DHS and MDH
Proposal for Ryan
White Part B Funding
Listening Session
October 5, 2015
Listening Session Agenda

Introductory Comments

Presentation from DHS and MDH
 Description of the problem we’re trying to solve
 Proposal overview
 How the proposal addresses the problem

Small Group Conversations
 Questions will be provided
 Small group reports

Next Steps

Closing
Part B Proposal Website and Mailbox

Website related to Part B Proposal has been set up and we
will post updated documents there as available:
http://www.health.state.mn.us/divs/idepc/diseases/hiv/ryan
white/index.html

Temporary dedicated mailbox has also been set up. Please
send your comments and questions to:
partbproposal@state.mn.us
Comparison of National and Minnesota Data
Nationally
(2011 data)
In Minnesota
(2014 data)
47,352
307
1.2 million
9,188
Estimated at 168,000
Estimated at 1,200
1.03 Million
7,988
Percentage of persons diagnosed
86%
86%
Linked to care 90 days after diagnosis
80%
87%
Engaged or retained in care
40%
62%
Prescribed antiretroviral therapy
37%
Unknown
Virally suppressed
30%
55%
New cases of HIV
Estimated Living with HIV
(diagnosed and undiagnosed)
Infection is unknown
Living with HIV (diagnosed)
The MN data about engaged/retained in care and virally suppressed were calculated using the estimated number of living with HIV (undiagnosed
and diagnosed) cases as the denominator. This is different from the care continuum data available on the MDH website, which uses living cases
that have been diagnosed as the denominator. The data were calculated differently for this table in order to compare with the national data. MN’s
linked to care percentage was calculated using the number of new cases diagnosed in 2013 as the denominator.
Problem We’re Trying to Solve

Lack of a cohesive and coordinated statewide HIV
prevention and care effort in MN

Average of 300 newly infected HIV cases in MN each year
over the last decade

Estimated 1200 individuals living in MN who don’t know
they are HIV positive

38% of persons with HIV are not engaged in care

45% of persons with HIV have not reached viral suppression

Some populations are disproportionately impacted by HIV
Data Source: Minnesota HIV/AIDS Surveillance System
Proposal Overview

Administrative change

Transfer federal grant responsibilities from DHS
to MDH

No changes to Program HH

No disruption to services that consumers
receive through funded agencies
Remaining at DHS
Services
Program HH
• Medication Program (ADAP)
• Insurance Services
• Dental Services
• Mental Health Services
• Nutrition Services
Administrative Services
• Administrative Specialist
• Budget Coordinator
Moving to MDH
Contract Management of:
• Medical Case Management1
• Benefits Counseling
• Medical Transportation
• Medical Nutrition Therapy
• Early Intervention Services
• Information and Referral
• Service Outreach
• Services to be funded as part of rebate
spend down
Other
• Training and Capacity Building
• Quality Management
• Overall Administration of Grant
Staff
1 FTE – ADAP Policy Analyst
1 FTE – Customer Care Specialist
8 FTE – Program HH Eligibility Specialists
1 FTE – Accounting Officer
1 FTE – ADAP Intake Specialist/OAS
3.5 FTE – Contract Managers1
1.25 FTE – Trainers2
1 FTE – Quality Management Coordinator
1 FTE – Management Analyst
1
2
Includes 1 FTE for managing unmet needs rebate funds
Includes a temporary .75 FTE
How Proposal Addresses the Problem

Brings together the strengths of DHS and MDH to implement a
coordinated response

Helps MN align with the National HIV/AIDS Strategy (NHAS) and
ensure the development of a statewide strategy
 Goals of the NHAS


Reduce new HIV infections

Improve access to care and health outcomes

Reduce HIV-related health disparities

Achieve a more coordinated national response
Positions MN to be part of the evolving national response to HIV
 According NASTAD, we are only one of two states with care and
prevention in two different agencies and only one of a few that haven’t
fully integrated their care and prevention programs
NASTAD = National Alliance of State and Territorial AIDS Directors
How Proposal Addresses the Problem

Care and prevention expertise under the same roof would provide
ongoing opportunities to identify and pilot innovative ways to:
 Decrease new infections
 Reach individuals and communities most impacted
 Address co-morbidities such as TB, hepatitis and STDs
 Improve the health of PLWH/A

Reduced administrative cost and burden would allow redirection of
time and resources to client services
 Decreased administrative contracting costs at state level
 Decreased administrative burden for agencies contracted for both prevention
and care
How Proposal Addresses the Problem

What is the plan?
 Administrative decision regarding this proposal is step one
 If adopted, a transition team of DHS and MDH staff and
management would be convened
 In late 2016, MDH will begin leading a process to develop a
statewide strategy for addressing HIV/AIDS in MN with
community, agency and government involvement

Develop innovative approaches that directly impact the
prevention and care continuum

This will be the plan

Having prevention and care administered out of the same office
would make it easier to facilitate development and
implementation of the plan
HIV Prevention & Care Continuum (Cascade)
100%
100%
Medical Case Management, Housing, Transportation, Linguistic Services,
Peer Support (Navigators), Mental Health and Psychosocial Support,
Substance Abuse Outpatient Treatment, Prevention with Positives
86%
80%
PrEP
60%
Risk
Reduction
Education
HIV Testing
Early Intervention Services
Outreach
Partner Services
HIV Testing
40%
Condom
Distribution
20%
Media/
Social
Marketing
0%
aCalculated
62%
55%
ADAP, Health Insurance Premium Assistance
Outpatient/Ambulatory Medical Care
Oral Health
Care Link Services
8,828
HIV Negative
87%
Living with HIVa
7,628/8,828
261/299
Diagnosed with HIVb Linked to Carec
5,514/8,828
Retained in cared
Treatment
Adherence
4,826/8,828
Virally Suppressede
using the estimate of number of undiagnosed persons with HIV in Minnesota, 2012. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6424a2.htm
as persons diagnosed with HIV infection (regardless of stage at diagnosis) through year-end 2013, who were alive at year-end 2014.
cCalculated as the percentage of persons diagnosed with HIV who were linked to care within 90 days of initial diagnosis in 2013. In different color because uses 2013 data and different denominator.
dCalculated as the percentage of persons who had ≥1 CD4 or viral load test results during 2014 among those assumed to be living with HIV through year-end 2013 and alive at year end 2014.
eCalculated as the percentage of persons who had suppressed viral load (≤200 copies/mL) at most recent test during 2014, among those assumed to be living with HIV through year-end 2013 and alive at year
end 2014.
bDefined
Activity
SMALL GROUP CONVERSATION
Small Group Conversation

Your small group is the group you’re sitting with

Choose both a facilitator and a recorder at each table
 Facilitator Responsibilities

Keep group on track to answer all the questions

Report back to the larger group
 Recorder Responsibilities

Keep group notes on flip chart paper to be shared with the
larger group
Question 1

What is your vision for
HIV/AIDS in Minnesota?
Question 2

What do you like about
the proposal?
Question 3

What are your concerns
about the proposal?
Question 4

How could this proposal
address the problem as
presented?
Question 5

What other options should
DHS and MDH consider?
Question 6
 How
could this proposal
help us reach your vision?
Report Back
Next Steps
Closing