Situational AnalysisCentral Ohio EHE Advisory Committee

August 20, 2020

Epi Overview

Response Overview

Team

Melissa Federman, MPHConsultantThe Center for Community Solutionsmtfederman@gmail.com

Loren Anthes, MBA Public Policy Fellow, Center for Medicaid PolicyThe Center for Community Solutionslanthes@communitysolutions.com

What We Will Cover

•Flow of Dollars

•Regional Response by EHE Pillar• Programming & Funder• Capturing Your Insight• This is a first step

The Bigger Picture

Ohio Department of Health Funding Sources

CDC

• EHE Health District Funding: $3.2M

• Health Service Prevention Specialist: $70k

• Epidemiology investigator: $61k

• Contractor to administer testing at home program: $300k

• HIV Surveillance, Component A: $870k

• HIV Prevention, Component A: $4.8M

• STD Control Grants: $3.1M

HRSA

• Ryan White Part B: $7.2M

• Covers MCM and NMCM

• Emerging Communities Award (Hamilton Co only): $342k

• CARES Act Support for RW: $641k

• ADAP: $16.9M

Ohio GRF

• HIV/AIDS Prevention: $3.5M

• Personnel, testing, local funding support, TPA for PrEP

• Rebates ($30M)

• Supports open drug formulary, expansion to 500%FPL

• Covers OAMC, medical transportation, translation services, mental and oral health & health insurance premiums

How it Works (Ryan White)

Health Resources & Services Administration (HRSA)

Ohio Department of Health (ODH) - Administration

PLWHA (Medication, Co-pay/Insurance premiums)

Columbus Public Health

Equitas & Southeast, Inc. (Medical and Non Medical Case Management)

Part A

Part

B

OH

DA

P

Pro

gram • Medicaid

• Private Insurance• SAMSHA• Private philanthropies and

donors• CDC (HIV prevention)• Ohio general (tax) revenue

fund

-Nationwide Children’s -Equitas

Pillar 1: Diagnose all Ohioans with HIV as early as possible after infection.

Activities supporting this strategy:• Improved, more accessible, and routine HIV testing• Immediately connecting people with HIV to care

services• Connecting those who test negative to appropriate

prevention services

Continuum Crosswalk: HIV Positive & Unaware, HIV Diagnosed, Linked to Care

Diagnose

Program Funder Sites/ModelsRoutine* HIV testing – EDs Integrated OSU East

• pilot for HIV/Syphilis Mt. Carmel

Routine HIV testing – CHCs, HDs, RHCs CPH CPHTitle X/ODH

HRSA/EHEHRSA/EHEHRSA/EHE/GileadHRSA/EHE/Gilead

Equitas Health (3)AHFCPHPlanned ParenthoodHeart of Ohio (coming)OSU (coming)SE Community Mental HealthPrimary One (coming)

Routine HIV testing – SUD programs CPH/ADAMH CPH outreach• Maryhaven• CompDrug• Centaro

*routine = culturally competent, barrier-free access to HIV testing offered to all patients+public = Medicaid, Medicare

Diagnose

Program Funder Sites/ModelsTargeted HIV testing in nonclinical settings ODH/GRF + CDC/CPH

(appendix X for details on sites)

CPH

Title X

CTR with cross organization teamEquitasCPH - South End Bar (outreach focus)AHF Out of the Closet Thrift StoreFranklin Co Jail (LGBTQ mens group and womenssolicitation group)CATCH court

HIV testing in pharmacy settings Walgreens HIV Specialty Pharmacy Colocation with Dr. Beasley (ID)

Self-testing ODHPatient

Ohiv.orgWalgreens, CVS

Partner Services = DIS CPH CPH: HIV & Syphilis(& Resistant GC)

*routine = culturally competent, barrier-free access to HIV testing offered to all patients+public = Medicaid, Medicare

Diagnose

Program Funder Sites/ModelsLinkage to Care CPH

Equitas, AHF, CPH

ADAMHS/GRF/Equitas

CPH• Passport to Partner Services (DIS)• Reengagement & data to care (D2C)CPH, AHF, Equitas• Linkage to Care via cross organizational team

(ARTAS-based)Equitas, Safe Pointe (SSP)

STI Testing ODH & integratedTitle X Public+/private insurance & RW

CPHPlanned Parenthood & CPHNetwork of providers including CPH and RW providers

*routine = culturally competent, barrier-free access to HIV testing offered to all patients+public = Medicaid, Medicare

Diagnose: Strengths, Weaknesses, Opportunities, Threats:

Funded QI projects regarding retention and health literacy in system navigation.

More shared decision-making and co-creation with community members.

Health literacy demands we put on clients.

More transparency on the part of organizations regarding changes (eg, case manager turnover and access).

Lack of navigation once diagnosed.

Providing overall healthy living to prevent comorbidities.

To create a one-stop-shop for services and create more convenience for individuals and coordinate.

HIV Legislation in the state of Ohio – comes with stigma, lack of routine testing in PC settings.

Lack of trust.

Lack of diversity of providers

SWOT

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Helpful Harmful

Achieving this target requires:

• Promptly linking individuals newly diagnosed with HIV to care and treatment, including through rapid start treatment programs;

• Finding innovative and effective ways to re-engage Ohioans who are aware of their infection but not receiving HIV care and treatment; and

• Supporting those already in care who have not yet achieved viral suppression to achieve control of the virus.

Pillar 2: Treat people in Ohio living with HIV rapidly and effectively to reach sustained viral suppression.

Continuum Crosswalk: Retained in Care, Re-engaged in Care, Virally Suppressed

Treat

Program Funder Sites/ModelsLinkage to Care CPH

Equitas, AHF, CPH

ADAMHS/GRF/Equitas

CPH• Passport to Partner Services (DIS)• Reengagement & data to care (D2C)CPH, AHF, Equitas• Linkage to Care via cross organizational team (ARTAS-based)Equitas, Safe Pointe (SSP)

Rapid ART Integrated (case-by-case based on patient readiness)EquitasAHFNationwide Children’s OSU

Medical Transportation CPH/RWPA & RWPB Rebates

RWPB RebatesMedicaid

EquitasAHFNationwide Children’s OSU• Bus passes, gas cards, taxi services, flexible funds for

subgranteesSoutheast, IncIndependent network

Treat

Program Funder Sites/ModelsHIV Primary Care/OAMC CPH/RWPA

CPH/RWPA & RWPCCPH/RWPA & RWPCMedicaidODH/RWPB RebatesIntegratedVA

AIDS Healthcare FoundationOSUEquitasNationwideDr. Murray (Fairfield)Nationwide Children’s HospitalEquitasIndependent network of providersDr. Weiss, Dr. Herbert, Dr. Beasley, Dr. Keeling (ID consultants) Grant HospitalVA (Chillicothe)

HIV Medication Assistance(home delivery?)

CPH/RWPAODH/RWPBMedicaidPAPsNIH

EFA exception (CBCF)OHDAP (open formulary); mail order, pharmacyMail order, pharmacy

OSU AIDS Clinical Trials Group (experimental)

Treat

Program Funder Sites/ModelsMedical Case Management CPH/RWPA & ODH/RWPB

CPH/RWPA

ODH/RWPB

EquitasAIDS Healthcare FoundationNationwideOSUDr. Murray (Fairfield)Southeast Inc.

Community Health Worker HRSA/CPH/EHE Equitas (Hybrid Peer Nav/CHW)EFA CPH/RWPA Equitas

• Medications (exceptions)Early Intervention Services(4 parts)

CPH/RWPA Funds used to augment testing (CTR) and linkage to care (see above)

Oral Health Care ODH/RWPB Rebates Medicaid

Network in progress (provider agreements out)Independent network

Mental Health Services CPH/RWPA ODH/RWPB RebatesIntegratedIntegrated Medicaid

EquitasNetwork in progress (provider agreements out)AHFNationwideProvider network

Treat

Program Funder Sites/ModelsFood Bank/Home Delivered Meals (non-HIV) Mid-Ohio independent network

Lifecare Alliance (for HIV and cancer patients)• Delivery

Non-Medical Case Management (lower acuity clients)

CPH/RWPA EquitasAHFChildren’s CPH(14 staff covered)

Psychosocial Support CPH/EHE Equitas• support groups

Legal Services Integrated Equitas• Trans and non-binary legal needs

TransHealth Integrated EquitasOSUNationwide Children’s THRIVE Clinic

Data to Care CPH HD based and staffed

Treat

Program Funder Sites/ModelsHousing Case Management CPH/RWPA &

HOPWA

Ohio Means Jobs network

Equitas Lancaster Fairfield Community ActionLicking Coalition for Housing Jewish Family Services• Employment readiness and linkage to jobs

Housing Support Services (Employment)

HOPWA Jewish Family Services• Employment readiness and linkage to jobs

Housing Resources – Financial HOPWA EquitasLancaster Fairfield Community ActionLicking Coalition for Housing • Short term rent, mortgage and utility assistance (STRMU)• Permanent housing placement• Tenant based rental assistance (TBRA)

Linguistic support ODH/RWPB Rebates EquitasSoutheast, Inc.

Health insurance premiums/co-pays

ODH/RWPB Rebates OHDAP

Treat: Strengths, Weaknesses, Opportunities, Threats:

Cultural and system competency of case managers.

Additional funding for FQHCs that will increase provider capacity with complementary services.

Cultural and system competency of case managers.

Diversity in the whole spectrum of providers/ “providers that look like us”.

SWOT

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Helpful Harmful

Scale-up needed and proven prevention interventions and strategies.

Pillar 3: Prevent new HIV transmissions in Ohio by using proven interventions, including (PrEP) and syringe services programs (SSPs).

HIV Continuum Cross Walk: HIV Negative & At Risk

Prevent

Program Funder Sites/Models

PEP Integrated/AGIntegrated/AGODH/EHE

AHFEquitasCPH/partners

PrEP (Prescribing/Follow Up)

Integrated/Medicaid/Private Insurance/PAPI (ODH/GRF)HRSA/EHEHRSA/EHEHRSA/EHEHRSA/EHEODH/EHENIH

(CPH & OHIV.org list)

Heart of OhioOSUSE Community Mental HealthPrimary OneCPHOSU AIDS Clinical Trials Group (research)

TelePrEP Integrated/PAPI (assume for most OHIV.org providers due to covid-19)EquitasOSUCPH

PrEP Navigation ODH/EIS Equitas

Prevent

Program Funder Sites/ModelsPrEP Assistance ODH/GRF PAPI

Access aside from Ohiv.org(assume navigators/EIS)?

SSP CPH/Equitas Equitas• SafePoint

Condom distribution CPH ODH/GRF

By requestOHIV.org

Evidence Based Interventions (EBIs) Equitas• Mosaic

Social marketing/campaigns/info distribution

CPHODH AHF EquitasGilead

KNOW HIVPrEPSTI/HIV awareness?PrEP

Prevention case management/addressing SDOH

ODH 2019 model of care for community- based testers

Prevent: Strengths, Weaknesses, Opportunities, Threats:

PrEP awareness increasing (but more work to do!).

Lack of knowledge regarding PEP prescribing by providers (ER, PCPs).

Hours of operation limiting access to PEP affecting course of treatment effectiveness.

Currently do not prescribe PEP as a standard.

Leveraging wellness model to address social factors that contribute to success/health.

Lack of insurance coverage for Rx may cause access issues.

Attacks on ACA.

Reducing services for trans individuals via federal govt.

Institutionalized racism.

SWOT

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Helpful Harmful

Achieving this target requires:

Pillar 4: Respond quickly to potential HIV outbreaks to get needed prevention and treatment services to Ohioans who need them.

• Using data to identify where HIV is spreading most rapidly and guide decision-making to address prevention, care, and treatment needs

• Supporting jurisdictions to establish local teams committed to the success of the EHE plan who will work with the community to design & develop tailored plans to expand HIV prevention and treatment services

• Increasing investments in geographic hotspots

Respond

Program Funder Sites/Models

Planning ODH/CDC CPH• Surveillance• DIS• Molecular surveillance• Frontline staff

Training ODH/CDC CPH• Among staff

Collaboration (ODH) ODH/CDC CPH

Respond: Strengths, Weaknesses, Opportunities, Threats:

Monthly HIV assessment via CPH with data trends, utilization.

Focusing on behavior of individuals over systemic factors which may influence outcomes.

Potential deficit in lab capacity for molecular testing.

Community and education in molecular surveillance.

Increasing SSP availability in more geographies.

Addressing social determinants.

Social determinants

HIV criminalization law and how it intersects with molecular surveillance.

SWOT

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Where to Send Feedback

Melissa Federman, MPHConsultantThe Center for Community Solutionsmtfederman@gmail.com

Loren Anthes, MBA Public Policy Fellow, Center for Medicaid PolicyThe Center for Community Solutionslanthes@communitysolutions.com