Ryan White Part D - Coordinated HIV Services and Access to Research for Women, Infants, Children , and Youth (WICY)

Summary of Request: The Bluegrass Care Clinic (BCC) is a university-affiliated clinic, housed in the University of Kentucky’s Kentucky Clinic, which has served as the safety net for HIV medical care in Kentucky since 1990. The BCC serves 1094 (2011) active HIV-positive patients and for Fiscal Year 2012 is funded by: Ryan White (RW) Part B ($948,620), Part C ($688,932), and Part D ($350,000). The BCC requests $400,000 in RW Part D funds to continue to serve 63 rural/medically underserved counties in central and eastern Kentucky. The BCC proposes to use a patient-centered multidisciplinary team approach to care. This currently includes on-site services of: 7 board certified infectious disease physicians, 4 internists, a clinical pharmacist; a mental health counselor; a registered dietician; three Patient Service Coordinators (PSC); seven RW Part B HIV Care Coordinators, and over 40 specialty referral clinics onsite. Target Populations: As a Ryan White Part D provider, the BCC proposes to continue services to all four priority target populations: HIV-infected women, children, and youth, as well as HIV-infected and exposed infants. In 2011, BCC WICY patients represented 38% of the newly enrolled patients; up from 26% in 2008. The BCC anticipates serving 270 WICY patients during the first grant year. Ethnic and racial minorities are disproportionately affected by HIV/AIDs in the BCC service area. In 2011, 21% of the patient population was African American, while 8% were Hispanic, compared to 2.4% and 1.7% of the total service area population, respectively. An increasing percentage of the patient population at the BCC is uninsured (43%) compared to the general population in the service area (17.8%); as well as below the poverty level (50% in the patient population compared to 24.6% in the service area). The BCC serves a wide variety of persons with various cultural backgrounds, and has an equally diverse team of providers to provide culturally and linguistically competent care. The BCC has employees on staff representing a variety of cultural/ethnic backgrounds: Rural/Appalachian (7); African-American (4); Asian (2); Bilingual Spanish-speaking (3); Gay/Lesbian/Transgender (2). Challenges: In 2007, the BCC evaluated patient appointment adherence and retention to care. Women and racial minorities were more than twice as likely to miss scheduled patient appointments as compared to their male/white counterparts. A follow-up survey found various barriers to care for our WICY population including: transportation, childcare, and appointment wait time. Receipt of RW Part D funds in 2009 allowed the BCC to expand both staff and services available to address many of these barriers, resulting in a significant increase in the WICY population remaining and enrolling into care. By 2011, WICY patients represented a growing percentage of the patient population, increasing by 35% since 2007 (compared to only an 18% increase in the non-WICY population). This proposal is to request continued Part D funding so the BCC can maintain the expanded staff and services need to address the challenges in accessing and retaining WICY patients in care. Loss of these funds will be detrimental to this population. Objectives: With receipt of the Ryan White Part D funds, the BCC will provide outpatient ambulatory medical care, adherence counseling, mental health screening/counseling, nutritional assessment/counseling, and specialty referrals as appropriate to a growing WICY population. Ryan White Part D funds will allow the BCC to: enroll 45 new WICY patients; serve a total WICY population of 270; and follow 8 pregnant women and 16 HIV-infected and/or exposed infants.