1. Chicago’s Transition to an Integrated Planning Council
November 15, 2017
H.L. Anderson Peter McLoyd Sara Zamor CDPH Administrator Community Co-Chair Community Co-Chair
Peter McLoyd
Introduction of the Chicago EMA team

2. Chicago’s Transition to an Integrated Planning Council
Hana L. Anderson – Former Government Co-Chair / CDPH
Peter McLoyd
Slide 4

3. Chicago’s Transition to an Integrated Planning Council
Peter McLoyd – Community Co-Chair
Peter McLoyd
Slide 3

4. Chicago’s Transition to an Integrated Planning Council
Sara Zamor – Community Co-Chair
Peter McLoyd
Slide 5

5. Chicago’s Transition to an Integrated Planning Council
David Kern – Deputy Commissioner, CDPH
Peter McLoyd
Slide 6

6. Chicago Area HIV Integrated Services Council
Chicago’s Transition to an
Integrated Planning Council
Chicago Area HIV Integrated Services Council
CAHISC
Peter McLoyd
The name of the integrated council CAHISC
Slide 7

7. Presentation Overview
The Chicago EMA
Prevention & Care Planning Activities
Impetus for Integrated Planning
Process for Integrated Planning
Challenges
Support & Endorsement
Integration Work Group
Selection Committee Tasks
Peter McLoyd
Slide 8

8. Presentation Overview
New Configuration
Initial Phase – Year 1
Initial Phase – Year 2 (proposed)
Final Configuration
Committee Structures
Resources
Lessons Learned
Moving Forward
Peter McLoyd
Slide 9

9. Chicago EMA Like other Eligible Metropolitan Areas
(EMAs), the Chicago EMA is comprised of urban, suburban and rural communities. The Chicago EMA consists of 9 counties.
Of the EMA's residents, 94% live in urban areas,
2% live in suburban areas and 4% live in rural areas.  85% of PLWHA in Illinois live in the EMA.
There are 33,856 people living with HIV and AIDS (PLWHA) in Illinois. Eighty five percent (28,741) reside in the EMA and 64.5% (21,844) reside in the city of Chicago.
Peter McLoyd
Slide 10

10. Prevention and Care Planning Activities in Chicago from 1999 - 2006
Consider value of joint Community Planning
Increase understanding between Prevention / Care
Create and implement a Strategic Plan
Identify data to create collective outcomes
Ensure the continuous involvement of all stakeholders
Identify and evaluate best practices
Prevention & Care Work Groups established
Peter McLoyd
Slide 11

11. Impetus for Integration
November 2009
Test Linkage to Care + Treatment (TLC Plus)
(HPTN 065) (RM Granich, et al)
December 2009
HHS Revised Treatment Guidelines
March 2010
ACA signed into law
July 2010
White House release National HIV/AIDS Strategy (NHAS)
2010
ECHPP /12 Cities Project
February 2011
CROI - Can Lowering Community Viral Load Decrease New HIV Infections?
March 2011
Gardner Cascade
Aug. 2011
HPTN 052 (M. Cohen et al)
June 2012
ACA and Supreme Court decision
July 2012
CDC Revised HIV Planning Guidance
Peter McLoyd
Slide 12

12. Peter McLoyd
Slide 13

13. Challenges Community Support Ryan White Part A / Prevention balance
How to Integrate Housing?
Integrated Membership By-laws
Synchronize Planning Cycles
Prevention & Care Planning Guidance
Respectful transition of current members
Peter McLoyd
Slide 14

14. Level of Support
HIV Stakeholders: Planning Council, HPPG, and other partners
Federal Partners (HRSA & CDC)
Community Co-Chair Leadership
CDPH Leadership: STI/HIV Division and staff commitment
Peter McLoyd
Slide 15

15. Endorsement
H.L. Anderson
Slide 16

16. Integration Work Group
Composition:
Twelve CDPH Employees: Prevention, Care, Housing, and Public Information
Fourteen Community Representatives: Leadership from PC and HPPG: 50% Consumers
Tasks:
Review Prevention and Care Models
Create Integration Model
Hand-off charge to Selection Committee
H.L. Anderson
Slide 17

17. Selection Committee Tasks
Review Ryan White Primer
Review CDC Prevention Planning Guidance
Develop Scoring Criteria
Review and Score Candidate Applications
Identify candidates slated for interviews
Present slate for review and vetting by CDPH
Present final slate to Steering Committee
H.L. Anderson
Slide 18

18. Initial Phase – Year 1 May 2011: Integration Workgroup
Membership recruitment put on hold recognizing imminent changes
Dec 2011: Interim Bylaws, call for applications and new name – CAHISC
Jan 2012: Selection Committee: New Applications
Feb 2012: Joint Meeting – the Council and HPPG
The Chicago Area HIV Services Council and the HIV Prevention Planning Group voted on February 17, 2012 to dissolve both planning groups to create a streamlined planning process and ultimately a unified plan for the Chicago EMA.
H.L. Anderson
May 2011
December 2011
January 2012
February 2012
Slide 22

19. CAHISC Processes Prevention NA/GA Eval/QM Priority setting Care
Steering Committee
Initial Phase – Year 1
Prevention
NA/GA
Eval/QM
Priority setting
Care
Housing
Member Services
Processes
Governance
OUTREACH
H.L. Anderson - Pilot Project to assess and evaluate the effectiveness of the new planning body.
Capacity Building
Slide 23

20. Housing & Other Services
CAHISC
Steering Committee
Initial Phase – Year 2
(Proposed)
NA/GA
Prevention
Care
Housing & Other Services
Eval/QM
Priority Setting
Member Services
Processes
Governance
OUTREACH
H.L. Anderson
Capacity Building
Slide 24

21. Phase 2 March 2012: Select applicants
April/May 2012: The first CAHISC planning body, strategic planning meeting
January 2013: The CAHISC steering committee held a two-day strategic planning meeting to review integration progress
Reviewed epidemiological data
Membership survey results on integration process
Compared HRSA and CDC community planning requirements
7 new models were considered
H.L. Anderson
March 2012
April/May 2012
January 2013
Slide 27

22. Current HIV Continuum of Care* Chicago EMA, 2010
Sara Zamor: We used this as a foundation for final model
Test Link & Treat Prevent
Slide 28
*Continuum revised 9/12
CDPH – STI/HIV Surveillance, Epidemiology and Research Section – 09/2012

23. CAHISC Council Model, 2/2013 Needs Assessment
Primary Prevention and Early Identification
Linkage and Retention to Care
Adherence/Access to ART &Viral Suppression
Membership and Community Engagement
Gap Analysis
Priority Interventions/Services
Needed resources QM
Gap Analysis
Priority Interventions/Services
Needed resources QM
Gap Analysis
Priority Interventions/Services
Needed resources QM
Sara Zamor
Gap Analysis
Ensure parity, inclusion and representation of all sectors affected by HIV and contributing to the solution
Slide 30

24. Final Configuration . . . the CAHISC Structure
CAHISC Vision: “Develop a city-wide plan that identifies and addresses how housing, treatment, substance abuse, mental health and other essential services can prevent HIV infection through suppressed viral load and behavioral interventions”
Sara Zamor
Slide 29

25. Primary Prevention and Early Identification
Goals:
Decrease the number of new HIV infections.
Increase number of people living with HIV who know their status.
Sara Zamor
Slide 31

26. Linkage and Prevention
Goals:
Increase number of people linked to care.
Increase number of people retained in care.
Re-engaged people lost to care.
Sara Zamor
Slide 32

27. Adherence/Access to ART & Viral Suppression
Goals:
Increase number of people accessing ART
Increase number of people adhering to ART
Increase number of people virally suppressed
Sara Zamor
Slide 33

28. Membership and Community Engagement
Goal:
Ensure parity, inclusion and representation of all sectors and stakeholders affected by HIV.
Promote governance though bylaws.
Assure engagement of membership and other stakeholders in process.
Sara Zamor
Slide 34

29. Steering Committee Goal: Activities:
Ensure the achievement of CAHISC’s deliverables.
Promote integration across committees.
Govern CAHISC and its activities.
Activities:
Lead the development of a comprehensive plan.
Promote communication and collaboration across committees.
Organize monthly full body meetings and presentations.
Monitor committee work plans.
Review and approve letters of support.
Establish need-based ad hoc committees (when necessary).
Sara Zamor
Slide 35

30. CAHISC Resources Resources outlined in the MOU with budget
Multi-program approach to support and funding
Deputy Commissioner guides CDPH roles with CAHISC : Governmental Co-Chair
Program Directors &liaisons support committees
Special units provide support: Evaluation and Surveillance Units
Consultant
Un-Doing Racism Workshop
H.L. Anderson
Slide 36

31. Lessons Learned Need more time to complete and validate slate
Generated robust applications 
Brought new leadership with new perspectives & need for training
Standardized community planning process for all HIV funding sources
Directly supports objectives of NHAS
Peter McLoyd: Conversation
Slide 37

32. Lessons Learned
Initially perpetuated “silos” but changed model to address this issue
Selection of members was completely objective
Time constraints and competing priorities for integration and funder requirements
How does Housing factor into HIV planning?
Peter McLoyd: Conversation
Slide 38

33. Lessons Learned
How do we ensure that all members of CAHISC have equal voice and a “level playing field of knowledge”
Commitment and stability of leadership critical (both CDPH and Steering Committee)
Reasonable timelines to accomplish all work
Grantee staff have to be involved and at the table every step of the way
Peter McLoyd: Conversation
Slide 39

34. Where are we now?
We have antiretroviral (ARV) medications that significantly reduce HIV transmission – HIV treatment and pre-exposure prophylaxis (PrEP).
Modeling suggests we could reach functional zero in the next decade if we use treatment and PrEP in a coordinated fashion.
Yet…
New HIV infections have plateaued (921 new diagnoses in 2015).
< 50% of people living with HIV are in care and virally suppressed.
Only 1 in 10 HIV-negative individuals are on PrEP.
We’re not making sufficient progress even though we have to tools to do so.

35. Why are we here?
Insufficient access to HIV healthcare services for HIV PrEP and treatment.
Insufficient access to essential supportive services, including housing.
Inflexibility and lack of coordination in current service delivery system that puts burden on clients.
Inconsistent public education and marketing about HIV prevention and treatment.
Uncertainty with new Administration’s and Congress’ policies, including ACA replacement and human rights protections.

36. Where are we going? Vision: Getting to zero new HIV infections
Impact: A significant and rapid reduction in HIV transmission
Outcomes:
Suppress viral load in the population of PLWH (99% efficacy)
Increase use of PrEP among persons at increased risk for HIV infection (92-99% efficacy)
Endorsed by:
National HIV/AIDS Strategy
Centers for Disease Control and Prevention
Health Resources and Services Administration
Many local and state jurisdictions, including City and County of San Francisco, City and State of New York and State of Washington

37. ARV for PrEP/HIV Treatment Successful PrEP Use*/ Viral Suppression
How do we get there?
ARV Pathway
ARV for PrEP/HIV Treatment
Successful PrEP Use*/ Viral Suppression
*Sufficient concentration of ARV to confer protection

38. A New Direction HIV Services Portfolio
Marketing – Raise awareness in communities most impacted by HIV by building a consistent and relatable brand that educates and promotes healthy behaviors.
Community Development – Address the intersections of HIV and other community needs, such as employment, violence, healthcare access and housing.
Population-Centered Health Homes – Ensure people have access to high-quality, effective healthcare, including supportive services, to increase the number of persons who successfully use ARVs for PrEP and HIV.
Housing – Ensure people have access to safe and secure housing, including those who don’t currently receive these supporting services: working class PLWH and HIV-negative persons vulnerable to infection.
Drug-User Health – Leverage HIV resources to help address the opioid epidemic by responding to health needs of persons who inject drugs, including HCV, overdose and substance use disorders.
HIV Services Portfolio
Public Awareness Campaign and Health Promotion
Housing
Drug User Health
Population-Centered Health Homes
Community Development
H.L. Anderson/Peter/Sara: CAHISC business must align with new direction, assessing current structure

39. How do we get there? Population-Centered Health Homes
PURPOSE: To create comprehensive and coordinated programs that help populations access and utilize healthcare and ARVs.
Integrates clinical care and supportive services at the client level.
Expands access to HIV treatment, PrEP and supportive services.
Services reflect each step along the ARV pathway from recruitment to ARV use AND essential supportive services that help individuals successfully navigate the pathway.

40. How do we get there? Population-Centered Health Homes
Integrate funding across HIV prevention, care, treatment and housing
Integrate services for HIV-negative persons and persons living with HIV – ARV Pathway and essential supportive services
Can be composed of multiple organizations
Can act as an amplifier for responses to co-morbidities and social determinants of health

41. How do we get there? Population Centered Health Home
Person/ Population
Medical care / RX
Care coordination/ management
Navigation to/ through systems
Health insurance / financial assistance
Housing
Behavioral Health (integrated into medical care)
Other medical and supportive services
Population Centered Health Home
The specific strategies or interventions are examples. The important part of this is in looking at the impact any given service has on that particular step in the path toward ARV use for PrEP or viral suppression.
While ARV use is biomedical in nature, essential supportive services are important to linking and retaining people in healthcare.

42. Moving Forward Integrated Comprehensive Plan Strategic Planning
Consider new Healthcare Landscape
Invite content experts as needed to inform the plan
Multi-agency / multi-funding approach: HIV Services Portfolio
Create an innovative community engagement plan
Peter McLoyd: Conversation
Slide 40

43. Moving Forward
Integrated Comprehensive Plan represents a true health department / community partnership for Prevention, Care & Housing
Creating the plan affords us the opportunity to listen, share, and ask important questions to get us to the collective/common goal
The plan’s focus are the desired achievements above & beyond usual funding sources
Peter McLoyd:
Slide 41

44. H.L. Anderson Hannah.Anderson@cityofchicago.org 312-745-0537
Contact Information
H.L. Anderson
H.L. Anderson
Slide 42

45. Slide 43