Ryan White Title IV Women, Infants, Children, Youth and Affected Family Members

Project Title: Ryan White HIV/AIDS Program Part D –Coordinated HIV Service and Access to Research for Women, Infants, Children, and Youth (WICY) - Existing Geographic Service Areas Applicant Organization Name: University of Kentucky Research Foundation – Bluegrass Care Clinic; Applicant Organization Address: 109 Kinkead Hall Lexington, KY 40506-0057 Project Director: Alice C Thornton, MD Contact Numbers: 859-323-4792 (W); 859-257-3477 (F) E-mail: [email protected] Web-Site: https://internalmedicine.med.uky.edu/bluegrass-care-clinic Funding Requested: $408,098 Base & $150,000 Supplemental for HIV Care Innovation Model of Care: The Bluegrass Care Clinic (BCC) is a university-affiliated clinic which has served as the safety net for HIV medical care in Kentucky since 1990. The BCC proposes to use a patient-centered, multidisciplinary team model of care to serve HIV positive WICY patients. WICY PLWHA served: Since receiving Ryan White Part D funding in 2012, the BCC has seen a 34% increase in the number of WICY patients; serving 282 (2014), 290 (2015); and 298 (2016). BCC Service Area: The BCC proposes to continue providing comprehensive HIV services to the entire 20,054 square mile service area, encompassing 63 counties in central and eastern Kentucky. Target population to be served: Of the WICY patients served in 2016, 47% were White, 42% were Black, and 10% were Hispanic. Seventy-six percent of the WICY patients served at the BCC are below the federal poverty level (2016). Due to increased access to insurance, through ACA and Medicaid Expansion in Kentucky, 49% percent of WICY patients have Medicaid, 19% have Medicare, 19% have private insurance, and 14% remain uninsured (compared to over 40% pre-ACA). Unprotected sex is the most common risk factor for WICY HIV/AIDS within the service area, 84% (53 patients) of the youth served were behaviorally infected; 14% are HIV positive due to perinatal transmission. Ninety-One percent of the women served at the BCC in 2016 were infected via heterosexual transmission (83%) or injection drug use (8%). The proposed project targets persons at-risk for HIV disease in the 63 county service area, including persons of color, migrant farm workers, medically underserved, and rural residents. The project is designed to address unmet needs and to overcome barriers to care. Key Ryan White Part D Services: The BCC proposes to continue to provide HIV care to WICY patients by an onsite multidisciplinary care team, including: 8 infectious disease (ID) physicians, 2 internists, a nurse practitioner, a pediatrician, two mental health counselors, a dietician, a nurse, a Patient Service Coordinator; and two Health Educators. The BCC receives RWHAP Part B from the Commonwealth of Kentucky which funds ten on-site Medical Case Managers (MCMs), and one non-medical case manager. As part of the university health system BCC patients have access to an additional 40 specialty referral clinics onsite. Ryan White Part D - Quality Improvement Measures: The BCC has an active Continuous Quality Management (CQM) Program that meets monthly and has representation of the multidisciplinary care team including: a nurse practitioner, two HIV physicians, two ID fellows, one Internist, the clinic manager, two health educators, a nurse, a data analyst, two program coordinators, and two MCMs. The BCC’s CQM team is actively involved in assessing and improving HRSA/HAB’s performance measures. Current quality goals for the WICY population include: increasing the % of patients with suppressed viral load to 92% (currently 90.5%) and increasing the % of patients with at least 2 medical appointments every 12 months to 98% (currently 96%). Additional quality goals including increasing the percentage of patients receiving the following services: annual pap smears; adherence assessment/counseling; annual lipid and STD screenings. Ryan White Part D Supplemental Funding – In this application the BCC proposes $134,279 in supplemental funds to pursue an HIV Care Innovation project. This project will focus on the implementation of Intimate Partner Violence Screening and Counseling in the clinical setting to address retention in care and viral suppression on the HIV Care Continuum.