Deirdre Burke Assignment 1 February 11, 2015

The Ryan White Program Part A.

Background

For individuals and families infected with the Human Immunodeficiency Virus, the extensive medical bills and treatment requirements become difficult to afford, manage, and find access to. In 2010 the average annual cost of HIV care was around

$23,000, and lifetime treatment costs averaged around $370,000 (CDC.gov). When those infected come from a low-income situation, managing the disease requires financial, medical, and community support. Statistics show that Black and Hispanic populations have ten and seven times more HIV diagnoses that the white population, illustrating high demand for services focused on minority groups (mass.gov). There is a need for more access to HIV/AIDS assistance for low-income communities, including minority groups, in the Boston Eligible Metropolitan Area (EMA) and Transitional Grant Areas (TGA) that are highly affected by HIV.

Program Overview

The Ryan White Program Part A provides financial assistance to improve access to high-quality community-based health services for low-income individuals and families with HIV in the Boston eligible Metropolitan area and Transitional Grant Areas. The program began in 1990 as the Ryan White Comprehensive AIDS Resources Emergency

Act, and underwent several amendments including the addition of the Minority Aids

Initiative funding in 1999, targeting the Hispanic and African American communities in the EMA. The U.S. Department of Health and Human Services, Health Resources and Services Administration, and the HIV/AIDS Bureau oversees the program. The current program consists of Parts A through F, but part A provides the direct financial aid. The total grant award for 2014 was $14,322,315. The Boston Public Health Commission distributes the grant funds according to the established priorities of the HIV/AIDS

Services Planning Council, appointed by the EMA’s CEO (“Ryan White HIV/AIDS

Services”).

The Community

The EMA region consists of Bristol, Essex, Middlesex, Norfolk, Plymouth and

Worcester counties in Massachusetts, and Hillsborough, Rockingham and Strafford counties in New Hampshire, and must include at least 2,000 aids cases in the past 5 years to qualify. By having these requirements for the eligible communities, the program can focus on assisting the areas that are in demand for more access to care. The short-term goal is to promote health and the long-term goal is to enhance the quality of life for HIV positive people (Client Services Handbook, 2014; HRSA.gov).

The MAI supports participants who have different cultural backgrounds or language barriers, ranging from African American and Latino, to Native American and

Asian cultures. The agencies that are funded for the MAI services must be minority- based, opening up a level of comfort and community for these people infected with HIV, to serve social justice. The goals of the MAI are “to reduce health disparities among racial and ethnic minorities through outreach and education services and to strengthen the capacity of community based organizations serving people of color affected by

HIV/AIDS,” (HRSA.gov). Due to the higher statistics of diagnosis in these minority groups, education and outreach for these communities will help prevent further spread of HIV and also decrease the numbers of deaths from AIDS related complications (Client

Services Handbook, 2014).

Activities

The services provided range from housing to primary care. The AIDS Drug

Assistance Program provides prescription pharmaceuticals for the prevention, management and treatment for individuals who are HIV positive. Home-delivered meals provide nutritionally appropriate foods, and there are also nutrition counseling services by registered dieticians. There are housing services either in a group home or on a site setting, and financial assistance for emergency house related expenses. The medical case management services link individuals with primary care and health support services, and the MAI medical case management services assist participants in accordance with their cultural and language barriers, using minority-based agencies. The other funded services include medical nutrition therapy, medical transportation, oral health care, peer support, psychosocial support (mental health and substance abuse), and substance abuse- residential services (Client Services Handbook, 2014).

Stakeholders

The stakeholders in this project include the low-income communities in Boston’s

EMA’s, including the African American and Hispanic minority groups. There are also the

HIV positive peer support systems, which allow fellow HIV positive individuals to help those who need a support system that understands the physical and mental challenges associated with HIV. The program’s staff list includes administrative, client services, quality management, planning council support, fiscal, and data workers. The list of providers from the Ryan White handbook is as follows:

AIDS Drug Assistance Program Manet Community Health Center (ADAP/HDAP) Community Research Massachusetts Alliance of Portuguese Initiative of New England Speakers New Hampshire Department of Health Merrimack Valley Assistance Program and Human Services MGH Chelsea HealthCare Center Food Bank/Home-Delivered Meals Montachusett Opportunity Council, Inc. AIDS Project Worcester Victory Southern New Hampshire HIV/AIDS Programs, Inc. (Boston Living Center) Task Force Montachusett Opportunity Council, Inc. Whittier Street Health Center Housing Father Bill's & MainSpring Medical Nutrition Therapy Housing (Rental Assistance) AIDS Community Servings, Inc. Action Committee Medical Transportation AIDS Project MAI Medical Case Management Worcester Dimock Community Health Center Greater Lawrence Family Health Center Upham's Corner Health Center Lynn Community Health Center MAI Psychosocial Support Dimock Montachusett Opportunity Council, Inc. Community Health Center Oral Health Care BPHC HIV Dental Greater Lawrence Ombudsperson Program Medical Case Management AIDS Peer Support (Training) Justice Response Seacoast Resource Institute Beth Israel Deaconess Hospital - Psychosocial Support (Peer Support) Plymouth Boston Health Care for the AIDS Project Worcester Homeless Program Centro Latino BMC Pediatric AIDS Program East Boston Neighborhood Health BPHC Homeless Services Safe Harbor Center Greater Lawrence Family Health Program Center Justice Resource Institute Cambridge Health Alliance Manet Community Health Center Catholic Charitable Bureau of Montachusett Opportunity Council, Inc. Archdiocese of Boston Multicultural AIDS Coalition Centro Latino, Inc. Whittier Street Health Center Dorchester House Multi-Service Center Psychosocial Support (Mental Health) East Boston Neighborhood Health AIDS Project Worcester Center Edward M. Kennedy Community BMC Pediatric AIDS Program Health Center Psychosocial Support (Substance Fenway Community Health Center Abuse) Justice Resource Institute Greater Lawrence Family Health Center Span, Inc. Harbor Health Services, Inc. Substance Abuse – Residential Casa Lynn Community Health Center Esperanza, Inc. GAAMHA, Inc. Victory Programs, Inc. (Client Services Handbook, 2014).

Critique and measurements The Funded Providers list of services is quite extensive; in 2013 63 programs were funded, which brings up the potential issue that the program’s funds might be spread too thin amongst all of the providers whose services are required to make an impact on this HIV community. There is also a possibility that the members of the community may not take advantage of these services if they have to use new physicians and facilities that they are not accustomed to. Another issue may be that the clinics and physicians that receive funding for the low-income participants may not treat them the same as other participants who are able to afford all of the medical services. The participants who are also struggling with drug addiction could potentially abuse the system, or not use the services at all.

The data needed to evaluate the program would be how many individuals from low-income communities in the EMA take advantage of the programs, how much money do the participants save because of the program, and which services in particular do they use the most. To further assess the participants using the program, it would be important to see how they feel using the program, whether they are comfortable in the facilities and feel they receive adequate care, and how their health is improving or sustaining. A measurement of how much of the grant money is used by the providers and how it is used would also be necessary for the evaluation of the effectiveness of the program (“Client

Services Handbook, 2014”).

LOGIC MODEL for The Ryan White Program INPUTS Providers Medical professionals, hospitals and clinics, transportation, food preparation workers, addiction specialists, trainers, HIV peer supporters, partners/collaborators. Staff Administrative, client services, quality management, planning council support, fiscal, data, HIV/AIDS Bureau of the Health Resources and Services Administration, HIV/AIDS Services Planning Council, EMA’s Chief Elected Official, US Department of Health and Human Resources. Funding (FY 2014) $14,322,315. Over the course of the program, the funding has steadily increased, assuming the pattern follows, 2015 and on should expect around this same amount. Community Boston Eligible Metropolitan Area low-income HIV positive people, including minority groups (African American and Hispanic) OUTPUTS Activities/services  AIDS Drug Assistance program  Medical Case management and MAI: Medical Cast management  Housing Services- providing housing units  Mental Health- therapy with professionals, and  Oral Health- dental visits and educating on hygiene  Outpatient Ambulatory Medical Care  Substance abuse Services- Outpatient addiction treatment  Psychosocial Support and MAI Psychosocial support  Psychosocial support for mental health and substance abuse  Substance Abuse Residential- provide sober housing units  Medical Transportation Services- to and from doctors appointments, or emergencies  Food bank/home delivered meals  Medical nutrition therapy- educating on how to eat nutritionally when living with HIV/AIDS Participation  Providers- medical professionals, hospitals, transporters, food preparation, minority based agencies  Partners/collaborators  Staff – administration, quality management, coordinators.  Low-income HIV positive individuals and families  Minority groups infected with HIV OUTCOMES Short-term goals Promote better health practices: improve number of dental visits and at home hygiene, medical physicals, eating nutritious meals daily, attending addiction treatments/detoxing/meetings, living in a housing unit, mental support via therapy sessions and peer support group meetings. Medium-term goals Increased health practices with dental hygiene, physical/medical health, treating/managing addiction to drugs, Long-term goals To improve the quality of life for low-income and minority individuals and families infected with HIV in the Boston metropolitan area.

Citations

"Ahead Of The Curve." The Ryan White HIV/AIDS Program Progress Report 2012. U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, 1 Nov. 2012. Web. 1 Feb. 2015. .

"Client Services Handbook FY 2014." Boston Public Health Commission. 1 Jan. 2014. Web. 1 Feb. 2015. .

"HIV Cost-Effectiveness." Centers for Disease Control and Prevention. 1 Jan. 2014. Web. 1 Feb. 2015. .

"Massachusetts HIV/AIDS Data Fact Sheet: The Massachusetts HIV/AIDS Epidemic at a Glance."Mass.gov. 1 Jan. 2014. Web. 1 Feb. 2015. .

"Ryan White HIV/AIDS Services." Boston Public Health Commission. Web. 1 Feb. 2015. .