therapy (ART) is highly effective. When taken as prescribed, ART can stop HIV disease progression and ensure persons living with HIV infection can live near-normal lifespans without the complications of HIV disease. Persons living with HIV infection who are successfully treated cannot transmit HIV sexually to others. Furthermore, some of the same drugs used to treat HIV can be up to 99% effective at preventing infection when taken by those who are HIV-negative. HIV drugs can even prevent HIV infections in persons who are HIV-negative but have had a very recent high-risk exposure to HIV within the prior 72 hours.
The County receives funding for HIV prevention services from the California Department of Public Health Office of AIDS (CDPH-OA), which originates from the Centers for Disease Control and Prevention funding. The two grants include the High Impact Prevention and Surveillance Programs for Health Departments funding and the High Impact Prevention and Surveillance Programs for Health Departments - Ending the HIV Epidemic funding. These two grant components align, and the funding supports testing, outreach, health education, linkage to medical services, comprehensive services for persons who inject drugs and transgender individuals, benefits navigation, and continuation of a mobile resource guide for HIV services throughout San Diego County. In 2023, this funding provided 440,000 visits on websites hosted by HIV prevention providers, 21,000 HIV tests, 9,255 outreach contacts in which HIV education and testing information was provided, 843 residents with linkage to pre-exposure prophylaxis (PrEP) medication used to prevent HIV acquisition, 520 residents with linkage to health and other benefits programs such as primary care, mental health and substance use treatment services, and 500 hepatitis C tests. Additionally, 81% of persons newly diagnosed with HIV were linked to anti-retroviral therapy within 10 days of diagnosis, and 97% were linked within 30 days.
Today’s action requests the San Diego County Board of Supervisors to authorize the acceptance of $7,592,529 in grant funds for High Impact Prevention and Surveillance Programs for Health Departments and $8,879,370 in grant funds for High Impact Prevention and Surveillance Programs for Health Departments - Ending the HIV Epidemic. Both grants are from the CDPH-OA and are for the period of August 1, 2024, through May 31, 2029. Lastly, today’s action requests the Board authorize applications for future funding opportunities to support the prevention, testing, care, and treatment needs of those impacted by HIV.
A waiver of Board Policy B-29 is requested because the funding does not offset all costs. Today’s action will result in: Recommendation #2: Estimated costs of $1,248,573 and revenue of $1,199,969 in FY 2024-25, and estimated costs of $1,611,794 and revenue of $1,549,050 in FY 2025-26, for an estimated total of $7,900,062 in costs and $7,592,529 in revenue through FY 2029-30, for High Impact Prevention and Surveillance Programs for Health Departments. The unrecovered costs are estimated to be $48,604 for FY 2024-25, and $62,744 for FY 2025-26. The total unrecovered costs are estimated to be $307,533 through FY 2029-30. The funding source for these unrecovered costs will be existing Realignment. Recommendation #3: Estimated costs of $1,433,097 and revenue of $1,398,700 in FY 2024-25, and estimated costs of $1,856,905 and revenue of $1,812,335 in FY 2025-26, for an estimated total of $9,097,734 in costs and $8,879,370 in revenue through FY 2029-30, for High Impact Prevention and Surveillance Programs for Health Departments - Ending the HIV Epidemic. The unrecovered costs are estimated to be $34,397 for FY 2024-25, and $44,570 for FY 2025-26. The total unrecovered costs are estimated to be $218,364 through FY 2029-30. The funding source for these unrecovered costs will be existing Realignment. The public benefit for providing these services far outweighs these costs, as CDPH, Office of AIDS High-Impact HIV Prevention and Surveillance Programs for Health Departments funding fills an important gap in the local HIV service delivery system by ensuring support for HIV prevention contracts deployed into the community.
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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