Ryan White HIV/AIDS Program - Part D Grants for Coordinated HIV Services to Women, Infants, Children and Youth

The Bluegrass Care Clinic (BCC) is a university-affiliated clinic, which has served as the safety net for HIV primary care in the 63 counties of central and eastern Kentucky since 1990. The BCC is not located in an Eligible Metropolitan Area or a Transitional Grant Area, and is not eligible for Ryan White (RW) Part A funding. With the award of RW Part C funds in 2001, the BCC increased the number and range of services to persons living with HIV/AIDS (PLWHA). Board-certified infectious diseases (ID) physicians provide HIV care services and serve as consultants for hospitalized HIV-infected patients. A multidisciplinary team approach to care includes on-site services of: a Patient Services Coordinators (PSC) providing medical case management; 5 HIV specialists; a clinical Pharmacist; a Mental Health Counselor; and two Internists. On-going expansion funds allowed the BCC to add a full-time Physician Assistant, a part-time PSC, an additional Clinical Pharmacist, and a Registered Dietician. Four monthly support groups (general, women, Hispanic, and caregivers) are facilitated by our PSC and Part B HIV Care Coordinators (HIV CC). Since 2001, the Bluegrass Care Clinic (BCC) patient population has increased more than 100% from 425 patients to 879 patients in 2008. The number of ambulatory care appointments has increased by 136%. The number of case management encounters has increased by 620%, in part due to the addition of RW Part B Care Coordinators in 2006. The percentage of BCC patients below the poverty level and the percentage of uninsured patients have increased by 184% and 202%, respectively. Inadequate funding coupled with a growing patient population, increase in clinical salaries, and increased utilization of services, has limited the BCC’s ability to expand patient services at the pace of the growing patient population. The need for Part D Funds is evident from the increased growth and increased vulnerability of the BCC ‘s proposed target population. Women, infant, children, and youth represent an increasing patient population at the BCC. The percentage of female patients presenting for initial care slightly outpaced our male population, increasing by 86% since 2002 (compared to males at 83%). In 2005, the BCC welcomed Dr. Brian Murphy who is board certified in general medicine, pediatrics, and infectious disease. The addition of Dr. Brian Murphy allowed the BCC to expand patient services to pediatric HIV infected and affected patients. The BCC currently serves 19 HIV positive/indeterminate patients under the age of 18. Retention data demonstrates that the female population at the BCC is particularly vulnerable to a higher drop out rate. Part D funds will enhance BCC services by increasing access to care through increased clinic sessions, and increased support services to the WICY population. Additional enhanced medical case management should promote patient retention. As an established HIV provider, serving women, infant, children, and youth (WICY), and the only safety net for HIV care in central and eastern KY, the BCC is an appropriate organization to provide focused HIV care and retention for this patient population. The BCC is requesting $350,000 in Ryan White Part D funds, with funding preference for increased burden, as well as rural and medically underserved areas. The purpose of this funding request for Ryan White Part D funds is to allow the BCC to address the following emerging needs for our WICY patients. 1) Increase Infectious Disease physician FTEs to provide 3 clinics/ week to accommodate increasing patient load and to decrease wait times (currently 1to 2 months); 2) Establish collaboration with the Division of Medicine-Pediatrics to offer a primary care clinic with providers who are familiar with and comfortable dealing with HIV infected infants and children. 3) Increase HIV Clinical Pharmacist FTE to offer 1 additional clinic/week for adherence counseling uniquely related to the WICY population; 4) Add one University of Kentucky Research Foundation on behalf of the Bluegrass Care Clinic Physician Assistant clinic per week to address emerging women’s health issues (pap smears, breast exams, etc.); 5) Increase the FTE of the BCC Registered Dietician to provide HIV specific nutrition counseling; 6) Increase PSC FTE to provide intensive, focused medical case management to improve appointment and medication adherence and HIV care retention 7) Increase collaboration between the PSC and HIV CCs to facilitate more efficient entry into care of newly identified WICY patients and to facilitate patient support groups unique to the WICY population; 8) Add a part time Clinical Services Technician to provide clinical support during the increased clinic sessions as well as coordinate patient referrals and specialty care of WICY patients 9) Increase Mental Health Counselor to add 4 one-hour clinic sessions/week to address unmet mental health needs; 10) Collaborate with UKMC’s newly established bilingual Hispanic Outreach Coordinator to provide intensive, focused medical case management services to our Hispanic WICY patients, and to coordinate entry into care of newly identified Hispanic WICY patients; 11) Increase FTE of bilingual Patient Services Project Assistant to assist with continuity of care by interacting with the Emergency Department (ED) and inpatient physicians about outpatient follow-up, and to assist with support group facilitation. Additionally, the BCC will utilize Part D funds to offer expanded medical specialty care for our WICY population on-site and via referral; as well as initiate a childcare assistance program and increase transportation assistance to improve patient retention to care and medical appointment adherence.