Ryan White Part C: Outpatient Early Intervention Services to HIV Positive Persons 2018-2021

BCC Service Area: The Bluegrass Care Clinic (BCC) is a university-affiliated clinic at the University of Kentucky Healthcare (UKHC), which has served as the safety net for HIV primary care for 63 counties in central and eastern KY since 1990. With the award of Ryan White HIV/AIDS Program (RWHAP) Part C funds in 2001, RWHAP Part B funds in 2006, as well as ongoing expansion funds and RWHAP Part D funds in 2009, the BCC has developed a comprehensive health care delivery system for a growing population of persons living with HIV (PLWH), increasing 220% from 2001 (481 unduplicated patients) to 2016 (1547 unduplicated patients). Board-certified infectious diseases (ID) physicians provide HIV care services and serve as consultants for hospitalized PLWH. A multidisciplinary team approach to care includes on-site services of: 10 ID physicians, 2 internists, a nurse practitioner, a pediatrician, a clinical pharmacist, two mental health counselors, a dietician, a nurse, two Health Educators, 10 Medical Case Manager (MCMs), and one non-MCM. In this application the BCC proposes to continue providing comprehensive HIV services to the entire 20,054 square mile, 63 county Kentucky service area. HIV Epidemiology of the Service Area: Of the 63 targeted counties served, 51 of the counties are designated as Appalachian, 38 are federally recognized as economically distressed, and 43 counties have been identified as medically underserved. The BCC service area is predominately White (95%). African Americans and Hispanics are disproportionately represented in the patient population of the BCC; of the PLWHA served in 2016, 68% were White, 23% were Black, and 7% were Hispanic. In 2016, 53% percent of the PLWH served at the BCC were below the federal poverty level (FPL); an additional 19% had incomes between 100 and 200% of the FPL. Unprotected sex is the most common risk factor (84%) for PLWH within the BCC’s service area; 60% identified MSM as their primary risk factor, an additional 24% identified heterosexual sex as their primary risk factor. Key Ryan White Part C Services: The BCC requests $666,345 per year for three years continue to address the emerging needs of our PLWH target population by providing the following proposed services: 1) Access to high quality, comprehensive HIV primary care services; 2) Referral to medical specialty care (mental health and substance abuse services); 3) Medical Case Management; 4) Nutritional assessment/counseling services; 5) Access to oral health care via UK’s RWHAP Dental Program; 6) Multidisciplinary adherence education program; 7) Access to appropriate vaccines and emergency HIV and prophylactic medications; 8) Culturally and linguistically appropriate services; 9) Services consistently improved based on an active continuous quality management (CQM) program; 10) Consumer involvement in program development, implementation, and evaluation activities; 11) Prevention case management and HIV testing and counseling for high-risk partners, friends, and family members of patients; and 12) Patient Support Groups (Men’s, Women’s, & Hispanics). Target population to be served: The proposed project targets persons at-risk for HIV disease in the service area, including persons of color, young MSM, migrant farm workers, and medically underserved, and rural residents. The project is designed to address unmet needs and to overcome barriers to care. The BCC requests funding preference for increased burden, rural areas, and the medically underserved.