Ryan White Part C: Outpatient Early Intervention Services to HIV Positive Persons

A. INTRODUCTION - 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 thus is not eligible for Ryan White Part A funding. With the award of Ryan White 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: Patient Services Coordinators (PSC) providing medical case management; 5 HIV specialists; 2 Clinical Pharmacists; a psychotherapist; two Internists, a full-time Physician Assistant, and a Registered Dietician. Monthly support groups are facilitated by our PSCs and Part B HIV Care Coordinators (HIVCC). Since 2001, the 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 Part B HIVCCs in 2006. Since 2001, 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 BCC is requesting continued funding of $688,932 in Ryan White Part C funding with funding preference for increased burden, as well as rural and medically underserved areas. The purpose of this funding request for continued Ryan White Part C funds is to allow the BCC to continue to address the emerging needs of our HIV patients by providing: 1) Access to and outreach for high quality, comprehensive HIV primary care services; 2) HIV counseling, testing, referral, and partner counseling to 30 persons at the BCC.; 3) Comprehensive HIV primary medical care to 75 new patients over the next year; 4) Physician access weekdays, and after-hours 24 hours/day, 7days/week, 365 days/year; 5) Medical specialty care by referral, as appropriate; 6) Nutritional assessment and counseling services to 50%-75% of patients, as appropriate; 7) Mental health and substance abuse services to 90%-100% of indicated patients; 8) Oral health care (UK’s RW Dental Reimbursement Program) for 80%-100% of patients; 9) A multidisciplinary health/adherence education program to 80%-90% of qualifying patients; 10) Prevention case management services to patients and their partners; 11) Appropriate vaccines and emergency HIV medications; 12) Culturally and linguistically appropriate services; 13) A continuous quality improvement plan; 14) Consumer involvement in program development, implementation, and evaluation activities; 15) A patient-led Clinic Advisory Board, and satisfaction survey; 16) Patient Support Groups (Men’s, Women’s, & Hispanics).