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

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 patientcentered, multidisciplinary team model of care to serve HIV positive WICY patients. PLWHA served: Since receiving Ryan White Part D funding in 2012 the BCC has seen an increasing number of WICY patients annually; from 228 (2012), 237 (2013) and 282 (2014). In 2014 the BCC enrolled 169 new patients into care, 52 (31%) were WICY patients. 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 2014, 51% were white, 40% African American, and 8% Hispanic. Seventy-five percent of the WICY patients served at the BCC are below the federal poverty level (2014). Due to increased access to insurance, made available through ACA and Medicaid Expansion in Kentucky, only 14% of the WICY population remains uninsured (compared to over 40% pre-ACA). Fifty percent of WICY patients have Medicaid, 15% have Medicare, and 20% have private insurance. Unprotected sex is the most common risk factor for WICY HIV/AIDS within the BCC’s service area, 85% (50 patients) of the youth served were behaviorally infected; the remaining 15% are HIV positive due to perinatal transmission. Eighty-eight percent of the women served at the BCC in 2014 were infected via heterosexual transmission (82%) or injection drug use (6%). The proposed project targets persons at-risk for HIV disease in the 63 county service area, including persons of color, migrant farm workers, and 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 in this application to continue to provide HIV care to WICY patients by a multidisciplinary care team, including on-site services of: 7 board certified infectious disease physicians, 3 internists, a pediatrician, a mental health counselor, a registered dietician, a nurse, a Patient Service Coordinator; and a Health Educator. The BCC receives Ryan White Part B from the Commonwealth of Kentucky which funds nine on-site Part B HIV Care Coordinators to provide medical case management. In addition to comprehensive Infectious Disease care, as part of the larger University of Kentucky Healthcare Enterprise patients seeking care at the BCC have access to an additional 40 specialty referral clinics onsite. Ryan White Part D - Quality Improvement Measures: The BCC has an active Quality Management Program that meets monthly and has representation from members of the multidisciplinary care team including: four HIV physicians, two infectious disease fellows, one Primary care physician, the ambulatory practice clinic manager, a health educator, a nurse, a program assistant, two program coordinators, and three medical case managers. The BCC’s CQM team is actively involved in assessing and improving many of HRSA/HABs recently released performance measures. Current quality goals for the WICY population include: increasing the percentage of patients with suppressed viral load to 90% (currently 88%) and increasing the percentage 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 and counseling; annual lipid screening; and annual STD screening. Ryan White Part D Supplemental Funding – In this application the BCC proposes $100,000 in supplemental funds to address the HIV Continuum of Care specifically to improve virologic suppression of the youth population. While the total WICY patient at the BCC has virologic suppression of 90%, youth are currently at only 82%.