HIV Early Intervention Services (EIS) Program Limited Competitive Service Areas (Brooklyn, NY, and Boston, MA)
This announcement solicits applications for fiscal year (FY) 2013 Ryan White HIV/AIDS Program Part C Early Intervention Services (EIS) Limited Competitive Service Areas (Brooklyn, NY, and Boston, MA). The Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) announces this funding opportunity for competing Part C Early Intervention Services (EIS) to support outpatient HIV early intervention and primary care services. These services target low-income, medically underserved people living with HIV/AIDS. The purpose of the Ryan White HIV/AIDS Part C EIS Program is to provide HIV primary care in the outpatient setting. Applicants must propose to provide a comprehensive continuum of outpatient HIV primary care services in the targeted area including: 1) targeted HIV counseling, testing, and referral; 2) medical evaluation and clinical care; 3) other primary care services; and 4) referrals to other health services. Primary care for persons with HIV disease should start as early in the course of the infection as possible. However, entry into a Part C EIS program may take place at any point in the spectrum of the disease or the patient’s lifespan. As established in section 2651 of the PHS Act, and according to the terms and conditions of these awards, a Part C program grantee must expend grant funds to provide HIV primary medical care in a proposed service area. These services must be reflected in the budget. Staff positions such as nurses, medical assistants and dental hygienists can be included in the budget when the position proportionately complements HIV primary medical care providers, such as physicians, dentists, physician assistants, or nurse practitioners for the Part C program. Accordingly, a Ryan White HIV/AIDS program Part C budget must reflect a medical model of care in which providers can assess, treat and refer, as applicable. Providers must be authorized, via credentialing and licensure, to prescribe medications, order medically indicated tests/exams, interpret symptoms, treat, and meet HHS guidelines. Applicants will be expected to have the financial capabilities to execute the fiduciary responsibilities that come with acceptance of a Federal award. Applicants must demonstrate that they are fiscally able to perform the duties and services outlined in this grant. As established in section 2693 of the PHS Act, the Minority AIDS Initiative (MAI) is intended to address the disproportionate impact that HIV/AIDS has on racial and ethnic minorities and to address the disparities in access, treatment, care, and outcomes for racial and ethnic minorities, including African Americans, Alaska Natives, Hispanic/Latinos, American Indians, Asian Americans, Native Hawaiians, and Pacific Islanders. MAI funding is designated as part of the base award for applicants who meet the description below. Minority AIDS Initiative (MAI) The goal of the MAI is to help reduce the disproportionate impact of HIV/AIDS and address disparities by:  Increasing the number of persons from racial and ethnic minority populations receiving HIV care, and  Increasing the number of persons from racial and ethnic minority populations who stay in care. MAI funds are granted to health care organizations that provide culturally and linguistically appropriate care and services to racial and ethnic minorities. Funded Part C EIS programs will be assigned funds under the MAI based on the data provided in the application by the HRSA/HAB Division of Community HIV/AIDS Programs (DCHAP), which administers the Part C EIS program. The MAI assignment is based on the percentage of the population served or proposed to be served from racial/ethnic minority communities. The amount of MAI funds awarded is noted under the grant specific terms section of the Notice of Award (NOA) which establishes the final funding for the budget period. National HIV/AIDS Strategy (NHAS) The National HIV/AIDS Strategy (NHAS) has three primary goals: 1) reducing the number of people who become infected with HIV, 2) increasing access to care and optimizing health outcomes for people living with HIV, and 3) reducing HIV-related health disparities. The NHAS states that more must be done to ensure that new prevention methods are identified and that prevention resources are more strategically deployed. Further, the NHAS recognizes the importance of getting people with HIV into care early after infection to protect their health and reduce their potential of transmitting the virus to others. HIV disproportionately affects people who have less access to prevention, care and treatment services and, as a result, often have poorer health outcomes. Therefore, the NHAS advocates adopting community-level approaches to identify people who are HIV-positive but do not know their serostatus and reduce stigma and discrimination against people living with HIV. To the extent possible, program activities should strive to support the three primary goals of the NHAS. As encouraged by the NHAS, programs should seek opportunities to increase collaboration, efficiency, and innovation in the development of program activities to ensure success of the NHAS. The NHAS also calls for improved federal coordination of HIV/AIDS programs, as evidenced by streamlining and standardizing data collection and reducing reporting requirements for grantees. Over the past year, the Office of HIV/AIDS and Infectious Disease Policy in HHS has worked with a group of Federal Agencies, National Partners and grantees to identify indicators, data systems, and elements used across HHS programs to monitor HIV prevention, treatment, care services. A set of common indicators is being implemented within 7 domains: 1) HIV testing; 2) Late HIV diagnosis; 3) Initial linkage to HIV medical care; 4) Retention/engagement in HIV medical care; 5) ARV Therapy; 6) Viral Load suppression; and 7) Housing Status. These indicators are covered under the Ryan White HIV/AIDS Program Services Report (RSR) that grantees and service providers report to HRSA on an annual basis, and thus HRSA/HAB will be positioned to calculate and report on these indicators. Part C programs should comply with Federally-approved guidelines for HIV Prevention and Treatment (see http://www.aidsinfo.nih.gov/Guidelines/Default.aspx as a reliable source for current guidelines). More information can also be found at http://www.whitehouse.gov/administration/eop/onap/nhas. Part C EIS Program Requirements and Expectations Required Services The following primary care services must be provided to all persons living with HIV/AIDS, whether on-site or at another facility: HIV counseling, testing, referral, and partner counseling services HIV counseling, testing, referral, and partner counseling should be available for high risk targeted service populations, but Part C funding for these services should not duplicate services from other sources, if these are available and accessible to the targeted population(s). Instead, linkages and formal referral mechanisms should be established with these programs to ensure follow-up and evaluation for those persons identified as HIV-positive. Part C funding should not be used for routine HIV testing in general patient populations or generic efforts such as health fairs. If HIV counseling, testing, referral, and partner counseling are provided directly by the applicant, these services must comply with provisions stipulated by the Department of Health and Human Services (DHHS) in accordance with Sections 2661, 2662 and 2663 of the Ryan White HIV/AIDS Program. The Revised Guidelines for Counseling, Testing, and Referral are available at: http://aidsinfo.nih.gov/. The counseling, testing and referral program also must assure the confidentiality of patient information in compliance with applicable Federal, State, and local law. Medical evaluation and clinical care Medical evaluation and clinical care includes CD4 cell monitoring, viral load testing, antiretroviral therapy, prophylaxis and treatment of opportunistic infections, malignancies and other related conditions, routine immunizations, prevention of perinatal transmission, and patient education, including linkage to prevention services. Funded programs must offer individuals a comprehensive continuum of HIV care including primary medical care and, when applicable, perinatal care. At a minimum, the applicant, in accordance with the latest HHS guidelines, should provide periodic medical evaluations; appropriate treatment of HIV infection; and prophylactic and treatment interventions for complications of HIV infection, including opportunistic infections, opportunistic malignancies and other AIDS defining conditions. The program also must provide for a system to confirm the presence of HIV infection, and must provide tests to diagnose the extent of deficiency in the immune system. Individuals must have access to ongoing prevention services while other treatment is being administered. The system of care must provide appropriate diagnostic and therapeutic measures for preventing and treating the deterioration of the immune system and related conditions, conforming to the most recent clinical care protocols. The program must also have a system in place for after-hours and weekend clinical coverage for medical and dental services. Tuberculosis, Hepatitis B and C, and sexually transmitted infections (STI) evaluation and treatment are indispensable components of an HIV primary care program. Ryan White Part C EIS programs should be able to diagnosis, prophylaxis, and treat or refer persons co-infected with these diseases. Program-wide clinical protocols should be in place to address these co-morbidities.  To ensure consistency and continuity of care, the clinical staff of the program should track and coordinate all inpatient care. Staff should develop plans for the resumption of the care of the patient in the program once they have been discharged from the hospital. Likewise, Part C EIS programs are required to have a systematic tracking mechanism in place to follow-up on referrals for patients in the Ryan White program. The system of tracking referrals must include documentation of the outcome of the referral in the medical record. Part C EIS programs are required to have a plan for referring patients to biomedical research facilities or community-based organizations that conduct HIV-related clinical trials. For information on these protocols, call the AIDS Clinical Trials Information Service at 1-800-HIV-0440 or visit the AIDSinfo website at http://www.aidsinfo.nih.gov . In the face of rapidly changing clinical management of HIV disease, continuing education opportunities must be provided to EIS program staff to ensure they remain abreast of clinical advances. The program must document, implement, and practice recommendations as presented in the following HHS guidelines. Program specific clinical protocols must be updated accordingly as changes occur in the HHS guidelines. The following publications are available on-line at http://www.aidsinfo.nih.gov/ or may be obtained by calling: 1-800-HIV-0440. • Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents • Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents • Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection • Recommendations for the Use of Antiretroviral Drugs in Pregnant HIV-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the U.S. Patients should be involved and fully educated about their medical needs and treatment options within the standards of medical care. A document describing patient rights and responsibilities should be posted in a prominent place within the facility, and policies should be reviewed with each patient at intake. The policies and posted document should clearly describe the recourse a patient has if he/she is dissatisfied with the care provided. Other primary care medical services In addition to providing each patient with a thorough medical evaluation and related clinical care, the applicant should ensure, directly or via referral, access to oral health care, adherence counseling, outpatient mental health care, outpatient substance abuse treatment, nutritional services and specialty medical care, as described below. If a program is unable to provide any of these services on-site, it may establish and demonstrate formal arrangements, such as contracts or memoranda of understanding with appropriate providers. It is recommended that all practitioners for these services have experience working with the target population and with HIV. • Oral Health: Grant funds may be used to support the provision of oral health services by general dental practitioners, dental specialists, dental hygienists, and other trained dental providers at on-site facilities. Funds may also be used to secure or subsidize such services obtained off-site by referral. Funding may also be available through Part A, Part B, and Part D-supported programs in the area. If a HRSA-supported HIV/AIDS Dental Reimbursement Program (DRP) or Dental Community-Based Partnership Program (DCBP) exists in the service area, programs should document efforts to collaborate with the DRP and/or DCBP. A list of HRSA supported HIV/AIDS Dental Reimbursement awards is available on-line at: http://hab.hrsa.gov/abouthab/partfdental.html#2.  Treatment Adherence: Successful treatment adherence programs are most effective when they use a multi-disciplinary approach. A treatment adherence program might include readiness assessments, patient education, adherence monitoring and counseling.  Outpatient Mental Health: Outpatient mental health services include screening, assessment, diagnosis, and treatment of common mental health illnesses. Optimal mental health treatment requires a multidisciplinary approach involving primary care and/or specialty physicians and mental health professionals who are trained, experienced, and/or certified in the field.  Substance Abuse Services: Outpatient substance abuse services include screening, assessment, diagnosis, and treatment of substance abuse related illnesses. Optimal substance abuse treatment requires a multidisciplinary approach involving primary care and/or specialty physicians and substance abuse professionals who are trained, experienced, and/or certified in the field.  Nutritional Services: Nutritional services include: screening, nutrition education and/or counseling, dietary/nutritional evaluation, and nutritional supplements, optimally provided by a licensed, registered dietitian or licensed, registered nutritionist. Nutritional services may be provided in individual and/or group setting.  Specialty Care: Patients must have access to specialty and subspecialty care. Such services may include access to hematology/oncology, dermatology, ophthalmology, gynecology, gastroenterology, and pulmonary care. Prevent new infections by working with persons diagnosed with HIV and their partners Applicants are encouraged to incorporate the “Recommendations for Incorporating HIV Prevention into Medical Care of Persons Living with HIV” into their clinical program. These recommendations were developed jointly by the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) (Morbidity and Mortality Weekly Report July 18, 2003, Volume 52, Number RR-12). Recommendations for Incorporating HIV Prevention into Medical Care of Persons Living with HIV provide the guidance for making risk screening, STI screening, and prevention messages part of the routine medical care delivered to patients with HIV infection. Please see http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5212a1.htm. Health care providers are in a unique position to help persons living with HIV/AIDS stop the further transmission of HIV. Members of the health care team, including physicians, nurses, and mid-level providers have a strong influence on patients’ behavior, and therefore can positively impact health-related choices by delivering brief prevention messages and asking patients about risk behaviors, in ways that are culturally and linguistically appropriate during patient visits. Health care providers can help to reduce the number of new HIV infections and impact the HIV epidemic by:   Screening patients for behavioral risk through interviews or questionnaires regarding sexual and needle-sharing behaviors and screening for STIs and pregnancy.   Offering behavioral interventions to change knowledge, attitudes, and behaviors to reduce personal risk of transmitting or acquiring other STDs. These might include posters and brochures in waiting and exam rooms; verbal discussions with patients supplemented by written materials; condoms readily accessible in the clinic; and referral to other persons or organizations providing services such as substance abuse treatment.   Providing partner counseling and referral services (PCRS), including partner notification, as described above. Such services can help the sex and needle-sharing partners of HIV-infected patients learn their HIV status and take steps to avoid becoming infected (or, if infected, to avoid infecting others) and gain earlier access to medical evaluation, treatment, and other services. Activities and behavioral interventions related to prevention for current patients and others must be properly documented in the medical recor
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