1. end+disparities Learning Exchange: African American & Latina Women’s Health March 16, :00-2:30 pm ET Michael Hager & Nanette Brey-Magnani, NQC Kneeshe Parkinson & Dawn Trotter, Learning Exchange Spokespersons Arianna Lint, Arianna’s Place Amy Newton, Broward Regional Health Planning Council Allyson Baughman, Boston University
Michael
Welcome to our February webinar focused on African-American and Latina Women’s health!
This is our third month that focuses on one of our four populations. Stay tuned for more information on our other population focus months at the end of today’s webinar. Be sure to visit our website to learn more about past events

2. Before we start… Please type your name, organization, city and state in the chat room
Michael
Please note that this webinar is being recorded for later replay by those who missed the call.
Before we start our webinar, let’s take a moment and ask participants to introduce themselves via our chat room, which can be found on the right hand side of your screen, just underneath the participants section. There is a small box labelled Chat.
Please enter your name, organization, city, and state so others can see who we have on the call today.

3. Ground Rules for Webinar Participation
Actively participate and write your questions into the chat area during the presentation
Do not put us on hold
Mute your line by pressing the microphone button to the right of your name
Please complete the post-webinar evaluation
This call is recorded for replay for those who missed the webinar
Michael
Ground rules for todays webinar:
- Actively participate and write your questions into the chat room; we have several staff and consultants who will answer your comments – I want to thank them and HAB representatives
- Please mute your phone line; you can press the microphone button to the right of your name
- Please complete the post-webinar evaluation, which will be sent to your at the conclusion of the webinar. We look forward hearing from you.
- As stated earlier the call will be recorded for replay for those who missed the webinar

4. Clemens Steinbock, MBA Director, NQC
Michael introduces Clemens and turns it over to Clemens to provide words of welcome
Clemens Steinbock, MBA
Director, NQC

5. The end+disparities Learning Exchange a 9-month initiative that promotes the application of improvement interventions to reduce HIV-related disparities in four key subpopulations while building and sustaining a community of learners among Ryan White HIV/AIDS Program recipients. The Learning Exchange offers informational opportunities by content experts and utilizes the power of peer learning to facilitate local improvement efforts on eliminating HIV-related disparities.
Michael

6. Communities of Learning: collaborative, QI campaign, Regional Groups
Consultation: On/off-site coaching of recipients to advance their clinical quality management programs
Together, we can make a difference in the lives of people with HIV. NQC provides assistance to RWHAP recipients to improve HIV care since gaps in HIV care still exist and advances are uneven across HIV populations.
250 recipients participated in 28 Regional Groups
51% of all recipients joined the largest HIV QI campaign; viral suppression increased from 70% to 76%, a statistically significant improvement
Training and Educational Fora: monthly webinars, advanced trainings, online QI tutorials
40% of RWHAP recipients received TA and 95% would recommend TA to others
40 online QI tutorials are available; over 35,000 have been taken so far
Intensity
Information Dissemination: monthly newsletters, websites, publications, exhibits, QI awards
Michael
NQC is funded by the HRSA HIV/AIDS Bureau since 2004 and provides technical assistance to all RWHAP recipients to build their sustainable clinical quality management programs. Over 90% of all recipients have accessed intensive NQC offerings and take advantage of our various services. The Learning Exchange is an extension of these offerings.
As you see in this graphic, NQC provides opportunities
To participate in monthly webinars to learn more about QI – next week’s webinar focuses on the 2016 NQC Award winners
To attend our 4 3-day face-to-face training programs or take one of 40 online tutorial we have available
To request onsite assistance by our pool of QI experts
To join one of our 28 Regional Groups, a local community of learning
If you would like to learn more, please visit our website at NationalQualityCenter.org.
over 90% of the 587 RWHAP recipients accessed NQC services
~1,300 individuals (61% of recipients) graduated from 45 three-day advanced trainings
NationalQualityCenter.org |

7. Agenda Welcome & Introductions
African-American & Latina Voices in Healthcare
Broward County’s Project
The Research Pipeline
Resource Sharing!
Q & A Session
Michael

8. Learning Objectives
Describe the ways in which the African-American and Latina women community is diverse
List specific challenges that different women face regarding engagement in their HIV care
Name three solutions that consumers or providers can pursue to improve health outcomes for African-American and Latina women living with HIV.
Michael

9. African-American & Latina Women’s Voices in Healthcare
Nanette
We are going to hear from three women who are part of this important community who are also part of our system. Each woman’s story is uniquely powerful and is an example of what folks in your communities might be feeling or experiencing related to their own care. Listen to the stories and think of questions to ask – they are all experts in their own lived experience!

10. Kneeshe Parkinson Learning Exchange Spokesperson St. Louis, MO
Nanette, introduce Kneeshe:
Kneeshe has worked for Washington University School of Medicine-Project Ark for  14yrs in many capacities for PLWH.
Kneeshe is currently the consumer liaison in her region who has worked  countless hours over the last 24 months working on Quality Improvement efforts for PLWHA alongside the Missouri Statewide Quality Management Team in collaboration with H4C Continuum Collaborative spearheaded by the National Quality Center. 
Kneeshe (10 minutes)
Provide a sneak preview of your story and that you are excited to share more on next week’s partners in+care call. Specifically for this call:
Explain a little bit about your motivations for joining end+disparities and what you hope can come from it
What are the biggest misconceptions providers have about serving African-American and Latina women and engaging them in care?
What are common missed opportunities that the health system has to engage African-American and Latina women?
If you had 1-2 concrete steps any provider should take to better understand the African-American and Latina women they serve, what would they be?

11. Dawn Trotter Learning Exchange Spokesperson Buffalo, NY
Nanette introduce Dawn:
Dawn Trotter was diagnosed with HIV in 2007 and a heart condition soon after, given a prognosis that she would likely live for one year. Her uncertainty about her health mobilized her to learn as much about it as possible and inspired her to share what she had learned with others as overwhelmed as she had been. A mother of three, she has gone on living far beyond that year and has served on the NYS AIDS Institute Consumer Advisory Board since 2014 and became Co-Chair of the Peer Certification Board in Currently, Dawn works full time at Evergreen Medical Group as a Retention Support Assistant, applying her passion to maintain HIV positive people in healthcare and promoting their adherence toward viral suppression to her daily work.
Dawn (10 minutes)
Provide a sneak preview of your story and that you are excited to share more on next week’s partners in+care call.
Specifically for this call:
Explain a little bit about your motivations for joining end+disparities and what you hope can come from it
What are the biggest misconceptions providers have about serving African-American and Latina women and engaging them in care?
What are common missed opportunities that the health system has to engage African-American and Latina women?
If you had 1-2 concrete steps any provider should take to better understand the African-American and Latina women they serve, what would they be?

12. Arianna Lint CEO founder Arianna’s Center Fort Lauderdale – Florida
Latin Trans in HIV care
Arianna Lint
CEO founder Arianna’s Center
Fort Lauderdale – Florida
Nanette – introduce Ariana Lint.
Arianna Lint, is a “refugee” Latina Transgender Woman from Lima Peru, founder and CEO of Arianna's Center FL (Translatina Florida). her last job was the Director of Transgender Advocacy for a South Florida not-for-profit. Now Her role is to help connect transgender residents with employment opportunities, safe housing, social networks and medical services. Educate and profesional training, motivational speaker. She has served on the board for Coalition, Chair of the Community Empowerment Committee of the HIV Broward planning council, she is part of TransAction Florida group of EqualIty Florida and has also recently become a Member of the Trans (T+) National Advisory Board sponsor Transgender Law Center of San Francisco and Elton John Fundation also she I'd the Community Advisory Board and Spanish Blogger for The Well Project, Arianna is originally from Peru, where she lived through her graduation from Law School at San martin de Porres University. Actually Ariann and Center provide consulting to CDC and White House in HIV issues for transgenders individuals living in USA. We dont just provide services We changes life's .

13. America is known as the land of the freedom and opportunity
America is known as the land of the freedom and opportunity. It is a place to live the “American Dream”. Sadly not everyone has complete access to these opportunities advertise, especially Latina women, Latina Trans women. For many Latinas, it is a struggle to get here and a struggle to survive. These barriers come from many directions; however the biggest barrier is financial stability. One of the few ways to ensure this stability is through education. Education can provide financial security, advancement and knowledge.

14. Estimated New HIV Diagnoses in the United States and 6 Dependent Areas for the Most-Affected Subpopulations, 2014
Source: CDC. Diagnoses of HIV infection in the United States and dependent areas, HIV Surveillance Report 2015;26

15. In 2014, Hispanics/Latinos accounted for 24% (10,887) of the estimated 44,784 new diagnoses of HIV infection in the United States and 6 dependent areas. Of those, 86% (9,379) were in men, and 14% (1,490) were in women.
Among Hispanic women/Latinas, 86% (1,282) of the estimated HIV diagnoses were attributed to heterosexual contact.
Diagnoses among Hispanic women/Latinas declined steadily (35%).
In 2014, an estimated 4,689 Hispanics/Latinos were diagnosed with AIDS.

16. Prevention Challenges A number of factors contribute to the HIV epidemic in Latino communities.

17. A higher prevalence of HIV in Latino communities
A higher prevalence of HIV in Latino communities. More people are living with HIV (prevalence) in Hispanic/Latino communities than among some other races/ethnicities. Since Hispanics/Latinos tend to have sex with partners of the same race/ethnicity, the risk of HIV infection among Hispanics/Latinos is increased.
Higher rates of sexually transmitted diseases (STDs). Hispanics/Latinos have relatively high rates for STDs compared to some other races/ethnicities, including chlamydia, gonorrhea, and syphilis. Research shows that the presence of another STD makes it easier to become infected with HIV.
Cultural factors. Some Hispanics/Latinos might not seek testing, counseling, or treatment if infected because of stigma and discrimination. Traditional gender roles, cultural norms (“machismo” or toughness for males and “marianismo” or purity for females), and the stigma around homosexuality may add to prevention challenges.
Social and structural factors. Poverty, migration patterns, lower educational level, limited access to health care, and language barriers may contribute to HIV among Hispanics/Latinos by limiting awareness about risks and opportunities for testing and care.
Immigration status. Undocumented Hispanic/Latino immigrants may be afraid of disclosing their immigration status, making Hispanic/Latino immigrants less likely to get tested and enter care.

18. +Transgender Latinas in ICE

19. Arianna's Center engages, empowers and lifts up the trans community of South Florida.
We place a special emphasis on the most marginalized, including the Trans Latinx community, undocumented immigrants, people living with HIV and AIDS, and those who have experienced incarceration.

20. Charnelle Bacchus-Powers
Amy Newton
Charnelle Bacchus-Powers
Kelsey Holloman
Broward County Regional Planning Council
Ft Lauderdale, FL
Nanette – introduce the ladies from Broward county:
Amy Newton Biosketch
Amy Newton currently works as the Quality Improvement Manager with the Broward Regional Health Planning Council providing support and technical assistance to the Ryan White Part A Grantee's Clinical Quality Management Program (CQM). In this capacity, she manages the development, implementation, and evaluation of performance measures and standards of care for HIV services and provides technical assistance for quality improvement activities. Amy received both her Master of Public Health and Bachelor of Health Science from the University of Florida. She has experience planning and implementing community-based public health programs and grants; conducting qualitative and quantitative research and analysis for quality improvement purposes; working collaboratively with a variety of stakeholders from different professional, cultural, and socioeconomic backgrounds; and producing high-quality grant applications, policy briefs, technical reports and presentations. She is passionate about improving access to quality health care and reducing health disparities for underserved populations.
Kelsey Holloman Biosketch
Kelsey Holloman received her Master of Public Health from the Florida International University and is a Certified Health Education Specialist. She has experience in program planning and evaluation; data analysis and reporting as it relates to quality improvement; and grant writing. Kelsey began her public health career as a Health Planner providing support to the Ryan White Part A Grantee's Clinical Quality Management Program in the Broward County EMA. As she continues her career as a Health Planner, she is eager to work to provide quality healthcare to HIV+ persons in Broward County. 
Charnelle Bacchus-Powers Biosketch
Charnelle Bacchus-Powers is a public health professional with experience in quality management, health education, and program planning. Charnelle was intrigued by the field of public health while working at the Florida Department of Health and this experience encouraged her to pursue and receive her Master's in Public Health from Florida International University. Charnelle is passionate about improving the health of those around her and became a Certified Health Education Specialist (CHES) in In her current role as a Clinical Quality Management Health Planner, she is continuing to pursue her passion through quality improvement within Broward County's Ryan White Part A Clinical Quality Management program.

21. Barriers to Care for Black Women Quality Improvement Project (QIP)
Broward County Ryan White Part A Clinical Quality Management Program
Amy Newton, MPh—quality improvement manager
Charnelle Bacchus-Powers, MPH, CHEs—health planner
Kelsey Holloman, MPH, CHEs—health planner

22. Background Target Population Methods
Black Non-Hispanic women utilizing Case Management services in the Ryan White Part A Program with a viral load > 200 copies/mL
Methods
Ryan White Part A case managers conducted an in-depth assessment, including patient interviews, multidisciplinary case staffing, and chart reviews, to identify the barriers to care for black women who were not virally suppressed.
A modified version of the Barriers to Care Scale1 was utilized for data collection with the following categories: demographics, medication adherence, comorbidities, financial and economic concerns, stigma, and service availability.
The barriers were rated as “very slight problem,” “somewhat of a problem,” or “major problem.”
The barriers to care findings were collected and aggregated from the six agencies and analyzed.
1. Heckman TG, Somlai AM, Peters J, Walker J, Otto-Salaj L, Galdabini CA, Kelly JA. Barriers to care among persons living with HIV/AIDS in urban and rural areas. AIDS Care Jun;10(3):365–375.

23. Barriers to Care Reported by Black Women in Case Management Services (N=60)
Very Slight Problem
Somewhat of a Problem
Major Problem
Total # of Patients
Lack of personal financial resources 6 13 23 42
Mental health 11 10 27
Lack of adequate and affordable housing 5 7 12 24
Lack of transportation to access services
Not taking meds (forgetfulness, pill burden, travel, etc.) 4 9 18
Co-morbidities (cancer, diabetes, high blood pressure) 2 17
Lack of employment opportunities 3 16
Community stigma against HIV 14
Level of knowledge about HIV in the community
Refuses medication
Breaches of confidentiality 1
Substance abuse
Long distances to medical facilities 8
Ineffective regimen (resistance, other)
Lack of psychological support groups
Lack of supportive work environment
Can't afford food
Shortage of mental health providers
Lapse in insurance or benefits
All 6 case management agencies were included in the QIP, which included 60 clients.

24. Barriers to Care Reported by Black Women in Case Management Services (N=60)
All 6 case management agencies were included in the QIP, which included 60 clients.

25. Challenges and Recommendations
Collecting data directly from client
Recommendation: Discuss best method to collect client information prior to beginning a project. Reflect on all available resources and known trends in client communication.
Clients not self-reporting mental health issues due to stigma
Recommendation: Rely on client’s reported medical history to gather accurate information. Our case managers recommend establishing a basic comfort level with client prior to asking about mental health status to make client more comfortable and willing to be honest.
Difficulties using data collection tool made analyzing data a tedious process
Recommendation: Complete an in-depth training on using the data collection tool and provide a hard copy of specific instructions for using the tool at the time of data entry.

26. Next steps
Currently, Ryan White Part A case managers are conducting the second phase of the QIP by implementing individualized interventions to address reported barriers to care.
Examples of interventions include: Graphs/visuals, repetitive teaching, medication reminder alarms, pillbox, bus pass, home visits, budget counseling, referrals to other Part A services, etc.
Interventions are tracked along with each client’s viral load to measure improvement.
Utilize MAI funding to implement a pilot care coordination program for black women to minimize barriers and improve viral suppression.
Conduct focus groups with target population to gather further information to address barriers to care.

27. Questions

28. Allyson Baughman Boston University Boston, MA
Nanette – introduce Allyson:
Allyson Baughman is a program manager for the HRSA funded project, “Using Community Health Workers (CHW) to Improve Linkage and Retention in HIV Care.” For more than eight years she has been engaged in public health research projects on a range of topics, including food insecurity, chronic homelessness, gender-based violence, and the needs of lesbian, gay, and bisexual cancer survivors. Her interests including effective framing and messaging for positive change in social and economic policy, effective data visualizations, and translating and disseminating research findings to policymakers and the public.
Allyson received a Master of Public Health from the Boston University School of Public Health in Currently, she is pursuing a Ph.D. in public policy and public affairs at the McCormack Graduate School of Policy and Global Studies at the University of Massachusetts, Boston. For her dissertation project, Allyson is studying the impact of work requirements under 1996 welfare policy reform on the health of low-income single mothers.

29. Resource Sharing! What has worked for you?
Nanette
Let’s have a conversation about what has worked to improve linkage, retention, and viral suppression for your patients as an HIV provider organization serving African-American and Latina women.
What health equity problem have you tried to solve for your African-American and Latina women patients, clients, and community members?
What resources or strategies did you find helpful toward closing disparity gaps for African-American and Latina women ?
What advice do you have for others who are trying to bring health equity to the African-American and Latina women in your community?
How do we ensure we are serving all African-American and Latina women equitably to help achieve optimal health outcomes?
Ask Kneeshe, Dawn, Arianna, Amy, and Allyson if there are any resources they recommend and ask if they want Michael to show folks where they are located online (he will navigate to them in the webinar to show folks how to find them).

30. Q&A Session
Nanette
Now we open the discussion to general inquiries for the next 30 minutes. This is only needed if it wasn’t mixed in with the Resource Share!

31. Next Steps and Activities in end+disparities
Coming Up!
Next Steps and Activities in end+disparities
Michael

32. Partners in+care Roundtable Discussions
Each date is a clickable link with additional information to save in your calendar!
March 23: African-American and Latina Women Health
April 27: Youth (13-24 years) Health
May 25: Sustaining Our Gains
June 22: Greater Than the Sum of its Parts
Michael
Each month we focus on another topic. Partners in+care roundtables will occur on the fourth Thursday of the month from 1-230pm ET.
When we develop content for consumers to join the discussion, we’ll be sure to focus in on our challenges and opportunities in each area and will explore ways consumers can get involved in the work. The main toolkit available to us is the Partners in+care toolkit presented today, but there is plenty of room to introduce new tools and resources that are of interest to you

33. end+disparities Learning Exchange Webinars
Each date is a clickable link with additional information to save in your calendar!
March 16: African-American and Latina Women Health
April 20: Youth (13-24 years) Health
May 18: Sustaining Our Gains
June 14: Greater Than the Sum of its Parts
Michael

34. Office Hours Opportunities
March 31: Comprehensive Health Needs of African-American and Latina Women
Office Hours discussions are informal opportunities to dive deeper into core issues affecting our work
They are participant led and directed based on YOUR questions!
Michael
Office Hours discussions are informal opportunities to dive deeper into the issues
They are participant led and directed based on YOUR questions!
Occur on various Fridays from 1-2pm ET (check the calendar on our website for exact dates and topics!)

35. Closing Remarks
Michael Hager and Clemens Steinbock provide closing remarks. Ask Julia if she would like to add anything.

36. end+disparities Video
Visit our NQC YouTube channel to see our 3min video about disparities in HIV care -
Michael
A reminder to check out our video and the website!
Another cool informational tool that we have developed is a short animated video about disparities in HIV care and outcomes. Please take a look and feel free to share with others. 36

37. THANK YOU!
Michael

38. 212-417-4730 NationalQualityCenter.org Info@NationalQualityCenter.org
Michael 38