Central Texas
HIV/AIDS Planning Area
______
Comprehensive Services Plan
2012 – 2015
Amber Alvarez, M.A.
Planner
Brazos Valley Council of Governments
HIV Administrative Services
Phone: 979.595.2801 ext. 2224 or 866.841.7288
Fax: 979.595.2815
Email:
Web: http://www.bvcog.org/hiv
Thank You
Without the contributions of many people and groups, this plan would not be possible. Thank you to the staff at the Brazos Valley Council of Governments HIV Administrative Services, whose insights and analysis helped to shape the goals and objectives of the plan. Thanks are also extended to the subcontracted agencies of BVCOG and their directors and staff, who provided valuable information on care system characteristics, needs, and resources in their respective areas. Lastly, BVCOG HIV Administrative Services expresses gratitude to the consumers and community members who voluntarily contributed their experiences and time in the community input process to ensure this plan reflects the needs and voices of people living with HIV/AIDS in the Central Texas HIV/AIDS Service Area.
TABLE OF CONTENTS
Executive Summary 1
Section 1: Where Are We Now: What is Our Current System of Care? 5
Population Description 5
Summary of PLWHA in the CTHASA 5
Current Population Served 7
Summary of PLWHA Population Out of Care 7
Most Recent Needs Assessment 10
Participant Profile 10
Needs Assessment Summary/Findings 11
Service Category Rankings and Explanation 13
Unmet Need Estimates 16
Out-of-Care Respondents 17
Gaps in Care Services 19
Barriers to Care Services 19
Prevention Needs 21
Summary of Current Care Resources 22
Austin HSDA 22
Bryan – College Station HSDA 23
Concho Plateau HSDA 25
Temple – Killeen HSDA 25
Waco HSDA 26
The Current Care System 29
Service Category Rankings and Explanation
Services Currently Available
Access Points and Process 29
Monitoring and Evaluation Procedures 32
Section 2: Where Do We Need To Go: What System of Care Do We Need? 33
Section 3: How Will We Get There: How Does Our System Need To Change
To Assure Availability of, and Accessibility to, Core Services? 34
Section 4: How Will We Monitor Our Progress: How Will We Evaluate Our
Progress In Meeting Our Short and Long Term Goals? 39
Appendix A: Counties in the Planning Area 40
Appendix B: Performance Measures 41
Appendix C: FY2012 Allocations for RW-B and SS 42
Appendix D: Services by HSDA and Funding Status 47
Appendix E: Ryan White Part B Contracted Providers Service
Locations 49
Executive Summary
Content and Focus of the Plan
As part of the Ryan White HIV/AIDS Treatment Extension Act of 2009, grantees must complete a comprehensive services plan. For the State of Texas under Ryan White Part B, each planning area must submit a comprehensive services plan to the Texas Department of State Health Services (DSHS). This plan is viewed not as a condition of participation, or requirement, but is written as a form of strategic plan for the Brazos Valley Council of Governments HIV Administrative Services (BVCOG). This plan details the system of care and support, problems present in the system, and strategies to address the problems for the 43 county Central Texas HIV/AIDS Administrative Service Area (CTHASA). This plan covers a three year project period, April 1, 2012 to March 31, 2015.
Section One asks the question, “Where Are We Now: What Is Our Current System Of
Care?” This section includes descriptions of the HIV/AIDS population in the CTHASA, a summary of the most recent needs assessment findings and activities, current care resources in the planning area, and entry/access points to care.
The Central Texas HIV Administrative Service Area is comprised of five health service delivery areas (HSDAs). The 10-county Austin HSDA also contains the Austin TGA, a Ryan White Part A and C grantee. Over 75% of all people living with HIV/AIDS in the CTHASA reside in the Austin TGA. The four other HSDAs are often referred to as the rural HSDAs, each with one or two hub cities, while Austin is considered a major metropolitan area. As of December 31, 2010, there were 2,531 people living with HIV cases and another 3,269 living with AIDS in the planning area. Of those that are infected, DSHS estimates 1,604 people (858 HIV and 746 AIDS) are considered out-of-care.
To evaluate the needs of people living with HIV/AIDS in central Texas, a comprehensive needs assessment was conducted in the planning area in late 2009. Overall, 230 people were surveyed, with representation from each HSDA mirroring that HSDAs proportion of clients in the CTHASA. Of those surveyed, 57% said they needed health insurance and did not have the need met, 61% said they needed emergency financial assistance and the need was not met, and 62% said they needed oral health care and the need was not met. A small number of other services were noted as needed but the need not being met; this, along with other identified gaps and barriers to care, is explored more in depth in the assessment findings portion of this plan. BVCOG is also collaborating with the Ryan White Part A administrative agent and the Austin Area Comprehensive Planning Council to conduct a targeted needs assessment of traditionally unfunded/underfunded services in the Austin TGA/HSDA. Among the service categories being examined are transportation, both in rural and urban areas, as well as childcare assistance.
A brief summary of resources in the planning area is in the latter half of Section One. The processes for accessing the care system, its components, and entry points are also detailed in the last part of Section One.
Section Two asks, “Where Do We Need To Go: What System of Care Do We Need?” The mission, vision and values of BVCOG HIV/Health Services, needs assessment data, and feedback from providers, clients and community members have all shaped our conceptualization of what the future state of the Ryan White care system should look like in the CTHASA. This section describes the improved system of care we envision.
Mission:
The Brazos Valley Council of Governments HIV Administrative Services plans for the use of and administers funds to provide access to quality medical and social services for anyone living with HIV/AIDS in the Central Texas HIV/AIDS Administrative Service Area.
Vision:
The Brazos Valley Council of Governments HIV Administrative Services will be the premier administrative agency that is forward looking and innovative, and constantly improving the system of care in our responsibility.
Values:
The values that guide our practices and decisions include data and science based decision making; use of evidence based best practices; a willingness to innovate; to not shy away from difficult changes or challenges; a desire to provide high quality services as defined by professional and clinical organizations; a belief in continuous quality improvement; planning for the future and agilely responding to change; ethics; compassion; and the voice of the client/patient.
Based upon the findings from the needs assessment, the resources available, our current care system, and the epidemiology, four broad goals were identified:
Þ Increase access to services through expansion of services and reduction of barriers
Þ Improve the quality of services provided
Þ Improve the care system through better planning and administration
Þ Equip the care system to articulate with the changing nature of healthcare at national, state and local levels
Section Three provides the goals and objectives of this plan, answering the question, “How Will We Get There: How Does Our System Need to Change to Assure Availability of and Accessibility to Core Services?” Findings from the needs assessments and other information in Section One shaped the goals and objectives; plans for meeting these goals and objectives over the next three years that will move us toward the system of care are envisioned in Section Two. These goals include reducing the number of out of care PLWHA in each HSDA; increasing client receipt and agency tracking of preventive vaccinations and screenings; supporting client self-advocacy; and preparing agencies for health care reform and the changes the Affordable Care Act will bring to the CTHASA.
Section Four describes, in brief, how we will monitor our progress toward the envisioned system of care. Traditional clinical and programmatic monitoring of contracted providers will allow us to assess our progress towards the goals outlined in the plan., while client satisfaction surveys and monthly monitoring of expenditures and utilization of services will further our understanding of how far we have come in achieving our goals. Quarterly monitoring of goal-specific data and feedback, project matrices, and yearly reports to DSHS and all interested parties will also assist us in monitoring our progress and improving the overall system of care.
In sum, this comprehensive plan provides a framework for establishing and monitoring (1.) where we are now, (2.) where we want to go, (3.) how we will get there, and (4.) how we will know we are getting there. Once the three year planning cycle is complete, the process will begin anew, starting April 1, 2015.
Development of the Plan
Developing this comprehensive services plan utilized various methods of input, the first of which was town hall meetings with PLWHA and others interested in HIV/AIDS community planning. In 2011, the BVCOG Planner conducted town hall meetings in the Bryan – College Station, Concho Plateau, Temple – Killeen, and Waco health service delivery areas (HSDA). Input from the Austin HSDA was obtained through recommendations from the Austin Area Comprehensive HIV Planning Council, a Part A grantee, and public comment regularly provided at planning council meetings.
Participants at the town hall meetings were presented with major findings from the needs assessment, the methodology for setting service category priorities and allocations, and the proposed goals and objectives in the comprehensive plan. Participants were then invited to discuss the proposals and offer suggestions for alternative methods of setting priorities and allocations, suggesting different contingency plans for increased or decreased allocations, and other goals and objectives. Each town hall meeting began a 30-day comment period, during which anyone could contact the BVCOG Planner by mail, email, phone (toll-free), or fax.
In 2012, the new BVCOG Planner began scheduling community input meetings to gain client and community perspectives on allocations, service system improvement goals, and emerging needs and trends. The first of these meetings was scheduled April 25, 2012 in the Bryan-College Station HSDA. Clients that have indicated they are willing to receive mail from their service provider were mailed a flyer two weeks prior to the community input meeting, informing them of the meeting and encouraging them to attend in order to ensure the proposed comprehensive plan reflects their needs, values and perspectives. Clients who are primarily Spanish speaking were sent a Spanish copy of the allocations for the Bryan-College HSDA and a flyer inviting the clients to call a Spanish speaking BVCOG employee to provide feedback as well. As community input meetings are held throughout the 2012-2013 fiscal year, the BVCOG Planner will update this plan accordingly, both with DSHS and on the BVCOG-HIV website.
Ryan White Reauthorization
Reauthorization of the Ryan White Treatment Extension Act of 2009 is anticipated in 2013. The 2014 update of this comprehensive plan will incorporate any changes necessary in response to the reauthorization.
Limitations
The community planning process is not an exact science, and limitations surface particularly with regard to data collection and the extent to which it may be generalized to the entire PLWHA population. The HIV/AIDS services allocation process is a lower form of actuarial work, estimating the needs of the population as well as the cost of providing services.
Limitations in data gathering for the needs assessment are discussed in Section One in the summary of the most recent needs assessment. Of the clients that participated in the needs assessment, only two reported not currently being in care. For this reason, the needs assessment findings may not be generalized to the out of care population in the administrative service area. This limitation also informed the development of the first goal in Section Three: reducing the number of out of care PLWHA in each HSDA.
Implementation
Prior to implementation of this plan, a comment period was opened from April 25, 2012 to May 20, 2012 to allow a last chance for input. Suggestions offered were evaluated according to the criteria in the community input plan and adjustments made accordingly. Community input meetings in all five HSDAs of the CTHASA will be conducted to inform the communities this plan serves and to provide community input for the 2013 update of this plan.
Section 1: Where Are We Now: What is Our Current System of Care?
Population Description
Population Description: Summary of PLWHA in the CTHASA
As of December 31, 2010, there are 2,531 living HIV cases and 3,269 living AIDS cases in the Central Texas HIV/AIDS Service Area (CTHASA). Of these 5,800 individuals, 80.66% (4678) are male while 19.34% are female. Additional data describing the demographic composition of people living with HIV/AIDS (PLWHA) in the CTHASA are best displayed in table format. The following tables were created using data extracted from the Enhanced HIV/AIDS Reporting System (eHARS) database and Texas State Data Center population estimates as presented in the Texas Department of State Health Services (DSHS) 2010 Texas Integrated Epidemiologic Profile for HIV/AIDS Prevention and Services Planning. The data reflect HIV/AIDS infection cases in the Central Texas HIV Administrative Service Area through December 31, 2010.
Current age
Age in 2010 / NumberPercent
Under 13 / 13
0.22%
13 to 24 / 285
4.91%
25 to 34 / 987
17.01%
35 to 44 / 1,676
28.90%
45 to 54 / 1,983
34.19%
55 & up / 856
14.76%
Total / 5,800
Though the 35-44 age group contained the highest percentage of people living with HIV in the CTHASA as recently as 2008, the 45-54 age group has grown rapidly since the last comprehensive plan, and now compromises the highest percentage of PLWHA. In part, this shift reflects the success of statewide and local initiatives to increase adherence to treatment, as more PLWHA are living longer with the disease. Along with the rest of the nation, the CTHASA is facing an aging population with HIV/AIDS, and must be flexible in order to develop a system of care that best serves clients of all ages.