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

Funding Opportunity Number: HRSA-22-03 CFDA(s): 93.153 Applicant Name: University of Kentucky Research Foundation Descriptive Title of Project: Ryan White Part D Coordinated HIV Services and Access to Research for Women, Infants, Children and Youth - Existing Geographic Service Areas 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. PWH served: Since receiving Ryan White HIV/AIDS Program Part D funding in 2012 the BCC has seen an increasing number of WICY patients; from 391 (2018), 401 (2019) and 414 (2020). The WICY population comprises 24.7% of the total population of PWH at the BCC (414/1,670). Service Area: The BCC proposes to continue providing comprehensive HIV services to the entire 20,054 square mile, 63 county service area in central and eastern Kentucky. Target population: Of the WICY patients served in 2020, 49% were white, 40% African American, and 9% Hispanic. This is significantly disproportionate when compared to the service area population which is 95%, 2.4% and 1.7% respectively 1. Seventy-six percent of BCC WICY patients served are below the federal poverty level (2020). The ACA and Medicaid Expansion have allowed for only 3% of the BCC population remains uninsured. Unprotected sex is the most common risk factor for WICY PWH within the service area, 80% of the youth served were behaviorally infected; 20% are HIV positive due to perinatal transmission. IDU in the youth population at the BCC has increased from 10% to 13% from 2018 to 2020. Eighty-seven percent of the women served at the BCC in 2020 were infected via heterosexual transmission (75%) or IDU (12%). The proposed project is designed to address unmet needs and barriers to care for persons at-risk for HIV in the service area, including persons of color, young MSM, people who inject drugs, transgender individuals and medically underserved and rural residents. Key Services and Quality Improvement Measures: The BCC is requesting continued funding of $477,806 in funding to continue to address the needs of our WICY population by providing the following key services: 1) Access to comprehensive HIV care services 2) Physician access weekdays, and after-hours 3) Referral to medical specialty care 4) Medical Case Management 5) Nutritional assessment/counseling services 6) Access to oral health care 7) Multidisciplinary adherence education program 8) Access to appropriate vaccines and emergency HIV and prophylactic medications 9) Culturally and linguistically appropriate services; 10) Services consistently improved based on an active continuous quality management (CQM) program 11) Consumer involvement in program development, implementation, and evaluation activities 12) Prevention case management and HIV testing and counseling for high-risk partners, friends, and family members of patients; 13) Patient Support Groups 14) Transportation Assistance The BCC’s CQM Team meets quarterly and has representation of the multidisciplinary care team including: a nurse practitioner, physicians, fellows, health educators, nurse navigators, data analyst, program coordinators, adherence coordinator, peer support and MCMs. The BCC’s CQM team is actively involved in assessing and improving HRSA/HAB’s performance measures. Current goals for the WICY population include: increasing the percentage patients with suppressed viral load to 90% (currently 84%) and increasing the percentage of patients with at least 2 medical appointments every 12 months to 95% (currently 92%). Additional quality goals including increasing the percentage of patients receiving the following services: annual pap smears; adherence assessment/counseling; annual lipid and STD screenings. References 1 United States Census Bureau, QuickFacts Kentucky: https://www.census.gov/quickfacts/KY