The Weekly Update

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April 11, 2008

Vol. VII, Number 12

This Week in Washington

1. HRSA Awards Title II Grants

2. NAHC Holds Congressional Briefing: Housing is Healthcare

3. Annual ADAP Report Released

 

Announcements

1. Upcoming AETC Workshop, “Psychiatric Management with Patients with HIV/AIDS”

2. OMH Launches Strategic Framework for Reducing Health Disparities

3. Registration Open for AIDSWatch 2008

 

This Week in Washington

1. HRSA Awards Title II Grants

On Friday, April 4, 2007, the Health Resources and Services Administration (HRSA) announced the release of Ryan White CARE Act Part B (Title II) grant awards for Fiscal Year (FY) 2008. HRSA awarded $1,103,104,015 in Title II (Part B) grants to the 50 states, the District of Columbia, Puerto Rico, Guam, the Virgin Islands and the Pacific Ocean territories. 

 

The $1.1+ billion is divided into three categories: Title II (Part B) base grants, AIDS Drug Assistance Program (ADAP) grants and Emerging Community (EC) grants.  The Part B (Title II) base grants total approximately $324 million, the ADAP grants total $774.1 million, and EC grants total $5 million.  The EC grants are being distributed to 11 states with jurisdictions that qualify as Emerging Communities under the reauthorized CARE Act.  To be eligible as an EC, a metropolitan area must have a cumulative total of at least 500, but fewer than 1,000, AIDS cases over the most recent five calendar year period. 

 

The states with ECs in FY 2008 are: Alabama (Birmingham-Hoover), Delaware (Wilmington metropolitan area), Florida (Port St. Lucie-Fort Pierce, Sarasota-Bradenton-Venice and Lakeland), Georgia (Augusta-Richmond County), Kentucky (Louisville), Mississippi (Jackson), New York (Rochester, Buffalo-Niagara Falls and Albany-Schenectady-Troy), North Carolina (Raleigh-Cary), Ohio (Columbus and Cincinnati-Middletown), Pennsylvania (Pittsburgh), Rhode Island (Providence metropolitan area), South Carolina (Columbia), Virginia (Richmond) and Wisconsin (Milwaukee-Waukesha-West Allis).

 

During the Fiscal Year (FY) 2008 appropriations, the Title II base received a $5 million decrease and ADAP received a $4.9 million increase. This is due to the omnibus compromise that resulted in a 1.7% across the board rescission to the Labor-HHS bill. Originally, the Appropriations committee reported that the cut would be taken solely from Part B base and not ADAP. That was incorrect. The new numbers reflect the rescission, taken from both the base and ADAP. ADAP supplemental grants have yet to be distributed. 

 

To read HRSA’s full press release containing award amounts for each state, the District of Columbia and the territories please visit: http://www.os.dhhs.gov/news/press/2008pres/04/20080404a.html.

The list of grant awards follows:

Ryan White HIV/AIDS Treatment Modernization Act of 2006
FY 2008 Part B Grants

State/Territory

FY 2008 Base

FY 2008 ADAP

Emerging Communities

FY 2008 Total

Alabama

$8,101,079

$9,055,936

$318,361

$17,475,376

Alaska

$500,000

$508,178

 

1,008,178

Arizona

$3,932,676

$9,610,361

 

13,543,037

Arkansas

$3,655,520

$4,245,310

 

7,900,830

California

$32,421,532

$89,623,287

 

122,044,819

Colorado

$3,828,052

$9,527,197

 

13,355,249

Connecticut

$ 3,404,759

$ 11,471,742

 

14,876,501

Delaware

$1,697,534

$3,291,545

237,170

5,226,249

District of Columbia

$4,201,289

$14,392,258

 

18,593,547

Florida

$32,136,640

$83,509,558

500,065

116,146,263

Georgia

$9,346,897

$25,396,411

189,302

34,932,610

Hawaii

$1,180,282

$2,057,066

 

3,237,348

Idaho

$522,228

$583,136

 

1,105,364

Illinois

$8,691,758

$27,628,149

 

36,319,907

Indiana

$3,715,002

$7,469,885

 

11,184,887

Iowa

$1,186,317

$1,359,141

 

2,545,458

Kansas

$1,169,453

$2,265,222

 

3,434,675

Kentucky

$3,085,487

$4,307,876

206,669

7,600,032

Louisiana

$6,261,913

$15,132,653

 

21,394,566

Maine

$525,000

$871,574

 

1,396,574

Maryland

$8,203,661

$26,541,994

 

34,745,655

Massachusetts

$4,784,718

$14,782,288

 

19,567,006

Michigan

$5,122,836

$11,681,534

 

16,804,370

Minnesota

$1,917,325

$5,143,281

 

7,060,606

Mississippi

$6,406,910

$7,277,816

312,500

13,997,226

Missouri

$3,923,707

$9,789,559

 

13,713,266

Montana

$500,000

$294,995

 

794,995

Nebraska

$1,125,139

$1,256,366

 

2,381,505

Nevada

$2,225,402

$5,784,830

 

8,010,232

New Hampshire

$502,920

$998,421

 

1,501,341

New Jersey

$12,281,708

$33,221,747

 

45,503,455

New Mexico

$1,822,033

$2,238,552

 

4,060,585

New York

$41,099,269

$125,611,598

717,045

167,427,912

North Carolina

$10,672,863

$18,587,094

260,616

29,520,573

North Dakota

$200,000

$143,526

 

343,526

Ohio

$8,074,925

$14,529,892

668,961

23,273,778

Oklahoma

$3,804,744

$4,253,231

 

8,057,975

Oregon

$1,599,240

$4,186,545

 

5,785,785

Pennsylvania

$10,230,406

$28,159,902

281,131

38,671,439

Puerto Rico

$ 9,874,482

$ 20,674,920

 

30,549,402

Rhode Island

$1,119,203

$2,002,014

235,650

3,356,867

South Carolina

$11,787,655

$13,399,717

395,971

25,583,343

South Dakota

$500,000

$305,924

 

805,924

Tennessee

$5,625,974

$12,597,325

 

18,223,299

Texas

$21,871,138

$53,842,575

 

75,713,713

Utah

$1,701,451

$2,109,364

 

3,810,815

Vermont

$500,000

$402,212

 

902,212

Virginia

$7,534,293

$16,730,761

405,848

24,670,902

Washington

$3,028,971

$8,694,418

 

11,723,389

West Virginia

$1,082,833

$1,373,538

 

2,456,371

Wisconsin

$3,827,539

$4,290,852

270,711

8,389,102

Wyoming

$500,000

$180,188

 

680,188

Guam

$200,000

$91,055

 

291,055

Virgin Islands

$500,000

$640,973

 

1,140,973

American Samoa

$50,000

$1,978

 

51,978

Marshall Islands

$50,000

$2,893

 

52,893

N. Marianas

$50,000

$3,958

 

53,958

Republic Of Palau

$50,000

$-

 

50,000

F. States Micronesia

$50,000

$4,934

 

54,934

Total

$323,964,762

$774,139,253

$5,000,000

$1,103,104,015

 

 

 

 

 

 

2. NAHC Holds Congressional Briefing: Housing is Healthcare

On Friday, April 4, 2008, The National AIDS Housing Coalition (NAHC) held a Congressional briefing on Housing and HIV/AIDS entitled “Housing is Healthcare.”  The briefing included a video on HIV/AIDS Housing, an overview of the funding needs of the Housing Opportunities for Persons with AIDS (HOPWA) program, key findings from the third National Housing and HIV/AIDS Research Summit, and perspectives from AIDS Housing consumers. Representatives Jerrold Nadler (D-NY), Henry Waxman (D-NY), Christopher Shays (R-CT), and Joseph Crowley (D-NY) sponsored the briefing.

 

Shawn Lang, NAHC Board President and Connecticut AIDS Resource Director of Policy, offered opening remarks. Nancy Bernstine, NAHC Executive Director, and Kathie Hiers, CEO of AIDS Alabama, then gave an overview of the funding needs for HOPWA. NAHC recommends funding HOPWA at $470 million in Fiscal Year (FY) 2009, a $170 million increase from FY 2008. That increase would provide urgently needed housing assistance for an additional 40,000 people with HIV/AIDS and their families. It is estimated that 50% of people living with HIV/AIDS (600,000 people) need some form of housing assistance. Research has shown that housing is the greatest unmet service need for people living with HIV/AIDS. 

 

After their remarks, they showed a video produced by NAHC, Housing Works, Inc., and the San Francisco AIDS Foundation.  The video used personal stories to portray that homelessness is both a cause and a consequence of HIV infection.  The video explained that HOPWA is the only stream of federal funding that addresses the housing needs of people living with HIV/AIDS in this country; helping people attain and maintain stable housing and fill the gaps in comprehensive medical care.

 

Next, panelists Charles King, Housing Works; Christine Campbell, Housing Works; Kathie Heirs; and Nan Roman, National Alliance to End Homelessness shared key findings from the Third National Housing and HIV/AID Research Summit that took place on March 5-7, 2008. Preliminary data from to major studies was released at the summit providing new evidence for housing as an effective and cost saving health care intervention for homeless and unstably housed persons with HIV and other chronic health conditions. Panelists shared finding from the “Housing First” Chicago Housing for Health Partnership (CHPP) and the groundbreaking Housing and Health (H&H) study conducted by the Centers for Disease Control and Prevention (CDC) and the Department of Housing and Urban Development (HUD).

 

The Chicago “Housing First” study was a large scale randomized control trial that followed 407 chronically ill homeless persons over an 18 month period after their discharge from a Chicago hospital. More than a third of participants were HIV positive. Half of the study participants received immediate supportive housing placements after discharge, while the remaining half continued to rely on usual care provided by shelters, family, and recovery programs. Preliminary study findings found that 73% of housed participants were still stably housed at 18 months compared to only 15% of the usual care group. The housed group used almost half as many nursing home days as their usual care counterparts, and they were nearly two times less likely to be hospitalized or use an emergency room. Annual medical expenses for housed clients were at least $873,000 less than their usual care counterparts, after subtracting the annual $12,000 expense of providing the supporting housing intervention. Housed HIV positive participants were twice as likely at 12 months to have an undetectable viral load as those who did not receive housing.

 

The Housing and Health study followed 630 HIV positive participants in Baltimore, Chicago, and Los Angeles to investigate the effect of housing on HIV risk behaviors, medical care, and treatment adherence. Half of the participants received immediate HOPWA rental assistance, while the other half continued with customary care from participating HIV/AIDS service providers. 82% of HOPWA voucher participants were stably housed after the 18 month period compared to 52% of the customary care croup. Housing resulted in a 34% reduction in emergency room visits, a 21% reduction in hospitalizations, a 44% reduction in opportunistic infections, a 40% reduction in sex trade, and significant improvement in mental health status.

 

Complete results and research findings from the third NAHC Housing and HIV/AIDS Research Summits can be found at www.nationalaidshousing.org.

 

3. Annual ADAP Report Released

On Tuesday, April 8th, the Henry J. Kaiser Family Foundation and National Alliance of State and Territorial AIDS Directors (NASTAD) released the 2008 ADAP Monitoring Project Annual Report.  Jen Kates (Kaiser) and Murray Penner (NASTAD) presented major themes and findings of the report after introductions by Diane Rowland, Executive Vice President of Kaiser and Julie Scofield, Executive Director of NASTAD. 

 

The report primarily found that pressures on many state ADAPs have eased over the last year, at least temporarily, due to a combination of factors including increased non-federal funding sources (especially state revenue support and drug rebates), the transition of some ADAP clients to the Medicare Part D prescription drug program, and increased funding through the Ryan White ADAP Supplemental Drug Treatment grants. As a result, Montana is the only state with a current ADAP waiting list. Montana’s list recently increased from 3 to 6 patients.  Many states were also able to ease eligibility requirements and expand formularies over the past year. All states currently meet the new federal requirement that they maintain at least one drug in all classes of anti-retrovirals. 

 

The presenters noted that some of the factors leading to higher accessibility of ADAP services and coverage were one time gains.  Additionally they expressed concern that the pace of federal appropriations for ADAP within the Ryan White CARE Act has remained relatively flat in recent years.  Finally the presenters said that signs of an economic downturn may signal trouble for State budgets which could contribute to decreases in funding.  

 

Ms. Kates then moderated an ADAP panel discussion. Panel participants were: Douglas Morgan, HIV/AIDS Bureau, Health Resources and Services Administration; Christine Olson, Ryan White Part B/ADAP and HIV Surveillance Program, South Dakota Department of Health; Noreen O’Donnell, Ryan White Program, South Carolina Department of Health and Environmental Control; and Ron Snell, National Conference of State Legislatures. 

 

Ms. O’Donnell explained that South Carolina had gone from having the largest waitlist (of more than 600 people) in June 2006 to having no waitlist in September of 2007.  She said elimination of the waitlist could be traced in part to organized advocacy efforts which convinced state legislators to provide $3 million annually above their previous appropriation of $500,000.  In addition the State of South Carolina also provided a one time appropriation of $1 million in 2007.  Ms. O’Donnell pointed out that they had additionally taken funds for ADAP from Part B base which placed constraints on access to medical services.  Mr. Morgan later returned to this topic and noted concerns about the strain on critical Part B base funding. Part B medical services are necessary in order for patients to receive comprehensive care and ADAP prescriptions. 

 

Ms. Olson discussed the expansion of South Dakota’s formulary to include protease inhibitors.  She said that the State ADAP had surveyed all nine doctors providing services in South Dakota. They all agreed that there was a strong need for a complete formulary. The survey results and the new requirements contained in the CARE Act reauthorization helped South Dakota move forward on the inclusion on protease inhibitors on the state formulary.

 

Mr. Morgan cited the increase of the ADAP supplemental from 3% to 5% as a source of funding for states that were experiencing severe need.  He noted that some states had been able to waive the requirements for matching funds, which are a requirement to receive the supplemental, but that smaller states with fewer resources were less able to provide matching funds or to meet waiver requirements.  Finally Mr. Snell provided an overview of the State budgeting process.  He noted that state healthcare funds for ADAP would be at risk during an extended economic downturn.

 

The 2008 ADAP Monitoring Project Annual Report and related materials can be found here:  http://www.kff.org/hivaids/7746.cfm

 

A webcast of the presentation can be found at:

http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=2559

 

Announcements

1. Upcoming Workshop: “Psychiatric Management with Patients with HIV/AIDS”

The American Psychiatric Association, Office of HIV Psychiatry; the Pennsylvania/MidAtlantic AIDS Education and Training Center, and the University Of Pittsburgh School of Medicine, Department of Psychiatry will be holding an educational workshop, “Psychiatric Management with Patients with HIV/AIDS,” on Monday, May 5, 2008 from 1:00-6:00 PM at the Jury’s Hotel in Washington DC.

 

The workshop, occurring simultaneously with the 2008 American Psychiatric Association Meeting, will bring together leading experts in HIV psychiatry from around the country. The opportunity is available to primary care providers, mental health professionals, substance abuse treatment professionals, HIV clinicians, nurses, case managers, and other members of the HIV treatment team. Topics will include Triple Diagnosis: Substance Use, Mental Health, and HIV; Psychiatric Management of HIV/AIDS, Relationships, Risk Assessment, Testing and Disclosure; and Case Discussion.

 

To learn more about the program, please visit: http://www.pamaaetc.org/downloads/Save%20the%20DatePGH55.pdf. Register online at http://www.pamaaetc.org/registration.asp?rid=PGH-55 or by phone at 412-624-1895. The Registration deadline is May 1st. There is no charge for this program. Please pass this announcement on to interested colleagues.

 

2. OMH Launches Strategic Framework for Reducing Health Disparities

On Wednesday April 9, 2008 the Office of Minority Health (OMH) launched a National Partnership for Action: A Strategic Framework for Improving Racial/Ethnic Minority Health and Eliminating Racial/Ethnic Health Disparities. The Strategic Framework is intended to help guide, organize and coordinate the systematic planning, implementation and evaluation of efforts within OMH, Health and Human Services (HHS), and across the nation to achieve better results relative to minority health improvements and health disparities reductions. According to the Office of Minority Health, there is significant evidence of poor health outcomes among racial/ethnic minority populations with respect to premature death and preventable disease. These disparities are currently increasing. The persistence of such disparities suggests that current approaches and strategies are not producing the kinds of results needed to ensure that all Americans are able to achieve the same quality and years of healthy life. The Office of Minority Health’s new Strategic Framework aims to promote systems approaches to understanding and eliminating racial and ethnic disparities through program, policy, and research activities. More information on the OMH’s strategic plan and framework can be found at http://www.omhrc.gov/npa/.

 

3. Registration Open for AIDSWatch 2008

Registration is now open for AIDSWatch 2008, taking place in Washington DC from April 28-30, 2008. AIDSWatch is a grassroots advocacy program, organized by the National Association of People With AIDS (NAPWA), which brings HIV positive people and their supporters to Washington DC to meet their elected Members of Congress. AIDSWatch participants are given the opportunity to educate their legislators on the need for an improved governmental response to the domestic HIV epidemic. This year’s AIDSWatch will focus on the need for improved treatment accessibility, science and evidence based prevention, and increased appropriations for HIV/AIDS programs.

NAPWA says, "We invite all persons infected and affected by HIV in America to join us in 2008 to allow your voice to be heard in our nation's capital. Please revisit the website frequently for updates about the 2008 program and registration."

To learn more and to register, please visit: http://napwa.org/index.php?option=com_content&task=view&id=19.

 

The AIDS Action Weekly Update

The Weekly Update is written with the interests of our members in mind. If you are interested in membership with AIDS Action, we invite you to contact aford@aidsaction.org.

 

AIDS Action works to end the HIV epidemic by advancing public policies that prevent new infections, provide care for people living with HIV, and support the search for a cure. AIDS Action serves as the national voice for AIDS service organizations, health departments, and a diverse network of community-based organizations across the country, working with and for people living with and affected by HIV.

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