State of Connecticut Comprehensive Jurisdictional Plan for HIV Care and Prevention 2012-2015 June 8, 2012 State of Connecticut / Page 2 Table of Contents Acknowledgements ............................................................................................................... 4 Executive Summary ............................................................................................................... 6 The Connecticut HIV Planning Consortium (CHPC) ............................................................... 15 Section I: Where are we now? ......................................................................................... 20 A. Description of local HIV/AIDS epidemic ........................................................................ 20 1. Epidemiological profile (Calendar Year 2010) .............................................................. 29 2. Unmet Need Estimate (2010) ....................................................................................... 31 3. EIIHA/Unaware Estimate (2009) ................................................................................... 32 B. Current continuum of care and prevention .................................................................. 32 1. Ryan White funded HIV care service inventory ............................................................ 37 2. Non-Ryan White funded – HIV care and prevention service inventory ........................ 46 3. Interaction between Ryan White-funded and non-Ryan White-funded services ......... 47 4. Impact of budget cuts ................................................................................................... 48 C. Description of need .................................................................................................... 48 1. Care and prevention needs ........................................................................................... 50 2. Capacity development needs: underserved communities and rural communities ...... 50 3. Gaps in care and prevention ......................................................................................... 52 D. Description of priorities for allocation of funds ......................................................... 53 1. Size and demographics of the population living with HIV/AIDS ................................... 53 2. Future scope of prevention services ............................................................................. 56 E. Description of barriers to care and prevention .......................................................... 59 1. Routine testing .............................................................................................................. 59 2. Program related barriers ............................................................................................... 60 3. Provider related barriers ............................................................................................... 60 4. Client related barriers ................................................................................................... 60 F. Evaluation of 2009 Comprehensive Plan .................................................................... 61 Section II: Where do we need to go? ..................................................................................65 A. Plan to meet 2009 challenges .................................................................................... 65 B. 2012 proposed care and prevention goals ................................................................. 74 C. Goals regarding Awares but not in care (unmet need) .............................................. 75 D. Goals regarding EIIHA (unaware) ............................................................................... 76 E. Proposed solutions to close the gaps in care ............................................................. 77 F. Proposed solutions for addressing overlaps in care ................................................... 78 G. Proposed coordinating efforts ................................................................................... 78 Connecticut Comprehensive Jurisdictional Plan for HIV Care and Prevention 2012 to 2015 State of Connecticut / Page 3 Table of Contents (continued) Section III: How will we get there? .....................................................................................82 A. Addressing closing gaps in care and prevention ........................................................ 82 B. Addressing the needs of individuals aware of their HIV status, but not in care ........ 83 C. Addressing the needs of individuals unaware of their HIV status ............................. 84 D. Addressing the needs of special populations ............................................................ 85 E. Activities to implement the proposed coordinating efforts ....................................... 87 F. How the Plan addresses healthy People 2020 ........................................................... 91 G. How the Plan reflects the Statewide Coordinated Statement of Need ..................... 92 H. How the Plan is coordinated with and adapts to the ACA ......................................... 93 I. How the Plan addresses the goals of NHAS ................................................................ 95 J. Response to unanticipated changes and budget cuts ................................................ 96 Section IV: Monitoring and Evaluation ...............................................................................97 A. Assessing Connecticut’s goals and challenges ........................................................... 97 1. Improved use of Ryan White client level data .............................................................. 108 2. Use of data in monitoring service utilization ................................................................ 109 3. Measurement of care and prevention outcomes ......................................................... 110 4. Future endeavors .......................................................................................................... 119 Appendices Statewide Coordinated Statement of Need Service Matrix Glossary of Terms CHPC Membership Diversity Chart Youth Advisory Group Magazine HIV Newsletter CHPC Meeting Dash Board Connecticut Comprehensive Jurisdictional Plan for HIV Care and Prevention 2012 to 2015 State of Connecticut / Page 4 Acknowledgements Connecticut’s 2012-2015 Comprehensive Jurisdictional Plan for HIV Care and Prevention represents a collaborative effort by various representatives of Ryan White Parts, the State of Connecticut Department of Public Health (DPH), the Connecticut HIV Planning Consortium (CHPC), State agencies, provider agencies, PLWHA, and public participants from across the Connecticut. These partners all share a profound commitment to ensuring that a comprehensive continuum of care and prevention exists for residents of Connecticut. We dedicate this plan to Janis Spurlock (1955 - 2011). Janis, a Health Program Supervisor in the HIV Prevention Unit at the Connecticut Department of Public Health, will forever be known as one of Connecticut’s leading champions of and ambassadors for reducing the spread and impact of HIV/AIDS. Peace be her journey. Department of Public Health Infectious Diseases Section Chris Andresen, Section Chief Barbara Mase, Health Program Supervisor, Part B Health Care and Support Services (HCSS) Unit Aaron Roome, Epidemiologist 4, Supervisor HIV/AIDS Surveillance Unit Rory Angulo, Epidemiologist 3, HIV Surveillance Unit Laura Aponte, Health Program Associate, HCSS Marianne Buchelli, Health Program Associate, HIV Prevention Unit Kenneth Carley, Epidemiologist 3, HIV/AIDS Surveillance Unit Gina D’Angelo, Health Program Associate, HIV Prevention Unit Deborah Gosselin, Nurse Consultant, HCSS Unit Dulce Dones Mendez, Health Program Associate, HIV Prevention Unit Michael Ostapoff, Health Program Associate, HCSS Unit Christine Romanik, Health Program Associate, HCSS Unit Ramon Rodriguez-Santana, Health Program Assistant II, HIV Prevention Unit David Wagner, Health Program Assistant 2, HIV Prevention Unit Consultant Cross Sector Consulting, LLP Connecticut Comprehensive Jurisdictional Plan for HIV Care and Prevention 2012 to 2015 State of Connecticut / Page 5 Connecticut HIV Planning Consortium (CHPC), 2012 * denotes leadership position *Paul Agogliati, Litchfield County (Membership and Awareness Committee Co-Chair Elect) Lorna Bocachica, Waterbury Hospital ID Clinic, New Haven County Tom Butcher, New Haven/Fairfield Ryan White Office, New Haven County Janier Caban-Hernandez, Greater Hartford AIDS Legal Network Jose Castillo-Caban Irma Colon, Hispanos Unidos, New Haven County Carmen Cruz, New Haven County Brian Datcher, Statewide Community Advisory Board, Fairfield County Richard Dumas, New Haven County Ann Galloway Johnson, Waterbury Health Department, New Haven County Blaise Gilchrist, CT Children’s Medical Center, Hartford County, Youth Advisory Group Miguel Gonzalez, Hartford Gay and Lesbian Health Collective Linda Guillorn, CT Department of Mental Health and Addiction Services, Statewide Michael Hawkins, New Haven County Rebecca Hopko, CT Department of Social Services Robert Houser, Southwest Community Health Center, Fairfield County Nancy Kingwood, GBAPP, Fairfield County William Knox, New London County *Shawn Lang, CT AIDS Resource Coalition, Statewide (CHPC Co-Chair) *George Lawson, Middlesex County (CHPC Co-Chair elect) Beverly Leach, Waterbury Hospital *Ronald Lee, New Haven County