2012-2015 State of Georgia Statewide Comprehensive HIV Services Plan [2012]

2012-2015 State of Georgia Statewide Comprehensive
HIV Services Plan
Georgia Department of Public Health Division of Health Protection HIV Office Ryan White Part B
1

TABLE OF CONTENTS

Page No.

Letters of Concurrence

6

Contributors

10

Introduction

12

Executive Summary

13

Acronyms

16

Section I. Where are we now?

18

A. Description of Georgia local HIV/AIDS epidemic

18

CY 2010 Epidemiological Profile

18

Unmet need estimate for 2010

23

Early Identification of Individuals with HIV/AIDS (EIIHA)/Unaware estimate 26

B. Description of the current continuum of care

28

Ryan White funded HIV care and service inventory (by service category,

31

organized by core and support services)

Non Ryan White funded HIV care and service inventory (organizations and 35

services)

How Ryan White funded care/services interact with Non-Ryan White funded 36

services to ensure continuity of care

How the service system/continuum of care has been affected by state and

36

local budget cuts, as well as how the Ryan White Program has adapted

C. Description of need

36

Care needs

37

Capacity development needs resulting from disparities in the availability of

37

HIV-related services in historically underserved communities and rural

communities

D. Description of priorities for the allocation of funds based on:

38

Size and demographics of the population of individuals with HIV/AIDS

38

Needs of individuals with HIV/AIDS

38

E. Description of gaps in care

38

2

F. Description of prevention and service needs

40

G. Description of barriers to care

45

Routine testing (including any state or local legislation barriers)

45

Program related barriers

45

Provider related barriers

46

Client related barriers

48

H. Evaluation of 2009 Comprehensive Plan

51

Successes

52

Challenges

52

Section II. Where do we need to go?

62

A. Plan to meet challenges identified in the evaluation of the 2009 Comprehensive Plan 62

B. 2012 proposed care goals

62

C. Goals regarding individuals Aware of their HIV status, but not in care (Unmet Need) 65

D. Goals regarding individuals Unaware of their HIV status (EIIHA)

65

E. Proposed solutions for closing gaps in care

65

F. Proposed solutions for addressing overlaps in care

66

G. Proposed coordinating efforts with the following programs to ensure optimal

66

access to care:

Part A

67

Part C Services

68

Part D Services

69

Part F Services

69

Private providers (Non-Ryan White funded)

70

Prevention programs including: Partner Notification Initiatives and Prevention 70

for Positive Initiatives

Substance abuse treatment programs/facilities

71

STD programs

71

Medicare

71

Medicaid

71

Children's Health Insurance Program

71

Community Health Centers

72

H. Transitional Grant Areas - not applicable

72

I. Role of the Ryan White Program in collaborating with the Enhanced

72

Comprehensive HIV Prevention Planning and Implementation for Metropolitan

3

Statistical Areas (MSAs) Most Affected by HIV/AIDS (ECHPP) initiative

Section III. How will we get there?

74

A. Strategy, plan, activities (including responsible parties, and timeline to close

88

gaps in care

B. Strategy, plan, activities (including responsible parties), and timeline to address

88

the needs of individuals Aware of their HIV, but that are not in care (with an

emphasis on retention in care)

C. Strategy, plan, activities (including responsible parties), and timeline to address

88

the needs of individuals Unaware of their HIV status (with an emphasis on

identifying, informing, referring, and linkage to care needs)

D. Strategy, plan, activities (including responsible parties) for addressing the needs 89

of special populations including but not limited to: adolescents, injection

drug users, homeless, and transgender

E. Description of activities to implement the proposed coordinating effort with

90

the following programs to ensure optimal access to care:

Part A Services

90

Part C Services

90

Part D Services

90

Part F Services

90

Private providers (Non-Ryan White funded)

91

Prevention programs including: Partner Notification Initiatives and Prevention 91

for Positive Initiatives

Substance abuse treatment programs/facilities

91

STD programs

91

Medicare

91

Medicaid

91

Children's Health Insurance Program

91

Community Health Centers

92

F. How the plan addresses Healthy People 2020 objectives

92

G. How the plan reflects the Statewide Coordinated Statement of Need (SCSN)

93

H. How the plan is coordinated with and adapts to changes that will occur with

135

the implementation of the Affordable Care Act (ACA)

I. How the comprehensive plan addresses the goals of the National HIV/AIDS

135

Strategy (NHAS), as well as which specific NHAS goals are addressed

J. Strategy to respond to any additional or unanticipated changes in the continuum of 136

care as a result of state or local budget cuts

4

Section IV. How will we monitor our progress?

137

A. Plan to monitor and evaluate progress in achieving proposed goals and identified 137

challenges

B. How the impact of the Early Identification of Individuals with HIV/AIDS (EIIHA) 140

initiative will be assessed

Appendices

Appendix 1: SCSN Meeting Agenda

142

Appendix 2: Facilitator Guide - A.M. Breakout Session: Consumer

145

Appendix 3: Facilitator Guide - A.M. Breakout Session: Non-Consumer

150

Appendix 4: Facilitator Guide - P.M. Breakout Session: Geographical Area

155

Appendix 5: SCSN Meeting Evaluation

156

Appendix 6: Resource Inventory

157

Appendix 7: Contact Information

168

5

6

7

8

9

Contributors

Deborah Bauer, MPH, MSLS planning committee member, focus group recorder, Project Coordinator, Atlanta Family Circle Ryan White Part D Network
Libby Brown, BS planning committee, ADAP/HICP Manager Georgia Department of Public Health
Kandace F. Carty, MS planning committee, focus group facilitator Director, Ryan White Part A Program, Fulton County Government
Donato Clarke, MPA focus group recorder and presenter, Special Projects Coordinator, Georgia Department of Public Health
Michael (Mac) Coker, MSN, RN, ACRN planning committee, focus group facilitator HIV Nurse Consultant, Georgia Department of Public Health
Chiquita Covington, MPA planning committee, focus group facilitator, District Liaison, Georgia Department of Public Health
Marisol Cruz, DBA, MS planning committee HIV Care Manager, Georgia Department of Public Health
Michael DeMayo, MPH focus group facilitator, focus group note taker and presenter Research Projects Manager Southeast AIDS Training and Education Center, Emory University School of Medicine

Laura Donnelly, MPH planning committee, focus group note taker Deputy Director, Southeast AIDS Training and Education Center, Emory University School of Medicine
Rosemary J. Donnelly, MSN, APRN, ACRN planning committee, focus group facilitator Clinical Instructor/Georgia Program Director, Southeast AIDS Training and Education Center, Emory University School of Medicine
Dennis Flores BSN, RN, ACRN planning committee, focus group note taker Graduate Candidate, Emory University School of Nursing
Elizabeth Fullerton, MPH Focus group recorder, Training Coordinator Southeast AIDS Training and Education Center, Emory University School of Medicine
Felicia Guest, MPH planning committee, focus group note taker Director of Training, Southeast AIDS Education and Training Center, Emory University School of Medicine
L William Lyons, BS planning committee State AIDS Director, Georgia Department of Public Health

State of Georgia 2012-2015 Statewide Comprehensive HIV Services Plan

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Alecia McFarlane, MPH focus group recorder, Senior Research Project Coordinator, Southeast AIDS Education and Training Center, Emory University School of Medicine
Jeff Moody planning committee, focus group facilitator, District Liaison, Georgia Department of Public Health
Shandrecka Murphy, MPHplanning committee focus group note taker, District Liaison, Georgia Department of Public Health
Jacqueline T. Muther, BS planning committee HIV Policy and Contracts Manager, Part D Grantee, Grady Health System Infectious Disease Program
Souz Payne, BSN, RN planning committee, Graduate Candidate, Emory University School of Nursing
Pamela Phillips, BSW, MSA planning committee, focus group recorder HIV Quality Management Coordinator, Georgia Department of Public Health
Chayne Rensi, presenter, Pre- Release Coordinator, Georgia Department of Correction
Nicole Roebuck, LMSW focus group facilitator Director of client services, AID Atlanta
Elena Rushing, BS focus group note taker, Linkage Coordinator, Georgia Department of Public Health

Jim Sacco, LCSW meeting facilitator, focus group facilitator
Christy Sims, RN, APRN, WHNP-BC, Presenter, HOPE Center, Macon GA
Y. Omar Whiteside, MSPH, PhD- presenter Senior Epidemiologist, HIV/AIDS Epidemiology Section, Georgia Department of Public Health
Kathy W. Whyte planning committee, focus group note taker Special Project Assistant, Ryan White Part A Program, Fulton County Government
Eva Williams, MSN, FNP, MPH, AACRN planning committee, focus group note taker, PHSO Nurse Consultant Team Lead HIV Office Georgia Department of Public Health

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Introduction
Comprehensive HIV/AIDS services' planning is a central focus of the Ryan White HIV/AIDS Treatment Modernization legislation and an essential component of the Ryan White programs. Comprehensive planning is necessary to achieve the goals of the Ryan White HIV/AIDS Treatment Modernization: to develop, organize, coordinate, and implement more effective and cost-efficient systems of essential services to individuals and families with HIV disease.
Comprehensive planning guides decisions about services for people living with HIV disease and AIDS. Planning activities undertaken by the Georgia Department of Public Health Ryan White Part B state and local programs, the Metropolitan Atlanta Part A Planning Council, and Ryan White Part C, D and F programs across the state assist the decision-making process in the development and maintenance of a system of care and support for persons living with HIV and AIDS (PLWHA) in Georgia. This is especially important in light of the changing and increasingly complex health care environment.
The comprehensive HIV services planning process undertaken in Georgia required Ryan White providers, other HIV/AIDS providers, other public agency representatives, and PLWHA to ask four questions related to the state's HIV health service delivery system and to engage in a planning process that resulted in this written Comprehensive HIV Health Services Plan. The four questions addressed in the Plan are:
Where are we now? Where do we need to go? How will we get there? How will we monitor our progress?

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Executive Summary
According to the 2010 federal census population, Georgia ranked ninth among states in population size, with a total population of 9,687,653. Females comprise 51% of the population while males are 49% of the population. Among Georgians reporting one race, 60% were white, 31% were African American and 9% were Hispanic. About one-half of the population, 52% of the state's African American population, 66% of the Hispanic population 29% of the poor, live in the 20-county Atlanta Eligible Metropolitan Area (EMA). The other half of the state's population is widely dispersed among the remaining 139 counties which has historically presented challenges in healthcare resources and service.
Since the earliest days of the HIV/AIDS epidemic, Georgia has had a substantial number of reported cases of AIDS. Georgia ranked sixth highest in the nation for its reported rate of AIDS cases per 100,000 population in 2009. The HIV/AIDS epidemic continues to grow in Georgia. As of December 2010, there were 23,451 PLWA and 18,535 PLWH (non-AIDS). Seventy-two (72) percent of HIV (non-AIDS) cases were among African Americans, 22% among Whites, 4% among Hispanics and 2% among others.
The Georgia Department of Public Health (DPH), Division of Health Protection (DHP), Infectious Disease and Immunization (IDI) Program, HIV Office provides oversight and management of the state's HIV Care Grant Program Part B which serves 16 of the state's 18 public health districts. In addition, the Part B ADAP program covers all 18 districts and Part B provides funding to some HIV providers in the Part A service area. Ryan White Part A serves the 20-county metro Atlanta area, located in the remaining two districts.
The comprehensive HIV services planning process undertaken in Georgia required the State HIV Office to ask four questions related to the state's HIV/AIDS service delivery system and to engage in a planning process that resulted in this written Comprehensive HIV Health Services Plan. The four questions addressed in the Plan are:
Where are we now? Where do we need to go? How will we get there? How will we monitor our progress?
Georgia's FY 2012-2015 Comprehensive HIV Health Services Plan provides the goals, objectives, and strategies that will be used to guide further development and monitoring of the state's HIV/AIDS health care delivery system. Identified needs and barriers have been incorporated into the plan goals and objectives. The plan includes five major goals:

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Goal 1: Improve access to HIV-related core services.
1.1. Ensure continuity and availability of HIV primary care consistent with Public Health Services guidelines.
1.2. Evaluate and respond to the changing healthcare environment to assure HIV health and support services are available and accessible.
1.3. Assure health districts are aware of changes in the health and support service access and availability to help clients navigate the system of care.
1.4. Assure consumers are consistently informed about changes in health and support service access and availability, as well as aware of available supports/resources to respond to their changing needs.
1.5. Assess barriers to accessing core and support services to identify potential solutions and best practices.
1.6. Assess and enhance access to HIV medications.
Goal 2: Improve the quality of HIV core services and health outcomes.
2.1. Assure standards of care, including Public Health Services (PHS) guidelines and best practices, are consistently applied in the provision of HIV services.
2.2. Improve HIV/AIDS case management services throughout Georgia. 2.3. Implement statewide Ryan White Part B quality management plan. 2.4. Improve recruitment and retention of health care staff. 2.5. Adapt the Georgia Department of Public Health, HIV Office, practices and guidelines as
needed to align with the National HIV/AIDS Strategy, Healthy People 2020, the HIV/AIDS Bureau (HAB) Measures, and other state and federal initiatives focused on reducing health disparities.
Goal 3: Increase linkage to care for individuals newly diagnosed with HIV infection, through coordination of counseling and testing with treatment.
3.1. Identify individuals unaware of their status. 3.2. Collaborate with counseling and testing and prevention programs to facilitate identification
of individuals unaware of their status and link them to care. 3.3. In collaboration with the HIV Prevention program in the Georgia Department of Public
Health and federal Department of Health and Human Services (DHHS) directly funded entities (e.g., health departments, community based organizations) develop and implement strategies to facilitate integration of care, treatment and prevention.
Goal 4: Reduce health disparities.
4.1. Identify health disparities and barriers to care. 4.2. Improve cultural competency of service providers and programs. 4.3. Improve the utilization of interpretation and translation services for clients. 4.4. Maximize opportunities for clients to access affordable, stable and safe housing. 4.5. Advocate for policy change.

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Goal 5: Enhance collaboration and communication with partners statewide
5.1. Engage key stakeholders, including but not limited to Program Collaboration Service Integration (PCSI), HIV Office, Prevention Section grantees, Early Identification of Individuals with HIV/AIDS (EIIHA), Substance Abuse and Mental Health Services Administration (SAMHSA), Community Planning Group (CPG), the AIDS Drug Assistance Program (ADAP), ADAP Contract Pharmacy Network (ACP), Health Insurance Continuation Program (HICP), Preexisting Condition Insurance Plan (PCIP), Test-Link-Care Network, private providers, all Ryan White Parts, and Medicaid.
Ongoing monitoring, input, and adjustment are critical in continuing to ensure that available HIV/AIDS resources in Georgia are maximized and the use of these resources are prioritized when changes to the system are needed. Comprehensive Plan progress will be evaluated, and modifications made as needed, based on measures indicated in the plan, the development and implementation of detailed annual plans and regular progress reports.

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Acronyms

AAOI ACA ACP ADAP ARTAS ARV ASO BHDD CBO CDC CMS CM CPG CY DPH ECHPP eHARS EIIHA EIW EMA FDA FQHC GIA HAB HHS HICP HOPWA HRSA IDI IDP IDU ISP LGBT MSA MSM NHAS NIR OB/GYN PAP PBM PCIP PCSI PHS PLWHA PS QM RFP RN

African American Outreach Initiative Affordable Care Act ADAP Contract Pharmacy AIDS Drug Assistance Program Antiretroviral Treatment Access Study Antiretroviral AIDS Service Organization Behavioral Health and Developmental Disabilities Community-Based Organization Centers for Disease Control and Prevention Center for Medicare and Medicaid Services Case Manager/Case Management Community Planning Group Calendar Year Department of Public Health Enhanced Comprehensive HIV Prevention Planning Electronic HIV/AIDS Reporting System Early Identification of Individuals with HIV/AIDS Early Identification Workgroup Eligible Metropolitan Area Food and Drug Administration Federally Qualified Health Center Grant-In-Aid HIV/AIDS Bureau Department of Health and Human Services Health Insurance Continuation Program Housing Opportunities for People with AIDS Health Resources and Services Administration Infectious Disease and Immunization Program Infectious Disease Program Intravenous Drug Use Individualized Service Plan Lesbian, Gay, Bisexual, Transgender Metropolitan Statistical Area Men Who Have Sex With Men National HIV/AIDS Strategy No Identified Risk Obstetrics/Gynecology Patient Assistance Program Pharmacy Benefit Manager Preexisting Condition Insurance Plan Program Collaboration Service Integration Public Health Services People Living with HIV/AIDS Partner Services Quality Management Request for Proposal Registered Nurse

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RSR RW SA SAMHSA SCHIP SCSN SEATEC SEHD SPNS STD STI TB WICY

Ryan White Services Report Ryan White Substance Abuse Substance Abuse and Mental Health Services Administration State Child Health Insurance Program Statewide Coordinated Statement of Need Southeast AIDS Training and Education Center Southeast Health District Special Projects of National Significance Sexually Transmitted Disease Sexually Transmitted Infection Tuberculosis Women, Infants, Children, and Youth

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Section I. Where are we now?
A. Description of Georgia Local HIV/AIDS Epidemic
According to the 2010 federal census population, Georgia ranked ninth among states in population size, with a total population of 9,687,653. Females comprise 51% of the population while males are 49% of the population. Among Georgians reporting one race, 60% were white, 31% were African American and 9% were Hispanic. About one-half of the population, 52% of the state's African American population, 66% of the Hispanic population 29% of the poor, live in the 20-county Atlanta Eligible Metropolitan Area (EMA). The other half of the state's population is widely dispersed among the remaining 139 counties which has historically presented challenges in healthcare resources and service.
1. CY 2010 Epidemiological Profile
From 1981 to the end of 2009, the cumulative number of reported cases of AIDS in the United States (50 states and DC) was 1,142,714 (statistics for 2010 are not yet available from Centers for Disease Control and Prevention). This number reflected a case rate of 11.2 cases of AIDS/100,000 total population of the US. A total of 490,696(43%) were reported as living through 2009.1
Since the earliest days of the HIV/AIDS epidemic, Georgia has had a substantial number of reported cases of AIDS. Georgia ranked sixth highest in the nation for its reported rate of AIDS cases per 100,000 population in 2009. The HIV/AIDS epidemic continues to grow in Georgia. As of December 2010, there were 23,451 PLWA and 18,535 PLWH (non-AIDS). Seventy-two (72) percent of HIV (non-AIDS) cases were among African Americans, 22% among Whites, 4% among Hispanics and 2% among others.
Georgia's 2009-2010 AIDS Diagnoses, AIDS Prevalence, and HIV (not AIDS) Prevalence data by demographic group and exposure category is provided below followed by information on trends in Georgia's HIV prevalence for January 2009-December 2010.

1CDC. HIV/AIDS Surveillance Report Aug 11, 2011.

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AIDS Diagnoses, AIDS Prevalence, and HIV Prevalence by Demographic Group and Exposure Category, Georgia, 2009-2010

Race/Ethnicity

White, Non-Hispanic

Black, Non-Hispanic

Hispanic

Asian/Pacific Islander

American Indian/Alaska Native

Other/Multi-race/Unknown

Total Gender

Male

Female

Total Age

0 - 15 years

15 - 24 years

25 - 34 years

35 - 44 years

45 - 54 years

55 - 64 years

65+ years

Total

Transmission Category Men who have sex with men (MSM)

Injection Drug Use (IDU)

MSM and IDU High-Risk Heterosexual Contact

Other** Risk not reported or identified

Total

AIDS Diagnoses*

1/1/2009 - 12/31/10

n

%

247

15.2

1246

76.4

113

6.9

11

0.7

1

0.1

12

0.7

1630

100

1245

76.4

385

23.6

1630

100

0

0

161

9.9

416

25.5

509

31.2

394

24.2

125

7.7

25

1.5

1630

100

572

35.1

37

2.3

31

1.9

129

7.9

2

0.1

859

52.7

1630

100

AIDS Prevalence

12/31/2010

n

%

5676

24.2

16217

69.2

1110

4.7

78

0.3

26

0.1

344

1.5

23451

100

18007

76.8

5444

23.2

23451

100

155

0.7

1658

7.1

7780

33.1

8748

37.3

3927

16.8

989

4.2

194

0.8

23451

100

9845

41.9

2269

9.7

1117

4.8

3192

13.6

249

1.1

6779

28.9

23451

100

HIV (not AIDS) Prevalence

12/31/2010

n

%

4143

22.4

13253

71.5

779

4.2

82

0.4

28

0.2

250

1.4

18535

100

13138 5397 18535
309 3757 5924 5108 2567 678 162 18535

70.9 29.1 100
1.7 20.3
32.1 27.6 13.9 3.7 0.9 100

6713

36.2

803

4.3

441

2.4

1660

8.9

217

1.2

8701

46.9

18535

100

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Note: Source: Georgia Division of Public Health HIV/AIDS Reporting System (eHARS). Note: Numbers are based on cases entered. Note: Numbers are based on cases entered through June 30, 2011. *The number of AIDS cases diagnosed in the specified period. Prevalent cases are those persons living with AIDS or HIV and are based on current residence being in Georgia. AIDS Diagnoses cases are based on age at diagnosis and prevalent cases are based on current age as of December 31, 2010. Cases with unknown Transmission Categories are not included. High risk heterosexual is defined as sexual contact with someone of the opposite sex with known risk such as injection drug use, bisexual male (applied to females only), persons with hemophilia/coagulation disorder, transfusion recipient with HIV documentation, person with AIDS or documented HIV. Cases with no reported exposure to HIV or AIDS through any of the routes listed above are classified as NIR (no identified risk) and those with no risk at all as NRR (no risk reported).

AIDS Diagnoses, AIDS Prevalence, and HIV Prevalence for Females by Demographic Group and Exposure Category, Georgia, 2009-2010

Females

Race/Ethnicity

White, Non-Hispanic

Black, Non-Hispanic

Hispanic

Asian/Pacific Islander

American Indian/Alaska Native

Other/Multi-race/Unknown

Total Age

0 - 15 years

15 - 24 years

25 - 34 years

35 - 44 years

45 - 54 years

55 - 64 years

65+ years

Total Transmission Category

Men who have sex with men (MSM)

Injection Drug Use (IDU)

MSM and IDU High-Risk Heterosexual Contact

Total

Other** Risk not reported or identified

AIDS Diagnoses*

1/1/2009 - 12/31/10

n

%

28

7.27

334

86.75

19

4.94

1

0.26

0

0

3

0.78

385

100

0

0

23

5.97

86

22.34

143

37.14

96

24.94

26

6.75

11

2.86

385

100

0

0

14

3.64

0

0

73

18.94

0

0

298

77.40

385

100

AIDS Prevalence

12/31/2010

n

%

632 11.61

4537 83.33

191

3.51

17

0.31

5

0.09

62

1.14

5444

100

HIV (not AIDS) Prevalence 12/31/2010

n

%

719

13.32

4370

80.97

210

3.89

22

0.41

9

1.67

67

1.24

5397

100

20 104 606 1619 1928 888 279 5444

0.37 1.91 11.13 29.74 35.42 16.31 5.12 100

91 374 1188 1543 1486 568 147 5397

1.69 6.93 22.01 28.58 27.53 10.52 2.72 100

0 752 0 1964 107 2621 5444

0 13.81
0 36.07 1.97 48.14 100

0 354 0 1184 123 3736 5397

0 6.56
0 21.94 2.28 69.22 100

Note: Source: Georgia Division of Public Health HIV/AIDS Reporting System (eHARS). Note: Numbers are based on cases entered. Note: Numbers are based on cases entered through June 30, 2011. *The number of AIDS cases diagnosed in the specified period. Prevalent cases are those persons living with AIDS or HIV and are based on current residence being in Georgia. AIDS Diagnoses cases are based on age at diagnosis and prevalent cases are based on current age as of December 31, 2010. Cases with unknown Transmission Categories are not included.

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High risk heterosexual is defined as sexual contact with someone of the opposite sex with known risk such as injection drug use, bisexual male (applied females only), persons with hemophilia/coagulation disorder, transfusion recipient with HIV documentation, person with AIDS or **Other includes hemophilia, blood transfusion, transplant, perinatal, and pediatric. Cases with no reported exposure to HIV or AIDS through any of the routes listed above are classified as NIR (no identified risk) and those with no risk at all as NRR (no risk reported).

AIDS Diagnoses, AIDS Prevalence, and HIV Prevalence for Males by Demographic Group and Exposure Category, Georgia 2009-2010

Males
Race/Ethnicity White, non-hispanic Black, non-hispanic Hispanic
Asian/Pacific Islander American Indian/Alaska Native
Other/Multi-race/Unknown Total Age
0 - 15 years 15 - 24 years 25 - 34 years 35 - 44 years 45 - 54 years 55 - 64 years
65+ years Total Transmission Category
Men who have sex with men (MSM) Injection Drug Use (IDU) MSM and IDU
High-Risk Heterosexual Contact Other**
Risk not reported or identified Total

AIDS Diagnoses*

1/1/2009 - 12/31/10

n

%

219

17.59

912

73.25

94

7.55

10

0.80

1

0.08

9

0.72

1245

100

0 138 330 366 298 99 14 1245

0 11.08 26.51 29.40 23.94 7.95 1.12 100

572 23 31 56 2 561 1245

45.94 1.85 2.49 4.50 0.16 45.06 100

AIDS Prevalence

12/31/2010

n

%

5044

28.01

11680

64.86

919

5.10

61

0.34

21

0.12

282

1.57

18007

100

16

0.9

289

1.6

1673

9.3

4711

26.2

7325

40.7

3148

17.5

845

4.7

18007 100

9845 1517 1117 1228 142 4158 18007

54.67 8.42 6.20 6.82 0.79 23.09 100

HIV (not AIDS) Prevalence

12/31/2010

n

%

3424

26.06

8883

67.61

569

4.33

60

0.46

19

0.14

183

1.39

13138

100

89

0.7

1005

7.7

3102

23.6

3672

27.9

3662

27.9

1268

10

340

2.6

13138

100

6713 449 441 476 94 4965 13138

51.10 3.42 3.36 3.62 0.72 37.79 100

Note: Source: Georgia Division of Public Health HIV/AIDS Reporting System (eHARS). Note: Numbers are based on cases entered. Note: Numbers are based on cases entered through June 30, 2011. *The number of AIDS cases diagnosed in the specified period. Prevalent cases are those persons living with AIDS or HIV and are based on current residence being in Georgia. AIDS Diagnoses cases are based on age at diagnosis and prevalent cases are based on current age as of December 31, 2010. Cases with unknown Transmission Categories are not included. High risk heterosexual is defined as sexual contact with someone of the opposite sex with known risk such as injection drug use, bisexual male (applied to females only), persons with hemophilia/coagulation disorder, transfusion recipient with HIV documentation, person with AIDS or documented HIV. Cases with no reported exposure to HIV or AIDS through any of the routes listed above are classified as NIR (no identified risk) and those with no risk at all as NRR (no risk reported).

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Trends or Changes in HIV Disease Prevalence in Georgia for the Past Two Years (January 2009-December 2010)

Indicator AIDS Diagnoses AIDS Prevalence HIV Prevalence

2008-2009 1,961 23,194 17,512

2009-2010 1,630 23,451 18,535

Percent change 17% 1% 6%

Trend Decrease Increase Increase

Based on data from the Georgia Department of Public Health Electronic HIV/AIDS Reporting System (eHARS), Georgia reported 1,630 newly diagnosed AIDS cases during the period of January 1, 2009-December 31, 2010. This reflects a 17% decrease from the previous two-year period of 2008-2009. Approximately 76% (1,245) of diagnosed AIDS cases were males. In Georgia, there were 23,451 persons living with AIDS and 18,535 persons living with HIV (not AIDS) at the end of 2010.
Men who have sex with men (MSM) still represent the largest number of people living with AIDS in Georgia. They account for approximately 47% (42% MSM and 5% MSM who inject drugs) of the known cases of Georgians living with AIDS as of December 31, 2010. MSM represent the largest number of people living with HIV in Georgia. Based on HIV prevalence, as of December 31, 2010, MSM accounted for 36% of the HIV cases in Georgia.
Recent trends continue to indicate that HIV/AIDS is affecting African Americans, women, heterosexuals, and people living in rural areas at growing rates. In the United States, AfricanAmerican males and females, ages 18-44, are the most disproportionately affected population. Although African Americans make up only 31% of Georgia's population, 76% of the new cases of AIDS in 2009-2010 were African Americans. As of December 31, 2010, 72% of Georgians living with HIV were African Americans, according to eHARS.
The HIV/AIDS epidemic in Georgia continues to affect a significant number of women. From 1984 to 2010, the cumulative proportion of AIDS cases among women increased from 4% to 23%. African American women are disproportionately affected. As of December 31, 2010, 83% of women living with AIDS in Georgia were African American, and 81% of women living with HIV (not AIDS) in Georgia were African American, according to eHARS data. Heterosexual contact remains the primary mode of transmission in women. Many women were sex partners of men who have used drugs or of MSM. Twenty-three percent (5,444) of the individuals living with AIDS and 29% (5,397) of the cases of HIV in Georgia at the end of 2010 were female.
According to eHARS data, Hispanics accounted for 5% of Georgians living with AIDS and 4% of the HIV cases reported as of December 31, 2010. There were more Hispanic males (919) than females (191) diagnosed with AIDS during the two-year reporting period. Hispanic males represented 8% of newly diagnosed AIDS cases in Georgia and 4% of the population living with

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HIV (not AIDS) as of December 31, 2010. Hispanic females accounted for 5% of newly reported AIDS cases and 4% of reported cases of persons living with AIDS.

The epidemic is increasing in Georgia's rural areas and small cities and towns. In 2009, data indicated 33% of people living with HIV/AIDS were living outside the 20-county Atlanta Metropolitan Statistical Area (MSA). In rural areas of the state, resources are scarce. People and services are more dispersed and therefore harder to reach with treatment and prevention efforts. Geographic regions outside of the Atlanta MSA with a high HIV/AIDS morbidity include the East Central and West Central regions of the state.

2. Unmet need estimate for 2010 and Early Identification of Individuals with HIV/AIDS (EIIHA)/Unaware estimate
Using data from the HIV/AIDS reporting system (eHARS), the statewide laboratory database and the Georgia Department of Public Health, HIV Epidemiology Unit, it has been estimated that 55% (table below) of PLWHA in Georgia had not received primary health care services during 2010.

Quantified Estimate of Unmet Need for HIV Primary Care, Georgia 01/01/2010-12/31/2010

Quantified Estimate of Unmet Need for HIV Primary Care, Georgia, 2010

Population

Total

Data Source

Number of persons living

with AIDS (PLWA) as of

eHARS and Laboratory

Row A.

12/31/2010

25,300

Database

Number of persons living

with HIV (PLWH)/non-

AIDS/aware as of

Row B.

12/31/2010

19,676

C-A

Total number of

HIV+/aware as of

eHARS and Laboratory

Row C.

12/31/2010

44,976

Database

Care Patterns

Data Source(s)

Number of PLWA who

received the specified HIV

primary medical care

during the 12-month period

eHARS and Laboratory

Row D.

as of 12/31/2010

11,090

Database

Number of PLWH/non-

AIDS/aware who received

the specified HIV primary

medical care during the 12-

month period as of

Row E.

12/31/2010

9,312

F-D

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Total number of

HIV+/aware who received

the specified HIV primary

medical care during the 12-

month period as of

eHARS and Laboratory

Row F.

12/31/2010

20,402

Database

Calculated Results

Total

Percent Calculations

Number of PLWA who did

not receive the specified

Row G.

HIV primary medical care

14,210 56%

A-D

Number of PLWH/non-

AIDS/aware who did not

receive the specified HIV

Row H.

primary medical care

10,364 53%

B-E

Total HIV+/aware not

receiving the specified HIV

primary medical care

(quantified estimate of

Row I.

unmet need)

24,574 55%

C-F

Note:

Data sources were GA Laboratory Access Database and eHARS.

Reported cases in eHARS were matched to reports in GA Lab Database

All non-reported cases had documented positive Western Blot tests.

Unmet need analyses performed on complete dataset as of December 31, 2010.

eHARS may contain fewer cases than the actual count due to delayed case reporting by providers

The Unmet Need Estimate is updated utilizing the Georgia Laboratory Access Database and the Georgia eHARS database. The Georgia Laboratory Access Database captures lab reports such as CD4, viral load, and western blot (WB) while the eHARS database captures these same lab reports along with associated demographic information from HIV Case Report Forms. The eHARS database tracks over 200 indicators related to HIV/AIDS in Georgia. However, the eHARS laboratory data is not as comprehensive as the data from the Georgia Laboratory Access Database. For this reason, the reported cases in eHARS were matched to reports in the Georgia Laboratory Access Database to ensure data reliability.
The populations in the Unmet Need Estimate include Persons Living with AIDS (PLWA), Persons Living with HIV/non-AIDS (PLWH non-AIDS/aware), and PLWA In Care. These populations are defined as follows:
Persons Living with AIDS (PLWA): the number of persons living with AIDS and reported in eHARS and/or GA Laboratory Access Database in the surveillance period of interest. It is presumed that all people living with AIDS are aware of their status.
Persons Living with HIV/non-AIDS (PLWH non-AIDS/aware): the number of persons living with HIV/non-AIDS and reported in eHARS or the GA Laboratory Access Database in the report period.

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PLWA In Care: PLWA that have had at least one viral load or CD4 laboratory test reported in the GA Laboratory Access Database for the period of interest.



PLWH non-AIDS/aware In Care: PLWH non-AIDS/aware that have had at least one

viral load or CD4 laboratory test reported in the GA Laboratory Access Database for

the period of interest.

These populations are then tabulated in the Unmet Need Framework to describe population sizes, care patterns and calculated results.

In FY2012, the Part B Program plans to further assess the unmet need data through collaboration with the statewide HIV Prevention Program and the Atlanta Eligible Metropolitan Area (EMA). An area of focus in the plan includes planning, implementing, and evaluating a statewide needs assessment. The next step toward achieving a needs assessment is to identify an academic partner. Over the past five years, the state of Georgia has seen a 78% increase in the number of PLWA who received care, as well as an 11% decrease in the number of PLWH/non AIDS who did not receive are. Conversely, the data show a 6% decrease in the number of PLWH/nonAIDS who received care and a 23% increase in the number of PLWA who did not receive care.

Indicator # of PLWA who received Care # of PLWH/nonAIDS who received Care # of PLWA who did not receive Care # of PLWH/nonAIDS who did not receive Care

2005 6,213 9,945
11,475 11,675

2010 11,090 9,312
14,210 10,364

Percent change Trend

78%

Increase

6%

Decrease

23%

Increase

11%

Decrease

The gross number of PLWA has increased from 2005-2010; both those who are receiving care and those who did not receive care. This could be related to an increase in HIV testing efforts or better case-finding, although it would reflect testing late in the disease process. The gross number of PLWH/non-AIDS has not seen such a dramatic increase, although there have been slight decreases from 2005 compared to 2010 in those who are receiving care. In summary, the state has seen a large overall increase in PLWA as opposed to PLWH/non-AIDS.

An explanation for these trends may include the present state of the economy, the rapid expansion of the HIV/AIDS epidemic among low-income and uninsured populations, limited resources, and changes in data collection. When clients have insufficient financial resources or

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have competing time demands such as finding and maintaining work, the ability to maintain consistent HIV care is bound to suffer. Likewise, the populations most likely to be HIV-infected are those with the least resources and tools to manage their disease. Limited resources to care for the large number of uninsured clients led several HIV clinics to be unable to accept new patients during various parts of the year. For those clients unable to persevere, this could have led to a failure to access HIV care.

Data collection methods have changed from 2005-2010 and may reflect better HIV/AIDS case reporting and improved data sources. In 2005, the number of PLWH/non-AIDS was calculated based on the midpoint of the Centers for Disease Control and Prevention (CDC) estimate instead of the real number for Georgia. The number of PLWH/non-AIDS receiving HIV primary care during CY 2005 was calculated based on this estimate. In contrast, the 2010 calculations are based on real numbers from the enhanced HIV/AIDS Reporting System (eHARS) and the Georgia Laboratory Report Database.

3. Early Identification of Individuals with HIV/AIDS (EIIHA)

The estimated number of living HIV positive individuals who were unaware of their status as of December 31, 2009.
a) Estimated Back Calculation National Proportion Undiagnosed HIV = .21 Number of individuals in Georgia diagnosed with HIV and living as of December 31, 2009 = 17,307 State of Georgia Undiagnosed= (0.21/0.79) x 17,307 = 4,601

The table below provides information on EIIHA-HIV testing and awareness data for Georgia. A matrix follows of populations in Georgia who are unaware of their HIV status.

EIIHA-HIV Testing & Awareness Data (December 31st 2010) Total number of HIV tests conducted. Total number informed of their HIV status (HIV positive and HIV negative). Total number NOT informed of their HIV status (HIV positive and HIV negative). Total number of HIV positive tests. Total number of HIV positive informed of their HIV status. Total number of HIV positive referred to medical care. Total number of HIV positive linked to medical care. Total number of HIV positive NOT informed of their HIV status. Total number of negative tests. Total number of HIV negative informed of their HIV status. Total number of HIV negative referred to services. Total number of HIV negative NOT informed of their HIV status.

126,645 90,001 36,644 1,237 1,034
943 409 203 125,408 88,967 75,245 36,441

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P1.

All Individuals in Georgia who are Unaware of their HIV Status (HIV Positive & HIV Negative)

P2.

Tested in the Past 12 Months

P3.

Not Tested in the Past 12 Months

P4.
Individuals Not Post-Test Counseled
(HIV positive & HIV negative)

T3.

T4.

P5.

Received Preliminary
Positive Results Only No
Confirmatory Test

Failure to Re-Test After High
Risk Behavior

High Risk Individuals

T5.
Moderate & Low Risk
Individuals 13-64 Years
of Age

T1.
Tested Confidentially

T2.
Tested Anonymously

P6.
IDU

P7.
MSM

P8.
African Americans

P9.
Hispanics

T16.. MSM T15. Women T14. Heterosexual Men T13. Heterosexual Men T12. Women T11. MSM T10 .Transgender T9. Age 13-25 T8. African Americans T7. Women
T6. MSM

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B. Description of the current continuum of care
HIV Prevention
HIV Counseling, Testing, and Linkage (HIV CTL) services provide the foundation for Georgia's comprehensive HIV prevention activities. The program supports testing in healthcare and nonhealthcare settings. Currently, there are 18 public health districts (HD), and their satellite programs, substance abuse programs, jails, detention centers, and university health clinics that provide HIV CTL.
The program works closely with Community Based Organizations (CBOs) to conduct Opt-out HIV testing. Special emphasis is placed on areas with high co-morbidities of STD infections, substance abuse, and teen pregnancy rates. CBOs invited to participate in HIV testing have to demonstrate their ability to implement rapid testing based on specified criteria such as: access to the identified target population, previous counseling and testing experience, and Sexually Transmitted Disease (STD) and Tuberculosis (TB) testing referral protocol.
HIV Care
Georgia's system of health care is largely dependent upon the existing public health structure of 18 health districts and 159 county health departments, with community health centers, universities, hospitals, and community organizations playing a variety of roles in different parts of the state. All levels of Ryan White funding are distributed throughout the state. These funding streams have enabled Georgia to expand the resources available to PLWHA. As resources vary in different regions of the state, so does the scope of available services. Statewide planning and involvement on different planning bodies, as well as collaboration and coordination locally and regionally have assisted in service delivery development in Georgia. The Ryan White Part B program has a service delivery system which includes a comprehensive range of core medical services and essential support services for individuals infected with and affected.
The HIV Office contracts with 16 Ryan White Part B consortia and several agencies to deliver HIV/AIDS services throughout the state. The consortia are responsible for planning and prioritizing the delivery of HIV services in their respective geographic areas. The District Health Offices administer Ryan White Part B funds and are the lead agencies in the respective consortia. All consortia provide primary care services. Support services are prioritized by the consortia, using needs assessment data, and funded based on the availability of resources. The delivery of HIV care and support services are provided either directly by Part B funded public health districts or indirectly through sub-contractual agreements with local service providers. Part B funds also fund the Georgia AIDS Drug Assistance Program (ADAP) and Health Insurance Continuation Program (HICP), which provide medications and health insurance coverage.

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To receive Ryan White Part B services, a client must be a Georgia resident, HIV positive or affected, have no other payer source, and an income below 300% of the Federal Poverty Level. Georgia Part B contractors screen clients for eligibility through a financial screening process that requires the client to present verification of documents. Documentation of the client's available resources is assessed at the initial clinic visit and documented in the client's record and is reviewed every six (6) months. The Ryan White HIV/AIDS Program requires that Ryan White funds are the payor of last resort.
Public Health Districts: The Georgia Department of Public Health (DPH), Division of Health Protection (DHP), Infectious Disease and Immunization (IDI) Program, HIV Office provides oversight and management of the state's HIV Care Grant Program Part B which serves 16 of the state's 18 public health districts. In addition, the Part B ADAP programs covers all 18 districts and Part B provides funding to some HIV providers in the Part A service area. Ryan White Part A serves the 20-county metro Atlanta area, located in the remaining two districts.
The HIV Office disburses funds to 16 public health districts, through a contractual process known as Grant-in-Aid (GIA), to provide Part B services. The Part B Program Team Lead and Public Health Office of Budgets monitor and track funds and expenditures on a monthly basis. The state of Georgia does not provide services through consortia. Funding is provided directly to local health districts. Each district maintains a consortium that functions as a community and client advisory body. All 16 Part B funded public health districts receive administrative, fiscal, and programmatic monitoring via monthly desk audits and annual on-site monitoring.
ADAP: The Georgia AIDS Drug Assistance Program (ADAP) is the state administered program that provides HIV/AIDS medication to low-income individuals living with HIV disease who have little or no coverage from private or third party insurance. Georgia ADAP provides services to all eligible residents of Georgia. As a cost containment measure, Georgia ADAP only provides those medications listed on the ADAP formulary. The Georgia ADAP formulary includes all Food and Drug Administration (FDA) approved antiretroviral agents and a limited number of medications used to treat/prevent opportunistic infections related to HIV disease. Effective April 1, 2011, all three (3) phases of ADAP Contract Pharmacy (ACP) Network were implemented throughout all enrollment sites and all ADAP clients were able to receive their medications via the ACP Network.
Due to limited funding, a growing demand for ADAP services and increased enrollment, a waiting list was implemented on July 1, 2010. The duration of the waiting list is unknown. However, based on attrition rates of approximately 150 clients monthly and Emergency Relief Funding, limited enrollment of new clients from the waiting list into the ADAP is now possible. ADAP staff continues to monitor attrition of ineligible, non-compliant or those persons with other payers to determine the eligibility of current ADAP clients. Liaisons now combine the

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annual GrantIn-Aid and ADAP site visits to Part B health clinics to ensure a more comprehensive and time effective means of measuring district activities. The monitoring process for other designated ADAP enrollment sites within the Eligible Metropolitan Area (EMA) and not included in Grant In-Aid site visits are conducted by ADAP staff and/or the ADAP/HICP Manager.
ADAP Contract Pharmacy (ACP) Network: The main objective of the ACP is to provide comprehensive and convenient pharmacy services while maintaining cost saving to the AIDS Drug Assistance Program. The ACP allows ADAP clients the ability to fill monthly ADAP prescriptions at a contract pharmacy of their choice. Currently, there are 26 pharmacies in the ACP network that provide medications in convenient locations statewide with several pharmacies that offers statewide delivery. The ADAP replenishes contract pharmacies with all approved formulary medications dispensed to the ADAP clients. These medications are provided through the state pharmaceutical wholesaler Cardinal Health with the assistance of a Pharmacy Benefit Manager (PBM).
HICP: The HIV Office manages the Health Insurance Continuation Program (HICP) which pays health insurance premiums for eligible clients with health coverage. The payment of health insurance premiums has proven to be a more cost effective way to meet the needs of clients in comparison to providing expensive HIV/AIDS medications at a much higher cost. The HICP allows clients the opportunity and flexibility to continue to access their doctors, maintain a continuum of primary health care and sustain an improved quality of life.
Resource Inventory: A resource inventory describing Ryan White funded and non Ryan White funded HIV/AIDS care resources and services in Georgia are provided in Appendix 1. The Southeast AIDS Training and Education Center's (SEATEC) Key Contacts Metro Atlanta/Georgia Resources for HIV/AIDS 15th edition May 2011 telephone list of helping agencies and organizations served as the baseline for the inventory. Copies of the inventory are provided at no cost to service agencies and individuals A searchable digital version of Key Contacts is available at http://content.yudu.com/A1ujp0/SEATECMay2011/resources/index.htm. Key Contacts includes an alphabetical listing by agency/organization as well as identification of resources by the following categories:
Metro Assistance: advocacy, case management, clothing/furniture, financial/public assistance, food, funerals, housing/low income/homeless, legal, peer counseling, spiritual support, and transportation
Metro Education Services: AIDS information lines, education resources, education courses, hotlines and general information not HIV/AIDS, medical treatment information, prevention education and outreach, and speakers' bureaus

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Internet Resources: national AIDS service organizations, governmental agencies, access to treatment/health maintenance, medical, speakers of languages other than English, and substance abuse
Metro Medical Services: access to treatment, clinical trials, counseling/mental health care, dental, health departments/testing/medical care, HIV test sites other, home health care/hospice, medical care, nursing home/long term care, and wellness
Prevention and Care Planning Councils: Georgia HIV/AIDS prevention and care planning councils
Metro Services for Specific Populations: adolescents, alcohol and substance users, children, deaf and hard of hearing, family/friends, health care providers HIV caregivers, Hispanic, Hispanos, inmates/parolees/probationers/ex-offenders, low literacy, people living with hemophilia, people of color, speakers of languages other than English or Spanish, tuberculosis patients and caregivers, women, and lesbian, gay, bisexual and transgendered (LGBT) individuals.
Metro Support Groups: caregivers, people living with HIV/AIDS, and other Statewide Organizations Georgia Agencies Outside Metro Area Ryan White Program in Georgia

1. Ryan White funded HIV care and service inventory (by service category, organized by core and support services)

Individuals are eligible for services paid for by the Ryan White Part B Program if they are a person living with HIV/AIDS and their annual income is below 300% of the federal poverty level. HIV/AIDS care services vary among the state's public health districts. The table below highlights services provided by each district.

Part B Funded District/Contract Agency Rome Health District

Funded Core Services
Ambulatory/ Outpatient Medical Care Dental Care/Oral Health

Medical Nutritional Therapy

Dalton Health District

Medical Case Management (including Treatment Adherence)
Ambulatory/ Outpatient Medical Care

Funded Support Services
Case management (nonMedical) Emergency Financial Assistance Medical Transportation Services Psychosocial Support Services
Case management (nonMedical)

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Dental Care/Oral Health
Health Insurance Premium & Cost Sharing Assistance Mental Health Services
Medical Nutritional Therapy Substance Abuse Services Outpatient

Gainesville Health District

Ambulatory/ Outpatient Medical Care Dental Care/Oral Health

Mental Health Services

Cobb Health District Clayton Health District

Medical Nutritional Therapy Medical Case Management (including Treatment Adherence)
Ambulatory/ Outpatient Medical Care Medical Case Management (including Treatment Adherence)
Ambulatory/ Outpatient Medical Care

Gwinnett Health District LaGrange Health District

Ambulatory/ Outpatient Medical Care Dental Care/Oral Health
Medical Case Management (including Treatment Adherence)
Ambulatory/ Outpatient Medical Care Dental Care/Oral Health

Emergency Financial Assistance Food Bank/Home Delivered Meals Health Education/Risk Reduction Housing Services Linguistics Services
Medical Transportation Services
Case management (nonMedical) Emergency Financial Assistance Food Bank/Home Delivered Meals Linguistics Services Medical Transportation Services
Emergency Financial Assistance
Case management (nonMedical) Medical Transportation Services
Case management (nonMedical) Emergency Financial Assistance
Case management (nonMedical) Emergency Financial Assistance

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Dublin Health District Macon Health District
Augusta Health District Columbus Health District

Medical Nutritional Therapy
Medical Case Management (including Treatment Adherence)
Ambulatory/ Outpatient Medical Care Dental Care/Oral Health
Health Insurance Premium & Cost Sharing Assistance Medical Nutritional Therapy
Medical Case Management (including Treatment Adherence)
Ambulatory/ Outpatient Medical Care Dental Care/Oral Health
Medical Nutritional Therapy
Medical Case Management (including Treatment Adherence)
Ambulatory/ Outpatient Medical Care Medical Case Management (including Treatment Adherence)
Ambulatory/ Outpatient Medical Care Dental Care/Oral Health
Medical Case Management

Health Education/Risk Reduction Linguistics Services
Medical Transportation Services
Case management (nonMedical) Emergency Financial Assistance Housing Services
Medical Transportation Services
Case management (nonMedical) Emergency Financial Assistance Food Bank/Home Delivered Meals Housing Services
Medical Transportation Services Treatment Adherence Counseling
Case management (nonMedical) Emergency Financial Assistance
Housing Services
Case management (nonMedical) Emergency Financial Assistance Linguistics Services

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Valdosta Health District Albany Health District Coastal Health District

(including Treatment Adherence

Ambulatory/ Outpatient Medical Care Dental Care/Oral Health
Medical Case Management (including Treatment Adherence

Case management (nonMedical) Emergency Financial Assistance Food Bank/Home Delivered Meals
Health Education/Risk Reduction Medical Transportation Services Psychosocial Support Services Treatment Adherence Counseling

Ambulatory/ Outpatient Medical Care Dental Care/Oral Health
Health Insurance Premium & Cost Sharing Assistance Medical Nutritional Therapy
Medical Case Management (including Treatment Adherence Substance Abuse Services Outpatient

Case management (nonMedical) Emergency Financial Assistance Food Bank/Home Delivered Meals Health Education/Risk Reduction Housing Services
Medical Transportation Services Psychosocial Support Services Treatment Adherence Counseling

Ambulatory/ Outpatient Medical Care Dental Care/Oral Health
Mental Health Services
Medical Nutritional Therapy
Medical Case Management

Case management (nonMedical) Emergency Financial Assistance Health Education/Risk Reduction Medical Transportation Services

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Waycross Health District Athens Health District

(including Treatment Adherence Substance Abuse Services Outpatient

Ambulatory/ Outpatient Medical Care Dental Care/Oral Health
Health Insurance Premium & Cost Sharing Assistance

Case management (nonMedical) Emergency Financial Assistance Health Education/Risk Reduction Medical Transportation Services

Ambulatory/ Outpatient Medical Care Dental Care/Oral Health
Health Insurance Premium & Cost Sharing Assistance Medical Nutritional Therapy Medical Case Management (including Treatment Adherence

Case management (nonMedical) Emergency Financial Assistance Food Bank/Home Delivered Meals Linguistics Services Medical Transportation Service

See the resource inventory provided in Appendix 1 for additional information on Ryan White funded services in Georgia, including the 20 county metro Atlanta EMA (Part A).

Part B clients receive services from other Ryan White funded and non funded programs that enhance and augment the comprehensive range of services required by individuals and families. For example, Part B clients receive housing assistance through the Housing Opportunities for People With AIDS (HOPWA) program; Women, Infants, Children, and Youth receive assistance through Part D funds (Waycross and metro Atlanta); and Primary Care and Counseling & Testing are provided through Part C funds; and Part A allocates funding to help with clients on the ADAP waiting list. In this environment of limited funding for HIV/AIDS and the increased prevalence among emerging populations, integration and coordination of services ensures timely, uninterrupted care.

2. Non Ryan White funded HIV care and service inventory (organizations and services)

See the resource inventory provided in Appendix 6.

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3. How Ryan White funded care/services interact with Non-Ryan White funded services to ensure continuity of care
Ryan White Part B services are coordinated with other programs and funding streams. Coordination examples include coordination of services with the Housing Opportunities for Persons with AIDS (HOPWA) program; participation in needs assessments, consumer surveys, focus groups and other activities, including the Georgia Oral Health Coalition Strategic Planning Committee; participation of other programs and funding streams in the HIV Prevention Community Planning Group; and sharing of treatment sites with prevention and counseling sites.
4. How the service system/continuum of care has been affected by state and local budget cuts, as well as how the Ryan White Program has adapted
According to an analysis by the Georgia Budget and Policy Institute in its June 15, 2010 article "Deep Cuts to Government Mark Fiscal Year 2011, Budget May Yet Be in the Red" Georgia's financial safety and structure continues to erode.
The "Great Recession" has resulted in Georgia facing the worst fiscal crisis in more than 70 years. State revenues have dropped dramatically over the past two years, resulting in multibillion dollar budget deficits. Although federal Recovery Act funds have helped Georgia avoid cuts to Medicaid and limited somewhat cuts to education and public safety, most state agencies have seen their budgets reduced by 15 percent or more.
Beyond FY12, Georgia is facing additional structural deficit. Due to projected sluggish economic growth, normal budget growth due to a growing population resulting in an increased demand for state services, and the importance of growing the Revenue Shortfall Reserve, the existing tax base may be inadequate to balance the state budget in the long-term.
The number of persons being served through the Ryan White Program continues to increase as jobs and insurance coverage have been lost particularly for primary care, medications, and medical transportation services. The Part B providers work diligently to assure access to patient assistance programs for medications and routinely review eligibility for Medicare and/or Medicaid enrollment so that Ryan White funds continue to be the payer of last resort.
5. For jurisdictions that lost a TGA, describe the impact on services (Only Puerto Rico, New York, New Jersey and California grantees should respond)
N/A. Georgia did not lose a Transitional Grant Area.
C. Description of need

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1. Care needs
Georgia employs several different mechanisms to assess the need for primary medical care and other core medical services and barriers among PLWHA in the state. The primary method of collecting data regarding needs, unmet needs, and barriers to care has been through collaborative relationships with other entities, including the HIV/AIDS Epidemiology Surveillance Section, the Southeast AIDS Education and Training Center (SEATEC), district-level Ryan White Part B Consortia, other Ryan White programs such as the Atlanta EMA Part A Program, and the Prevention Program in the HIV Office. The process of updating the Statewide Coordinated Statement of Need (SCSN) also provides critical information regarding client needs.
Needs assessments conducted by the 16 health districts show that, in order of importance, the five most needed services are: Primary Care, Medical Case Management, Oral Health, Emergency Financial Services, and Non Medical Case Management. These five needs are identified across the state regardless of where HIV positive individuals reside (urban, suburban, or rural) as priorities by the consortia. Other needs identified by rank mirror the overall lack of services in the communities where HIV positive clients reside. Rural populations identify transportation as a higher ranked need while suburban and urban regions ranked mental health and substance abuse services as a greater need.
2. Capacity development needs resulting from disparities in the availability of HIV-related services in historically underserved communities and rural communities
Public health and community clinics serve as the foundation for the provision of primary care services in Georgia and enable disenfranchised populations to access care by providing services in clinics that are geographically located in communities where the majority of persons are minorities, indigent, and uninsured, and who represent the populations least likely to have access to care. The need for increased access to non-Ryan White funded oral health, mental health and substance abuse services have been identified, particularly for underserved communities and populations.
Part B providers assist clients in enrolling in AIDS Pharmaceutical Assistance Programs (PAP) in primary care sites which allows timely access to therapies and prophylaxis for opportunistic infections as a stop-gap measure until enrollment in ADAP or pharmaceutical PAP has been completed, and for long-term clients who are ineligible for ADAP due to the state requirement that a patient must be on HAART. However, Georgia has had an ADAP waiting list since July 2010. Pharmaceutical PAPs are currently available to provide access to needed medications; however, it is not known how long pharmaceutical companies will continue to offer PAP given demand.

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A training needs assessment was conducted in 2010 by the Southeast AIDS Education and Training Center of persons working with the state's Ryan White-funded program sites. The top clinical training topics requested included mental illness and HIV, substance abuse and HIV, and ART therapy. The top requested care-related training topics included chaotic patients, staff team building, and medical case management. Results from the assessment have guided statewide training and the inclusion of topics at the November 2011 Georgia Ryan White Meeting.
D. Description of priorities for the allocation of funds based on a) size, demographics, and location of people who know their status but are not in care and b) needs of individuals with HIV/AIDS.
Through health districts, state direct services, home and community-based care, and ADAP, Georgia's HIV Office allocates funds to the Health Resources and Services Administration (HRSA) defined core medical services and support services for People Living with HIV/AIDS (PLWHA). The HIV Office allocates funds to the core medical services in all state direct services and contracts. The yearly guidance to the 16 public health districts includes language from HRSA regarding how funds should be allocated at the local level to the core medical and support service areas. The public health districts submit yearly budgets that are reviewed and approved by the HIV Office to ensure funds are allocated to core medical service.
Georgia's planned services and implementation plan are reflective of HRSA's 75/25 core medical services requirement. Eighty-seven percent of Georgia's proposed Part B funds will be allocated to core medical services.
Statewide, there are 16 Part B public health districts that work collaboratively with consortia, which serve as advisory bodies and are charged with conducting regional needs assessments and gap analyses, making recommendations on how to prioritize Part B funds in their respective districts. Local Part B consortia membership includes people living with HIV/AIDS (PLWHA), district health staff, community based organizations, medical and social service providers, and other interested community members. Consortia meetings are open to the public.
E. Description of gaps in care
Service gaps have been documented in a number of specific needs assessments/consumer surveys. Planning is underway to conduct a statewide consumer survey in 2013 to identify needs and gaps in care. In addition, an across Ryan White Parts statewide client satisfaction survey is planned for Fall 2012. In the interim, a recent consumer survey conducted by the Metropolitan Atlanta HIV Health Services Planning Council has yielded valuable information for both the EMA and applicable statewide. Survey findings from the 2011 Atlanta EMA HIV/AIDS

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Consumer Survey (715 completed surveys), presented at the May 2-3, 2012 SCSN meeting identified the following top ten gaps in core services and in support services.
Top Gaps in Core Services 1. Treatment for dental problems (specialty) 2. Emergency dental care 3. Prevention dental care 4. Session with mental health doctor 5. One to one or group mental health counseling 6. Pharmaceutical assistance 7. Soft meals 8. Residential substance abuse treatment 9. Case management 10. One to one or group substance abuse counseling
Top Gaps in Support Services 1. Food vouchers 2. Emergency financial assistance for utilities 3. Food pantry 4. Legal services 5. Benefits counseling 6. Home delivered meals 7. Nutrition education/counseling 8. Housing information services 9. Peer navigator 10. Peer counseling
Top Gaps in Services: Gender Males: Food vouchers, nutrition supplements, treatment for dental problems Females: Food vouchers, treatment for dental problems, emergency dental care, preventive dental care Transgenders: Treatment for dental problems, food pantry, emergency dental care, preventive dental care
Top Gaps in Services: Race/Ethnicity African American: Food vouchers, treatment for dental problems, nutritional supplements Latino: Nutritional supplements, food vouchers, emergency dental care White: Food vouchers, preventive dental care, legal services
Top Gaps in Services: Special Populations

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Young Heterosexuals: Emergency financial assistance for utilities, preventive dental care, nutritional supplements Young MSM: Emergency financial assistance for utilities, food vouchers, nutritional supplements Women, children and adolescents: Food vouchers, nutritional supplements, emergency financial assistance, treatment for dental problems, emergency dental care Persons 50 years of age and older: Food vouchers, emergency financial assistance for utilities, treatment for dental problems, emergency dental care, preventive dental care
F. Description of prevention and service needs
Unmet need data indicate that there are 14,210 PLWA and 10,364 PLWH (non-AIDS) who are aware of their status but are not in care in the public or private health care system.2 Combined, these figures total 24,574 individuals with HIV/AIDS who are in need of regular primary care in either the public or private health system. To this total needs to be added those individuals who are infected but unaware of their status (EIIHA data, 5,230) for a grand total of 29,804. Based upon historical utilization patterns, an estimated 1/3 of the population access the public health system, 1/3 access the private health system, and 1/3 do not access any health system for the treatment of HIV disease. Applying this utilization figure, it is estimated that 1/3 of the 29,804 (or 9,934) would access the public health system. In addition, there are currently 8,140 individuals receiving HIV care through the Part B continuum. Thus, it could be crudely estimated that 18,074 individuals (9,934+8,140) are in need of services through the Part B continuum at the present time.
However, there has been a 6% increase in the number of PLWH (non-AIDS), and a 1% increase in PLWA in Georgia in 2009-2010 compared to 2008-2009, for a total increase of 7%. The number accessing primary care in 2012 (assuming another increase in the number of clients of 7%) can be estimated to be 19,339 (18,074 + (18,074*7%). These individuals will require additional Part B core services and essential support services as well.
Part B will continue to collaborate with the State's Enhanced Comprehensive HIV Prevention Planning (ECHPP) to support the current prevention activities targeting the populations included below as outlined in the ECHPP plan.
Emerging Trends That Impact Service Needs in Georgia:
(1) Population Group: Men who Have Sex with Men

2 GA/DPH/HIVEU, September 2011.

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Since the onset of the HIV/AIDS epidemic in the United States, AIDS incidence and prevalence has been the highest among men who have sex with men. The term "men who have sex with men (MSM)" refers to all men who have ever had sex with men regardless of how they identify themselves (gay, bisexual, or heterosexual).

Men who have sex with men (MSM) still represent the largest number of people living with AIDS in Georgia. They account for approximately 47% (42% MSM and 5% MSM who inject drugs) of the known cases of Georgians living with AIDS as of December 31, 2010. MSM represent the largest number of people living with HIV in Georgia. Based on HIV prevalence, as of December 31, 2010, MSM accounted for 36% of the HIV cases in Georgia. Seventy-eight percent of PLWHA in Georgia are MSM.
Unique Challenges Presented MSM are members of all communities, all races and ethnicities and all strata of society. The unique challenges presented to this segment of the population include social and economic factors such as racism, homophobia, poverty, and lack of access to health care services. African American and Hispanic males are more likely than White males to receive a diagnosis of HIV infection in the late stages, often when the infection has progressed to AIDS, which suggests that they are not accessing testing or health care services early in their infection when treatments might be more effective. The stigma associated with homosexuality may inhibit some men from identifying themselves as gay or bisexual, even though they have sex with other men. Some men who have sex with men and with women do not identify themselves as gay or bisexual. Research suggests that elevated rates of Sexually Transmitted Infections (STIs) and undetected or late diagnosis of HIV infection may contribute to higher rates of HIV infection among African American MSM.3
Data from the 2008 National HIV Behavioral survey found that not only were 19% of MSM HIV infected but that half did not know they were infected. When analyzed by race, 59% of African American MSM did not know their status compared to 26% of White MSM. Not surprisingly it was also found that HIV prevalence increased as education and income decreased.4
People with HIV infection are now living much longer and healthier lives than previously tends to portray it as less of a threatening disease and more like a regular infection that can be cured with treatment. It is also noteworthy that among older PLWHA, there is a greater proportion of White MSM than African American MSM again suggesting that the

3 Ibid. 4Prevalence and Awareness of HIV Infection Among Men Who Have Sex With Men --- 21 Cities, United States,
2008, September 24, 2010 / 59(37);1201-1207.

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African American PLWHA are not receiving the same level of medical care as White PLWHA.
African American and Hispanic males are less likely than White MSM to live in gayidentified neighborhoods. Therefore, prevention and treatment programs directed to gayidentified neighborhoods may not reach these MSM. For Hispanic MSM, cultural factors may discourage openness about homosexuality, the importance of non-confrontational relationships, and the importance of a close family relationship.5
Service Gaps: Service gaps include insufficient outreach initiatives that create awareness and educate MSM about HIV/AIDS and safer sex practices, social support groups that address substance abuse and mental health issues and the stigma associated with the complexity of multiple health problems. Other gaps in services identified by MSM through the HIV Consumer Survey include primary prevention services for oral health, transportation, and emergency assistance for paying household utilities.
(2) Population Group: Women
In 2010 women accounted for 24% of newly diagnosed AIDS cases and 29% of people living with HIV in Georgia. The HIV/AIDS epidemic in Georgia continues to affect a significant number of women. From 1984 to 2010, the cumulative proportion of AIDS cases among women increased from 4% to 23%.
African American women are disproportionately affected. As of December 31, 2010, 83% of women living with AIDS in Georgia were African American, and 81% of women living with HIV (not AIDS) in Georgia were African American, according to eHARS data.
Heterosexual contact remains the primary mode of transmission in women. Many women were sex partners of men who have used drugs or of MSM. Twenty-three percent (5,444) of the individuals living with AIDS and 29% (5,397) of the cases of HIV in Georgia at the end of 2010 were female.
In 2010 African American women accounted for 81% of HIV-NA and 83% of women with AIDS. Hispanic women accounted for 4% of female PLWHA. African American women are 19 times more likely to be infected than White women and nearly 4 times as likely as Hispanic women.6

5 Ibid. 6National HIV/AID Strategy for the United States, The White House Office of National AIDS Policy, July 2010.

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Sexually transmitted infections (STIs) are the most common co-morbidities of HIV and can facilitate exposure to, and progression of, HIV disease. Studies have shown that people who are dually infected with HIV and STIs are much more infectious than those who are infected only with HIV. Since most STIs can be asymptomatic, diagnosis and treatment of infection can be delayed.
According to the 2010 Georgia Annual STD Report, there were 44,612 reported cases of chlamydia and 15,652 reported cases of gonorrhea in Georgia. Women and AfricanAmericans were disproportionately affected by both diseases. Women accounted for 32,863 (74%) of reported chlamydia cases and had a case rate of 658.1/100,000, while African-Americans accounted for 20,553 (46%) of chlamydia cases with a case rate of 601.3/100,000. African-Americans accounted for 61% (9,516) of reported gonorrhea cases with a case rate of 324.7/100,000, while women accounted for 52% (8,297) of reported gonorrhea cases and had a case rate of 166.1/100,000.
Unique Challenges Presented: The challenges presented to women include discrimination, low socioeconomic status, poverty, and lack of insurance. In addition to the challenge of living with HIV, women also face challenges of domestic abuse, maternal health issues, and are often the primary caregivers for children and aging parents. HRSA's HIV/AIDS Bureau's Client Demonstration Project found that among women, receipt of medical care services, emergency financial assistance, housing assistance, or transportation services was predictive of continuing receipt of services in the following year. This finding indicates that many women are living in poverty and have a continuing need for support services. Among HIV positive women, psychological distress poses a significant barrier to care. In one study, 31% of women who tested positive for HIV delayed accessing care for three months or longer because of fear, depression, and anxiety about their serostatus. Of the 2,000 women enrolled in the National Institutes of Health Women's Interagency HIV Study nearly 50% reported a history of sexual abuse and 60% were victims of domestic violence.7
Since most female HIV infections are transmitted through heterosexual activities, women are at additional risk based on the activities of the men with whom they are having sex since most female HIV infections are transmitted through heterosexual activities. African American women are more at risk than White due to the higher drug use by their partners. This also applies to Hispanic women.8,9
Service Gaps: Services including outpatient ambulatory care, oral health care, mental health counseling, and family case management are needed for adult and adolescent women. The 2008 HIV Consumer Survey reports a high rate of primary care usage (80%)
7 HRSA Fact Sheet: Women & HIV/AIDS. 8 National HIV/AID Strategy for the United States, The White House Office of National AIDS Policy, July 2010. 9CDC, HIV/AIDS Surveillance in Injection Drug Users (through 2007) Slide set.

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among women, yet only 69% use antiretroviral medications. The top services needed but not received were: oral health care, food, transportation assistance, home-delivered meals, and referrals to services.
(3) Population Group: Hispanics
Hispanics include any person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.10According to the 2010 US Census Bureau population estimate, there are roughly 50.5 million Hispanics living in the United States representing 16% of the population in 2010.11Georgia has the third fastest growing Hispanic populations in the nation over the last 10 years. In 2010 it was estimated that Hispanics of any race accounted for 9% of the Georgia population.
Georgia eHARS data shows that Hispanics constituted 5% (1,110) of those living with AIDS and 4% (779) of those living with HIV (not-AIDS) as of December 31, 2010. The HRSA Fact Sheet: Hispanics and HIV/AIDS, reports that Hispanics tend to be tested for HIV late in their illness. They are more likely than non-Hispanic Whites to have AIDSdefining conditions at the time of their first test or within the first year after diagnosis.
Hispanics accounted for 7% of all newly reported cases of AIDS in the state of Georgia during 2010, an increase from 6% in 2009. (It is thought that this decline may be a result of recent state immigration legislation and persons may have chosen not to seek care for fear of imprisonment or deportation. Many Hispanics either declined or were very hesitant to participate in the recent Consumer Survey.) Among the 26,886 PLWHA, 5% are Hispanics. In the last year, the number of Hispanic PLWHA has increased from 1,319 to 1,351, an increase of 2%.
Unique Challenges Presented: Hispanics shoulder a disproportionate burden of AIDS in the United States. Study results show that 27% of Hispanic adults in the US do not have regular health care providers. Those who do seek treatment are getting into care late and are not getting diagnosed early. Thirty-two percent of HIV-positive Hispanics are diagnosed with AIDS within 30 days after testing positive for HIV, compared with 24% of both HIV-positive African Americans and Whites. Many face significant barriers to health information, HIV counseling, testing and care. Challenges for the Hispanic population include: poverty; language difficulty; lack of health insurance; availability of quality health services in their communities; distrust of the American health care system; citizenship status; and cultural perceptions, beliefs, attitudes and practices.12
Services Gaps: Service gaps include lack of culturally competent and bilingual prevention education and outreach initiatives, limited availability of bilingual healthcare services, lack of access to culturally competent sub-specialty care, limited access to

10HRSA Fact Sheet: Hispanics & HIV/AIDS. 11The Hispanic Population 2010, US Census Bureau, 2010 Census Summary File 1, May 2011. 12 HRSA Fact Sheet: Hispanics & HIV/AIDS.

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pharmaceuticals, mental health, and substance abuse services, and lack of culturally sensitive health care providers.
(4) Population Group: African-Americans
Although African-Americans make up only 31% of Georgia's population, 76% of all new cases of AIDS in 2009-2010 were among African-Americans. As of December 31, 2010, 72% of Georgians living with HIV were African-Americans, according to Georgia's eHARS.
Unique Challenges Presented: African-Americans present unique challenges that impact services delivery and access to care. Challenges for the African-American population include fear of stigma in community, reluctance to seek services, education and literacy rate, lack of insurance and availability of services in local communities, lack of adherence to medications, poverty, distrust of practitioners and social services providers, and limited access to healthcare.
Service Gaps: Gaps include population specific prevention education and outreach initiatives that educate African-Americans about HIV/AIDS, shortages of health professionals located in primarily African-American communities, and mental health counseling that deals with not only mental health concerns but also self-esteem and stigma.
G. Description of barriers to care
1) Routine testing (including any state or local legislation barriers) There are no legal barriers to routine testing. However, information provided by the State's Prevention Program indicates that some physicians are not aware of the CDC's recommendation for routine testing for HIV. Additional efforts are required to educate providers on the CDC recommendations.
In addition, a current law categorizes hypodermic needles as illegal drug paraphernalia, which is the barrier to implementing programs and activities that address prevention of persons who inject drugs.
2) Program related barriers
According to a 2006 article in the American Journal of Public Health, "data document substantial increases in AIDS cases in the Deep South... In contrast, other US regions are experiencing stable rates or small increases in new AIDS cases. Furthermore, the AIDS epidemic in the Deep South is more concentrated than in other regions among African Americans, women and rural residents. The Deep South also has some of the highest levels of poverty and uninsured

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individuals, factors that complicate the prevention and treatment of HIV infection."13In 2010, a report criticized the response to the AIDS epidemic in the 17 states in "the South".14 This report concludes that a combination of socioeconomic conditions and state laws and policies means that this region is disproportionately affected by the epidemic; half of all people living with HIV live in the South although this region is home to just over a third of the population. Poverty, poor access to healthcare relative to the rest of the country, a focus on abstinence based on sex education and laws that criminalize HIV transmission and restrict harm reduction programs for IDUs are some of the factors which explain why the risk of becoming infecting with HIV and dying from AIDS is highest in the South. A study examining data from across the country also found that, for socioeconomic reasons, nonwhite men and particularly nonwhite women residing in the South experience the worst clinical outcomes after being diagnosed with HIV.15AIDS continues to be a profound medical, psychosocial, and economic crisis in Georgia. In the context of a burgeoning diverse population base, overburdened public health care, social service systems, and economic recession, each year the number of AIDS and HIV cases increases. The basic service needs of the existing population of persons living with HIV/AIDS are barely being met, and acute information and capacity gaps are being increasingly noted. There also exist subgroups among PLWA who present further challenges to the system and specific needs for care, notably youth, with high rates of STIs; the homeless and recently incarcerated "hidden" populations; women, especially single mothers barely living above the poverty level; and the increasing rate of AIDS cases among MSM, notably men of color. Failure to meet the primary care, substance use, and mental health needs of these populations of PLWA will lead to increased cost as physical, social, and personal wellbeing are jeopardized. This could in turn lead to reduced capacity for, and access to, care. When complications related to housing, income, health, or personal wellbeing are present, the system is strained. The Georgia Ryan White system of health care and psychosocial services must continue to accommodate these client challenges and the increased demand for services as the epidemic continues to grow in the present economic environment.
3) Provider related barriers The cost and complexity of care for persons living with HIV infection is significantly increased with the presence of one or more co-morbid diseases, such as Sexually Transmitted Infections (STIs), including Hepatitis B or C, tuberculosis (TB); homelessness; lack of medical insurance; poverty; and the release of infected incarcerated individuals.
Factors that compound the high rates of STIs and prevalence of poverty among PLWHA in the are the lack of adequate medical insurance coverage, which further disenfranchises PLWHA from receiving adequate care; the presence of other complicating medical problems, such as TB
13 Reif, et al., American Journal of Public Health, June 2006. 14Human Rights Watch: Southern Exposure, Human Rights and HIV in the Southern United States, November 2010. 15Journal of Infectious Diseases, Sex, Race, and Geographic Region Influence Clinical Outcomes Following Primary HIV-1 Infection, February, 2011, 203(4):442-51.

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(Tuberculosis); and cofactors such as homelessness, poverty, substance use, or severe mental illness. Each additional complication creates further complex care and care coordination, and correspondingly drives up health care costs for treating the individual client.
At primary care sites, any of these co-morbidities increases the time spent by any health provider with a client. A medical follow-up visit for a patient adherent to treatment is approximately 45 minutes.16 Clients who have one or more co-morbidity factors require over an hour, and with acute illness, up to 4 hours. This reflects the need for more in-depth evaluation, laboratory tests, radiological exams, and even hospitalization. The presence of co-morbid factors presents barriers to routine and preventive care, and their attention is necessary to facilitate HIV treatment and increase survival rates. As people access routine health services with less regularity or encounter barriers to service access, they develop more urgent health and social service needs. Effectively addressing any of these problems can decrease cost and treatment complexity. For example, studies have documented that addressing the impact of STIs through early intervention can potentially reduce new HIV cases and associated treatment costs. One study documented how preventing syphilis-related new cases of HIV can result in savings of $833 million nationally in direct medical cost for HIV treatment.17
With respect to health infrastructure, Georgia is facing problems as the growing demand for Registered Nurses (RNs) outpaces the supply of the nursing workforce.18 Key factors driving these concerns are that Georgia continues to be one of the fastest growing states in the nation, and one that is aging. As the 9th most populous state in 2009, Georgia continues to attract new residents. Between 2000 and 2030, Georgia is projected to have a population increase of 46.8%, growing to over 12 million residents from 8.1 million in 2000. This will make Georgia the 8thfastest growing state between this time period, growing at a rate well above the national average growth rate of 29.2%. Not only is Georgia's population increasing, the state is also experiencing a rapid growth in the number and percentage of residents age 65 and older. Older populations typically place increased demand on healthcare services. Between 2000 and 2030, Georgia is projected to add 1.1 million people age 65 and older, an increase of 143%, which more than doubles the current population in this age group. This growth rate is the 8thlargest of the 50 states and District of Columbia and is nearly 40 percentage points higher than the national average. This rate of growth will mean that the state will change from having 9.6% of the population being 65 and older in 2000 to 15.9% of Georgia residents being age 65 and older in 2030. As a result of total population growth and change in the number of residents age 65 and over, Georgia must expect to face a substantial increase in demand for healthcare services. This is occurring at a time when the supply of RNs in Georgia is already too low to meet existing demand.
16 Grady Infectious Disease Program: Clinical data and chart review 2005. 17 Chesson, et al., American Journal of Public Health, 2003. 18 Policy Brief, University of Georgia Board of Regents, Center for Health Workforce Planning and Analysis: The Registered Nurse Workforce in Georgia, September 2009.

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4) Client related barriers In addition to the challenges described above, client related barriers include the following:
Uninsured Persons: The South is home to the greatest number of uninsured persons (estimated at 21 million or 19%). Nationally, 17% of the population is without insurance. In Georgia, 19% of residents reported no health insurance coverage in 2009, including no Medicaid or Medicare (11th highest uninsured rate of all States).19,20 This is a marked increase from the 16% just 5 years earlier.21 This figure increases to 25% among those aged 19-64 years.22
Georgia's difficult economic situation has also resulted in high unemployment. In July 2008, the state's unemployment rate was 6.2%. With the economic downturn experienced by the state, the rate increased to a high of 10.4% in 2011.23The state's unemployment rate has decreased to 8.9% in 2012, but still remains higher than the national rate of 8.1%. Loss of employment or inability to find employment has led to an increased number of uninsured PLWHA. Similarly, the proportion of individuals on Medicare/Medicaid will also likely rise at the same time as a decline in State funding for Medicaid of $43 million,24 which will result in fewer individuals on Medicaid and result in a larger number of individuals without any insurance coverage at all. Georgia is 6th worst in economic measures that include foreclosures, food stamps and unemployment levels.25
In Georgia, African Americans represent 69% of the total HIV/AIDS prevalence. According to a national assessment by the Kaiser Commission, access to health services by African Americans is compromised by an uninsured rate that is one and one-half times that of Whites. With half of all African Americans living in families with incomes below 200% of poverty, this rate would be much higher were it not for Medicaid coverage.26 Medicaid provides an important safety net for one in five African Americans, underscoring the role that Medicaid plays for low-income families with children. Medicaid covers one-half of African Americans with incomes below poverty and 17% of those between 100-199% of poverty. However, Medicaid's protection is incomplete leaving 30% of African Americans below 200% of poverty and uninsured.
Homelessness: Homelessness is a psychosocial, as well as an economic and health crisis. However, documenting the number of homeless persons at any given time remains a significant challenge. Data on the number of homeless in Georgia is limited; however a 2010 HUD
19US Census Bureau, Current Population Survey, 2005-2007, Update 2008. 20 Kaiser Commission on Medicaid and the Uninsured, April 2011. 21 Georgia Budget and Policy Institute, September 2009. 22Kaiser Family Foundation, 2011. 23 Atlanta Journal and Constitution, August 2011. 24 Georgia Budget and Policy Institute, Budget Primer 2012, August 2011. 25 Bureau of Labor and Statistics, August 2009. 26Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation, 2011.

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homeless census count identified sheltered (n=8,746) and unsheltered (n=11,090) homeless persons totaling 19,836 homeless individuals on any given night. From the 2010 statewide homeless census count, it is estimated that 75,000 people experience homelessness in Georgia at some time during one year. It is estimated that within the US, 3.4% of the homeless population is infected with HIV or 3 times the rate found in the general population.
Education and Health Literacy: Healthy People 2010, the federal government's public health policy initiative, addresses the connection between health literacy and health disparities. It states, "Equitably distributed health communication resources and skills, and a robust communication infrastructure can contribute to the closing of the digital divide and the overarching goal of Healthy People 2010 to eliminate health disparities."27 According to Healthy People 2020, the emphasis on the importance of health literacy is in its overarching goal "to achieve health equity, eliminate disparities, and improve the health of all groups."
Health literacy is one of the tools individuals need to access, understand, and act on health information. It enables consumers to navigate our complex health system, to seek and receive higher quality health care, and to be fully involved in self-management and maintaining good health.28 Although low health literacy affects individuals of every age, race, education and income level, the elderly, minorities, immigrants, poor, homeless, prisoners, and persons with limited education are more likely to have low health literacy skills. People who are managing multiple chronic diseases and/or multiple insurance systems are also likely to have greater difficulty understanding health messages. Recent studies demonstrate a higher rate of hospitalization and use of emergency services among patients with limited literacy. Patients with low literacy skills are twice as likely to be hospitalized and twice as likely to report poor health.29 A 2002 study indicated that, nationally, low health literacy was estimated to cost $73 billion annually in excess hospitalization days alone.30
Many Georgians have low health literacy because of low English proficiency. According to a 2007 report, Georgia is 49th in the country in high school completion and has the fastest growing immigrant population in the nation, having more than doubled in five years.31. In a large health literacy study in 1996,32 one-third of English speaking patients at two public hospitals were unable to read basic health materials. Forty-two percent of patients could not comprehend directions for taking medication on an empty stomach, 6% were unable to understand information on an appointment slip, 43% did not understand the rights and responsibilities
27 US Department of Health and Human Services, 2000. 28HealthVoices, Health Literacy A Key to Better Health for Georgians, Issue 2, 2007. 29 Ibid. 30"Low Health Literacy: What Do Your Patients Really Understand?," Nursing Economic$, May-June 2002/Volume 20/No.3, Joanne G. Schwartzberg. 31 HealthVoices. 32 Parikh, NS., et al., "Shame and Health Literacy: The Unspoken Connection." Patient Educ. Couns. 1996 Jan; 27(1): 33-9.

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section of a Medicaid application, and 60% did not understand a standard informed consent document. In a separate study, patients who presented for acute care at a large public hospital in Atlanta were interviewed.33 A total of 202 predominately African American patients completed a demographic survey (The Test of Functional Health Literacy in Adults) and answered questions about difficulty reading. Of the 202 interviewed, 42.6% had inadequate or marginal functional health literacy. This study found that about 1 of 4 people living with HIV/AIDS demonstrated difficulty comprehending simple medical instructions indicating low health literacy rates. HIVinfected people with lower health literacy rates had lower CD4 cell counts, higher viral loads, were less likely to be taking antiretroviral (ARV) medications, reported a greater number of hospitalizations, and reported poorer health than those with higher health literacy.34

The 2011 Atlanta EMA HIV/AIDS Consumer Survey (715 completed surveys) offers valuable information about client related barriers, including individual, organizational and structural barriers. Individual barriers refer to an individual's knowledge, physical and mental health. Organizational barriers include access (such as transportation or access to a specialist), sensitivity (how clients feel they are treated by providers) and expertise (quality of care by organization and individual provider) barriers. Structural barriers relate to insurance, cost, red tape, rules and regulations, and problems navigating the system. The top five barriers for each category are provided in the table below.

Top Five Barriers

Individual

% Structural

% Organizational

%

I did not know a service 59% Lack of health insurance 37% Lack of privacy by the

27%

was available to me

coverage

organization to protect my

medical chart

I did not know where to 56% Reduced services due to 36% Person providing services 23%

go to get the service

funding cuts

to me did not seem to

know enough

I did not know what

45% No transportation or

36% Cultural sensitivity of the 20%

medical services I needed

access to adequate

organization and person

transportation

providing services to me

My state of mind or

41% The amount of time I had 35% The organization did not 20%

ability to deal with the

to wait for an

refer me to the services I

treatment

appointment

needed

My physical health has 41% There is too much

32% I did not get along with the 20%

not allowed me to travel

paperwork and/or red

people providing the

to where the service is

tape

services

33 Williams, MV, et. al., "Inadequate Functional Health Literacy among Patients at Two Public Hospitals," JAMA
1995; 274:1667-82. 34Parikh, NS, et al.

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H. Evaluation of 2009 Comprehensive Plan
Progress, successes and challenges in implementing Georgia's 2009-2012 Comprehensive Plan's goals, objectives, and strategies are described in the goal tables on the following pages.

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Georgia's 2009-2012 Statewide Comprehensive HIV Services Plan

Goal 1: Improve access to HIV-related core services.

Objectives 1.1 Ensure continuity and availability of HIV primary care consistent with Public Health Services guidelines.

Strategies 1.1.1 Identify and assure points of entry for services exist in each health district. 1.1.2 Establish system to regularly disseminate current contact information on all identified access points to providers throughout state. 1.1.3 Assure transitional discharge planning for incarcerated individuals. 1.1.4 Establish standardized referral form and documentation requirements throughout the state.

Progress, Successes and Challenges 1.1.1 Clinics are located in each of the health districts and in the EMA. 1.1.2 Clinic and contact info is on the HIV Office website. 1.1.3 482 received an encounter with a CM (Had a referral with at least a onetime contact with the CM).
99 were active members (Were enrolled and received an Individual Service Plan) in 2011. Of the 99 active members, 55 are still in care.

1.2 Provide essential comprehensive oral health care.

1.2.1 In collaboration with the State Chief Dentist, establish an oral health workgroup to develop state oral health plan. 1.2.2 Provide continuing education opportunities for oral health providers. 1.2.3 Develop and implement strategies to integrate oral health care education in clinic settings. 1.2.4 Develop relationships with dental schools and oral hygiene programs.

1.1.4 Due to the variation in referral forms in the health districts, it is not necessary to develop this form or documentation at this time. 1.2.1 The Oral Health Coalition developed a State Oral Health Plan.
1.2.2 Ten trainings targeted specifically to oral health providers were conducted.
1.2.3 Fifty-four trainings conducted that included oral health care/HIV as a training topic.
1.2.4 Georgia Health Science University receives Part F funding and provides dental services for HIV-infected clients. A list of dental

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Objectives
1.3 Improve access to mental health and substance abuse services.
1.4 Ensure access to care for newly identified HIV positives.

Strategies
1.3.1 Increase linkages and collaboration at the state and local level with public and private mental health and substance abuse providers. 1.3.2 Evaluate current availability of mental health and substance abuse services at the local level. 1.3.3 Train local clinic staff to screen mental health and substance abuse status on clients. 1.4.1 Improve linkages between HIV counseling and testing and HIV care. 1.4.2 Coordinate outreach with early intervention services and HIV care. 1.4.3 Encourage clinic sites to dedicate a specific time/date for new patient evaluations. 1.4.4 Utilize trained peer advocates to facilitate new client enrollment in HIV Clinics

Progress, Successes and Challenges hygiene school was sent out to HIV Coordinators in December and January; one district currently has an MOU. 1.3.1 Current linkages have been maintained. 1.3.2 Several districts are funded to provide mental health and substance abuse services. 1.3.3 One hundred and twelve trainings conducted that included mental health and/or substance abuse as a topic in training.
1.4.1-2 The HIV Prevention Section was funded through the new CDC cooperative agreement to implement a 2 years demonstration project that focuses on retention to care using linkage case managers, HIV Service Providers, and a network of stakeholders.
HIV Prevention continues to move toward routinizing HIV testing. The program aims to fund more clinical settings. All agencies must have documented linkages.

HIV Prevention Program continues to work with EIHAA to identify gaps in services and trends. 1.4.3 All Ryan White Part B HIV clinics accept new patients. 1.4.4 Five districts currently utilize peers for client support activities.

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Objectives 1.5 Ensure HIV clinics provide clients with medical visits two or more times at least three months apart annually.

Strategies 1.5.1 Monitor clinic utilization data. 1.5.2 Work with providers to develop and implement strategies to ensure clients are accessing care on a regular basis, as defined in PHS.

Progress, Successes and Challenges 1.5.1-2 According to the HAB Performance measures, as of 12/31/11 80% of Part B clients met this objective.

1.6 Ensure mechanisms to maximize utilization of Medicaid and Medicare.
1.7 Identify and address client transportation barriers.

1.6.1 Improve the linkages and collaboration between all Parts and Medicaid/Medicare. 1.6.2 Monitor the effects of Medicaid and Medicare policy changes on clients. 1.6.3 Monitor the impact of Medicare Part D and ADAP on clients. 1.6.4 Monitor the effects of reductions in standard Medicare and Medicaid reimbursement rates.
1.7.1 Assess transportation barriers and resources by health districts. 1.7.2 Identify and implement possible solutions to key transportation barriers

1.6.1 We are collaborating with CMS to provide assistance with Medicare Part D. We have received approval from Office of Pharmacy Affairs (OPA) to become a rebate/hybrid state and adjudicate claims that count towards True out of pocket (TrOOP). Attempts to link with Medicaid are ongoing. 1.6.2-4 Monitoring will occur pending implementation of Medicare Part D co-payments on behalf of clients by June 30, 2012. 1.7.1 This has not yet been completed, although funding was provided. Plan to complete in FY2012. 1.7.2 Payments for public transportation, gas vouchers and arranging third party transportation have been implemented.

1.8 Improve efficiency of the Georgia Health Insurance Continuation Program (HICP) and the AIDS Drug Assistance Program (ADAP).

1.8.1 Maintain HICP and ADAP workgroup. 1.8.2 Collaborate with Medical Advisory Committee to ensure newly FDA approved medications are added to the ADAP formulary. 1.8.3 Improve HICP and ADAP application process (e.g., web-based application process). 1.8.4 Revise and disseminate HICP and ADAP policies and procedures. 1.8.5 Conduct internal audits of up to five percent

1.8.1 The ADAP/HICP QM Workgroup has met quarterly; the last meeting was Feb. 23, 2012. 1.8.2 The ADAP in collaboration with the Medical Advisory Committee ensures that newly FDA approved medications are added to the ADAP formulary. 1.8.3 A web based application process for ADAP and HICP will be implemented by Dec. 2012.

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Objectives

Strategies of HICP and ADAP new client applications and or recertification forms quarterly 1.8.6 Establish and implement a policy to allow Advance Practice Registered Nurses (APRN) ADAP and HICP signature authority. 1.8.7 Explore options to assist clients with health insurance co-payments for medications

Progress, Successes and Challenges 1.8.4 The ADAP and HICP Policies have been revised and will be disseminated by June 30, 2012. 1.8.5 A five percent audit of the ADAP applications/files will be performed annually; A five percent audit of the HICP applications/files will be performed quarterly. 1.8.6 A policy has been implemented to allow Advance Practice Registered Nurses (APRN) and Physician Assistance (PA) signature authority on ADAP applications and prescriptions. 1.8.7 ADAP currently assists clients with PCIP co-payments for premiums and other out-ofpocket expenses, and is collaborating with CMS to pay Medicare Part D Co-payments.

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Goal 2: Improve the quality of health care and health outcomes.

Objectives 2.1 Ensure Ryan White providers are meeting standards included in the Public Health Services guidelines.
2.2 Improve HIV/AIDS case management services throughout Georgia.

Strategies 2.1.1 Collaborate with SEATEC to provide education and training as needed to providers. 2.1.2 Monitor HAB performance measures. 2.1.3 Mentor HIV inexperienced providers. 2.1.4 Notify providers of revised PHS guidelines.
2.2.1 Provide case management training. 2.2.2 Develop, test, and implement a case management client Acuity Scale. 2.2.3 Develop and implement Women and Children specific case management standards. 2.2.4 Implement standardized case management intake forms. 2.2.5 Develop standardized referral form. 2.2.6 Monitor HAB case management performance measures 2.2.7 Maintain Case Management Sub-Committee.

Progress, Successes and Challenges 2.1.1 Two hundred six trainings were conducted. 2.1.2 There are 25 HAB Performance Measures monitored on a quarterly basis through Ryan White Part B. 2.1.3 Fifty individualized clinical preceptorship trainings were provided 2.1.4 Revised PHS Guidelines are disseminated to providers via the HIV Coordinators by the Part B HIV Nurse Consultants. 2.2.1 A total of 28 trainings occurred from 2009-2012 on a variety of CM topics via state office staff. In addition, 337 trainings were conducted by SEATEC that addressed case management activities. 472 case managers were trained. 2.2.2 Acuity Scale and Self Management Model was implemented in 11 districts to date. 2.2.3 Development of the Women's and Children's Case Management Standards will begin after the revision of the CM Standards. 2.2.4 Completed in 2009 2.2.5 Due to the variation in referral forms in the health districts, it is not necessary to develop this form at this time. 2.2.6 HAB CM Performance Measures were monitored via district quarterly

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Objectives
2.3 Implement statewide Ryan White Part B quality management plan.

Strategies
2.3.1 Provide quality improvement workshops. 2.3.2 Assure quality improvement projects occur at state and local levels. 2.3.3 Communicate findings to key stakeholders at least biannually. 2.3.4 Update the QM plan at least annually and the QM work plan at least quarterly. 2.3.5 Require that all Ryan White Part B funded-sites revise written QM plans annually, and submit quarterly QM progress reports. 2.3.6 Maintain QM Core Team.

Progress, Successes and Challenges reports; at present through CM chart review and attempting to track in CAREWare. 2.2.7 The Case Management SubCommittee continues to meet monthly. 2.3.1 RW Part B QM staff averaged 2 training sessions per year. 2.3.2 QM reports are reviewed quarterly to capture and highlight quality improvement projects. Technical assistance (TA) is provided as needed. 2.3.3 Blinded Part B HAB Measure data is disseminated to district HIV coordinators quarterly, as well as other relevant quality data. Additionally, the Part B QM Plan is shared internally within DPH and with district HIV Coordinators. 2.3.4 Completed as scheduled. 2.3.5 Complete. TA provided as needed. 2.3.6 Complete. The QM Core Team meets quarterly and is composed of a variety of Part B stakeholders.

2.4 Reduce the number of newly diagnosed individuals entering into care with an AIDS diagnosis.

2.4.1 Work with HIV/AIDS Surveillance to establish process to collect and report data. 2.4.2 Monitor the percentage of new clients entering into care with an AIDS diagnosis. 2.4.3 Work with HIV prevention provider agencies to develop and implement subpopulation strategies to identify HIV positive individuals and get them in care.

2.4.1 The HIV Office continues to meet quarterly with the Surveillance team in order to obtain data and establish a process for data collection. 2.4.2 Monitored via CAREWare, but CAREWare system unable to determine if client is new to care or transfer from another agency. Utilizing the In Care Campaign data to further define this

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Objectives

Strategies

2.5 Enhance efforts to retain clients in care and treatment.

2.5.1 Provide clients with treatment and care adherence education. 2.5.2 Train and utilize peer advocates to provide outreach, education, advocacy and retention services. 2.5.3 Identify and implement client self management and adherence approaches (e.g., client/provider contracts).

Progress, Successes and Challenges population. 2.4.3 The HIV Office has secured Part C Funds from CDC to Link and retain clients in care.
2.5.1 The HIV Office continues to meet twice yearly with the Surveillance team looking specifically at Enhanced HIV/AIDS Reporting System (eHARS) in order to obtain data. 2.5.2 Five districts currently train and utilize peer advocates to provide services. MAI was funded through 2010. 2.5.3 A Self Management Model was implemented in 11 districts to date.

2.6 Improve recruitment and retention of health care staff.

2.6.1 Mentor HIV inexperienced providers. 2.6.2 Collaborate with SEATEC to provide training and onsite technical assistance. 2.6.3 Collaborate with the Public Health Nursing (PHN) Section to address workforce crisis. 2.6.4 Reduce the time that staff positions are vacant.

2.6.1 Fifty individualized clinical preceptorship trainings provided 2.6.2 Collaborative efforts with SEATEC to provide training to health districts.
156 training and/or technical assistance events provided
2.6.3 Collaborated with PHN to develop a career ladder
2.6.4 Collaborated with HR to reduce vacant positions.

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Goal 3: Eliminate health disparities and barriers to care.

Objectives 3.1 Identify health disparities and barriers to care.

Strategies 3.1.1 Identify an academic partner to assist with the needs assessment process. 3.1.2 Develop the statewide needs assessment. 3.1.3 Implement the statewide needs assessment 3.1.4 Analyze findings and prepare a written report

Progress, Successes and Challenges 3.1.1-4 SEATEC has been identified to work collaboratively on developing, implementing and analyzing a consumer needs assessment in 2013.

3.2 Improve cultural competency of service providers and programs.
3.3 Increase the number of clients with affordable, stable and safe housing.

3.2.1 Coordinate training and education on cultural competence issues (i.e., language, race/ethnicity, literacy, religion, sexual orientation, gender identity, physical challenges). 3.2.2 Improve client involvement in planning and implementation of programs. 3.2.3 Encourage the use of culturally and linguistically materials and resources. 3.3.1 Assess clients for housing needs and eligibility for housing resources, (e.g., HOPWA, Section 8, public housing). 3.3.2 Ensure clinic sites, community-based organizations, and other providers have current housing resource information for their area. 3.3.3 Establish linkages at local level between case managers and housing resources. 3.3.4 Improve collaboration between Part B Grantee and HOPWA.

3.2.2 Client representation is required on each districts' Consortia Planning Committee. Clients are also represented on many other committees. 3.2.3 Several districts are funded for language services.
3.3.1 Clients are assessed for housing needs through the Case Management intake process 3.3.2-3 Resource information is disseminated to clinics and organizations via resource guides (ie, Key Contacts). 3.3.4 Collaboration is ongoing.

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Objectives 3.4 Improve the utilization of interpretation and translation services for clients.

Strategies 3.4.1 Encourage Part B providers to budget funds for interpretation services where needed. 3.4.2 Collaborate with DHR Limited English Proficiency and Sensory Impairment program to ensure clients have access to all interpreter services as needed.

Progress, Successes and Challenges 3.4.1 Four districts are currently Part B funded to provide linguistic services.

3.5 Encourage consumers to become active partners in their healthcare and improve the quality of their lives.

3.5.1 Train and utilize peer counselors to provide outreach, education, advocacy and retention services. 3.5.2 Identify and implement consumer self management and adherence approaches (e.g., consumer/provider contracts). 3.5.3 Improve client involvement in planning and implementation of programs.

3.5.1 MAI funded peer counseling program was completed. Peer advocates continue to work in seven districts. 3.5.2 Statewide acuity scale developed and in the process of being implemented 3.5.3 Client representation is required on each districts' Consortia Planning Committee. Clients are also represented on many other committees.

3.6 Improve access and utilization of emergency financial assistance to clients.

3.6.1 Encourage Part B providers to budget funds for emergency financial assistance where needed. 3.6.2 Monitor use of Part B funds for emergency financial assistance. 3.6.3 Encourage collaboration with local community based agencies to assist with emergency financial services.

3.6.1 Fifteen of 16 Part B funded health districts have some funding allotted for EFA during 2011-12. 3.6.2 Funds for EFA are monitored quarterly via expenditure reports and reviewed during annual site visits.

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Goal 4: Enhance collaboration and communication with partners statewide.

Objectives 4.1 Enhance relationship with state partners to identify common goals and coordinate utilization of resources.

Strategies 4.1.1 Coordinate statewide HIV/AIDS meetings to share information and best practices and identify collaborative opportunities. 4.1.2 Work with the Department of Public Health to facilitate data sharing agreement. 4.1.3 Work collaboratively with the Southeast AIDS Education and Training Center (SEATEC) to improve the quality of provider and program staff education. 4.1.4 Maintain Part B Grantee participation in the MetroAtlanta EMA Planning Council.

Progress, Successes and Challenges 4.1.1 Statewide meetings occurred annually to share information and best practices. 4.1.2 The HIV Office continues to meet quarterly with the Surveillance team in order to obtain data and establish a process for data collection. 4.1.3 Collaborative efforts with SEATEC to provide training to health districts. 50 individualized clinical preceptorship trainings provided
156 training and/or technical assistance events provided

337 trainings conducted by SEATEC that addressed case management activities

4.2 Improve communication, cooperation, and collaboration among HIV providers and key stakeholders.

4.2.1 Facilitate meetings and conference calls/and other communication technologies. 4.2.2 Develop and sustain state work groups to address system-level issues (e.g. oral health workgroup).

4.1.4 Part B staff regularly attends and participate in EMA Planning Council meetings. 4.2.1 At least quarterly ADAP and QM Core Team meetings Annual Statewide HIV Coordinators meeting. 4.2.2 Case Management subcommittee, Perinatal Advisory Council, Oral Health Coalition, and ADAP workgroup

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Section II. Where do we need to go?
A. Plan to meet challenges identified in the evaluation of the 2009 Comprehensive Plan
Part B Program was successful in addressing the strategies outlined in the 2009-2012 Comprehensive Plan, with many having been achieved and others currently in progress. Challenges were primarily encountered in implementing the following: 1.2 Provide essential comprehensive oral health care. Despite successfully implementing our strategies oral health remains a priority area in Georgia due to overarching systemic barriers. Lack of oral health care was identified in multiple breakout groups as a barrier or gap. 1.7 Identify and address client transportation barriers. One method of assessing these barriers would be to conduct a survey in order to identify district resources and barriers related to transportation.
B. 2012 proposed care goals
Since the earliest days of the HIV/AIDS epidemic, Georgia has had a substantial number of reported cases of AIDS. The epidemic continues to grow and more people are living longer with HIV/AIDS in the state. There are not enough HIV/AIDS prevention, care and treatment services in Georgia to meet the increasing demand for services, and there are not enough financial resources to meet all of the costs of medical and support service needs. The state recognizes the importance of addressing key HIV/AIDS care issues, enhancing coordination across Ryan White programs, and allocating and utilizing resources to address identified needs, especially those of traditionally underserved populations and subpopulations.
In developing a 2012-2015 Comprehensive HIV Services Plan that most effectively uses limited resources to meet the needs of Georgians living with HIV/AIDS, particularly its most vulnerable populations, Georgia utilized the following key HRSA directives and strategies:
Improve access to HIV-related core services by linking newly diagnosed individuals to care and identifying individuals who know their HIV status but are not in care, informing them about available treatment and services, and assisting them in the use of those services;
Improve the quality of HIV core services and health outcomes by ensuring the availability and adequacy of critical HIV-related local core services (primary medical care that is consistent with PHS Treatment Guidelines; HIV-related medications, mental health treatment, substance abuse treatment, oral health and case management; and
Increase linkage to care for individuals newly diagnosed with HIV infection, through coordination of counseling and testing with treatment by addressing the primary health care and treatment needs of those who know their HIV status and are not in care, as well as the needs of those currently in the HIV/AIDS care system through coordination of HIV prevention and treatment, including outreach and early intervention services;

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Reduce health disparities in access to core and support services among disproportionately affected sub-populations and historically underserved communities.
Enhance collaboration and communication with partners statewide in an effort to maximize funding and resources for the mutual benefit of the HIV/AIDS community.
The values that guided the identification and selection of the state's strategic HIV system of care goals and objectives were derived from the Shared Vision, Mission Statement, and Shared Values listed below. The planning goals and objectives are consistent with the Healthy People 2020 goal for HIV services: To prevent human immunodeficiency virus (HIV) infection and its related illness and death.
Shared Vision
Excellence in Georgia's HIV/AIDS services through innovation and community partnership.
Mission Statement
To ensure collaboration and information sharing among programs in the state of Georgia funded under all parts of the Ryan White HIV/AIDS Treatment Act of 2009 and other partners to avoid duplication of services and to assure access to quality, cost-effective services that help individuals living with HIV have an improved quality of life.
Shared Values for System Changes
The development of Georgia's Statewide Coordinated Statement of Need and 2012-2015 Statewide Comprehensive HIV Services Plan were guided by the following shared values:
1. The quality and dignity of human life. 2. Cultural competency/appropriateness in service delivery. 3. Respect for diversity and cultural differences. 4. Effective and timely support for basic needs. 5. The involvement of HIV infected individuals in decision-making. 6. The involvement and support of each affected individual's personal support system, as well
as the greater community, in caring for persons with HIV. 7. An individual's right to self-determination. 8. The health of the community. 9. Service delivery systems that promote independence and self-sufficiency. 10. The efficient use of resources. 11. Prevention, education, and early intervention.
The five 2012 Statewide Comprehensive HIV Services Plan goals and objectives will help assure availability and accessibility to core services in Georgia:

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Goal 1: Improve access to HIV-related core services.
1.1. Ensure continuity and availability of HIV primary care consistent with Public Health Services guidelines.
1.2. Evaluate and respond to the changing healthcare environment to assure HIV health and support services are available and accessible.
1.3. Assure health districts are aware of changes in the health and support service access and availability to help clients navigate the system of care.
1.4. Assure consumers are consistently informed about changes in health and support service access and availability, as well as aware of available supports/resources to respond to their changing needs.
1.5. Assess barriers to accessing core and support services to identify potential solutions and best practices.
1.6. Assess and enhance access to HIV medications.
Goal 2: Improve the quality of HIV core services and health outcomes.
2.1. Assure standards of care, including Public Health Services (PHS) guidelines and best practices, are consistently applied in the provision of HIV services.
2.2. Improve HIV/AIDS case management services throughout Georgia. 2.3. Implement statewide Ryan White Part B quality management plan. 2.4. Improve recruitment and retention of health care staff. 2.5. Adapt the Georgia Department of Public Health, HIV Office, practices and guidelines as
needed to align with the National HIV/AIDS Strategy, Healthy People 2020, the HIV/AIDS Bureau (HAB) Measures, and other state and federal initiatives focused on reducing health disparities.
Goal 3: Increase linkage to care for individuals newly diagnosed with HIV infection, through coordination of counseling and testing with treatment.
3.1. Identify individuals unaware of their status. 3.2. Collaborate with counseling and testing and prevention programs to facilitate identification
of individuals unaware of their status and link them to care. 3.3. In collaboration with the HIV Prevention program in the Georgia Department of Public
Health and federal Department of Health and Human Services (DHHS) directly funded entities (e.g., health departments, community based organizations) develop and implement strategies to facilitate integration of care, treatment and prevention.
Goal 4: Reduce health disparities.
4.1. Identify health disparities and barriers to care. 4.2. Improve cultural competency of service providers and programs. 4.3. Improve the utilization of interpretation and translation services for clients. 4.4. Maximize opportunities for clients to access affordable, stable and safe housing. 4.5. Advocate for policy change.

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Goal 5: Enhance collaboration and communication with partners statewide
5.1. Engage key stakeholders, including but not limited to Program Collaboration Service Integration (PCSI), HIV Office, Prevention Section grantees, Early Identification of Individuals with HIV/AIDS (EIIHA), Substance Abuse and Mental Health Services Administration (SAMHSA), Community Planning Group (CPG), the AIDS Drug Assistance Program (ADAP), ADAP Contract Pharmacy Network (ACP), Health Insurance Continuation Program (HICP), Preexisting Condition Insurance Plan (PCIP), Test-Link-Care Network, private providers, all Ryan White Parts, and Medicaid.

C. Goals regarding individuals Aware of their HIV status, but not in care (Unmet Need)
Georgia is approaching finding people not in care and getting them into primary care in several ways. Part B providers require that individuals must demonstrate enrollment in primary care prior to receiving other Part B funded services such as medical case management, oral health services, home delivered meals, etc. Second, the HIV Office is examining unmet need for HIV care among subpopulations and working with agencies and other Ryan White Parts (e.g., Part A) which target those subpopulations to enhance existing outreach efforts through client tracking and other methods. Finally, The HIV Office is working with Part A and the Counseling and Testing (CT) program and directly funded CDC programs to develop a coordinated plan to identify and link newly positive individuals into care.
Georgia's proposed 2012-2015 Goal 3 addresses individuals Aware of their HIV status, but not in care is to: increase linkage to care for individuals newly diagnosed with HIV infection, through coordination of counseling and testing with treatment. Goal objectives and strategies are provided on page 82.
D. Goals regarding individuals Unaware of their HIV status (EIIHA)
To make individuals who are unaware of their HIV status aware of their status, all prevention and treatment partners will be identified, strong collaboration will be promoted among these partners, specific target populations will be identified, activities developed and implemented to address barriers in reaching the target populations, and proper documentation will be collected.
Goal 3 of the Georgia HIV Office's proposed 2012-2015 Comprehensive Plan goals addresses individuals Unaware of their HIV status, but not in care. (See page 82.) For additional information, see the Early Identification of Individuals with HIV/AIDS (EIIHA) strategies discussed on page 73.
E. Proposed solutions for closing gaps in care

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In planning and implementing strategies to address issues of:
Ensuring access and availability Reducing disparities Linking people aware of their status but not currently in care with appropriate care and
treatment Integrating testing/counseling/prevention to facilitate linkage to care/treatment Evaluating and responding to upcoming changes as future aspects of the Affordable Care
Act impact systems and services for persons living with HIV/AIDS
Comprehensive Plan Goals 1, 2, 3, and 4 investigate current gaps and search for solutions to close those gaps in order that Georgians living with HIV/AIDS access a client-centered, integrated and coordinated continuum of care.
F. Proposed solutions for addressing overlaps in care
Contractual requirements include client level data reporting in CAREWare by all Part B funded agencies for monitoring of services provided by site, payer of last resort determination, and coordination and collaboration with other Ryan White Part funded agencies. District liaisons conduct quarterly monitoring of sub-grantee contracts to ensure compliance with Federal and state Ryan White regulations and requirements.
G. Proposed coordinating efforts with the following programs to ensure optimal access to care
Ryan White Part B services in Georgia are coordinated with other programs and funding streams to ensure optimal access to care. Part B's coordinating efforts during 2012-2015 will build on existing coordination and collaboration of Federal, State and local services for individuals with HIV/AIDS. Part B clients receive services from other programs that enhance and augment the comprehensive range of services required by individuals and families. For example, Part B clients receive housing assistance through the HOPWA program; Women, Infants, Children, and Youth receive assistance through Part D funds; Primary Care and Counseling & Testing are provided through Part C funds; medications are provided through the State ADAP program; and insurance premium payments are provided through the HICP. In this environment of limited funding for HIV/AIDS and the increased prevalence among emerging populations, integration and coordination of services ensures timely, uninterrupted care.
Part B has well established relationships with other Ryan White Programs in Georgia as well as with other programs that provide prevention and care services for individuals with HIV/AIDS.

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For example, Parts A, B, C, D, and F held Georgia's first Ryan White Statewide Conference in October 2007. For the first time, Parts A, B, C, D, and F Ryan White program administrators, staff, and clinicians were able to come together to learn, share, build skills, and network with their Ryan White colleagues throughout the State. The second Statewide All Parts meeting was held November 8-9, 2011. The three-day meeting included a clinical track on November 8, and a programmatic track on November 9 and 10. The clinical session was attended by over 60 physicians, nurse practitioners, physician assistants, nurses, dentists, dental hygienists, and pharmacists from across the state, and covered medical treatment topics. The programmatic session, attended by over 125 staff representing all Parts A, B, C, D, and/or F funded agencies in Georgia, included presentations on the federal Ryan White Program, the Affordable Care Act, medication assistance programs, testing and linkage to care, quality management, a variety of care topics, care for the caregiver, and the future of HIV medicine.
The following is a description of the type and scope of collaborative efforts currently in place in Ryan White Part B.
Part A Services: There is one Part A funded metropolitan area in Georgia. The Atlanta EMA consists of 20 counties and represents 53% of the state's population. Within the Atlanta EMA, 61% of the total population resides in the four most urbanized counties (Fulton, DeKalb, Cobb, and Gwinnett). Some of the counties also receive Part B funding, but Fulton and DeKalb Counties, where the largest percentage of PLWHA lives, do not. Fulton and DeKalb counties don't receive federal Part B funding due to the availability of Part A funding, although they do receive Ryan White state match funding. The EMA has a coordinated service delivery system, which encompasses a comprehensive range of primary care, other core services, and support services for individuals and families infected with, and affected by, HIV disease. These services are accessible to all eligible PLWH in the EMA. Included in this delivery system are mechanisms to address the service needs of newly infected, underserved, hard to reach individuals, disproportionately impacted communities of color and those who know their HIV status but are not presently in care to access and remain in care.

These services include those provided by ADAP and the Health Insurance Continuation Program (HICP). Some Part A funded agencies or health departments included within the EMA receive Part B funding to provide additional client services. Due to Part A funding, Fulton and DeKalb counties do not request, nor receive Part B funding. These areas coordinate Part A and B funds and other funding sources to provide a comprehensive continuum of care and ensure that a maximum number of clients receive services. Examples of such coordination are seen in Gwinnett County located in the northeastern part of the EMA. The Gwinnett County Board of Health receives Part B funds directly from DPH and contracts with AID Gwinnett, an AIDS Service Organization (ASO) that receives Parts A and C funds. Ryan White funds support the infrastructure for HIV services in this region. Without such coordination, services would be

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significantly compromised, as none of the resources is sufficient to meet the growing demand for services in this region.
Further demonstration of collaboration is demonstrated in the Georgia ADAP. All primary care clients within the EMA are screened for ADAP eligibility. If eligible, applications are submitted to the Georgia DPH to complete the enrollment process. The Georgia DPH contracts with the Grady Health System, which participates in the State's ADAP Contract Pharmacy (ACP) Network. The pharmacy is co-located within the Grady Infectious Disease Program (IDP), one of the Part A funded primary care providers. IDP clients within the Atlanta EMA can pick up their ADAP medications. Of the 3,680 active clients in the State ADAP in FY11, 2,546 (68%) resided within the 20 county EMA. DPH implemented a waiting list on July 1, 2010. There are currently 490(6/7/12) persons on the waiting list with 304 (62%) residing in the 20 county EMA. DPH received in FY 11-12 an ADAP supplemental award of $3,000,000 which allowed 273 persons to be removed from the waiting list.
Prior to FY07, the Atlanta EMA supported the Georgia ADAP with funds in the amount of $1.5 to $1.9 million. In consideration of the overall increase in the Part B ADAP award, Part A funds were not allocated to support the ADAP for FY08-FY11 in the base funding range. However, unexpended Part A funds were redirected in FY08-$413,604; FY10-$789,530 and FY11$848,731 to support increases in demand for ADAP. In FY12, Part A funds support the local AIDS Pharmaceutical Assistance (APA) program which provides clients an avenue to access ADAP formulary medications while waiting for final ADAP approval, and covers those clients who are not taking antiretrovirals and are, therefore, ineligible for ADAP
The HIV Office Ryan White Part B Program administers the Health Insurance Continuation Program (HICP). This program, funded with Ryan White State Match dollars, provides eligible clients assistance with third-party insurance premium payments. This program currently serves 405 active clients, with 352 (87%) residing within the EMA. By paying the insurance premiums for these eligible individuals, primary health care services are provided by the private sector, allowing Ryan White funds to be used for those with no other resources.
Part A and Part B program staff participate in meetings periodically to update each other on successes and barriers to provision of services, i.e. - the ADAP waiting list and wait times for new appointments in Part A funded primary care sites, Quality Management coordination.
Part C Services: There are 17 Ryan White Part C grantees operating in Georgia, providing early intervention and primary care services. Eleven of the 17 Part C grantees are public health districts. Ten of the Part C care sites are also Ryan White Part B funded recipients. As with all agencies receiving Ryan White funding from multiple sources applying for Part B funds, Part C recipients are required to describe and demonstrate how Part B funds will be coordinated with

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Part C. Part B funds do not supplant services funded by Part C, or for any other funding source. Part B applications must include an itemization of other funding sources by line item for personnel, supplies, equipment, and services.
Part D Services: Georgia has two Part D funded programs. The Grady Health System, Infectious Disease Program (IDP), founded in 1986, serves as the grantee of record for the Atlanta Family Circle HIV/AIDS Network: Ryan White Part D Services for Women, Children, and Adolescents. The Part D Network includes four service providers: AID Atlanta, the Grady IDP's Ponce Family and Youth Clinic, Grady Health System's Department of Gynecology and Obstetrics (Grady OB), and Sister Love, Inc. The project serves women, children, youth and families infected or affected by HIV/AIDS who reside in the five core Metropolitan Atlanta counties (Fulton, DeKalb, Cobb, Clayton and Gwinnett) and the surrounding 15 Metro counties in the 20 county Atlanta EMA. The majority of the population targeted for Part D services are low-income minorities. The Atlanta Family Circle Part D supports a program to identify HIV positive Hispanics and provide linkage into care. Individuals identified through this program are referred to primary care throughout the EMA, some of which are supported directly by Medicaid, Part D, or by Parts A, B or C. Georgia's other Part D program is located in Waycross and serves a rural area of the state.
Georgia's other Part D Program is located in Waycross, Georgia and provides services to the Southeast area of the state. The Part D funding provides services to the following 16 rural counties: Appling, Atkinson, Bacon, Brantley, Bulloch, Candler, Charlton, Clinch, Coffee, Evans, Jeff Davis, Pierce, Tattnall, Toombs, Wayne and Ware. Because of the limited number of specialty medical care providers, Southeast Health District (SEHD) has become recognized as the primary provider of services for patients with HIV/AIDS within the 16 county areas.
In the SEHD, there were 207 (43.67%) Ryan White Part D clients actively enrolled in 2010. That number that has steadily increased since the beginning of the HIV service and care program was established in the late 1980s. Comparatively, Ryan White Part D accounts for only 23.33 % of enrolled patients statewide. Heterosexual contact is indicated as the primary risk behavior among women diagnosed with HIV infection in the SEHD (89%), much higher than the state incidence of 23.4%. (2010 Ryan White Data Report, Basic Epidemiologic Profile of HIV/AIDS, Georgia, 2011).
Part F Services: Part F - Special Projects of National Significance (SPNS): AID Atlanta, funded by Parts A and B, is also funded for a demonstration project to determine best practices/interventions for connecting HIV-infected inmates into medical care at release. The demonstration project targets HIV-infected substance abusing men in the EMA. Through this initiative, medical case management services are provided to inmates who agree to take part in the demonstration project. Inmates who decline to enroll in the demonstration project are

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followed under Part A and B funded case managers for discharge planning. AID Atlanta receives Part A funding for its primary care clinic where inmates are linked for receipt of primary care services. The evaluation center for the project is Emory University Rollins School of Public Health in Atlanta.
Part F - AIDS Education and Training Centers: Georgia is served by SEATEC which conducts comprehensive training for healthcare providers who work throughout the state. Instruction focuses on medical management of HIV, ensuring that DHHS treatment guidelines constitute the core teaching message. SEATEC trainings frequently include Part B funded staff and health care providers associated with other Ryan White programs and other federal and non-federal programs.
SEATEC places special emphasis on training newly-hired medical staff that may have limited experience in HIV medicine in order to help them move quickly toward optimal functioning. In addition, SEATEC seeks guidance from Georgia's Ryan White Parts' (including Part B) administrative staff and clinical staff in identifying community clinicians who might benefit from HIV training and informs identified clinicians of training opportunities. SEATEC conducted a statewide training needs assessment. Topics identified were included in the agenda for the Georgia Ryan White Meeting being held November 8-10, 2011.
Part F - Dental Reimbursement Programs: Georgia Health Sciences University is funded to provide a full range of services for HIV infected clients. They provide a source of dental care for clients in regions of the state without dental resources. However, lack of transportation can be a barrier to accessing services.
Private providers (Non-Ryan White funded): Persons receiving primary care services from private providers who meet Ryan White eligibility criteria may access other Part B funded services in Georgia. Part B requires that all persons must have had a primary care appointment within the last six months. Part B works with private providers to obtain documentation regarding primary care. Individuals under the care of a private physician may also access ADAP and HICP.
Prevention programs including Partner Notification Initiatives and Prevention for Positive Initiatives: In Georgia, the Department of Public Health (DPH) is the recipient of the majority of funding through the CDC Prevention Program. As a condition of the new federal CDC funding opportunity, DPH will implement a comprehensive prevention program that will include: partnering with Community based Organizations (CBO), health districts, Ryan White (RW) Clinics, and other organizations that provide services to HIV positive individuals and those at highest risk for acquiring as well as transmitting HIV infection. To ensure that positive clients are being linked to care and receiving prevention services, both prevention and care is working

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together to streamline data to be tracked.
Substance abuse and mental health treatment programs/facilities: The core of substance abuse and mental health treatment services in Georgia is funded through the Georgia Department of Behavioral Health and Developmental Disabilities (BHDD). Georgia has a set-aside for services to PLWHA in substance abuse treatment funding from the Substance Abuse Mental Health Services Administration (SAMHSA) for HIV/AIDS services through BHDD. The required 5% set-aside for HIV is $2,517,908.
STD programs: HIV/STD Programs are co-located in health departments in Georgia Department of Health. Persons who test positive in the STD clinics are counseled and linked to care. Part B providers utilize health department Communicable Disease Specialists for partner notification and assistance in directing clients to primary care sites.
Medicare: The Part B clinics remain diligent in their efforts to enroll clients in Medicare for coverage of medications to maximize Part B funds needed for HIV medications. However, enrollment in Medicare Part D presents challenges and compromises many clients' ability to receive and/or afford their ARVs. The standard drug benefit defined in the Medicare Modernization Act of 2006 has a $320 deductible and 25% beneficiary coinsurance in the initial benefit period. The initial benefit period ends after $2,930 in total drug costs. From this point until catastrophic coverage begins, the beneficiary pays 100% of drug costs. This gap in coverage is commonly referred to as the "doughnut hole".35 The Affordable CARE Act changes which out-of-pocket expenses count towards the Medicare Part D annual out-of-pocket threshold. As of January 1, 2011, ADAPs became "TrOOP" (True-Out-Of-Pocket) eligible entities. Payment of Medicare Part D co-pays through the State ADAP will be effective with completion of testing and connectivity between the State's Pharmacy Benefit Manager (PBM) and the Center for Medicare and Medicaid Services (CMS). Full data exchange will begin after testing is completed. Part B-funded HIV clinics also bill Medicare for appropriate medical services and ensure that all clients are enrolled in medical care.
Medicaid: The Georgia Department of Community Health, Division of Medical Assistance, which administers Medicaid, is the largest payer for inpatient care for persons with HIV disease. Due to strict eligibility guidelines, males with HIV must become considerably ill, and be disabled before being eligible for coverage allowing access to necessary care. Part B clinics utilize Medicaid for services when a female client becomes pregnant.
State Children's Health Insurance Program (SCHIP): Enrollment in PeachCare (Georgia's SCHIP) is available by referral or on-site at all of the primary care sites although the majority of

35The Medicare Drug Benefit, "The Role of Part D for People with HIV/AIDS: Coverage and Cost of Antiretrovirals under Medicare Drug Plans", The Henry J. Kaiser Family Foundation, July 2006.

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infants, children and youth (l8 and under) receive services at the Grady Infectious Disease Program's Ponce Family and Youth Clinic in metro Atlanta. Children also receive services in select areas of the state including Augusta (Georgia Health Science University Hospital), Macon and Waycross Health District.
Community Health Centers: Public health and community clinics serve as the foundation for the provision of primary care services in Georgia and enable disenfranchised populations to access care by providing services in clinics that are geographically located in communities where the majority of persons are minorities, indigent, and uninsured, and who represent the populations least likely to have access to care. There are 145 clinics which serve as "one-stop shops" that provide comprehensive services such as primary care, mental health treatment, substance abuse treatment, oral health care, medical case management, and support services in one location to facilitate client access and reduce barriers to system navigation. If the service is not readily available at one location, referrals are made
H. For jurisdictions that lost a TGA, describe the impact on services (Only Puerto Rico, New York, New Jersey and California grantees should respond)
N/A. Georgia did not lose a Transitional Grant Area.
I. Role of the Ryan White Program in collaborating with the Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan Statistical Areas (MSAs) Most Affected by HIV/AIDS (ECHPP) initiative
The Ryan White Part B Program will continue participation in the EMA's Early Identification Workgroup (EIW) quarterly meetings. Other participants include leadership from Parts A, C, and D; Southeast AIDS Training and Education Center (SEATEC); State HIV Prevention Program including the Georgia Community Planning Group; HIV Surveillance Program; HIV Testing / Partner Services Program; Centers for Disease Control and Prevention (CDC); City of Atlanta Housing Opportunity for People with AIDS (HOPWA); ECHPP; and federal and state funded agencies for counseling and testing and prevention activities. The purpose of the EIW is to facilitate collaboration and coordination across all HIV/AIDS programs.
ECHPP, whose activities focus on five counties within the EMA Clayton, Cobb, DeKalb, Fulton and Gwinnett, has representation on the EIW.
EIW is developing a standardized protocol to be used by all counseling and testing sites to promote linkage and retention to care. Work is also underway in the EMA to identify all service

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partners, promote strong collaboration among partners, identify specific target populations, develop activities to address barriers for reaching the target populations, and ensuring proper documentation is collected. Parties responsible include the Fulton County Department of Health and Wellness and the State ECHPP.
Other Ryan White Part B Program's EIIHA strategies include the following:
Each strategy listed is consistent with the National HIV/AIDS Strategy (NHAS). The NHAS goals that are being supported by the collaborative efforts of the Part B program and the ECHPP initiative are (1) reduce new HIV infections, (2) increase access to care and improve health outcomes for people living with HIV, and (3) reduce HIV-related disparities and health inequities.
Goal 1: Reduce new HIV infection
To achieve this goal, the Georgia Department of Public Health (DPH), as part of its ECHPP activities, will increase HIV testing in clinical and non-clinical settings. These testing efforts will target high risk populations in the Atlanta metro area, including Clayton, Cobb-Douglas, DeKalb, Fulton, and Gwinnett public health districts, which are areas in Georgia that have been identified as having the highest concentrations of HIV cases. Health departments and organizations that receive resources from DPH to conduct HIV testing in clinical or nonclinical settings under the ECHPP initiative will also be required to establish a working and collaborative partnership with HIV care and treatment providers in order to link those testing HIV-positive into care. These collaborations will include establishing partnerships with service provides involved with Part B EIIHA.
Under ECHPP activities, DPH will also increase condom distribution in clinical and nonclinical settings (including Part B providers) to reach individuals at high-risk for HIV and those who are HIV-positive. Persons newly diagnosed with HIV will also have the option of requesting Partner Services (PS) under the ECHPP strategy, which will include three primary options: (1) elect to opt-out, (2) request PS by the service provider, or (3) postpone PS to another time. These services will be supported by ECHPP and, in some instances, be available at sites where Part B services are also rendered.
Goal 2: Increase access to care and improve health outcomes for people living with HIV
Georgia DPH provides technical assistance and support to increase linkage to care efforts and activities among its funded service providers and other community partners, including those participating in the EIIHA network. Under the ECHPP initiative, DPH will fund health departments in the Atlanta MSA to provide a comprehensive HIV prevention for positives program and services (i.e. a combination of services from HIV testing, prevention interventions for positives, condom distribution, linkage to care activities, perinatal transmission prevention, and partner services) that specifically target those persons newly diagnosed with HIV or those who are lost to care and re-enrolled into primary care services.

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DPH recently received funding from SAMHSA to support mental health counseling, substance abuse prevention, and substance abuse treatment services for HIV-positive persons and those newly diagnosed with HIV. The purpose of this five-year program is to facilitate the development and expansion of a culturally competent and effective integrated behavioral health and primary care networks for 1,050 people living with HIV in the metro-Atlanta area.
Goal 3: Reduce HIV-related disparities and health inequities
Georgia DPH will reduce HIV-related disparities and health inequities by targeting and allocating resources to support programs and activities that are provided in areas and populations that have the highest concentrations of HIV infection based on current epidemiological data, HIV surveillance, and other sources of information (e.g. Community Planning priorities, unmet need estimates, etc.).
The strategies are also are consistent with making individuals who are unaware of their HIV status aware of their status by identifying all prevention and treatment partners, promoting strong collaboration among partners, identifying the specific target populations, developing activities to address barriers for reaching the target populations and ensuring that proper documentation is collected.
Section III. How will we get there?
The Georgia HIV Office's FY 2012-2015 Statewide Comprehensive HIV Health Services Plan on pages 75-87 provides the goals, objectives, and strategies that will be used to guide further development and monitoring of the state's HIV/AIDS health care delivery system over the next three years.

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Georgia's Statewide FY 2012-2015 Comprehensive HIV Services Plan

Goal 1: Improve access to HIV-related core services.

Objectives

Strategies

1.1. Ensure continuity and availability of HIV primary care consistent with Public Health Services guidelines.

1.1.1 Identify and assure points of entry for services exist in each health district.
1.1.2 Establish system to regularly disseminate current contact information on all identified access points to providers throughout state.

Time Frame Years 1-3

Accountability Measure
Part A Grantee, 1.1.1 HIV clinics in each health district and Part B Grantee EMA. Offices

Years 1-3 Part A Grantee, 1.1.2 HIV clinic and contact information

Part B Grantee posted on HIV Office and Ryan White Part

Offices

A website.

1.1.3 Assure transitional discharge planning for incarcerated individuals.

Years 1-3

Part B Grantee Office, Georgia Department of Corrections

1.1.3 The number of inmates who received an encounter with a case manager.

1.1.4 Facilitate implementation of prescriptive authority for APRN's working in public health HIV clinics.

Years 1-3

1.2. Evaluate and respond to the changing healthcare environment to assure HIV health and support services are available and accessible.

1.2.1. Follow directives from the Affordable Care Act and/or Ryan White Reauthorization as applicable.

Years 1-3

Part B Grantee Office, HIV Nurse Consultants, HIV Coordinators Part B Grantee Office, health districts

1.1.4 Number of trainings and/or meetings related to facilitating the prescriptive authority process.
1.2.1 Grantee Report Review HRSA directives Assessment reports List and description of environmental changes List and descriptions of adjustment

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Objectives
1.3. Assure health districts are aware of changes in the health and support service access and availability to help clients navigate the system of care.

Strategies

Time Frame

1.3.1. Communicate effectively with health districts utilizing a variety of communication methods, including e-mail, website, conference call, and others.

Years 1-3

Accountability Measure

Part B Grantee Office

and modifications Health districts consumer surveys Review of budget revision requests 1.3.1 HIV Office website contains most updated information related to changes in health and support service access and availability.

At least annually, sites will be provided the most updated information about changes in health and support services.

1.4 Assure consumers are consistently informed about changes in health and support service access and availability, as well as aware of available supports/resources to respond to their changing needs.

1.4.1. Encourage health districts to communicate with consumers utilizing a variety of communication methods, including posting changes and via case managers or other staff.

Years 1-3

1.4.2. Include in district liaison site visit tool a question regarding methods of informing consumers of changes in health and support services provided.

Years 1-3

Part B Grantee Office, HIV Coordinators

1.4.1-2. Number of health districts compliant with informing consumers of changes in health and support services provided (assessed annually).

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Objectives
1.5 Assess barriers to accessing core and support services to identify potential solutions and best practices.

Strategies
1.5.1 Explore ways to maximize available resources for dental services.

Time Frame Years 1-3

Accountability Measure

Part B Grantee Office, HIV Coordinators

1.5.1 Percentage of clients who received an oral exam by a dentist in the measurement year. List dental resources and barriers by health district.

1.5.2. Explore ways to maximize available resources for case management services.
1.5.3. Explore ways to maximize available resources for transportation services.

1.5.2 Percentage of medically case managed clients who had an Individualized Service Plan (ISP) developed within 30 days of intake and updated 2 or more times in the measurement year.
1.5.3 List transportation resources and barriers by health districts.

1.5.4. Explore ways to maximize available resources for substance abuse/mental health services.

1.5.4 List substance abuse/mental health resources and barriers by health districts.

1.6 Assess and enhance access to HIV medications.

1.5.5. Explore ways to maximize available resources for primary care services. 1.6.1 Collaborate with Medical Advisory Committee to ensure newly FDA approved medications are added to the ADAP formulary.

Years 1-3

1.5.5 List primary care resources and barriers by health districts.

Part B Grantee Office, Medical Advisory Committee

1.6.1 Number new FDA approved ADAP medications added to the ADAP formulary.

1.6.2 Improve ADAP application process (e.g., web based application process).

Years 1-3

1.6.2 Implementation of a web-based ADAP application process.

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Objectives

Strategies

Time Frame

Accountability Measure

1.6.3 Revise and disseminate HICP and ADAP policies and procedures.

Years 1-3

1.6.3 HICP and ADAP policies revised and posted on HIV Office website.

1.6.4 Maintain a policy to allow Advanced Practice Registered Nurses (APRN) and Physician Assistant (PA) ADAP and HICP prescriptive authority

Years 1-3

1.6.4 ADAP APRN and PA Policies maintained and revised as needed.

1.6.5. Continue to implement a process to assist clients with Medicare Part D co-payments for medications, as well as copayments for PCIP.

Years 1-3

1.6.5 Number of clients receiving assistance with Medicare Part D and/or PCIP copayments for medications.

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Goal 2: Improve the quality of HIV core services and health outcomes.

Objectives
2.1. Assure standards of care, including Public Health Services (PHS) guidelines and best practices, are consistently applied in the provision of HIV services.

Strategies
2.1.1 Monitor HIV/AIDS Bureau (HAB) Performance Measures.
2.1.2 Collaborate with SEATEC to provide education and training as needed to providers.
2.1.3. Mentor HIV inexperienced providers.

Time Frame Year 1-3
Year 1-3
Year 1-3

Accountability
Part B Grantee Office, SEATEC

Measure 2.1.1 Performance measure reports monitored at least quarterly. 2.1.2. Number of trainings conducted.
2.1.3 Number of providers mentored.

2.2. Improve HIV/AIDS case management services throughout Georgia.

2.1.4. Notify providers of revised PHS Guidelines. 2.2.1. Provide case management training.
2.2.2. Revise the Georgia HIV/AIDS Case Management Standards.

Year 1-3

Year 1-3 Year 1-3

Part B Grantee, SEATEC, QM Core Team Case Management Subcommittee

2.1.4 Providers updated of revised Guidelines at least biannually. 2.2.1 Number of trainings conducted.
2.2.2 CM Standards revised and finalized.

2.2.3. Conduct case management Year 1-3 chart reviews.

2.2.3 Number of CM chart reviews completed.

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Objectives
2.3. Implement statewide Ryan White Part B quality management plan.

Strategies
2.3.1. Provide training in quality management.
2.3.2. Assure quality improvement projects occur at state and local levels.

Time Frame Year 1-3
Year 1-3

Accountability
Part B Grantee Office, Quality Management Core Team

2.3.3. Communicate findings to key stakeholders at least biannually.
2.3.4. Update the QM plan at least annually and the QM work plan at least quarterly.
2.3.5. Require that all Ryan White Part B funded-sites revise written QM plans annually.
2.3.6. Maintain QM Core Team.

Year 1-3 Year 1-3 Year 1-3 Year 1-3

Measure 2.3.1 Number of quality management trainings conducted. 2.3.2 Number of district QM Plans reviewed containing quality improvement projects.
2.3.3. Findings disseminated to stakeholders at least biannually.
2.3.4 QM Plan and work plan updated.
2.3.5 Number of districts revising written QM Plans annually.
2.3.6 Number of QM Core Team meetings.

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Objectives
2.4. Improve recruitment and retention of health care staff.

Strategies
2.4.1 Assess barriers to recruitment and retention.

Time Frame Year 1-3

Accountability
Part B Grantee Office, SEATEC

Measure
2.4.1 List the barriers identified for the recruitment and retention of healthcare staff.

2.4.2 Mentor HIV inexperienced Year 1-3 providers.

2.4.2 Number of HIV inexperienced providers mentored.

2.4.3. Collaborate with SEATEC to provide training and onsite technical assistance.

Year 1-3

2.4.3 Number of trainings conducted.

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Objectives
2.5. Adapt the Georgia Department of Public Health, HIV Office, practices and guidelines as needed to align with the National HIV/AIDS Strategy, Healthy People 2020, the HIV/AIDS Bureau (HAB) Measures, and other state and federal initiatives focused on reducing health disparities.

Strategies
2.5.1 Review National HIV/AIDS Strategy.
2.5.2 Review Healthy People 2020.
2.5.3 Review HAB Measures and DHHS Action Plan to Reduce Racial and Ethnic Health Disparities: A Nation Free of Disparities in Health and Health care.
2.5.4 Review other federal and state initiatives to identify policies and best practices to reduce health disparities.

Time Frame Year 1-3 Year 1-3 Year 1-3
Year 1-3

Accountability
Part B Grantee Office

Measure
2.5.1-4 Documents were reviewed for policies and best practices.

Goal 3: Increase linkage to care for individuals newly diagnosed with HIV infection, through coordination of counseling and testing with treatment.

Objectives
3.1. Identify individuals unaware of their status.

Strategies
3.1.1 Request that local health districts evaluate HIV counseling and testing data to determine individuals who tested confidentially and did not receive their results, and follow up with those individuals.

Time Frame Year 1-3

Accountability
Part B Grantee Office, DPH HIV Prevention Program, HIV Coordinators

Measure
3.1.1 Number of individuals tested confidentially who did not receive their results.

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Objectives

Strategies
3.1.2 Request that local health districts determine individuals with preliminary positive results who did not receive confirmatory testing, and follow up with those individuals.

Time Frame Year 1-3

Accountability

Measure
3.1.2 Number of individuals with preliminary positive results who did not receive confirmatory testing.

3.2. Collaborate with counseling and testing and prevention programs to facilitate identification of individuals unaware of their status and link them to care.

3.1.3 Implement a statewide social marketing campaign for general HIV awareness to encourage testing and linkage to care. 3.2.1 Standardize protocols for HIV care referral.

Year 1-3 Year 1-3

3.2.2 Standardize linkage Antiretroviral Treatment Access Study (ARTAS) protocol to ensure the client has one provider appointment within 90 days of first contact.

Year 1-3

Part B Grantee, DPH Prevention Program

3.1.3 Number of social marketing deliverables (ie, public service announcements, ads, billboards).
3.2.1-2 Standardized protocols developed and implemented.

3.3. In collaboration with the HIV Prevention program in the Georgia Department of Public Health and federal Department of Health and Human Services (DHHS) directly funded entities (e.g., health departments,

3.3.1 Develop an action plan to facilitate integration and coordination between prevention and care.
3.3.2 Implement action plan and monitor effectiveness of coordinating prevention, care and treatment.

Year 1-3

Part B Grantee Office, DPH Prevention Program

Year 1-3

3.3.1 Action plan developed.
3.3.2 Action plan implemented and monitored for effectiveness.

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Objectives

Strategies

community based organizations) develop and implement strategies to facilitate integration of care, treatment and prevention.

Time Frame

Accountability Measure

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Goal 4: Reduce health disparities.

Objectives
4.1. Identify health disparities and barriers to care.

Strategies
4.1.1 Develop the statewide needs assessment.

Time Frame Year 1-3

4.1.2 Implement the statewide needs Year 1-3 assessment.

Accountability Measure

Part B Grantee 4.1.1-3 Statewide needs assessment

Office,

developed, implemented and

SEATEC

analyzed.

4.2. Improve cultural competency of service providers and programs.

4.1.3 Analyze findings and prepare a written report. 4.2.1 Coordinate training and education on cultural competence issues (i.e., language, race/ethnicity, literacy, religion, sexual orientation, gender identity, physical challenges).

Year 1-3 Year 1-3

Part B Grantee Office, SEATEC

4.2.1 Number of trainings conducted and/or integration of cultural competence training into programspecific training requirements.

4.3. Improve the utilization of

4.2.2 Maintain client involvement in planning and implementation of programs.

Year 1-3

4.2.2 Continue to require client representation on district Consortia Planning Committees.

4.2.3 Encourage the use of culturally and linguistically appropriate materials and resources. 4.3.1 Encourage Part B providers to budget funds for interpretation

Year 1-3 Year 1-3

4.2.3 Number of districts funded to provide language services.
Part B Grantee 4.3.1 Number of clients receiving Office, HIV interpretation and/or translation

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interpretation and translation services for clients. 4.4 Maximize opportunities for clients to access affordable, stable and safe housing.

services where needed.
4.4.1 Maintain the case management intake process, including housing assessment.
4.4.2. Ensure clinic sites, community-based organizations, and other providers have current housing resource information for their area.

Year 1-3

Coordinators services.
Part B Grantee 4.4.1 Case management housing Office, HIV assessment maintained. Coordinators
4.4.2 Resource information disseminated as available (i.e., number of Key Contacts provided).

4.5 Advocate for policy change.

4.5.1 Continue to advocate for Georgia Ryan White clients during the implementation of the Affordable Care Act (ACA), the reauthorization of the Ryan White Care Act and other changes in the healthcare landscape.

Year 1-3

Part B Grantee 4.5.1 Number of advocacy activities

Office

and/or processes implemented.

Goal 5: Enhance collaboration and communication with partners statewide

Objectives
5.1. Engage key stakeholders, including but not limited to Program Collaboration Service Integration (PCSI), HIV Office, Prevention Section grantees, Early

Strategies
5.1.1 Coordinate statewide HIV/AIDS meetings to share information and best practices, and identify collaborative opportunities.

Time Frame Year 1-3

5.1.2 Maintain Part B participation Year 1-3 in all identified stakeholder activities and committees.

Accountability Measure

Part B Grantee Office, DPH Prevention Program

5.1.1 Number of meetings held.

5.1.2 Number and type of committee participation.

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Identification of Individuals with HIV/AIDS (EIIHA), Substance Abuse and Mental Health Services Administration (SAMHSA), Community Planning Group (CPG), the AIDS Drug Assistance Program (ADAP), ADAP Contract Pharmacy Network (ACP), Health Insurance Continuation Program (HICP), Preexisting Condition Insurance Plan (PCIP), Test-Link-Care Network, private providers, all Ryan White Parts, Medicaid.

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A. Strategy, plan, activities (including responsible parties, and timeline) to close gaps in care
Strategies, plans, activities and timeline to close gaps in care are outlined in 2012-2015 Comprehensive Plan Goals 1, 2, 3, and 4 on pages 75, 79, 82 and 85. These goals support the provision of a coordinated, integrated and comprehensive system of care that is responsive to the needs of individuals with HIV/AIDS and helps closes the gaps in prevention and treatment services for these individuals.
Unmet Need results support the continuation of currently funded components of the care system including: activities to track individuals lost to care and bring them back into care (e.g., phone calls and letters after missed appointments, outreach to physically locate individuals, etc.), and linkages to care for individuals testing positive through Parts A and B primary care sites, Part C early intervention clinics, and at HIV counseling and testing sites. The state's HIV system of care is consistent with HRSA and NHAS goals of increasing access to services and decreasing HIV health disparities among affected subpopulations and historically underserved communities.

B. Strategy, plan, activities (including responsible parties), and timeline to address the needs of individuals Aware of their HIV, but that are not in care (with an emphasis on retention in care)
Strategies, plans, activities and timeline to address the needs of individuals aware of their HIV status but are not in care are outlined in 2012-2015 Comprehensive Plan Goals 1, 2, 3, and 4 on pages 75, 79, 82 and 85. The HIV Office and its other Ryan White partners (e.g., Parts A, C, D, F) will continue to work on identifying and addressing barriers that clients face in accessing primary care services. To address reported information barriers, Part B providers will use on-site medical case management to provide clients with information about available services. As additional persons are brought into primary care, the HIV Office and partners will evaluate the impact on the continuum to ensure the availability and accessibility of comprehensive services.

C. Strategy, plan, activities (including responsible parties), and timeline to address the needs of individuals Unaware of their HIV status (with an emphasis on identifying, informing, referring, and linkage to care needs)
Strategies, plans, activities and timeline to address the needs of individuals unaware of their HIV status are outlined in 2012-2015 Comprehensive Plan Goal 3 on pages 82 and 84. As described previously, the Georgia Department of Public Health (DPH) is the recipient of the majority of prevention funding through the CDC Prevention Program. Counseling, testing and referral services target MSM, homeless, and African American heterosexual males and females.

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Activities include linkage to care, evidence-based intervention in clinical and group settings, and case finding. These activities facilitate identifying individuals unaware of their status and promote linkage to primary care.
The Part B activities to address the needs of individuals unaware of their status and not in care will be coordinated with other programs/facilities and community efforts through information updates and progress reports provided by community partners at regularly scheduled EIW meetings. This will allow us to reduce duplication of effort, identify barriers to success or share best practices, support State policy and procedure updates (i.e., `opt-out' or routine HIV testing) through distribution at jointly funded Ryan White sites, strengthen coordination between the correctional facilities and treatment sites, and evaluation of the EIW's social network.
EIIHA activities and strategies have been included in the Part B Request for Proposals (RFP) and will be included in future RFPs. Ryan White Part B applicants are required to describe current and proposed linkages with agencies that provide primary prevention and HIV counseling and testing. Descriptions of the target populations and activities in place to assure all clients are linked and maintained in care are also required.
D. Strategy, plan, activities (including responsible parties) for addressing the needs of special populations including but not limited to: adolescents, injection drug users, homeless, and transgender.
Goal 4 (To reduce disparities) on page 85 addresses the needs of special populations. Ryan White Part B addresses disparities in access and services among affected subpopulations and historically underserved communities through its identification of target populations and implementation of activities to eliminate barriers to counseling and testing, enrollment, and retention in treatment services. Ryan White Part B funds geographically located primary care sites, and access to other core medical and supportive services including medical transportation, peer counseling, and linguistic services.
Ryan White Part B funded health districts conduct individualized cultural competence activities to address the subpopulations represented in their clinics. Each local health district in collaboration with their consortium explores the special populations for their local geographic area, and develops strategies and activities to address their needs. Cultural competence activities are also supported statewide; for example all nursing staff must complete cultural competence training as part of the clinic orientation and training process. The HIV Office provides technical assistance to the local districts in developing their strategies and activities.

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E. Description of activities to implement the proposed coordinating effort with the following programs to ensure optimal access to care:
Part A Services: Part B will coordinate with Part A in all aspects of EIIHA as well as data collection and sharing through the active participation on the EIW, collaboration on specific activities through quarterly updates, and ensuring that Part B primary care sites are participants in the ADAP network and aware of the HICP and PCIP.
Part B will also coordinate with Part A to ensure that funded providers are reporting cases to the state, that clients have received partner services, that routine opt-out HIV testing is integrated in other care settings for individuals seeking care for STIs (syphilis, gonorrhea, and Chlamydia), HBV and HCV and all individuals who present to their TB clinic for TB screening, medication or follow-up. Individuals who test positive are linked into HIV treatment and care while at the testing or clinic site.
With respect to referral to medical care and services, planned activities include ensuring access to a resource listing of care and treatment service providers, and prevention and counseling and testing programs across the state. These activities will assist in the referral process to facilitate access to care and treatment; as well as the development of inventive ways to educate providers on available resources to encourage referral. In addition, Part B will coordinate with prevention and disease control programs by providing the resource listing for distribution to all prevention and counseling and testing programs to be utilized in the referral for medical and support services.
Part B and Part A program staff will continue to participate in meetings periodically to update each other on successes, barriers to provision of services, and efforts to address barriers.
Part C Services: Part B will ensure that Part B funded HIV care sites that are also Part C funded recipients describe and demonstrate how Part B funds will be coordinated with Part C. Part B funds will not supplant services funded by Part C, or for any other funding source.
Part D Services: Part B will continue to work with the funded Part D providers in the Southeast Health District in Waycross, GA and the Atlanta Family Circle Part D Network to coordinate the referral to and provision of services for women, children, and youth living with HIV/AIDS. Part D agency representatives will continue to participate in statewide committees and meetings to facilitate communication and coordination of services.
Part F Services: SEATEC will provide training and mentoring for Part B providers to ensure the provision of quality services. The HIV Office will continue collaborations with SEATEC to develop and implement special projects statewide.

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Private providers (Non-Ryan White funded): Persons receiving primary care services from private providers who meet Ryan White eligibility criteria will continue to be able to enroll in other Part B funded services, including core medical and support services along with access through State ADAP, HICP and PCIP.
Prevention programs including: Partner Notification Initiatives and Prevention for Positive Initiatives: To increase access to care and improve health outcomes for people living with HIV, Part B will continue to work with the Georgia Department of Public Health HIV Prevention Program to participate in Program Collaboration Service Integration (PCSI), which includes TB, STD, Hepatitis, Refugee Health, and HIV. This organizational structure and collaboration allows for coordinated efforts to conduct partner notification and identify individuals unaware of their HIV status.
Part B will also coordinate with prevention and disease control intervention programs through collaboration and participation on the Community Planning Group (CPG) by Ryan White Part B leadership to ensure the sharing of information pertaining to prevention, screening and treatment. Ryan White Part B staff will assist the HIV Prevention Program in developing Prevention Plans, including strategies for ensuring that individuals are provided their positive or negative test results. Part B funded providers will ensure appropriate case reporting.
Substance abuse and mental health treatment programs/facilities: To enhance substance abuse and mental health services, Part B will continue to fund substance abuse treatment programs to expand capacity and facilitate access to care and treatment. This will help address the increasing demand for substance abuse and mental health treatment services for individuals living with HIV/AIDS in the state.
STD programs: HIV/STD Programs are co-located in health departments in Georgia Department of Health. Persons who test positive in the STD clinics will continue to be counseled and linked to care. Part B providers will continue to utilize health department Communicable Disease Specialists for partner notification and assistance in directing clients to primary care sites.
Medicare: The Part B HIV care sites will continue efforts to enroll clients in Medicare for coverage of medications to maximize Part B funds needed for HIV medications.
Medicaid: The Part B HIV care sites will continue efforts to enroll eligible clients in Medicaid.
Children's Health Insurance Program: Part B will continue to provide enrollment in PeachCare (Georgia's SCHIP) by referral or on-site at all HIV care sites although the majority of infants, children and youth (l8 and under) receive services at the Grady IDP in Atlanta, the HOPE Center in Macon, and the Southeast Health District in Waycross. Families are assigned a

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social worker who assists with the enrollment process.
Community Health Centers: Part B will continue to fund AID Gwinnett and Clayton County Board of Health, who are applying to become Federally Qualified Health Centers (FQHCs). These clinics provide comprehensive services such as primary care, mental health treatment, substance abuse treatment, oral health care, medical case management, and support services. Part B will continue to involve FQHCs in statewide planning processes.
F. How the plan addresses Healthy People 2020 objectives
The Georgia Part B Program 2012-2015 Comprehensive Plan is compatible not only with the Healthy People 2020 major goals of increasing the quality and years of a healthy life of all Americans and eliminating the country's health disparities, but also with specific Healthy People 2020 objectives. The Part B's 2012-2015 Goals 1 and 2 (improve access to HIV related core services; Improve the quality of HIV core services and health outcomes) will increase the quality and years of healthy life for people living with HIV/AIDS by providing an HIV/AIDS service delivery system that includes comprehensive health and support services and is flexible and responsive to a client's changing needs. Goal 3 (increase linkage to care for individuals newly diagnosed with HIV infection, through coordination of counseling and testing with treatment) will assist in increasing the proportion of people living with HIV who know their status, and reduce HIV transmission by linking and retaining those individuals in care. Goal 4 (reduce health disparities) will facilitate identification of populations and communities with disparate health outcomes and develop and implement strategies to increase access to health services and related support services in order to reduce disparities. Goal strategies will also include adapting Part B practice and guidelines as needed to align the National HIV/AIDS Strategy, Healthy People 2020, the HIV/AIDS Bureau (HAB) Measures, and other state and federal initiatives focused on reducing health disparities.
The Healthy People 2020 (HP2020) HIV topic area objective most directly aligned with the purpose of the Ryan White Part B Program and the strategies outlined in the State of Georgia 2012-15 Comprehensive Plan is HIV-10: Increase the proportion of HIV-infected adolescents and adults who receive HIV care and treatment consistent with current standards. The Part B continuum of care efforts also demonstrates accordance with the following Healthy People 2020 Oral Health and Sexually Transmitted Disease topic areas:
HIV HP2020-1: Reduce the number of new HIV diagnoses among adolescents and adults. (State of Georgia 2012-2015 Goal 3) HIV HP2020-2: Reduce new HIV infections among adolescents and adults. (State of Georgia 2012-2015 Goal 3) HIV HP2020- 3: Reduce the rate of HIV transmission among adolescents and adults. (State of Georgia 2012-2015 Goals 2 and 3)

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HIV HP2020- 4: Reduce the number of new AIDS cases among adolescents and adults. (State of Georgia 2012-2015 Goals 1 and 4) HIV HP2020-5: Reduce the number of new AIDS cases among adolescent and adult heterosexuals. (State of Georgia 2012-2015 Goals 1 and 4) HIV HP2020-6: Reduce the number of new AIDS cases among adolescent and adult men who have sex with men. (State of Georgia 2012-2015 Goals 1 and 4) HIV HP2020-7: Reduce the number of new AIDS cases among adolescents and adults who inject drugs. (State of Georgia 2012-2015 Goals 1 and 4) HIV HP2020-8: Reduce the number of perinatal acquired HIV and AIDS cases. (State of Georgia 2012-2015 Goals 1, 2, 3 and 4) HIV HP2020-9: Increase the proportion of new HIV infections diagnosed before progression to AIDS. (State of Georgia 2012-2015 Goal 3) HIV HP2020-10: Increase the proportion of HIV-infected adolescents and adults who receive HIV care and treatment consistent with current standards. (State of Georgia 2012-2015 Goals 1 and 2) HIV HP2020-11: Increase the proportion of persons surviving more than 3 years after a diagnosis with AIDS. (State of Georgia 2012-2015 Goals 1, 2, 3 and 4) HIV HP2020 -12: Reduce deaths from HIV infection. (State of Georgia 2012-2015 Goals 1, 2, 3 and 4)
G. How the plan reflects the Statewide Coordinated Statement of Need (SCSN)
The purpose of the Statewide Coordinated Statement of Need (SCSN) is to provide a collaborative mechanism to identify and address the most significant needs of people living with HIV/AIDS disease (PLWHA) and to maximize coordination across Ryan White Programs. Georgia developed its first SCSN in 1998 and updated it every three years thereafter. On May 23, 2012, the Georgia Department of Public Health, HIV Office convened a statewide meeting in Atlanta, Georgia to update the state's 2009-2012 SCSN.
The May 2012 SCSN meeting was the collective efforts of a planning committee consisting of eighteen (18) individuals representing Ryan White providers and HIV service providers. The planning committee was dedicated to developing a SCSN process that would result in useful data and to have wide range HIV service providers and consumers participants. Each planning committee participant was asked to forward the registration for the 2012 SCSN to their HIV Service Providers. All Part B recipients were invited and were asked to bring two (2) consumers. To maintain the focus of the SCSN on overarching goals, the planning committee decided to update the 2008 SCSN Input Summary, revise the questions asked in the 2008 SCSN, collect updated information, and maintain the types of focus groups from that meeting.

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The 2012 Georgia SCSN meeting was well attended with a total of 162 participants including Ryan White providers, other HIV service providers (prevention and treatment), public agency representatives, and persons living with HIV/AIDS. (See Appendix 1-4 for meeting agenda and other meeting materials.)
REPRESENTATIVES PARTICIPATING IN SCSN UPDATE MEETING Part A Grantee, Planning Council representatives Part A Funded Agencies Part B Grantee, District Representatives, and Subcontractors Part C Grantees Part D Grantee, Atlanta Family Circle Part D Director and Project Coordinator,
Subcontractors Part F Southeast AIDS Education and Training Center Persons Living with HIV/AIDS Community Based Organizations Faith Based Organizations Substance Abuse and Mental Health Organizations HIV/AIDS Surveillance Georgia Department of Behavioral Health and Developmental Disabilities Divisions of
Mental Health and Addictive Diseases Georgia Department of Community Health, Division of Medicaid Aging and Special
Populations Georgia Department of Corrections Veterans Administration Medical Center, Infectious Diseases State Refugee Health Program HIV Prevention Providers Georgia Health Sciences University Kennesaw State University
Day one included presentations on HIV/AIDS in Georgia (epidemiological data and consumer survey data), an overview of the national HIV/AIDS strategy and its impact on Georgia, and an update on Georgia's 2009-2012 Comprehensive Plan. On the morning of day two, meeting participants were divided into six groups: administrators (2 groups), clinical care providers, social service providers, women consumers, and men consumers. The groups were asked to brainstorm responses to four questions:
1) What is working well? 2) What are the gaps in the provision of services for persons living with HIV/AIDS in
Georgia? 3) Why are these gaps occurring?

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4) What are the top issues on the horizon that will significantly impact both the provision of services and the level of need for persons living with HIV/AIDS in Georgia?
In the afternoon, participants were assigned to one of five geographical focus groups: Metro Atlanta 1, Metro Atlanta 2, North Georgia, Middle Georgia, and South Georgia. Focus group participants were asked to help identify strategies to address key barriers or issues impacting access to HIV care. Each group developed strategies for at least three of the following barriers/issues:
1) How do we help persons who know their status and are not in care, access care? 2) How do we help them stay in care and fully participate in that care? 3) How do we reach persons who do not know their status? 4) How do we increase HIV testing? 5) How do we improve referral and linkage systems? 6) How do we develop and implement community-level approaches to reduce health
disparities among young MSM of color? 7) How do we develop and implement community-level approaches to reduce health
disparities among African-American women? 8) How do we develop and implement community-level approaches to reduce health
disparities among adolescents? 9) How do we develop and implement community-level approaches to reduce health
disparities among Hispanics/Latinos?
The tables beginning on page 97 provide a compilation of the comments that resulted from the focus groups discussions on day two. It is important to note that the need statements and gaps and barriers are not presented as, nor intended to be, a comprehensive listing of these issues nor do they necessarily represent a consensus. Instead, the SCSN seeks to highlight the most common perceived issues in providing HIV related services to consumers. Rather than an exhaustive list of specific needs, this document includes generalized descriptions that encompass many client needs. Additionally, the needs are not prioritized due to greatly varying geographic differences in intrinsic level of need. Finally, not all of the needs listed are, or can be, addressed by Ryan White programs.
Participants were surveyed at the completion of the meeting to determine there level of satisfaction with the process. A Lickert Scale was utilized in the evaluation process to determine responses. On a scale of 1 to 5, 1 = strongly agree and 5 = strongly disagree. A total of 106 participants completed the survey. Overall the meeting was well received by participants. Fiftynine (59) percent of participants strongly agreed that the meeting was beneficial, additionally; thirty-nine (39) percent agreed the meeting was beneficial. Sixty-nine (69) percent strongly

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agreed that they had opportunities to express their opinions during the meeting and twenty-eight percent agreed with this statement. (There were no 4's or 5's received for this question.)

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What's working well

Administrators (divided into two groups because of size) Improvement in CAREWare documentation
Coordination of services - Can be hard work,
especially with changes at the State (see barriers)

SCSN Stakeholder Summary Tables

Georgia SCSN Meeting May 2-3, 2012

Healthcare Providers

Support Service

Women's Consumer

Providers

Group

Men's Consumer Group

Quality management (QM) - QM program progress with
benchmarks from state and HRSA (with completion of RSR are able to get benchmark information gives you a sense of where you are and where you want to focus on quality indicators - QM has improved and is more meaningful - Quality in public health has been an improvement in quality structure in Ryan White. Really have performance measures that have had an upward movement. There is access to quality care Training - Training is better/good between SEATEC and the State, between HIV basic and care. Trying to get more TB testing and similar topics - More webinars has helped

Supplemental transportation
Consumer involvement on planning council leadership

OB/GYN services Peer advocacy program

Specialty care referrals for oral health (Douglas, GA Waycross, GA)
Patient flow (less time waiting in lobby or waiting area)

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What's working well

Administrators (divided into two groups because of size) Collaborative and better communication between Ryan White Parts

Healthcare Providers

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

Nationally VA has been proactive related to HIV (last year VA lab tested 19,000 people huge effort related to federal law for testing and counseling being repealed are now able to test a huge number of people

Clinic appointments within 2 weeks upon release from prison

Primary care physicians and services

Primary care (Atlanta, GA) (Specially named Grady IDP great clinic, provides seminars from pharmaceuticals) Increased self management

Low turnover of providers, excellence in care, level of experienced providers

HIV screening in substance abuse clinics

Fewer HICP complaints Grady has removed barriers to HIV testing

Better communication - Inter- and Intra-
clinic/agency relationships due to internal training - between office staff and CMS has improved with ADAP staff regarding the wait list (with some districts) Dental - Relationship with dental providers - Peer advocate, dental (Waycross) - Waycross dental services (also cited EMR and case management in Albany)

Case management services
The clinics, labs, medications that are all accessible at one location, i.e., one stop shopping" (Grady IDP, Absolute Care, Decatur VA, Newnan's Haven Hope)

Support groups for substance abuse and PLWHA (specifically named Fulton County Department of Health and Wellness)
Food/Nutrition assistance (Specifically mentioned Meals on Wheels that serve in Atlanta, GA)

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What's working well

Administrators (divided into two groups because of size) Drug assistance program (PAP)
Focus on quality of care (quality indicator targets)
State office staff support; responsive (part B)

Healthcare Providers

Support Service Providers

Women's Consumer Group

Access to providers has somehow improved

Advisory groups - Grady IDP Youth
Advisory Group - Client Advisory Board
(Newnan, Grady IDP)

Peer advocates

ADAP working well by not going through Grady. Clients are happy with less medication waste and local pharmacist has gotten very involved in counseling clients
Better collaboration - with Grady IDP, state
leadership (i.e. QM Process), Dr. Katner and Medical Advisory Committee, local dentists - with new clients (i.e. Consumer Advisory Boards), Part A consumer caucus, community leaders

Linkage to care (IDP) - Adolescent clinic
linkage to other facilities (Young Adult Network/YAN, newly diagnosed IDP, teenagers transitioning in their last 3 months)
African American Outreach Initiative linkage to care strategies to link people not in care to substance abuse services, case management, and medical care
Good collaboration between legal and case management. Also with private attorneys.

Food services
Client-provider relationship

Men's Consumer Group
Walk in clinic services - no appointment necessary, seen an increase number of people who access this service (Dalton, GA) Case management is good (Dougherty County), but not as good as in Atlanta.
`Wrap-around' services with all services being accessed through different Parts in one location.

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What's working well

Administrators (divided into two groups because of size) Good use of consumer input
Access and availability of services in each district Effective documentation of services
Provision of surveillance data
Positive individuals finding our clinic Testing programs and targeted HIV interventions by CDC HIV Early Intervention services (substance abuse) linking well with HIV treatment services
Newly diagnosed individuals able to access care fairly quickly
ARTAS program

Healthcare Providers
Patient Assistance Programs (PAP) working well
Case management services help maximize primary care Expanded age range for pediatric care continuing pediatric clinic to age 25 has helped with retention of adolescents Peer programs are working well although not to their full potential Having many services in one clinic works well Outreach and collaboration with high risk OB
Savannah participating in clinical trials. Can get on meds and provide a better outcome. Provides funding for clinic to hire additional staff. Grady IDP compassionate use - by using pharmaceutical companies for peds with a lot of resistance Rotating staff among different clinics addresses access to care (satellite clinics) in rural areas

Support Service Providers
Advocacy efforts
HOPWA
Electronic medical records and technology (being able to access information electronically)
Better reporting from private providers
Utilization of peers
Case management training and peer advocate program (Albany) Reduction efforts for out-ofpocket expenses (Medicaid, insurance)
Patient Assistance Programs are working well fill in the gap with ADAP

Women's Consumer Group
Availability of educational materials
Some agencies clearly outline funding

Men's Consumer Group
Contract pharmacies money savings, drugs not being destroyed, home deliveries. Nursing case management (Dalton) Patient empowerment is good, but client capability to be empowered should be assessed Consumer advisory boards (Muscogee County, GA) SCSN and similar meetings African American Outreach Initiative (AAOI) in Atlanta. Transportation issues between services that may be referred by service providers

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What's working well

Administrators (divided into two groups because of size) InCare campaign retention strategies
Collaboration with other partners like colleges, private CBOs to get work done Willingness of ADAP to take on pilots to transfer ADAP clients to PCIP Partner services in districts (prevention and care) Budget flexibility

Healthcare Providers
Using Telehealth - physician does not have to go back and forth so much Good participation with consumer advisory boards good to have opportunity to hear clients' perspectives

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

Gaps/ Unmet Needs /

Administrators (two groups)
Primary care
Oral health, including insufficient funding

Healthcare Providers (See barrier section below)

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

HOPWA working well in

Need patient navigation

some places, but not in others services

Case management for the self-managed

Referrals to clinic are delayed referral process in private sector as well as knowledge of resources and appropriate management

Oral health services in many Transportation geographic locations in the state

Impact on budget cuts consumers need to know SSI eligibility should continue with HIV diagnoses not only AIDS diagnoses

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Gaps/ Unmet Needs /

Administrators (two groups)
Subspecialty care (GYN, Orthopedics) limited funds to pay for specialty care
Job training limited job supply, lower education level

Healthcare Providers (See barrier section below)
Adolescents/Teenagers - behaviorally acquired and not referred for 6 months and then becoming complicated to manage - may not adhere to meds and waste medication Primary care gaps in HIV setting

Support Service Providers Loss of funding for CDS staff
HOPWA is non-existent (District 4)

Integrated care (Women, Youth) Housing
Needs of low-income population
Aging population Comorbidities. Not clear what "geriatric" means.

Access for transgenders - difficult to keep in care, housing, etc Lack of resources for Hep C - private sector, no funding for Medicaid/Medicare to pay, expense of labs ADAP - Need to maximize ADAP
funding opportunities Medicare Part D bureaucratic collaboration - Electronic filing for ADAP applications Transportation to care

Transportation
Access to food banks
Housing - Housing in general - Housing for felons (sex
offenders)
Prevention efforts

Women's Consumer Group Funds for emergencies (i.e., housing and utilities)
Coordinated medical services
Adherence counseling Providers
Confidentiality
Takes too long to get medication after it is called in

Men's Consumer Group
Need to strengthen the usage of electronic medical records and systems
Access to after hour services at least one wellness center open on weekends Less stringent housing criteria Substance abuse and mental health services
Vision care
Peer advocates and counselors

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Gaps/ Unmet Needs /

Administrators (two groups)

Healthcare Providers (See barrier section below)

Support Service Providers

Incarceration Issues - discharge planning, limited medication supply
- Prison release services
- Felons' ineligibility for services (i.e. Augusta)
- Different providers serve different jails and lack of coordination
Mental Health Services - in rural areas, for undocumented workers, substance abuse

DPH bureaucracy
Pharmacy services - Do not include pharmacist
in patient care team - ADAP pharmacists do not
have access to patient ADAP data through dataRx

Funding
Providing services to consumers above the poverty level

Training community health center staff about HIV/AIDS care some are not willing to see HIV/AIDS patients without pay. Limited (acute) care provided, if any, in many rural areas.

Undocumented patients - Lack of services for
pregnant, undocumented women

Uncertainty with case reporting when a client is referred from another agency

Women's Consumer Men's Consumer

Group

Group

Lack of support for peer programs why is peer position a volunteer position? Why are they not given anything or as much respect as other positions (Would be nice to have paid positions, structured plans in place, retreat, etc.)

Sub-specialty (mixed discussion)

Lack of information about services and providers (e.g., no primary care physician does not know how to find one; had more funding in NYC)

Case management overall too fragmented

Supportive services, especially funding in rural areas (e.g., mental health, peer services)

Primary care doctors refusing Medicaid / Medicare clients

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Gaps/ Unmet Needs /

Administrators (two groups)
Technology telemedicine
Legal services in rural areas not available outside of Atlanta to protect the legal rights of HIV/AIDS patients, because of lack of funding Health information exchange more funding needed Stigma (primarily in rural areas)
Substance abuse services in rural areas no or limited programs available Access to healthy nutrition programs

Healthcare Providers (See barrier section below) Clients Lost to Care -unmet needs, retention, tracking Access to education and lack of provider education
Limited providers for complex patients
Prescriptive authority for nurses in public health
Stigma
Case management screening people out of case management and they still need it

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

Access to Care -refugees, undocumented individuals, transgender persons Data collection/access based on location for service integration

More collaboration with schools and communitybased organizations
Marketing re: available programs - have to be pro-active to find what is out there

Facility space
Staff training and shortages not well trained and not enough of them

Staffing - Lack of staff - Staffing expertise Data collection for the nonidentified risk group and no risk reported groups
Life skills coaching (budgeting and employment, etc.)
More outreach/prevention in colleges/universities

Lack of faith-based support groups
Mental health services
Services to support "whole self" (e.g., healthy food, massage, nutrition education, etc.) More participation from consumers in Ryan White consortium

Mental health services
Documentation of needs and what's not being provided as it relates to the client Nutrition / food pantry
Weak coordination of services across service providers

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Gaps/ Unmet Needs /

Administrators (two groups)
Support systems /Education for peers lack of funding in rural areas or motivation to train peers for other positions

Healthcare Providers (See barrier section below)

Transportation Assistance outside of Atlanta

Linguistic services and trained medical interpreters bilingual does not equal interpreter Patients are losing insurance
OBs not testing women because of reimbursement issues (Medicaid will not reimburse for any test that the state lab will do). Have had six babies seroconvert recently.

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

Lost to care (target homeless population)
Lack of education (schools, churches, colleges, general public, etc. that addresses discrimination) ADAP (waiting list, policy changes)

No merit for some service providers to provide quality services (an example shared was RateMyProfessor.com which allows students to provide feedback on their professors) Fragmented services and lack of communication between service providers Weak leadership within service organizations

Substance abuse and mental health
Rise in STIs and Hep C

Clients are not always aware of what services are available Rural areas do not have enough (if any at all) AIDS service organizations

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Gaps/ Unmet Needs /

Administrators (two groups)

Healthcare Providers (See barrier section below)

New law requiring drug testing for individuals applying for TANF. Some HIV drugs "mimic" individual on these drugs may test positive during drug testing. May have to disclose status. Also, patients with Substance Abuse (SA) problems who may lose benefits if they have to undergo a drug test. Medical Case Management outside of Atlanta Services for transgenders (e.g., housing, job placement, lack of information on new rules & regs on housing and employment) how to serve the transgender population as a whole Physicians reporting "no identified risk" (NIR) missing data, including risk factors. Need complete data sets. Out of pocket costs for patients

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

Address issues for 45+ year old population

Not enough client satisfaction surveys / feedback regarding service providers and the availability of services available.

Services for transgender population SSI/SSDI approval process may take up to 2 years
Post release collaboration between jails/responses with case managers
Poverty or unemployment

Cultural barriers (e.g. lack of education, etc.)
People who fall out of services are not relinked to services (follow up with lost to care clients)
Accessibility to assessments

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Gaps/ Unmet Needs /

Administrators (two groups)

Healthcare Providers (See barrier section below)

Staffing shortages and unrealistic demands within the districts Services for undocumented individuals Youth services access issues for testing and treatment Need to retrain staff on new ways of doing business (i.e. cultural diversity training for providers), especially staff who been there a long time. Gaps in ADAP program need better education for providers and consumers on how to access PAPs as well as mechanisms to help them access ADAP.

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

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Gaps/ Unmet Needs /

Administrators (two groups)

Healthcare Providers (See barrier section below)

Need to streamline ADAP process, e.g., electronic submission, web-based portals, telecase management programs like program in State of Washington. No need to reinvent the wheel. Look at Washington, Wisconsin and other states. Look at Medicaid system for Food Stamps. Need to make use of all available resources while there is an ADAP waiting list, e.g., ADAP count as TROOP, using drug rebates, etc.

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

a Barriers Administrators - why gaps occur s why gaps occur
Limited funding

Healthcare Providers

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

Longer turnaround to get patients in due to growth in number of patients coming into clinics

Funding hard to retain staff, not enough pay leading to burn-out and high turnover

Dental care lack of or delay in accessing care

Lack of service provider knowledge /familiarity with job description

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a Barriers - why gaps occur s why gaps occur

Administrators
Funding policies direct v. indirect expenses

Core v. Support Funding Model

Communication (i.e. No statewide listserv)

Advocacy communication with consumers

Lack of awareness/appreciation for nutrition
Direct/indirect criminalization of HIV/AIDS clients

Healthcare Providers

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

Patients without ability to pay deductibles impacts access to medications, labs
Working with private providers for HIV testing for pregnant women perinatal transmission Paperwork involved with PAPs
Clients needing to inform case managers (?)
Private providers' lack of knowledge around state health benefits resources
Difficulty finding peers to be peer advocates in pediatric/adolescent clinic due to stigma and reluctance to disclose

Politicians/supports don't care
Impact of downturn of the economy (unemployment, etc.) on clients Stigma (overall fear from dental offices), denial, shame
Refugees language barriers, lack of translators
Cultural sensitivity
Need increased linkages for clients

Lack of insurance/eligibility (worry about loss if status is known) Housing requirements to attain medication and services need more adequate housing Lack of funding
Stigma surrounding HIV/AIDS (e.g., perhaps work with college and high school professors and teachers to address stigma
Denial of HIV positive status (especially among young, newly diagnosed) Providers who do not accept Medicaid

Lack of familiarity with system navigation and when services are available Lack of cultural sensitivity from the provider
Lack of planning and coordination of activities and services between agencies (i.e. providers) in rural areas Stigmas associated for heterosexual men accessing HIV-related services (i.e. heterosexual men being assumed to be homosexual) Lack of communication between state agencies
There should be a portal for HIV services

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a Barriers - why gaps occur s why gaps occur
Q

Administrators
Housing - Affordability issues - Criminal history prohibits access to it
Requirement for income before care (eligibility criteria for services)

Healthcare Providers
Difficulty for older peer advocates to relate to adolescents/children
Decreasing EFA funds

Support Service Providers
Post-release collaboration between prison/jail and case management
Proof of income requirements

External/ internal stigma
Geographic (local) restrictions on providing services

Ability to access clinical trials in public health loss of state staff related to research Lack of staff for case management high case loads

10% administrative cap
Lack of information about Ryan White services by private providers

Poverty

Need more collaboration with Prioritization of resources faith-based organizations

Women's Consumer Men's Consumer

Group

Group

Lack of services in particular areas of the state (e.g., Paulding County) having to drive long distances to get services Getting medication for other opportunistic infections/non-HIV meds Transportation
Lack of funding for mental health services (time it takes to get a referral or names of people to talk to) Uneducated/ inexperienced/ insensitive service providers

Too much funding for top level position salaries instead of services
Better utilization of resources
Requirements around fringe benefits Confidentiality in rural clinics
Lack of funding

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a Barriers Administrators - why gaps occur s why gaps occur
Resistance by private doctors to treat HIV

Healthcare Providers

Support Service Providers

In some places CABs have not contributed anything positive "going through the motions"

Collaboration among agencies/providers

Medicaid reimbursement Need to access creative

Navigating the system

rates resisted by private funding initiatives, need more (clients)

doctors

funding opportunities

Wait times (appointments and phone calls)
Gap between prevention and care providers

Clients who get better, make too much money to qualify for RW but still do not have health insurance Community hospitals discharging patients at "poor" time

Inflexibility within the system

Women's Consumer Men's Consumer

Group

Group

New employment or beginning own business (entrepreneur example providing peer counseling as a nonprofit) having to lose Medicaid, etc. if forced to disclose status Lack of knowledge of Ryan White Planning Council funding allocation process at consumer level Questionable confidentiality

Burdensome paperwork and duplicate requirements across service providers
Limited peer advocacy and counselors

Lack of active role for consumers in Ryan White consortia that are already there - need more clients to show up (don't disclose what each person does at meeting, e.g., nurse, HIV positive client, etc. because it "outs" the client)

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a Barriers Administrators - why gaps occur s why gaps occur
Paperwork
Provider and staff turnover (state and agency levels) burnout Sense of entitlement by consumers Low levels of health literacy by consumers
Insurance copays/deductibles Lag in lab time
Scheduling appointments that are convenient for consumers Lack of priority for prevention

Healthcare Providers
Lack of staff education or testing in the community/ private providers (i.e. to do testing). Late testers with sicker patients
Overall aging of population
Hospital do not want uninsured patients dump them out very soon Clients not admitted
Community health center testing issues related to funding and reimbursement Fees related to accessing community health centers in rural areas to access care Application to different PAPs is a barrier to getting medications to patients

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

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a Barriers - why gaps occur s why gaps occur

Administrators
Perception of lack of confidentiality by patients

Still seen as a "gay" disease Cost benefit analysis not understood HAB measures don't work in real world, regarding oral health leaves clients hanging once met Lack of CBOs and ASOs to advocate in rural areas Policies/behaviors that promote waste/duplication Cultural competency and diversity among ID physicians and upper management Challenges as a result of changes in the Department contracts, PCIP audit, etc.

Healthcare Providers
Community health center testing is an issue patients do not want to pay for the test, would rather refer because RW clinics are less costly for patients Clinic entry process
Private providers do not participate in state planning Access to Grady for clients outside of Fulton and DeKalb
Slow referrals for primary care Limited formulary for primary care medications
Primary care needs: training, personnel
Lack of funding to obtain primary care provider

Support Service Providers

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Group

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a Barriers Administrators - why gaps occur s why gaps occur
New drug screening/testing law Archaic technology
Lack of communication of policy and funding changes, including federal to state and state to local Lack of trust among Federal, state, and local

Healthcare Providers

Support Service Providers

Can get patients seen by specialists but cannot pay for treatment Oral Health Care
- lack of access to Grady IDP
- VA does not provide it
- Limited funding - No dental case
managers - No collaboration with
rural GA dental providers - Patients not educated on need for oral care, use peers - Funds by some agencies for oral care not being used Need to recruit providers for rural Georgia need to do education
Hormone therapy for transgender patients

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Group

Group

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a Barriers - why gaps occur s why gaps occur

Administrators
Lack of transparency up the management chain Need better written policies and procedures and dissemination of information Regulations regarding sex offenders, including housing Regulations regarding other felons (non sex offenders) Lack of staff and space available for one stop shop provision of services integration of services Existing linguistic services are limited difficulties with dialects, need for training on medical translation, lack of bilingual staff. Language Line can be intimidating for some clients. Services for hearing impaired.

Healthcare Providers
Mental health/substance abuse Lack of knowledge about HIV, lack of social marketing, public media
Need to set up relationships in rural Georgia to prepare for needle sticks Lack of referral options for pap smears and women's health Lack of sex education in schools
With patients losing their insurance patient had 3rd party insurance does not cover prescriptions and patient could not apply for patient assistance due to having insurance. Can see provider, but can't get labs or medications

Support Service Providers

Lack of political will to VA is in a silo due to work with undocumented independent funding

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Group

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a Barriers - why gaps occur s why gaps occur

Administrators
Lack of funding for oral health services and availability of providers and services (preventive, maintenance, restorative) Medicaid policies that do not pay for testing of pregnant women vs. state lab

Healthcare Providers

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

Future Issues/ Emerging Needs

Administrators
Health Care Reform impact Ryan White Extension/ Reauthorization - Coverage for
undocumented Prevention technology

Healthcare Providers
Medical nutritional therapy Healthcare after 2014
Needing more funding for less care

Support Service Providers
Support services may disappear Afford Care Act impact
Medicare Part D rates increase and other health insurance (co-pays, deductibles, premiums)

Women's Consumer Men's Consumer

Group

Group

Education about available resources Provider education need sensitivity training

Money
Public education and awareness

Long term care for long term survivors especially for aging women

ADAP/availability of medication

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Future Issues/ Emerging Needs

Administrators Incomplete data

Technology
Lack of diverse health care providers and providers in general
Quality HIV care at community health centers
Long term effects of HAART
Health literacy and system navigation Immigration law
Adolescents

Aging population

Healthcare Providers

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

More HIV positive pregnant women and lack of carrying AZT on formulary (19% of 40 EMA hospitals) TEAP and HIV health reform
Prep: who will pay for it, who will see those clients
Affordable Health Care Act does not impact oral health care

PAP may disappear
Drug test for entitlement programs Social services disability re-evaluation of those on disability (are no longer eligible) Need to acquire skills to obtain employment (funding for training/retraining)

HIV peer advocates-- more attention on their value and role
Mental and emotional health Funding
Faith-based/church participation

Emerging senior population
Stigma Medical side effects on long term survivors
Access to specialty referral care

Getting other providers to do HIB counseling and testing

Partner notification with increased STIs (i.e., young adult population) Younger people becoming infected Criminalization of HIV positive inmates

Programs that target the youth/young
Advocates for federal/state funding Nutrition and exercise resources

Ryan White funding going away
Poor quality of life

Info/resources to identify/foster "grass roots" advocacy within Georgia Community organizing; need to link groups and resources across the state

Need for more advocacy (specifically for long term survivors) Asking better questions by providers Advanced training for the health care providers for long term survivors Targeting certain populations
Comprehensive screenings (to include STD screenings)

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Future Issues/ Emerging Needs

Administrators Medical home model

Healthcare Providers

Need to demonstrate outcomes Integration of prevention treatment and care
Young MSMs increasing HIV rates
Substance abuse treatment for crystal meth, prescription drugs Sexual health education
Social media
Treatment is prevention (reduced risk of transmission) Availability of medications Reductions in funding

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

Political environment
Developing advocacy interventions Returning military Doomed!!
Hope is on the horizon

Using technology and social media to connect HIV+ people/groups for mental health services (cyber psychology) Including consumers when creating policy Need for cultural competency/sensitivity training for providers Annual/ongoing invitation for consumers to participate in planning/prioritizing process

City officials, clergy, and politicians taking a stand and being tested in public Faith-based organizations stepping up Lack of mass testing events
Immigrants may go into hiding Co-morbidities

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Future Issues/ Emerging Needs

Administrators
Complicated Medicaid and Medicare reforms

Healthcare Providers

Emerging populations non Hispanic immigrants, transgenders, older adults, perinatal, youth Increased waiting lists for services, including ADAP, primary care, oral health, specialty care, housing Putting caps on number that can be served Lack of HIV knowledge within state legislature . could increase with upcoming elections. Individuals aware of and not aware of status and not in care. Need for surveillance. Changing guidelines on when to initiative ARVs. State laws requiring drug testing before can access services Rising out of pocket costs

Support Service Providers

Women's Consumer Men's Consumer

Group

Group

Electronic health records & advanced technology some clients cannot adapt with how to use tech. Revamp primary care for aging clients

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Future Issues/ Emerging Needs

Administrators
Need an economic impact study

Healthcare Providers

Support Service Providers

Top Five Priority Areas

Administrators

Healthcare Providers

Support Service Providers

Admin. Group 1 1. ADAP gaps 2. Streamlining ADAP
electronic transmission, etc. 3. Transgendered population 4. Mental health services 5. Transportation
Admin. Group 2 1. Primary care 2. Subspecialty care 3. Integrated care (co-
morbidities, women, youth) 4. Mental Health/ Substance Abuse services 5. Aging population needs/technology

1. ADAP waiting list 2. Private sector
involvement miss or ignore HIV 3. Primary care gaps in HIV settings (i.e., training, personnel, funding) 4. Oral health services including need for dental case management 5. Timely access to care access to care begins late for some consumers

1. Funding 2. Housing 3. Transportation 4. Income 5. Lack of staff

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Women's Consumer Men's Consumer

Group

Group

Women's Consumer Men's Consumer

Group

Group

1. Need more support services in rural areas
2. Advocates for federal/state funding (emerging needs)
3. Community organizing need to link groups and resources (emerging need)
4. More collaboration between schools and community organizations
5. Programs that target youth/younger consumers (emerging need)

1. Lack of funding for services
2. Not enough peer advocates/counselor
3. Housing 4. Case management 5. Cultural barriers

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Development of Strategy Area Action Steps
Using the met and unmet needs, barriers, and emerging issues identified by the five groups during the morning sessions, meeting participants were divided into five geographic groups (North Georgia, Metro Atlanta Group 1, Metro Atlanta Group 2, Middle Georgia and South Georgia). Each group was assigned barriers and/or issues and was tasked to identify to actions to address their assigned areas. These identified strategy area action steps beginning on page 122, guided the development of Georgia Comprehensive HIV Services Plan on page 75. The SCSN will also be used to guide the development of programs to provide services to persons living with HIV/AIDS in Georgia and to encourage effective collaboration and coordination among service providers across funding streams. As a living document, the SCSN will evolve to reflect the changing landscape of HIV in Georgia through subsequent revisions.

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Strategy Area Action Steps

Strategy Area Question

Metro Atlanta Group 1

How do we help people access care Outreach, intake, community involvement

who know their status but are not

Community volunteers for outreach

in care?

Open forum for community

members/providers to share

Public service announcements

Case trackers who locate clients

Appointment log contact clients to confirm

access to care

Equip peers

Case management

- Increased linkage to care case management

- More community-based case management

Address other social issues (e.g., substance

abuse, mental health housing)

Recovery support programs

Drop-in center

Transitional Center (Grady IDP)

Health literacy

How do we help them stay in care Motivational incentives

North Georgia (answered this question mainly for young MSMs) Knowing what is available and give people the
information they need Knowing where HIV clinics are Education with diagnosis so people do not think they
can ignore diagnosis (it will go away if ignore diagnosis) and/or are scared because they do not want people to know Younger people have a lot of denial "I feel fine and my health is good, why do I want to start meds?" Confidentiality and how to follow up Calling agency to get the referral Testing/screening: follow up care with linkage to stable relationship after diagnosis is given Dalton poor quality post-test counseling "here's a brochure and off you go" Culturally competent care immigrants, non-native English speakers, transgender have a bad experience and do not return Transportation and insurance People there are not services ADAP wait list, Medicaid, Medicare Fear of rejection and stigma Lack of peer advocate program a barrier due to increased rapport with peer advocate program Location of clinic within health department is an issue due to confidentiality Other issues for patients and different priorities: housing, substance abuse, other health conditions also a challenge for retention
Peer advocates for tracking lost clients

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and fully participate in their care?
Realizing not everyone has equal access to services, how do we develop and implement community-level approaches to reduce health disparities and increase access to HIV services among Hispanics/Latinos?

HIV/AIDS education opportunities (lunch/learn) Clients need to "buy in" to their own care may not

- Health literacy

mean medications adherence

- Staff educational opportunities/training

Running reports to track and make contact (follow

Elite services Address mental health at intake Track no-shows and identify how can help get
them to next appointment

through) with lost clients Home visits Case conferences Support groups if people will show up and stay

Stable housing

interested, view of consequences ("scare tactics"), -

One stop shopping

people more likely to stay compliant

Staffing cases

More satellite clinics available for areas with more

Consistency in care team

newly diagnosed clients



Address capacity/structural issues (i.e., wait time for appointments, ADAP recertification every 6



Multiple services offered such as mental health, substance abuse

months, information needed for Medicare Part A Less appointments and get more done (efficiency

Non-traditional hours of operation

during visits, social stressors)

Peer advocates

Access case management services

Address language barriers

- Language Line (access to live person)

- Interpreter on site/bilingual staff

- Translate more documents/brochures into

Spanish

Outreach/safe environments to avoid fear of

immigration

Latin American Association strategies for

effective community outreach

Social media/marketing (e.g., television,

Hispanic radio stations, Facebook, Linked In)

Advertise early testing

Hispanic health coalition

Reach out to Latino churches

Cultural competency (norms for particular

group)

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What steps would you take to improve services?
How do you deal with the fact that HIV isn't as big of an issue as in the past?
What do we need to do to help the Latino community be selfempowered?

Non-traditional hours of service Latino lunch and learns Involve prevention staff in outreach initiatives
with the Latino community Latino commission on AIDS Less prevention efforts in the community focus
more on evidence-based interventions Treatment is considered prevention Address burn out of staff Identify and collaborate with agencies that are
currently providing services to the Latino community
Poor education around sex education (risk reduction skills)
Past efforts produced better results Discrimination and stigma with the increase of
infection rates among the African American community Target youth before infection Rapid test results may have given the illusion that it is ok to have unprotected sex Partner notification is not working Lack of communication among staff Train on disclosing status Mass test events counseling portion is condensed or not offered TB/HIV/STD clinics do not share data Healthcare is second; family comes first Fear of deportation is biggest fear among Latinos Gay HIV/AIDS is not acceptable in the Latino community Resources are limited in country origin Latinos are not used to asking for help

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Strategy Area Question

Metro Atlanta Group 2

South Georgia

How do we reach people who don't know their status?

Go to non-traditional spaces (bars, parks, go at Make testing mandatory, e.g., medical clinics,

random hours)--but make sure that you have

entry into school, application for public

peer support and other supportive systems to

services, etc. test everyone because

ensure that someone can get immediate help and

everyone is at risk. Make it part of standard

care if they have a positive result

care.

Prioritize locations for testing--go to homeless Education increased educational efforts to

shelters, not churches

the general population on risks and need for

Use social media to get the message out-- Facebook/Twitter, etc.; so many people are

care Increasing awareness by advertising

meeting through the internet for sex--educate them Target non-traditional lifestyles (for this work)

Establish partnerships with the education community (colleges, high schools) that include assignment of projects to their

(ex. Heterosexual couples)

students (e.g., nursing students) to not only

Collaborate with colleges and high schools (and their teachers and professors) to encourage

educate the students, but also get the word out about the need to be tested

projects around HIV care

Include testing in faith-based venues

Educate students and others about HIV and risky Educate primary care providers on CDC

lifestyles

testing guidelines (if sexually active, get

Go to the people--find out where high-risk folks are and go to them

tested yearly) and provide op out annual testing

Do "one-stop" healthcare education--hand out condoms to get people's interest, then test. While waiting for the test to process--educate

Include stigma reduction education as part of public awareness/testing campaign
Increase outreach to areas with high risk

the people during that 20 minutes. Also, have

populations and/or prevalence and limited

peer educators and other resources on hand to

resources cast a larger net for testing

help those with positive results Outreach testing

Increase enforcement of protocols and guidelines, and regs

Churches, communities where youth interact

Eliminate the cost to individuals for test

Create a safe space for positive results

Identify incentives to increase private provider

Educate about risks

testing

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How do we increase testing?

Conversations with PTA

Allow increased testing ability outside

prevention

Do better job of tracking down known

positives and contacting their partners about

getting testing target newly identified

positives. Strengthen partner notification and

interviewing of known HIV+ individuals to

identify if partners have been tested (both for

newly diagnosed individuals as well as during

care need to regularly ask about new

partners.

Increase communication among staff about

clients, their partners, and risk behaviors

Allow RW funding to support testing in "low

risk" populations

De-stigmatize and normalize testing--make it Use surveillance data to identify risk groups

opt-out

and develop plan to test identified groups

Make testing a normal test for getting into a

Create collaborative relationships with faith-

homeless shelter

based and other community organizations to

"Bar cards"--help people recognize their risk levels--and then provide testing for them at that

test such as Rotary Club. Make testing become the norm.

spot

Requiring HIV testing as part of application

OB-GYN--make tests more common there

for driver's license

Use better public service messages to talk more Educate high school health education teachers

about HIV tests--make them more creative and

about community testing resources for youth

frequent (ex. as frequent and on the same main- Increase testing sites

stream channels as Viagra commercials)

Work with college health services to increase

Use incentives to get tested

testing

Work with mobile units that provide other care to Put STD/HIV and sex education back in high

de-stigmatize the test (ex. domestic violence care

schools

clinics)

Offer parental permission slips for testing as

See where HIV+ folks go--and use their social

part of health education in schools and include

networks to figure out where to test

testing at school sites

Test spouses of those at high risk (such as drug Develop relationships with schools and work

users) as soon as they begin care

collaboratively to access grant funds

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Have folks from one county go into another to do Mobile testing

testing (thus, people don't have to worry about someone from their community--such as an Aunt or neighbor--knowing their status)
Community testing--have someone visible from that community be seen--so it helps destigmatize the event (ex. think of how everyone flocks to people on American Idol who is from their community)
Change in the mechanism of testing Testing of elderly

Use local and regional epi data to show local areas what HIV looks like in their community
Offer testing in gyms, etc. where young adolescents gather
Implement test initiative that encourages parent/adolescent testing
Link testing to everyone who gets a tax refund or that receives federal or state services of any kind, getting married marriage license
Implement train the trainer in communities to

increase educator resources, e.g., train barbers

Reduce stigma and fear thru education,

decriminalization HIV, make sure people who

are positive are protected and do not lose

housing, jobs, insurance, etc. Protect people

who are identified as positive

Increase education to business community on

HIV discrimination in the workplace

Provide incentives to people who get tested

(does not need to big). Decrease restrictions

on providing incentives

Conduct testing where high risk populations

go such as sex workers

Add HIV testing to parental consent school

health form for adolescents 13 and above

(need permission for youth under 16)

Make HIV testing part of any routine hospital

admission screening

Require mandatory HIV testing for state and

local health care staff

Require mandatory testing for politicians

Add HIV testing as part of requirements with

Drug Courts, drug probation, DFCS family

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How do we improve referral and linkage systems?

reunification, etc.

Implement a "test everyone" media campaign

Offer op out testing with Viagra prescriptions

Include HIV testing education as part of

reproductive health provision for not just

females but males as well

Reframe mandatory HIV testing and sell it as

normal part of medical testing normalize

HIV testing as a part of a normal healthcare

screen

Increase in-home testing (include education

resources) Offer confidential self testing at

home that includes link to education resources

(FDA is making a determination soon about

whether home testing will be licensed)

Offer one stop shopping including walk in

testing make sure HIV clinics can also test

Have peer counselors/advocates to help folks

Increase advertisement of available HIV

new to care navigate the system

clinics and providers better marketing

Meet people where they are--figure out what

More provider education to increase referrals

their barriers are to getting care

Better tracking monitoring, and follow up to

Have ability to make an appointment at the time

make sure identified individuals are in care

of diagnosis--don't have 3-4 month wait to get

(go with this one).

into care

Establish clear guidelines and a process that

Establish a list/referral to those needing care

gets a positive client into care at the

Work more with private providers

community level (because systems and

Make support groups readily available--they can

resources differ)

tell someone the "ropes" and can help them get Require that testing sites make sure

in the right mindset to get care

individuals identified as positive are referred

Use technology to connect to younger

and linked

generations--respond to texts or emails

Dissolve silos at the state and local level

Use social media to link up to others (ex.

between prevention and treatment

Facebook, etc.)

Encourage American Red Cross to include a

Distribution of more condoms

number to call when informing individuals

that they tested positive

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RETENTION IN CARE

Increase collaboration at the local level

Elite society of undetectables at AID Atlanta--

between testing agencies and clinics, e.g., use

require labs in order to attend dinner celebrating

consortiums

the patients' accomplishments

Work with private providers to make sure they

Encourage patients with positive words and/or

know what to do if identify someone that has

show them their labs for visual confirmation of

tested positive. Increase collaboration and

their dropping viral loads

communication between testing agencies,

Incentives

clinics, and private providers

Double up with other services (ex. food dispensing, etc.)

Add to prevention to deliverables for Part B consortiums

Use celebrations of life to keep everyone

encouraged to keep up with their care

Help patient feel empowered--let them have an

opportunity to help make decisions about their

own care--helps them stay engaged

Give culturally compliant classes

Testing with elderly--meet them where they are

Transgender patients--be cognizant of their

issues and help their care be compassionate and

sensitive care

Let colleagues have contact information for each

other so that someone can help meet a patient

and take them over to the next clinic and help

with paperwork to help them get from the

hospital to the clinic without falling out of care

Continue to test repeatedly--use of Viagra is

prevalent, etc.

Strategy Area Question

Middle Georgia

Realizing that not everyone has equal Look at other programs who have looked at

access to services, how do we

targeted MSM of color

develop and implement community- Consider social marketing strategies

level approaches to reduce health

North Georgia
Barriers to access Younger people have a lot of denial "I feel
fine and my health is good, why do I want to

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disparities among young MSM of color?

Partner with community partner (e.g. Walgreens, Bruster's Ice Cream) (Augusta, GA)
Garner or request statewide support and resources (e.g. posters, postcards, billboards, test kits)
Get more access to surveillance data Partner with universities and colleges (as well as
high schools) Development of media materials (e.g. DVD) Offer HIV testing in high schools, but this will
encounter challenges with state boards of education Continuation of the county-by-county disparities report Include other health disparities (e.g. STD) Train staff Increase usage of the internet and social websites (e.g. Facebook) Increase condom distribution and partner services Use local media (e.g. radio, newspapers, television) Use someone who young MSM of color can identify with to link clients to services Change community perceptions Figure out where young MSM of color hang out and use those areas to promote services Conduct a community survey to ask young MSM of color what will it take to get them tested and into services Use community champions to get the word out and get people tested via health fairs Build positive rapport and trust with community leaders Use unconventional HIV testing sites

start meds?" Dalton: poor quality post-test counseling
"here's a brochure and off you go" People think there are not services, ADAP
wait list, Medicaid, Medicare Fear of rejection and stigma Lack of peer advocate program is a barrier due
to increased rapport with peer advocate program Location of clinic within health department is an issue due to confidentiality Other issues for patients and different priorities: housing, substance abuse, other health conditions also a challenge for retention Community approaches -Barriers to access Knowing what is available and give people the information they need Knowing where HIV clinics are Education with diagnosis so people do not think they can ignore diagnosis (it will go away if ignore diagnosis) and/or are scared because they do not want people to know Confidentiality and how to follow up Calling agency to get the referral Testing/screening: follow up care with linkage to stable relationship after diagnosis is given Culturally competent care immigrants, nonnative English speakers, transgender have a bad experience and do not return Transportation and insurance Peer advocates for tracking lost clients Clients need to "buy in" to their own care: may not mean medication adherence

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How do we develop and implement community-level approaches to reduce health disparities among African American women?

Women who are married who think they are at low risk and don't believe they need to be tested because they are married
Host women's health summit and sex education themed party
Church collaboration Partner with sororities More effective advertising Target married women Encourage women to request an HIV test when
they see their primary care doctor Target spas and gyms where women go for
general wellness and provide them with packets of information that includes HIV information Target and address night integration Empowerment messages, reduce dependency on partners Target nail and hair salons

Running reports to track and making contact (follow through) with lost clients
Home visits Case conferences Support groups if people will show up and
stay interested, view of consequences "scare tactics", people more likely to stay compliant More satellite clinics available for areas with more newly diagnosed clients Multiple services offered such as mental health, substance abuse
Less appointments and get more done (efficiency during visits, social stressors)
Marketing: having other services available and clients will come to see therapist, dentist and be compliant with those appointments.
New programs (in-between appointment) Washington state: kiosks set up in community with case manager present, phone, fax to fill out paperwork
Lack of funding is a barrier Clinics collaborating better together "playing
nice with each other/clinics" County structuring to reach more clients, be
most convenient restructuring districts for accessibility, customer services Differences between Part B (serve your district) and Part C who you are able to serve Serving people not directly in your district lines were not so strictly enforced at that time and there were more resources, new people not so willing to take new people on who are not in district Half the staff and more patients than someone

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State of Georgia 2012-2015 Statewide Comprehensive HIV Services Plan

else, would rather send to another district if that is more appropriate Looking at obstacles faced beforehand for people coming back into care Consistency with patients re-accessing due to going in and out of jail/prison Issues with transition from prison to clinic Lack of care in jail Publicizing services offered to hospitals and referral centers, locations of clinics Provider training and access to medications in hospitals for non-HIV providers Providing holistic care (other health department clinics not doing pap smears, treating syphilis in HIV-infected client) One reason may be would rather take care of non-HIV to be payor of last resort (protection of funding) Marketing having other services available clients will come to see therapist, dentist and be compliant with those appointments New programs ( between appointments) Washington (state) has kiosks set up in community with case managers, phone, fax to fill out paperwork Lack of funding is a barrier Clinics collaborating better "playing nice with each other/clinics" County structuring to reach more clients, be most convenient restructuring districts for accessibility, customer services Differences between Part B (serve your district) and Part C who you are able to serve Serving people not directly in your district
132

How do we develop and implement community-level approaches to reduce health disparities among Hispanic and Latino consumers?
State of Georgia 2012-2015 Statewide Comprehensive HIV Services Plan

lines were not so strictly enforced at that time and there were more resources, new people not so willing to take new people on who are not in district Half the staff and more patients than someone else, would rather send to another district if that is more appropriate Looking at obstacles faced beforehand for people coming back into care Consistency with patients re-accessing due to going in and out of jail/prison Issues with transition from prison to clinic Lack of care in jail Publicizing services offered to hospitals and referral centers, locations of clinics Provider training, access to medications in hospitals for non-HIV providers Providing holistic care (other health department clinics not doing pap smears, treating syphilis in HIV-infected client) One reason may be would rather take care of non-HIV to be payor of last resort (protection of funding) Language barrier Education of Hispanic serving workers (awareness of risk that HIV is a problem in this population) Roman Catholic religion is a barrier Cultural understanding of sexual orientation and fidelity "down low" Anti-immigration laws are a barrier Testimonies from previously-served members of community Bilingual staff
133

How do we develop and implement community-level approaches to reduce health disparities among adolescents?
State of Georgia 2012-2015 Statewide Comprehensive HIV Services Plan

Address issues with younger Hispanics/Latinos as may be more receptive
Use naturally occurring community centers Hispanic religious leader buy-in (outreach at
community centers, churches etc.) Bundle with other services that affect the
Hispanic community (HTN, DM, TB) Education of non-Hispanic workers to be
culturally competent Hispanic peers, though may be difficult to
recruit Overly generalizing and identifying
differences within the Latino community Making assumptions about literacy in Spanish
and education level Work more closely with providers that offer
HIV-related services Develop a transition plan for adolescents to
access services from adult-focused centers / clinics Use social media Street parties Use colleges and university student organizations to come up with innovative ideas to reach young people Tap into churches Use attention grabbing media Use scare tactics or more realistic consequences Parental education Use campaigns that reflect target audience
134

H. How the plan is coordinated with and adapts to changes that will occur with the implementation of the Affordable Care Act (ACA)
The intent of the Affordable Care Act (ACA) is to "expand health insurance coverage while also reforming the health care delivery system to improve quality and value." Other provisions include eliminating health disparities, increasing access to health care, expanding and improving the health care workforce, and encouraging consumer wellness. ACA presents both challenges and opportunities for Ryan White funded programs, including Part B. Beginning in 2014, most Ryan White clients will have health insurance coverage. Although the exact impact is not known at this time, Part B recognizes that new reimbursement systems will be in place, health homes will play a new role in health care, new investments will be made in community-based care, and changes will be made in the mission of and services provided by Ryan White programs.
To coordinate with and adapt to the changes that will occur with ACA in 2014, the State of Georgia's 2012-2015 Comprehensive Plan includes Goal 1, objective 1.2, of evaluating and responding to the impact of the ACA on systems and services in Ryan White Part B. HRSA directives, assessment reports, environmental changes, adjustments and modifications will be reviewed. In accordance with Goal 1, objectives 1.3 and 1.4, any changes or needed alignments will be communicated with health districts and consumers. System modifications will be monitored and further modifications made as needed. Ryan White Part B will continue to explore opportunities to coordinate services and increase collaboration with state, federal and local partners.
I. How the comprehensive plan addresses the goals of the National HIV/AIDS Strategy (NHAS), as well as which specific NHAS goals are addressed
The Georgia Part B Program's Comprehensive Plan is compatible with and addresses all three of the National HIV/AIDS Strategy (NHAS) 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.
Goal 1: Reducing the number of people who become infected with HIV.
To achieve this goal, the Georgia Department of Public Health (DPH) will increase HIV testing in clinical and nonclinical settings. This is in accordance with the State of Georgia 2012-2015 Goal 3 (increase linkage to care for individuals newly diagnosed with HIV infection, through coordination of counseling and testing with treatment). These testing efforts will target high risk populations throughout the state with special emphasis on those health districts that have been identified as having the highest concentrations of HIV cases. Health departments and organizations that receive support from DPH to conduct HIV testing in clinical or nonclinical settings are required to establish functional partnerships with HIV care and treatment providers in order to link those testing HIV-positive into care.

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DPH will also increase condom distribution in clinical and nonclinical settings to reach person at high-risk for HIV and those who are HIV-positive.
Goal 2: Increasing access to care and optimizing health outcomes for people living with HIV.
Starting in 2012, the Georgia Department of Public Health, HIV/AIDS Office will require that all newly diagnosed clients and those who have been "lost to care" be linked to HIV care, treatment, and prevention services using the Antiretroviral Treatment Access Study (ARTAS) intervention and/or other medical adherence interventions as deemed appropriate by the service provider. This is in accordance with the State of Georgia 2012-2015 Goals 1, 2 and 3 (improve access to HIV-related core services; improve the quality of HIV core services and health outcomes; increase linkage to care for individuals newly diagnosed with HIV infection, through coordination of counseling and testing with treatment). Linkage to care will be tracked and reported each month by HIV testing sites as part of contract requirements using the CDC-defined performance indicator CTR3: Linkage to Care. This indicator is calculated as the percent of newly identified, confirmed HIV-positive clients referred to medical care who attend their first appointment with a medical care provider with prescribing privileges. For those providers utilizing the ARTAS intervention, the Georgia Department of Public Health will use an Access Database, specifically tailored to ARTAS, to ensure that clients have successfully been linked to medical care and other social services with the first 90 days of diagnosis or enrollment. The Georgia Department of Public Health will also work with providers utilizing other interventions to develop similar tracking mechanisms.
Goal 3: Reducing HIV-related health disparities
This is in accordance with the State of Georgia 2012-2015 Goal 4 (reduce health disparities). Ryan White Part B addresses disparities in access and services among affected subpopulations and historically underserved communities through its identification of target populations and implementation of activities to eliminate barriers to counseling and testing, enrollment, and retention in treatment services. Ryan White Part B funds geographically located primary care sites, and access to other core medical and supportive services including medical transportation, peer counseling, and linguistic services.
J. Strategy to respond to any additional or unanticipated changes in the continuum of care as a result of state or local budget cuts.
The Georgia Part B Program's strategy to respond to any additional or unanticipated changes in the continuum of care as a result of state or local budget cuts is first to prioritize the services provided with state funds. Prioritization will be based on the Statewide Coordinated Statement of Need, local priority needs, consumer and provider input. The majority of state funding is allocated for the purchase of ADAP medications and to support the HICP and PCIP programs. In the event of a decrease, patient assistance programs will be utilized to ensure the continuity of the services provided.

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Ryan White Part B plans its allocations on a Ryan White funding award which would maintain the continuum of care. In times of uncertain funding, Part B recognizes the importance of planning for potential increases or decreases in the Part B award.
Section IV. How will we monitor our progress?
A. Plan to monitor and evaluate progress in achieving proposed goals and identified challenges.
Implementation, monitoring, and evaluation: Ongoing monitoring, input, and adjustment are critical in continuing to ensure that available HIV/AIDS resources in Georgia are maximized and the use of these resources are prioritized when changes to the system are needed. The State of Georgia FY 2012-2015 Comprehensive Plan Goals and Objectives will be monitored by the Part B Program staff, in collaboration with Prevention staff and colleagues across other Ryan White Programs. Progress will be evaluated based on the measures indicated in the document and periodic updates provided to colleagues throughout the state, particularly those participating in the recent meeting to establish the plan.
Each Objective of the State of Georgia 2012-2015 Comprehensive Plan contains strategies, time frame, measures, and identified parties responsible for implementation and evaluation. The State HIV Office will oversee coordination and collaboration of identified parties in achieving the stated goals and objectives of the Plan.
The HIV Office and Part B sub-recipients will continue generating reports from the CAREWare database to monitor consumer level utilization of core services. By complying with the Ryan White Services Report (RSR) reporting requirement, Part B funded health districts will continue entering client level data elements into CAREWare. Performance Measure (PM) reports generated in CAREWare continue to become more accurate and useful for quality improvement activities. RSR reports as well as PM reports are reviewed by the Part B Program staff and the QM Core Team to identify opportunities for quality improvement.
The Part B Program will continue utilizing CAREWare to report the RSR to HRSA. All Part B funded sub-recipients are required to use CAREWare for data collection. The Part B Program will participate in all HRSA training on client level data to assure understanding and compliance with reporting requirements. The Part B Program offers technical assistance to health districts providing outpatient/ambulatory medical care and medical case management services. The Part B Program will continue to collaborate with other Ryan White Parts to maximize opportunities for training and technical assistance
Part B health districts will continue reporting on progress toward goals and objectives via quarterly reports. The health districts are required to fulfill the quality management components of the Part B Program GIA contracts. Deliverables in the FY 2012 GIA Annex included QM Program requirements. These requirements include: Ensure that the medical management of HIV infection is in accordance with the U.S. Department of Health and Human Services (DHHS) HIV-related guidelines; develop and implement a quality management (QM) program that

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include the following: a written QM plan; a leader and team to oversee the QM program; organizational goals, objectives, and priorities; performance measures and mechanisms to collect data; project-specific continuous quality improvement plan (CQI); and communication of results to all levels of the organization, including consumers when appropriate; participate in the statewide Part B QM Program; and monitor performance measures as determined by the QM Core Team. Part B funded health districts will be encouraged to utilize the State of Georgia 2012-2015 Comprehensive Plan to develop local strategic plans and activities.
The QM Core Team completes the National Quality Center's (NQC) Part B Quality Management Program Assessment Tool at least annually. The QM plan is assessed using the NQC's Checklist for the Review of an HIV-Specific Quality Management Plan. The Core Team completes an annual assessment and subsequent revision of the QM plan and evaluates the QM Program on an annual basis including rating the completeness of strategies.
QM staff members annually review local QM plans including QI activities and progress on case management standards and performance measures. Members provide feedback regarding each plan and provide technical assistance as needed. Health districts monitor selected performance measures and report to the HIV Office. The Core Team reviews these measures and compiles reports.
District Liaisons monitor health districts for general programmatic performance measures and compliance with the GIA deliverables. HIV Nurse Consultants and the HIV Medical Advisor review HIV clinical charts in Part B-funded agencies for specific clinical performance measures. The QM Coordinator monitors sub-recipients for compliance with case management (CM) standards and performance measures. Findings are summarized and reported back to each site with a request for improvement plan based on findings.
Clinical performance measures will be monitored through the following methods: The QM program will continue to monitor the approved HAB performance measures in all 16 Part B funded public health districts at least annually. Starting in October 2009, the HAB performance measures were generated by site via the CAREWare performance measures module. Statewide averages are monitored and calculated through aggregating performance measures from all Part B districts. HAB performance measures are generated from the CAREWare preset performance measures module. Performance measures are also monitored via chart review.
During 2010-11, the Medical Advisor and Nurse Consultants initiated clinical chart reviews for the measurement period of calendar year (CY) 2009. A total of 697 charts were reviewed in 18 Part B clinics. Clinical measures selected for this chart review were the same as those from the CY2006 clinical chart reviews with a few additional measures from the new HAB clinical performance measures. The QM team utilized the Scantron Class Climate system for data collection during the CY2009 clinical chart reviews. Individual summary reports were sent to each district after the review. Districts are required to submit an improvement plan within 60 days of receiving the review report, and encouraged to incorporate the plan into the local QM plan. Clinical chart reviews will continue to occur every three years.

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ADAP and HICP will be evaluated through the following methods: ADAP will continue to monitor monthly indicators: 1) percentage of Georgia ADAP clients recertified for ADAP eligibility criteria at least annually, and 2) percentage of newly applying ADAP clients approved or denied within two weeks of ADAP receiving a complete application; and percentage of correctly completed new/recertification ADAP applications submitted to ADAP. Two new indicators were added in 2008 for HICP: percentage of active HICP clients recertifying before their six month due date to prevent delays in payment of health insurance premiums; and the percentage of correctly completed new/recertification HICP applications submitted to HICP. Administrative site visits will be conducted to monitor the validity of local ADAP programs. Data sources for the ADAP/HICP indicators are the customized Access database for ADAP applications, HICP Excel spreadsheets, CAREWare, and case management client records.
Fiscal Accountability will be evaluated through the following methods: The statewide accounting system, People soft, will be used to monitor all expenditures on a monthly basis to ensure accomplishment of program activities. A contract monitoring site visit tool was revised according to the new National Monitoring Standards to monitor HIV providers at the local level to ensure compliance. The tool enables state staff to review line items expenditures ensuring funds are expended appropriately.
Administrative and Case Management performance measures will be evaluated through the following methods: The HIV Care District Liaisons will continue to assess the programs' compliance with Ryan White guidelines and regulations by closely monitoring programmatic and fiscal requirements of all contracts and GIA awards including quality management requirements. They ensure QM/QI findings/reports are shared at public health districts meetings. The District Liaisons, at least annually, conduct administrative site visits at each Part B funded health district. During administrative site visits, District Liaisons assess the following: client's eligibility for Ryan White Part B-funded services and availability of other benefits; the clinic's sliding fee scale policy, grievance policy, client rights and responsibilities; clinic confidentiality and security procedures; submission of reports; and fiscal accountability. Upon completion of the performance review (administrative site visit), a summary of findings is sent to the HIV Coordinator and District Health Director. If corrective action is recommended by the state office, the district is expected to complete and submit an action plan that identifies key actions and time frames to improve program performance for those areas. Upon receipt of the final administrative report, the service provider has 45 days to submit their corrective action plan to the state office. If corrective action measures are not implemented within the specified timeframe, funding may be restricted.
Case management client chart review or performance measures reports in CAREWare will be utilized to monitor case management indicators. The QM Coordinator utilizes a chart review tool to monitor implementation of the approved Part B Program CM Standards and CM performance measures. The tool includes the following CM performance measures: ISP updated every 6 months, ISP signed and dated by the client and CM, completion of standardized Intake and Income/Expense Spreadsheet, follow-up of primary medical care and treatment adherence at least every 6 months, collaboration and coordination of services, face-to-face contact every 4 months, referrals and follow-up, goals established during assessment/reassessment. The QM

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Coordinator will make recommendations on methods to improve CM services and documentation based on findings from this chart review process. Upon receipt of the final chart review report, the service provider has 60 days to submit their corrective action plan to the state office.
Data sources for the administrative and case management indicators include: case management client charts, review of district level client satisfaction survey results, health district quarterly reports, QM plan reviews, and CAREWare.
B. How the impact of the Early Identification of Individuals with HIV/AIDS (EIIHA) initiative will be assessed.
The HIV Office developed a plan to educate and inform the Part B health districts of the need to develop strategies focusing on EIIHA. Part B Health District Applications are evaluated for coordination of services and linkage to care strategies as part of an environmental scan of all HIV prevention interventions, counseling and testing, and care and treatment sites in each local district. HIV Office staff will continue participation in the EMA's Early Identification Workgroup (EIW) quarterly meetings. Participants include leadership of Parts A, B, C, and D; Southeast AIDS Training and Education Center (SEATEC); State HIV Prevention Program including the Georgia Community Planning Group; HIV Surveillance Program; HIV Testing/Partner Services Program; Centers for Disease Control (CDC); City of Atlanta Housing Opportunities for People with AIDS (HOPWA); Enhanced Comprehensive HIV Prevention and Implementation for MSA most affected by HIV/AIDS Group (ECHPP); and federal and state funded agencies for counseling and testing and prevention activities.
Georgia recognizes the need to widely promote routine HIV testing by creating more testing opportunities, both conventional and rapid, and to improve systems for linking newly identified clients to care that extends beyond the initial doctor visit. The Ryan White Program, along with the Georgia Department of Public Health HIV Prevention section collaborates to increase HIV testing opportunities for disproportionately affected populations, by providing HIV testing services in high prevalence areas of the state and actively linking individuals identified as HIV positive, to appropriate clinical care and supportive services.
The DPH HIV Prevention section will partner with Ryan White Clinics to promote routine HIV testing to high risk populations throughout the state and provide linkage to care to those newly diagnosed. Georgia DPH will comply with and follow the national-level objectives and performance standards for HIV testing and linkage to care activities: At least 85% of persons who test positive for HIV receive their test results; At least 80% of persons who receive their HIV positive test results are linked to medical care and attend their first appointment; At least 75% of persons who receive their HIV positive test results are referred and linked to Partner Services (PS).
EIIHA HIV testing and awareness data is evaluated at both the state and local levels. The HIV Office requests that local health districts evaluate HIV counseling and testing data to determine individuals who tested confidentially and did not receive test results. Each site will be advised to

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follow established protocols for contacting individuals. In addition, the HIV Office requests that local health districts determine individuals with preliminary positive test results, who did not receive a confirmatory test, in order to follow-up with individuals or referral sites to verify results of confirmatory test.

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Appendix 1

Georgia Statewide Coordinated Statement of Need Meeting Marriott Century Center Hotel Atlanta, GA May 2-3, 2012

AGENDA

Wednesday, May 2, 2012

General Session Centennial Ballroom

12:00 l:15 PM 1:15 1:30 PM

Registration (Lunch on Your Own) Centennial A Foyer
Welcome J. Patrick O'Neal, MD Director of Health Protection Georgia Department of Public Health (DPH)
L. William Lyons, BS State AIDS Director Georgia Department of Public Health

1:30 1:45 PM 1:45 2:30 PM

Purpose and Overview of the Day Jim Sacco, LCSW Meeting Facilitator
2009-2012 Comprehensive Plan Update
Brief Summary on Plan Progress Michael Coker, MSN, RN, ACRN
Quality Improvement for Cervical Cancer Screening Christie Sims, RN, APRN, WHNP-BC
HIV/AIDS Prisons/Release Program Chayne Rensi, MPH Georgia Department of Corrections

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2:30 3:00 PM BREAK Back of Centennial Ballroom

3:00 4:15 PM
4:15 - 5:00 PM 5:00 5:15 PM 5:15 5:30 PM

HIV/AIDS in Georgia Y. Omar Whiteside, MSPH Georgia Department of Public Health
Michael DeMayo, MPH Southeast AIDS Education and Training Center
Jeffrey Moody District Liaison
Overview of the National HIV/AIDS Strategy and Its Impact on Georgia
Donato Clarke, BA Georgia Department of Public Health
Overview of Day 2 Activities and Brief Update on New Goal Direction Jim Sacco, LCSW Meeting Facilitator
Wrap-up/Adjourn for Day Jim Sacco, LCSW Meeting Facilitator

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Georgia Statewide Coordinated Statement of Need Meeting Marriott Century Center Hotel Atlanta, GA May 2-3, 2012

AGENDA

Thursday, May 3, 2012

8:00 9:00 AM Registration and Breakfast - Centennial Foyer

9:00 9:15 AM

Overview of the Day/ Review of Day One Centennial Ballroom Jim Sacco, LCSW Meeting Facilitator

9:15 12:00 Noon

Breakout Session 1 - Centennial Ballroom and Breakout Rooms Men's Consumer Focus Group Women's Consumer Focus Group Healthcare Providers' Focus Group Administrators' Focus Group Social Services Providers' Focus Group

12:00 1:00 PM LUNCH Back of Centennial Ballroom

1:00 1:15 PM

Report Out Centennial Ballroom Jim Sacco, LCSW Meeting Facilitator

1:15 3:00 PM

Breakout Session 2- Centennial Ballroom and Breakout Rooms By Geographical Area

3:00 3:15 PM BREAK Back of Centennial Ballroom

3:15 3:30 PM

Wrap-up/Evaluation-Centennial Ballroom Jim Sacco, LCSW Meeting Facilitator

3:30PM

Adjourn

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Appendix 2
Georgia's 2012 Statewide Coordinated Statement of Need Consumer Focus Group Facilitator's Guide
As participants arrive Greet participants as they arrive. Ask them to take a seat and make themselves comfortable. (If there are refreshments, encourage them to help themselves)
Ask participants, if they have not already, to complete the profile questionnaire while they wait for the focus group to begin. Explain that the questionnaire will provide us information about their background and that this information will be used for descriptive purposes only. In other words, their name will not be in the survey, and we will never use any identifying information such as their name or the name of the agency where they get services in any of our reports.
For those participants who have not signed the informed consent, please have them do so at this time. Please read the consent forms to the participant since some people are reluctant to sign documents unless they have full understanding of what they are signing.
Be sure that participants who arrive later in the session also complete these forms.
Facilitator's Guidance
The focus group discussion will address the following four areas:
What is working well? (Met needs) Gaps/Needs Why do gaps exist? (Barriers) Future Issues/Emergent Needs
Prior to the start of morning focus groups, printed summaries of stakeholder comments that were captured during the 2008 SCSN meeting will be given to each facilitator for distribution to focus group participants. The summary tables will serve as a point of reference for the group discussion.
At the end of each topic discussion, except the last one, ask the group to identify up to five main points from that discussion. If they identified less than five points that is fine. The facilitator should spend approximately 40 minutes on each section. Thirty minutes should be spent on the discussion and input and 10 minutes to summarize the main discussion points.
At the end of the session, the facilitators/recorders will summarize the main points for each topic on a flip chart sheet (one sheet per topic). Post these summary sheets on the walls of the main meeting room.
Recorders will deliver their laptops to Deb Bauer. Leave the remaining flip chart sheets from the first three topic discussions in the room.
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Introduction
1. Introduction of facilitator and note taker
Welcome and thank you for coming today. My name is _____________ and this is ________. We are from ____________. I will be leading today's discussion. My role, for the most part, is to make sure that we get through our agenda, keep to the time frame, and make sure that everyone has a chance to participate. __________ will help me through the process, and s/he will also be taking notes. The discussion session today will take about two hours.
2. Participant Introductions
Now, let's go around the room and have each of you introduce yourselves; give your first name and any other information about yourself you want to share with the group.
3. Purpose of Focus Group Session
We have asked you here to talk about your experiences in seeking and receiving services both about the things you like and the problems you may have encountered. We are also interested in hearing about other services or help you may need that you are not currently receiving. At the end of all except the last the topic discussion, we will ask each of you to rank your top 5 priorities.
4. Confidentiality
All of the information we collect here today is confidential. We will not identify any of the participants. Confidential means we will not use your name, address, or any other identifying information in reports or other materials related to this process.
Instructions
Let me begin our discussion by reviewing a few things about how we will conduct the session.
During this discussion, we would like you to focus on topics that are of particular interest to the SCSN process. We are interested in what everyone has to say about our discussion topics. Occasionally, I may have to interrupt the discussion in order to bring us back to a particular topic to make sure that we cover everything on the agenda.
There are several common-sense guidelines that we will follow during this session:
1. We want all of you to express your opinions about the discussion topics. We are interested in multiple points of view about them. There are no right or wrong answers, and we are not here to resolve any issues you may bring up.
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2. Please do not hold side conversations. We want to be able to hear from everyone, and side conversations will disrupt the discussion. We want to make sure that we hear what everyone has to say. Because we are also recording the session, it would really help us if you could speak up so that everyone can hear you.
3. Please respect what each other has to say, because each comment is equally important. Do you have any questions so far? Let's begin.
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Focus Group Topics
What is working well?
(Approx. 40 minutes total, 30 minute discussion, and 10 minute summary of main points)
Discussion Questions What services are working well for persons living with HIV/AIDS in
Georgia? What services are meeting the needs of persons living with HIV/AIDS in
GA?
Main Points Out of what we discussed, please rank up to your top five priorities. (Use
colored dots to rank on flip chart paper)
Gaps/Needs
(Approx. 40 minutes total, 30 minute discussion, and 10 minute summary of main points)
Discussion Question During the 2008 meeting, the following were identified as gaps and/or needs
(refer to summary table). Do these the gaps and/or needs in the provision of services for persons living with HIV/AIDS in Georgia still exist? Are there additional gaps/needs in the provision of services for persons living with HIV/AIDS in Georgia?
Main Points Out of what we discussed, please rank up to your top five priorities. (Use
colored dots to rank on flip chart paper)
Why do you think these gaps are occurring? (Barriers)
(Approx. 40 minutes total, 30 minute discussion, and 10 minute summary of main points)
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Discussion Questions Why do you think the gaps occur for each gap indentified above? Are there other obstacles/barriers that discourage or prohibit persons living
with HIV/AIDS from receiving care?
Main Points Out of what we discussed, please rank up to your top five priorities. (Use
colored dots to rank on flip chart paper)
Future Issues and Emergent Needs
(Approx. 30-40 minute discussion)
Discussion Question During the 2008 meeting, the following were identified as (refer to summary
table list) the top issues on the horizon that will significantly impact both the provision of services and the level of need for persons living with HIV/AIDS in Georgia? Are these still the top issues that will significantly impact both the provision of services and the level of need for persons living with HIV/AIDS in Georgia? Are there additional issues on the horizon that will significantly impact both the provision of services and the level of need for persons living with HIV/AIDS in Georgia?
NOTE: DO NOT RANK THIS LIST
Thank you very much for participating in this focus group. The information you have provided has been very helpful. This information will be used to help better make informed decisions about service priorities and the use of resources.
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Appendix 3
Georgia's 2012 Statewide Coordinated Statement of Need Facilitator's Guide
Healthcare Providers / Administrators / Social Services Providers Breakout Session 1
9:15 a.m. to 12:00 p.m.
Non-consumers will be divided into three groups (Healthcare Providers, Administrators & Social Services Providers). Guide participants to their area/breakout room. Ask them to take a seat and make themselves comfortable. (If there are refreshments, encourage them to help themselves.) Let them know that there is no official break but they are free to step outside the room if needed. Introduce yourself. Have the recorder, note taker and participants briefly introduce themselves.
Facilitator's Guidance
The focus group discussion will address the following four topics:
What is working well? (Met needs) Gaps/Needs Why do gaps exist? (Barriers) Future Issues/Emergent Needs
Prior to the start of morning focus groups, printed summaries of stakeholder comments that were captured during the 2008 SCSN meeting will be given to each facilitator for distribution to focus group participants. The summary tables will serve as a point of reference for the group discussion.
At the end of each topic discussion, except the last one, ask the group to identify (using colored dots) up to five main points (fewer is OK) for that topic that will be used for the afternoon report out.
The facilitator should spend approximately 40 minutes on each of the four areas. About thirty (30) minutes should be spent on the discussion and input. Then spend about 10 minutes to summarize the main discussion points.
Remind the group to focus on realistic issues/needs in the current environment of flat or decreased funding. The goal is not to create a wish list, but to develop a realistic plan.
At the end of the session, the facilitators/recorders will summarize the main points for the topics on flip chart sheets. Post these summary sheets on the walls of the main meeting room.
Recorders will deliver their laptops to Deb Bauer. Leave the remaining flip chart sheets from the first three topic discussions in the room.
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Introduction
5. Introduction of facilitator and note taker
Welcome and thank you for coming today. My name is _____________ and this is ________. We are from ____________. I will be leading today's discussion. My role, for the most part, is to make sure that we get through our agenda, keep to the time frame, and make sure that everyone has a chance to participate. __________ will help me through the process, and s/he will also be taking notes. The discussion session today will take about two hours.
6. Participant Introductions
Now, let's go around the room and have each of you introduce yourselves; give your first name and any other information about yourself you want to share with the group.
7. Purpose of Focus Group Session
We have asked you here to talk about your experiences in seeking and receiving services both about the things you like and the problems you may have encountered. We are also interested in hearing about other services or help you may need that you are not currently receiving. At the end of all except the last the topic discussion, we will ask each of you to rank your top 5 priorities.
8. Confidentiality
All of the information we collect here today is confidential. We will not identify any of the participants. Confidential means we will not use your name, address, or any other identifying information in reports or other materials related to this process.
Instructions
Let me begin our discussion by reviewing a few things about how we will conduct the session.
During this discussion, we would like you to focus on topics that are of particular interest to the SCSN process. We are interested in what everyone has to say about our discussion topics. Occasionally, I may have to interrupt the discussion in order to bring us back to a particular topic to make sure that we cover everything on the agenda.
There are several common-sense guidelines that we will follow during this session:
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4. We want all of you to express your opinions about the discussion topics. We are interested in multiple points of view about them. There are no right or wrong answers, and we are not here to resolve any issues you may bring up.
5. Please do not hold side conversations. We want to be able to hear from everyone, and side conversations will disrupt the discussion. We want to make sure that we hear what everyone has to say. Because we are also recording the session, it would really help us if you could speak up so that everyone can hear you.
6. Please respect what each other has to say, because each comment is equally important. Do you have any questions so far? Let's begin.
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Focus Group Topics
What is working well?
(Approx. 40 minutes total, 30 minute discussion, and 10 minute summary of main points)
Discussion Questions
During the 2008 meeting, the following were identified (refer to printed summary table) as services that were working well for persons living with HIV/AIDS in Georgia. Are these services still working well of persons living with HIV/AIDS in Georgia?
Are there any additional services working well for persons living with HIV/AIDS in Georgia?
Main Points
Out of what we discussed, please rank up to your top five priorities. (Use colored dots to rank on flip chart paper)
Gaps/Needs
(Approx. 40 minutes total, 30 minute discussion, and 10 minute summary of main points)
Discussion Question
During the 2008 meeting, the following were identified (refer to printed summary table) as gaps in the provision of services for persons living with HIV/AIDS in Georgia. Do these gaps in the provision of services for persons living with HIV/AIDS in Georgia still exist?
Are there additional gaps in the provision of services for persons living with HIV/AIDS in Georgia?
Main Points
Out of what we discussed, please rank up to your top five priorities. (Use colored dots to rank on flip chart paper)
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Why do you think these gaps are occurring? (Barriers)
(Approx. 40 minutes total, 30 minute discussion, and 10 minute summary of main points)
Discussion Questions
Why do you think the gaps occur for each gap identified? Are there other obstacles/barriers that discourage or prohibit persons living
with HIV/AIDS from receiving care?
Main Points
Out of what we discussed, please rank up to your top five priorities. (Use colored dots to rank on flip chart paper)
Future Issues and Emergent Needs
(Approx. 30-40 minute discussion)
Discussion Question
During the 2008 meeting, the following were identified (refer to summary table) as the top issues on the horizon that will significantly impact both the provision of services and the level of need for persons living with HIV/AIDS in Georgia? Are these still the top issues that will significantly impact both the provision of services and the level of need for persons living with HIV/AIDS in Georgia?
Are there additional issues on the horizon that will significantly impact both the provision of services and the level of need for persons living with HIV/AIDS in Georgia?
NOTE: DO NOT RANK THIS LIST
Thank you very much for participating in this focus group. The information you have provided has been very helpful. This information will be used to help better make informed decisions about service priorities and the use of resources.
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Appendix 4

Georgia's 2012 Statewide Coordinated Statement of Need Facilitator's Guide

Consumers/Healthcare Providers / Administrators / Social Services Providers Breakout Session 2
1:15 p.m. to 2:45 p.m.

Participants will be divided into five geographical groups and will develop broad action statements and strategies for their assigned barriers and/or issues. A facilitator will lead group discussion. A note taker will capture the action statements and strategies developed by the group. Guide participants to their area/breakout room. Ask them to take a seat and make themselves comfortable. (If there are refreshments, encourage them to help themselves.) Let them know that there is no official break but they are free to step outside the room if needed. Have the facilitator, note taker and participants briefly introduce themselves.

Facilitator's Guidance

The group's task is to help identify strategies to address how GA is going to meet expectations to

maintain and improve the system of HIV care. The focus group discussion will develop broad

action statements and/or strategies for each assigned barrier/issue:

Barrier/Issues

Assigned Groups

Identifying individuals who know their status but are not in care,

North Georgia, Metro Atlanta Group

informing them about available treatment services and bringing them 1

into care.

How do we help persons, who know their status and are not in care,

access care?

How do we help them stay in care and fully participate in their care? Coordinate the provision of services programs for HIV prevention, including outreach and early intervention services.

South Georgia

How can we better coordinate HIV care and prevention services? Prevention and treatment of substance abuse.

South Georgia

How can we better provide or link to substance abuse prevention services?

How do we improve access to substance abuse treatment? Eliminating disparities in access to core medical services and support services (In terms of sub-populations, hard to reach populations, and those historically underserved) Realizing that not everyone has equal access to services, how do we ensure that everyone has access to care and services?

Metro Atlanta Group 2, and Middle Georgia

155

Appendix 5 156

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Appendix 6 RESOURCE INVENTORY

Provider

Service Area

A Friend's House Adult Health Clinic Adult Health Promotion Clinic AID Atlanta AID Gwinnett AIDS Alliance of Northwest Georgia AIDS Coalition of Northeast GA AIDS Law Project
AIDS Legal Project AIDS Research Consortium of Atlanta (ARCA) Al-Anon Family Groups Alateen Groups
Albany Area Primary are, Inc. Alcoholics Anonymous

Macon Tifton Tifton City HD Valdosta (testing in 10 co.) Atlanta EMA Atlanta EMA Northwest Georgia North Georgia
Middle Georgia Macon Atlanta
Atlanta
Atlanta
Atlanta Access website alanonatl.com Albany
Atlanta

X

X

X

X

X XX X XX

X X

X

X

X XX

X X

X

X XX

X X

X XX

X X X X

X XX X X X X X

X X

X

X X

X X X X
X X

X

X

X X

X

X X

X X

X

X

X X X X X

X X X X

X X

157

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Alpha and Omega AIDS Foundation AM Ministries
ANIZ, Inc. Another Chance
Atlanta Area Service Group
Atlanta Harm Reduction Center
Atlanta Legal Aid Society Atlanta Outreach Projects Atlanta Union Mission Men and Women Homeless Shelters Atlanta Urban Ministries Beulah Grove Church Bridge, the Bulloch Wellness Center Care and Counseling Center of Georgia

Atlanta
Rome, Griffin, Carrollton, Dalton, Gainesville, LaGrange Atlanta Buford, GA Thrift Shop Metro Atlanta and around Georgia Atlanta
Atlanta
Atlanta
Richmond County North Georgia Bulloch, Candler, Evans Co. Atlanta

XX X XX X X XX X X

X

X

X X

X

X XX

X

X X
X X X X X X
X
X X X
X

X X X
X X
X X X X
X X X X
158

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Center for Black Atlanta Women's Wellness

X

Center for Family Atlanta (one time

Resources

rent and utility

assistance)

Center for Family Atlanta

Resources Cobb

Center for Pan-

Atlanta EMA

Asian Community

X X

Services

CEPTA (Center for Atlanta EMA

Education,

Treatment, and

X X

Prevention of

Addiction

Central City AIDS Macon Network

X XX

Chatham County Board of Health

Chatham & Effingham Co.

X XX

Childkind, Inc.

Atlanta

City of Refuge

Warner Robins

X

Clarke County

Barrow, Clarke,

Board of Health

Elbert, Greene,

Jackson,

Madison,

X XX

Morgan, Oconee,

Oglethorpe,

Watson Co.

Clayton College Clayton (cleaning

and State

and x-rays only)

University Dental

Hygiene

Department

X X

X

X

X XX

X

X

X

X X

X X

X X

X

X XX X X X

X

X

X

X X

X XX X X X X X X

X

X X X X

X X X

X

X

X

X X X X X X X

X

X X X

X

X

X X X X X X

159

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Clayton County Board of Health Clayton Mental Health Substance Abuse Center Clifton Sanctuary Ministries Shelter Cobb and Douglas Board of Health
Coffee Wellness Center Columbus Dept. of Public Health
Comprehensive AIDS Resource Encounter Inc. (CARE) CSRA EOA
CSRA AIDS Resources and Education, Inc. (CARE)

Clayton Co.
Clayton Co.
Atlanta
Cobb & Douglas Co. Atlanta EMA (Part A) Douglas
Chattahoochee, Clay, Crisp, Dooly, Harris, Macon, Marian, Muscogee, Quitman, Randolph, Schley, Stewart & Sumter, Talbot. Taylor &Webster Co. Jesup/ Southeast Georgia
Richmond County Central Georgia

X XX X X
X X
X X X

X XX

X

X

X X

X X X

X XX X X X X X

X XX

X

XX X X X

X X X

X X X
X X

X X X X
X X X X
160

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

DeKalb Addiction Clinic DeKalb Board of Health
DeKalb Board of Health Early Care Clinic DeKalb Community Service Board at Kirkwood DeKalb Prevention Alliance Diversity House Project Dougherty County Board of Health
Douglasville Community Health Center Edgewood Medical Center, Inc. Edgewood SRO Ella Mae Thomas House

DeKalb
DeKalb Atlanta EMA (Part A) DeKalb County
DeKalb
Macon
Baker, Calhoun, Colquitt, Decatur, Early, Grady, Lee, Miller, Mitchell, Seminole, Terrell, Thomas and Worth Counties Douglasville
Stone Mtn.
Atlanta Atlanta

X X XX X X X X X X X X X

X

XX X X

X X X

XX X X

X XX

X X

X X

X

X

X

X

XX X X X

X X

X X

X

X X

X

X

X X X

X

X

161

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Empowerment Resource Center, Inc. Emory Psychological Counseling Center Emory University Hospital Midtown Infectious Disease Clinic Extended Sisters Families First Feed the Hungry Foundation Feminist Women's Health Center First Call for Help First Metropolitan Community Church Floyd County Board of Health
Fulton County Health Dept. IL Furniture Bank Gateway Center Gay and Lesbian AA Club Galano

Atlanta
Atlanta
Atlanta
Columbus Atlanta Atlanta
Atlanta
Atlanta Atlanta
Bartow, Catoosa, Chattooga, Dade, Floyd, Gordon, Haralson, Paulding, Polk and Walker counties Fulton, Atlanta EMA (Part A)
Atlanta

X X
X X
X X

X X
X X X XX X
XX X X X XX X X X

X X X
X X X

X
X X X X

X

X X X

X

X

162

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Genesis Shelter for women and newborns Georgia Council for the Hearing Impaired Georgia Crisis and Access Line (GCAL) Georgia Department of Corrections Georgia Law Center for the Homeless Georgia Legal Services Atlanta Georgia Mutual Assistance Association Consortium Georgia Perimeter College Dental Hygiene Clinic Georgia Regional Hospital Georgia State University Psychology Clinic Georgia Therapy Associates, Inc. Gift of Grace Home

Atlanta
Atlanta, Statewide
Statewide
Statewide Statewide services for refugees and immigrants Atlanta
Atlanta Atlanta
North Central Georgia Atlanta

X X

X X X X
X X
X X X

X

X

X X X X

X
163

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Glynn Board of Health
God's House of Human Services, Inc. Grady Health System, Infectious Disease Program Grady Women's Health Services
Gwinnett County Board of Health
Gwinnett County Mental Health Center Hall County Board of Health

Bryan, Camden, Liberty, Long, McIntosh, Glynn Co. Albany
Atlanta EMA
Fulton and DeKalb Counties/Atlanta EMA Gwinnett, Newton, Rockdale counties Gwinnett
Banks, Dawson, Forsyth, Franklin, Habersham, Hall, Hart, Lumpkin, Rabun, Stephens, Towns, Union, and White Co.

X X X
X XX X

X XX X

X

X

X

X

X X X X X X X

X XX X X X X X

X XX X X X X

X X X X

X X X X X X X

X

X X X X X

X

X

164

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Haven of Hope
Hemophilia of Georgian
H.E.R.O for Children H.O.P.E. Atlanta Programs of Travelers Aid of Metro Atlanta HIV/AIDS Legal Project HIV Outpatient Services HIV Outpatient Services Home But Not Alone Hope Center
J&S Consultants

Carroll, Heard, Troup, Meriwether, Pike, Upson, Lamar, Spalding, Butts, Henry, Fayette, Coweta Co. Statewide (for people with bleeding disorders and their partners)

X X

Central and South Georgia Savannah Savannah Chatham CHD Waycross

Atlanta

Macon, Warner

Robins, Fort

Valley,

X X

Milledgeville,

surrounding areas

Macon

X

X

X X

X

X

X

X

X

XX X

X

X XX

X XX X X X

X

X

X X

X X

X X

X X X
X

165

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Jerusalem House Jewish Family and Career Services Juxtaposed Center for Transformation Kirkwood Mental Health Clinic La Gender Lanier Tech Dental Hygiene Clinic

Atlanta
Atlanta Atlanta North Georgia

X X XX
X

Lauren County Board of Health
Legacy House Legacy Village Link Counseling Center Living Room Lowndes County Board of Health

Bleckley, Dodge,

Johnson,

Laurens,

Montgomery, Pulaski, Telfair,

X

Treutlen,

Wheeler, and

Wilcox Co.

Atlanta

Atlanta

Atlanta and Marietta

X

Atlanta EMA

Ben Hill, Berrien,

Brooks, Cook,

Echols, Irwin, Lanier, Lowndes,

X

X X

Tift, and Turner

Co.

X

X

X

X

X X

X

X

X

XX X

X

X

X

X

X

X X X

X XX X X X

X

X

X

X X X X

X

X

X X X X X

X

X X X

166

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Macon-Bibb Board of Health
Matthew's Place Medical College of Georgia Adult ID Clinic Medical College of Georgia Dental Clinic Medical College of Georgia Pediatric ID Clinic Medical College of Georgia Title III-B Michelle Antionette Jones Crisis Center, Inc. Midtown Assistance Center Morehouse School of Medicine, PADP IMANI Project Morehouse School of Medicine Narcotics Anonymous

Baldwin, Bibb, Crawford, Hancock, Houston, Jasper, Jones, Monroe, Peach, Putnam, Twiggs, Washington, and Wilkerson Co. Atlanta Central Georgia/ Richmond County Central Georgia/ Richmond County Central Georgia/ Richmond County Richmond County Atlanta
Atlanta
Atlanta EMA
Atlanta
Metro Atlanta and GA

X XX X X X X

X X

X X

X XX X X

X

X

X

X

X

X

X

X X

X XX

X X

X X

X X X

X X X

X

X

X X X

X X

X

X

X X X X

167

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

National AIDS Education and Services for Minorities National Black Men's Health Network New Start

Atlanta Atlanta Atlanta

North DeKalb Mental Health Center Part of Dekalb Community Services North Fulton Regional Health Center Northside Behavioral Health Northwest Georgia Specialty Care Clinic
Oakhurst Recovery Program Outreach, Inc. Planned Parenthood Planned Parenthood

DeKalb
North Fulton
Atlanta
Bartow, Catoosa, Chattooga, Dade, Floyd, Gordon, Haralson, Paulding, Polk, Walker Co. Atlanta
Atlanta Central Georgia
Savannah, Southeast Georgia

XX X X

X

X

X X

X

X X

X X X X

X X

X X X

X

X

X

X X
X
X X

X

X X

X

X
168

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Planned Parenthood of Georgia Positive Impact Positive Response
PrimeCare of Augusta Home Health Care Only Project Open Hand Atlanta
Raksha, Inc.
Recovery Consultants of Atlanta

Atlanta
Atlanta EMA Carroll, Coweta, Fayette and Spalding counties Central Georgia
Atlanta plus limited areas in Cobb, Clayton, Gwinnett Co. Atlanta assistance for immigrants from India, Pakistan, Bangladesh, Bhutan, Nepal, Sri Lanka

X X X

X X X X X XX

X X

X XX X X

X X X X X

X

X

X

X X

X

X

X

169

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Richmond County Burke, Columbia,

Board of Health

Emanuel,

Glascock,

Jefferson,

Jenkins, Lincoln, McDuffie,

X

Richmond,

Screven,

Taliafero, Warren

and Wilkes Co.

Road to Recovery Atlanta

X

Rome AIDS

Rome

Resource Council

X

Ropheka Rock of the World, Inc.

Atlanta

X

Salvation Army

Atlanta

Secular

Atlanta

Organizations for

Sobriety (SOS)

Sharing and

Toombs, Jeff

Caring, Inc.

Davis, Appling,

Tattnall Co.

Shepherd's Inn

Atlanta

Shrine of the

Atlanta

Immaculate

Conception

SisterLove, Inc.

Atlanta EMA

X X

Someone Cares, Inc.

Atlanta

X XX

Southeast AIDS

Atlanta and GA

Training and

Education Center

(SEATEC)

XX X X X

X

X

X X X X
X

X X X
X X X
X X
X X X

X

X

X X

X X X

X

X X

X

X

X

X

170

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Southside Medical Care Substance Abuse Center St. Ann's AIDS Ministry St. Joseph's Mercy Care St. Jude's Recovery Center St. Mark United Methodist Church St. Stephen's Ministry St. Thomas the Apostle St. Vincent de Paul Society Stand Inc. Sullivan Center
Task Force for the Homeless Toombs Wellness Center
Travelers Aid of Metro Atlanta

Atlanta
Cobb and North Fulton Atlanta EMA
Atlanta
Atlanta
Augusta
South and West Cobb Atlanta
Clayton, DeKalb, and Fulton Co. Atlanta
Toombs, Jeff Davis, Appling, Tattnall Co. Atlanta

X X X
X
X XX

X XX X
X X X X
X XX X

X X
X X X X X X
X X X

X

X

X X

X

X

X X

X

X X X

X

X X X
X

X

X

X

171

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Troup County

Butts, Carroll,

Board of Health

Coweta, Fayette,

Heard, Henry,

Lamar, Meriwether,

X

XX X

X

X

Pike, Spalding,

Troup and Upson

Co.

Union Mission Phoenix Project

Savannah

X

Unique

Soperton

Community

X

Women's Club

United Hospice of Macon Macon

X

University of

Athens students

Georgia Student only

X

X

Health Center

University Hospital Augusta, Central

Retroviral Disease Georgia

X

X

X

Outpatient Clinic

Veterans Affairs Statewide

Medical Center ID veterans only

X

X XX

X X

Clinic

Visiting Nurse

Atlanta EMA

X

X

X

X X X
X

172

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

Provider

Service Area

Ware County

Appling,

Board of Health

Atkinson, Bacon,

Brantley,

Bulloch, Candler,

Charlton, Clinch, Coffee, Evans,

X

X X

Jeff Davis,

Pierce, Tattnall,

Toombs, Ware,

and Wayne Co.

Ware Wellness

Ware, Pierce,

Center

Charlton,

X XX

Brantley Co.

Wayne Wellness Center nm

Wayne Co. In Jessup

X XX

Welcome House Atlanta

X

Wellness Clinic

Bryan, Camden,

Liberty, Long, McIntosh, Glynn

X XX X

X

Co.

Whitfield County Cherokee,

Board of Health

Fannin, Gilmer,

Murray, Pickens, X

XX X X

X

X X

and Whitfield

Co.

Wholistic Stress Control

Atlanta

X

X X

Winn Way Mental DeKalb Health Center

X

X

Women's

Atlanta

Resources Center to End Domestic

X

X X

Violence

173

174

* Many providers that offer HIV medical care work with local Obstetrician and Gynecologists (OB/GYNs) to provide care for HIV positive pregnant women.

Child care Legal services Transportation assist. Food/Nutrition assist. Housing assistance Financial assistance Translation assistance Emergency assistance OB care for + women* Hospice Home Health Substance abuse tx. Mental health co. Support groups Case management Medications Dental Care HIV medical care Counseling & testing Health ed/risk reduction. Peer education/co. Outreach/case finding Early intervention services.

X

Atlanta

Service Area

World Youth Alliance, Inc.

Provider

Additional Resources for People Living With HIV/AIDS
HIV/AIDS Information Lines/Hotlines and General Information AID Atlanta Educational Outreach Aniz Centers for Disease Control and Prevention Information Network (NPIN) Centers for Disease Control and Prevention National STD/AIDS Hotline Cocaine Anonymous Hotline Feminist Women's Health Center Georgia AIDS/STD Information Line Georgia Crisis and Access Line (GCAL) central access point to connect youth and adults to
local services for mental health, addictive diseases and developmental services Georgia Interpreting Services Network Healthy Mothers/Healthy Babies PowerLine Helpline Georgia H.O.P.E. Atlanta Programs of Travelers Aid of Metro Atlanta Project Inform HIV Treatment Hotline Public Health Information Line United Way 2-1-1 Call Center
Advocacy AID Gwinnett (client services, including Hispanic services) Gwinnett, Rockdale, Newton AIDS Alliance for Faith and Health AIDS Survival Project statewide advocacy training through Positive Action Network Al-Anon Family Groups ANIZ, Inc. Atlanta Atlanta Legal AID Society AIDS Legal Project Caminar Latino, Inc. Hispanic services Committee of Ten Thousand (grassroots nonprofit advocacy and policy group for people who
contract HIV and/or HCV through blood products) Feminist Women's Health Center Georgia Equality Juxtaposed Center for Transformation Mothers' Voices/Atlanta Chapter Positive Outlook Foundation Project Inform HIV Treatment Hotline St. Vincent de Paul Society SisterLove, Inc. Stand Inc. Vocational Rehabilitation Services
175

Clinical Research AIDS Research Consortium of Atlanta (ARCA) Emory Center for AIDS Research (CFAR)
Hope Clinic of the Emory Vaccine Center Emory University Hospital Midtown Infectious Disease Clinic Georgia AIDS/STD Information Line Grady Health System Ponce de Leon Center/Infectious Disease Program Emory AIDS
Clinical Trials Unit and Ponce Center Family and Youth Clinic Pediatric HIV Clinical Trials SHARE Project Veterans Affairs Medical Center ID Clinic (available only to veterans)
Spiritual Support AIDS Alliance for Faith and Health Al-Anon Family Groups Care and Counseling Center of Georgia Concerned Black Clergy of Metropolitan Atlanta Congregation Bet Haverim First Metropolitan Community Church Greater Piney Grove Baptist Church Hillside Chapel and Truth Center Life Ministry Jewish Family and Career Services Your Tools for Living Lutheran Church of the Redeemer Lutheran Services of Georgia North Decatur Presbyterian Church AIDS Ministry Oakhurst Baptist Church Salvation Army Red Shield services Shrine of the Immaculate Conception St. Mark United Methodist Church St. Phillip Benizi Catholic Church AIDS Ministry Tabernacle Baptist Church TBC Health and Wellness Visiting Nurses Health System Hospice Atlanta
Clothing/Food/Furniture Absolute Care Medical Center and Pharmacy AID Gwinnett ANIZ Atlanta Union Mission Women Atlanta Union Mission Shepherd's Inn soup kitchen Center for Family Resources food pantry First Metropolitan Community Church food bank/pantry Furniture Bank of Metropolitan Atlanta
176

Legacy House Midtown Assistance Center Assistance Line National AIDS Education and Services for Minorities Open Hand Raksha Salvation Army Family Emergency Services Shrine of the Immaculate Conception food pantry St. Philip Benizi Catholic Church AIDS Ministry Stand Inc. United Way 2-1-1 Call Center Women's Resource Center Other ChildKind Partnership for Prescription Assistance Pets Are Loving Support
177

Appendix 7
Contact Information
Georgia Department of Public Health Division of Health Protection Infectious Disease and Immunization Section HIV Office 2 Peachtree Street, N.W. 12th Floor Atlanta, GA 30303 Website: http://health.state.ga.us/ Telephone: 404-657-3100 Fax: 404-657-3119
178