MN HIV Services Planning Council
Meeting Minutes for July 12, 2005
Redeemer Missionary Baptist Church

 

 

I.          Welcome and introductions; lighting of the candle

Paul called the meeting to order at 9:05.  Introductions were made.  Susanne lit the candle sharing a poem that she wrote for the Community Voice Committee (staff has copies for those who are interested). 

 

II.          Review the minutes and proposed agenda

The minutes were approved by unanimous consent.  No changes were made to the proposed agenda.

 

III.   Open Forum

Sarah S. suggested amending the By-laws to extend terms.  This would accommodate mandated seats that need to be filled, but for which it will be difficult to find other interested individuals to fill them.  Examples ware the City of Minneapolis or Title IV.  This issue was referred to the Operations Committee.

 

IV.     Co-chair updates

Paul shared that there are lots of things coming up.  The CSAD (CARE Systems Demonstration Project) Plan of Action will take place on July 25^th and 26^th – he encouraged all who can to attend because the recommendations developed at this meeting, based on the CSAD findings, will be reported to the Planning Council to incorporate into long term plans for prioritization and allocation.  If a Planning Council member is not able to be there on the morning of the 25^t   it’s probably less useful to attend the second day because the work planned after that will be based on the findings, which will be reported in the morning of the 25th.  Jonathan provided some additional background on the project. 

 

Paul invited Council members to check on the Planning Council website.  It contains a wealth of information.  For example, Needs Assessment information has been added and other data sources will be added soon. 

 

Comp Plan Group is continuing to work on the Comp Plan.  There will be an update on the Comp Plan from the Planning and Priorities Committee later in this meeting.

 

Paul also mentioned that the Hennepin County Human Services and Public Health Department, Public Health Protection manager, Allain Hankey, attended the June Executive Committee meeting and presented a plan for a new reporting structure for Planning Council staff.  Under the proposed structure the Planning Council coordinator would report to Jonathan Hanft, the Ryan White grantee/supervisor.  Currently the Planning Council coordinator reports to Allain.  Paul expressed reservations about the plan.  The co-chairs are currently exploring other options because staff could be housed in a number of different ways.

 

V.          Committee written reports;time for questions, discussion    

A.          Planning and Priorities Committee

·        Comprehensive Plan update

Dan C, co-chair of the Planning and Priorities Committee, shared that the Comprehensive Plan work group has been meeting for several months and is close to completing the section related to the goals, objectives and activities for the next three years.  A retreat was held in March of this year where 51 critical issues were developed.  The group has continued to work on the plan and has worked to collapse these issues down to a more manageable number.  The group has reviewed needs assessment data, including results of the brief survey, as well as other data available.  Dan further shared a slide that Jonathan has used in previous presentations which represents transmission potential for those who are not in care and/or those who don’t know their status.  The slides show that when people are in care, transmission is reduced.  He reviewed the two goals (based on the critical issues) included in the Comp Plan and the objectives currently identified by the group.  The goals are: 

 

Goal 1:  Within three years, increase the percent of Minnesota persons living with HIV/AIDS (PLWH/A) from 59% to ___% who are receiving HIV medical care.

 

Goal 2:  Sustain and improve cost-effective components of the system of care that have demonstrated success at keeping people living with HIV/AIDS connected to their HIV medical care provider and adherent to medical care that meets Public Health standards through 2008.

 

Dan shared the next steps.  The committee will be meeting again tomorrow to continue developing the goals and objectives.  Community forums are being planned to get consumer input and the goal is to have a draft ready for review by the Planning Council on August 2^nd.  It will then come to the August Planning council meeting for approval of the goals, objectives, and activities section of the Comp Plan.  Feel free to contact the co-chairs with questions or feedback.

 

B.          Community Voice Committee

·        Technical Assistance update

Lennie Green’s (TA) work with the Community Voice Committee has been rescheduled for an all day work session on August 30^th,

 

C.          Needs Assessment and Evaluation Committee

               ACTION ITEM

Evaluation of the Grantee Mechanism

Mary Doyle shared that, as mentioned at the last meeting, one of the responsibilities of the Planning Council is to evaluate the administrative mechanism.  A mailing went out last week that everyone should have received that includes the questions asked of the grantee, measurement objectives, and the grantee’s response to those questions.  Members are asked to give their feedback and return the form to staff within the next week.

 

·        Time for form completion

·        Discussion of question six

There was one question (number six – HIV/AIDS medical and support services are reaching to communities intended (underserved and uninsured) by the Ryan White CARE Act) that didn’t have measurable goals to specifically address so the Committee has proposed discussion on that particular question.  Gary said there are a few questions they would like to pose that would facilitate this discussion.  Eric added a bit of information to help clarify the goal of asking these questions of members.

 

Questions:

1. What information does the Planning Council need to answer this question?

Pat suggested looking at underinsured rather uninsured – his reason being that there are many who are underinsured.

 

Jonathan suggested looking some of the socio-economic differences among health care use for certain populations, including looking at other programs and funding that might help inform members of sources where folks may be receiving services, if they underutilize CARE Act services .  Randy asked how you’d know if folks were using HIV related services?  Jonathan said that DHS can pull out those who are HIV positive through Minnesota health care programs.  They can then look at epi data to get a clearer picture of who is in the epidemic so they can then begin to look at gaps of service use in specific populations.

 

Gwen asked if there is a way to look at those who are out of care.  She believes there are a number of factors that may be involved in whether or not a person is receiving care that have an impact on that person getting into care.  She added that they are seeing a lot of chemical use and homelessness, which may become a priority over getting into medical care.  These are areas that are hard to get information about.

 

Eric summary:

Look at expenses – is there a different way to look at income (out of pocket) and looking at the different socio-economic picture – are needs getting met someplace else.  Are there other areas that are keeping people out of care (i.e., addiction and homelessness)?

 

2. What is currently being done do answer this question and what else needs to be done?

Paul asked if we can find out about those folks who are on Medicare to see if any of them are out of care.  Jonathan said there are Medicare supplement programs that we can get information on.  He’s not sure if we can find out about those on Medicare exclusively but suggested that it would be beneficial if we could.  Becky added that we do have a very good system within MDH that has much information but there are limitations because there are several large systems that do not report in the same way, if at all.  Those systems usually report 30 – 40% of folks who are out of care – this is an estimate but is as reliable as we have right now.

 

Randy shared that he is on another board that is serving hard to reach folks.  They have engaged outreach workers to get out into the community to talk to those folks and find out what their needs are.  He suggested finding a way to do similar outreach to get information from the folks we’re trying to reach. 

 

Eric asked if anyone knew of other systems with data of interest to the Planning Council.  Eduardo has suggested contacting healthcare for homeless projects to see if there is information they have that’s available.  Jonathan said that Wilder Research did a survey that we’ve been able to get a lot of information from but he doesn’t know if it would address these questions.  Becky added that Kim Lieberman did some surveying of folks needing housing in which respondents were asked about HIV status but she’s not confident about those results.  Gwen suggested that what we’re looking for is feedback from individuals and that may be the place to get the information we’re looking for.  It’s not always scientific – it’s really about whether or not we’re connecting to where folks are.  She said that’s not something we’ve historically done but that needs to be done.  Becky suggested inviting some outreach workers to come to talk about some of the questions expressed here.  They may be willing to share that information.  Gwen reminded the group that outreach was cut dramatically and that prevention has more projects funded.  LeMonte reiterated the problem with trust in getting to these folks.  Susanne asked if there could be specific outreach done to specific groups – as an example she spoke with some folks who were doing a project like this specifically targeting youth.  They are asking a variety of questions including those related to HIV and chemical use and maybe would be receptive to expanding their questions to include questions on HIV service use.  Jonathan added that the CSAD Project hopes to provide more information as well and suggested that if may make sense to look at information we already have and expanding on it a bit more – using interviewing and/or case studies to get folks to talk about their barriers.  Pat added that a certain portion of those out of care chose to be out of care, for a variety of reasons, which may be a good number of people.

 

Gary summary:  looking at existing information (HCH), think out of the box – ideas about getting feedback from real people (literally anecdotal), looking at NA challenge to reach those not connected, look at funded outreach programs, continue to look at outcomes data, find other methods to get information (observation, etc.) rather than just standard surveying.

 

Dan mentioned the Connecting to Care conferences that HRSA is sponsoring – there may be information gathered from other EMAs about populations who appear to be underrepresented in care.

 

3.  If we were able to get all of this additional information – how would we use it?

Dan said we can use any information we collect for prioritization and other activities as it relates to funding decisions.  Jim added that the information we’re talking about also links directly to the Comprehensive Plan.  Jonathan added that the information can improve the quality of services available to folks (i.e., outreach and how we can make it more accessible either by how providers deliver the service or how Planning Council members direct the process.  Andrea suggested that this may be an opportunity to define what care means because it does vary from person to person.

 

Gary thanked everyone and said that they will be taking this information back to the Needs Assessment Committee for further discussion.  Jonathan suggested while looking at what information is missing it might be helpful to prioritize the list.

 

D.          Community Participation Committee

E.          Operations Committee

F.          ADAP Ad Hoc Committee

·        Update on request for permanent committee status

Francis shared that after the discussion was tabled at the last Planning Council meeting.  The group met to clarify possible committee roles and responsibilities.  The committee will meet one more time next week (on the 20^th) to finish discussing what will recommend carrying forward into the work of other committees.

 

BREAK

 

VI.     Title II and ADAP update, Dave Rompa

          (If state shut down resolved)

There is no Title II report for today because DHS staff is catching up on work they missed during the shutdown.

 

VII.   Title I update, Jonathan Hanft

Jonathan shared that there is information about the CSAD Plan of Action meeting at the table and encouraged all to attend if possible.  He went on to report that the grantee’s office is currently working on submitting conditions of awards to HRSA.  In June the 2004 spending report for women, infants, children, and youth (WICY) expenditures has been submitted as well as a request for the waiver for next year’s services.  Sarah asked how the Council would know that we’re actually accurately reporting the information for expenditures for women, infants, children, and youth – has data like the Needs Assessment have been examined as well.  Jonathan shared that it’s a lot less burdensome to look at the actual state expenditures for this population.  Sarah further shared that there are specific services that have been identified for women under 24 that need to be addressed.  Debra added that there is a large number of older women as well that aren’t necessarily being considered and do have other needs that may not be being met.  Becky shared that HRSA has required some specific information broken out by age which helps inform some of the discussion.

 

They also submitted the annual progress report and he has copies available for those interested (contact Jonathan or Mary Doyle for copies).

 

Jonathan said the carryover request letter is done and waiting for signature.  He’s anticipating that the letter will go out this afternoon.

 

TA update – the two pieces of technical assistance 1) having Angela Wasunna return and 2) consideration of possible options for financing HIV healthcare in Minnesota currently not on the table.  The contract with the current vendors is done in September and all requests are currently on hold.  Dave has already contacted HRSA to reiterate the need to get this done in a timely manner.

 

Diane has organized a two part training series for supervisors – Planning Council members.  The first training is on August 4^th – Communicating across Context and Culture.  The second part is on August 29^th at the Children’s Home Society.

 

VIII.          Medical update, Dr. Ron Schut, HCMC

Ron recently gave an update to the Hennepin County Board of Commissioner’s about HIV drug resistance and was invited to repeat the presentation for the Planning Council members.  The genesis for this conversation stems from the recent highly resistant and quickly progressing case publicized in New York.

 

He moved the discussion to issues related to drug resistance and how it develops.  Currently all the pieces are that factor in the process are not clear.  He used the example of Sustiva that they’ve learned from.  When taking one drug at a time, like Sustiva, some resistance can occur in two weeks.  Aaron Keith asked why there haven’t been more tests done to see if resistance is developing.  There has been no consistent, accurate test to monitor drug resistance, it’s very expensive, and results can often be unclear.  There are two routes to drug resistance which are:  acquired; it occurs during transmission and resistance can develop over time.  He shared information about a cost and service utilization study that was conducted and illustrated it with information from a specific case study that shows how someone can become resistant.  Issues that help to prevent acquired drug resistance include:  adherence (by the patient), selecting the optimal regimen and counseling the patient (by the provider), and drug availability.

 

He then shared information from studies that have been conducted very recently.  Minnesota falls into a general range of 10% of cases that are resistant.  Ron then shared information about the specific New York case studied to illustrate the rapid course of resistance.  This patient is basically resistant to every drug available with the exception of two and rapidly progressed to AIDS.  What cannot be concluded is whether there is a genetic predisposition to resistance or if this is a single case vs. a cluster of cases that may develop.

 

In summary Ron shared that drug resistant HIV is increasingly prevalent both in patients receiving treatment and recently infected and costs will be significant – there is potential for more rapid disease progression and salvage therapy is significantly more complicated.  Members then asked additional questions related to specific issues of virology and resistance as well as the impact of methamphetamine and/or other drugs that may have an impact on an individual’s overall health. 

 

IX.          Member reimbursement update, Mary Dwyer, PC staff

Mary Dwyer handed out the current reimbursement policy and caps for reimbursement established by the Operations Committee.  She further explained the policy including the forms and/or documentation that is required for submission of meeting related expenses

 

Sarah asked about the incentive plan that was put in place earlier in the year for members who are not employed to receive some sort of compensation.  She again shared differences between the Titles saying her Title IV grant requires that she provide incentives for participation.  Randy expressed his feelings about this issue saying he feels that the current HRSA policy is very unjust.  He shared that the Community Voice Committee has decided to pursue the issue and asked the whole Planning Council support their efforts in forwarding this cause.  Francis reiterated Randy’s point and said it feels like a slap in the face.  Debra suggested that is a larger issue than Minnesota and that maybe other EMAs are facing similar situations and would be willing to rally together to make a change in this policy.  Eric asked if there is other data to support this position (i.e., how many are receiving lost wages) and wondered if there is a way for those who are not receiving reimbursement to pool their reimbursement to contribute to a pool for those who are not compensated for their time.  Jonathan suggested that trying to forward this position now is timely because reauthorization is going to be considered this summer.  Information about who is serving on the Congressional committees where this will be discussed is available and will be distributed to Planning Council members.  There are currently six or seven national organizations that are working on reauthorization.

 

A motion was made by Gwen with a second by Sarah that the Planning Council join in the efforts of the Community Voice Committee to provide incentives for members who are not paid wages to attend Planning Council and committee meetings, regardless of HIV status.  After more discussion, the motion was withdrawn by Gwen and Sarah for lack of a specific work goal.

 

Paul suggested referring this issue back to the Community Voice Committee for specific language and activities to support the concept.  Sarah suggested that someone draft a letter that is distributed to the full Planning Council for review.  Andy suggested that staff then send out a letter to other EMAs to see if they are dealing with similar issues and might be willing to sign on to the effort as well.

 

Dan asked if there is any potential impact on the current reimbursement policy and also if there are any other resources available in the budget that could be used to pay for information that the Planning Council is seeking, like contracting with a consultant.  Randy illustrated some of the expenses that don’t fall into the reimbursement categories, like ink jet cartridges, that he incurs but aren’t available for reimbursement.  Discussion moved to the status of the CARE Act reauthorization and what activities could be carried out.  Jonathan suggested that there might be options for government representatives to hold community meetings on subjects such as reauthorization.  Staff will research what legislative members are serving on committees dealing with reauthorization.  The co-chairs will draft a letter on behalf of the Planning Council with respect to this request.  Andy reiterated that it is very important to emphasize the why of providing incentives to members.

 

X.                Announcements, evaluation, next agenda

Please fill out evaluations before you leave.

 

Andy announced that the Red Ribbon ride kicks off on Thursday.  He, Francis, and John are riding this year and the nine agencies will benefits from the proceeds.  Opening ceremonies are at the Mall of America on Thursday morning.  Closing ceremonies are at Richfield High School on Sunday afternoon.

 

Mary Doyle shared that DHS is sponsoring a celebration for Linda Atlas because she is graduating and turning 50.  All are invited.

 

Documents distributed at or before the meeting:

·        Agenda and minutes from the June 14^th meeting

·        Written committee reports

·        Needs Assessment & Evaluation Committee action item – grantee evaluation

·        Grantee evaluation form

 

Meeting adjourned at 12:00 p.m.