Department of Health
FY12 Oversight Questions
DOH OVERSIGHT – HIV/AIDS, Hepatitis, STD, and Tuberculosis Administration (HAHSTA)
Note: If a particular question is not applicable to this particular program, simply state “N/A” as the response and indicate to which administration the program is applicable.
Organization, Performance Plan and General Questions
Q1: Please provide a current organizational chart for HAHSTA. Please provide information to the activity level. In addition, please identify the number of full time equivalents at each organizational level and the employee responsible for the management of each program and activity. If applicable, please provide a narrative explanation of any organizational changes made during FY12 or to date in FY13.
See attachment Q1 for the HAHSTA organization chart.
After thorough organizational assessment and evaluation, HAHSTA determined that changes to the organizational structure were needed in order to provide a more streamlined and efficient organization. HAHSTA completed its realignment during FY12. The realignment provided more clearly defined roles, an enhanced level of clinical and epidemiological support and reporting structures that ensure accountability and quality of services. The realignment was reviewed and approved by the Director of the Department of Health, the Department of Human Resources and the Mayor’s Office.
Based on the workload demands and the changes in program focus, the following is a summary of the major HAHSTA realignment actions.
· Consolidation of the Administrative Bureau, Grants Management Bureau and the Financial Management into one Bureau of Financial Management and Administrative Services. The consolidation reduced personnel by two (2) bureau chiefs and two (2) other staff positions. This change achieved more efficiency and reduced redundancies of positions. Staff were cross-trained to perform administrative, finance and grants management functions. The Division reports to the Deputy Director for Operations.
· Consolidation of the STD Control Division and the TB Control Division. The integration of the two programs consolidated management from two bureau chiefs to one. The Division is able to achieve new efficiencies by the cross training of the STD and TB Investigators who can conduct investigations on both disease cases. For clinical operations, there is now a single medical director to supervise clinical staff and improve cross-disease care. This also eliminated the need for a second Medical Officer. This consolidation improved administrative efficiencies in the reduction of one staff assistant position.
Q2: How many vacancies were posted during FY12? To date in FY13? Which positions? Why was the position vacated? In addition, please note how long the position was vacant, what steps have been taken to fill the position and whether or not the position has been filled.
FY12
18648 / 10/21/11 / 00013879 / Investigator / Competitive Promotion / F / 1/1/12
19469 / 3/9/12 / 00040058 / Supvy Pub Health Adv / Resignation / F / 6/18/12
19694 / 4/12/12 / 00047290 / Supvy Pub Health Analyst / Resignation / F / 5/20/12
19599 / 3/29/12 / 00075340 / Executive Asst. / Promotion / F / 5/21/12
19965 / 5/31/12 / 00075460 / Program Specialist / Resignation / F / 9/9/12
19978 / 5/31/12 / 00075472 / Epidemiologist / Resignation / F / 9/24/12
19981 / 6/4/12 / 00075473 / Epidemiologist / Resignation / F / 9/24/12
19988 / 5/31/12 / 00007322 / Program Analyst / Resignation / F / 10/28/12
19990 / 6/5/12 / 00075471 / Quality Assessment Specialist / New Position / F / 9/24/12
19992 / 6/5/12 / 00075474 / Quality Assessment Specialist / New Position / F / 12/31/12
20099 / 6/11/12 / 00075483 / Data Analyst / Resignation / F / 9/24/12
20093 / 6/11/12 / 00075488 / Public Health Analyst / New Position / F / 1/14/13 / Delay due to funding issue
20425 / 8/1/12 / 00036136 / Supvy Pub Health Analyst / Promotion / F / 9/23/12
20408 / 8/1/12 / 00036770 / Supervisory Nurse Coordinator / Resignation / V / Vacancy cancelled, reclassified to lower grade
20617 / 9/5/12 / 00075617 / PUBLIC HEALTH ANALYST (Bilingual) / V / Position on hold
20838 / 9/27/12 / 00077015 / Supvy Public Health Adv / New Position / F / 12/2/12
20835 / 9/28/12 / 00077024 / Public Health Analyst / Realignment Reclass / F / 10/28/12
20830 / 9/28/12 / 00077017 / Public Health Analyst / Realignment Reclass / F / 10/28/12
20832 / 9/28/12 / 00077021 / Contract Specialist / Realignment Reclass / F / 10/28/12
20832 / 9/28/12 / 00077023 / Contract Specialist / Realignment Reclass / F / 10/28/12
20840 / 9/28/12 / 00077025 / Community Relations Specialist / Realignment Reclass / F / 10/28/12
FY13
21172 / 11/26/12 / 00004080 / Grants Management Specialist / Resignation / V / Interviews Pending
21501 / 1/14/13 / 00077356 / Program Coordinator / Realignment Reclass / V / Interviews Pending
21522 / 1/14/13 / 00077358 / Program Specialist / Realignment Reclass / V / Interviews Pending
21530 / 1/14/13 / 00077357 / Administrative Specialist / Realignment Reclass / V / Interviews Pending
00046723 / Supervisory Housing Coordinator / Resignation / V / Pending OCA Approval
Q3: Did HAHSTA meet the objectives set forth in the performance plan for FY12? Please provide a narrative description of what actions HAHSTA undertook to meet the key performance indicators or any reasons why such indicators were not met.
HIV/AIDS, Hepatitis, STD, and TB AdministrationNumber / Measure / Frequency / FY 2012 Target / FY 2012
Actual
HAHSTA 1.1 / # of new HIV (HIV/AIDS) cases reported within the fiscal year / Annual / 1,300 / 721
This metric was met. There were 1,642 HIV cases reported to HAHSTA during FY2012 and there were 721 preliminary newly diagnosed HIV cases among DC residents during FY2012. This is due to HAHSTA’s continued efforts to implement routine HIV screening, timely linkage to HIV medical providers for full evaluations and treatment initiation and communication with health care providers about the importance of reporting HIV infections.
HAHSTA 1.2 / #of publicly supported HIV tests performed / Semi-Annual / 125,000 / 138,317
HAHSTA continues to scale up on its HIV screening initiative by engaging partners in a joint strategy to increase HIV screening performance. In addition, HAHSTA has sought additional funding support from the federal government as well as exploit private partnerships in order to increase test provision. HAHSTA exceeded its target by 11%.
HAHSTA 1.3 / # of needles off the streets through DC NEX Program / Semi-Annual / 400,000 / 549,464
HAHSTA successfully coordinated activities with the three needle exchange programs to identify new areas to increase distribution and provide additional services.
HAHSTA 1.4 / # of condoms (female and male) distributed by DC DOH Condom Program / Semi-Annual / 4,500,000 / 5,747,000
HAHSTA continues to expand the number of community partners and sites, which has led to a higher number of condoms distributed. In addition, HAHSTA has engaged and educated new community partners on the FC2 female condom, which is also increasing the numbers distributed. HAHSTA continued its “Join the Rubber Revolution” social marketing program, which has led to an increase in direct condom requests to HAHSTA and more community partners increasing their orders.
HAHSTA 1.5 / # of peri-natal HIV infections / Annual / 0 / 1
HAHSTA continues to work closely with hospitals, primary care clinics and OB/GYNs in the DC area to ensure that they observe current best practice around prevention of HIV transmission from mother to child. There was one perinatal HIV infection identified in 2012. HAHSTA is developing a new strategy to improve the timeliness of information on potential perinatal exposure and enhance coordination of care and treatment.
Number / Measure / Frequency / FY 2012 Target / FY 2012
Actual
HAHSTA 1.6 / # of youth (15-19 years) screened for STDs through youth outreach programs / Semi-Annual / 5,000 / 5,870
HAHSTA continues to maintain a successful partnership with DC Public Schools and select public charter schools to provide voluntary school-based STD screening in 25 schools during the school year. HAHSTA also has a partnership with youth-serving community based organizations to offer STD screening at their locations and in outreach activities.
Number / Measure / Frequency / FY 2012 Target / FY 2012
Actual
HAHSTA 2.1 / # of clients linked to care within 3 months of diagnosis / Annual / 70% / 87%
HAHSTA in collaboration with community partners continues to be successful in increasing the timeliness of linking newly diagnosed persons into HIV care and treatment. Through the Red Carpet Entry protocol and navigation programs, HAHSTA has ensured that individuals have access to a full HIV medical evaluation within 72 hours.
Q4: What are the objectives set forth in the performance plan for FY13? Please provide a narrative description of the progress HAHSTA has made to meet the objectives of the FY13 performance plan. Please describe any legislative goals or initiatives for FY13.
SUMMARY OF SERVICES
The HIV/AIDS, Hepatitis, STD and TB Administration’s (HAHSTA) mission is to prevent primary infection of HIV/AIDS, STDs, Tuberculosis and Hepatitis, reduce transmission of the diseases and provide care and treatment to persons with the diseases. HAHSTA partners with health and community-based organizations to offer HIV and STD testing and counseling, prevention education and interventions, free condoms, as well as medical support, medication at no cost and other support services needed by clients living with HIV/AIDS. In addition, HAHSTA provides direct services at its STD and TB Clinics for residents of the District, administers the District’s budget for HIV/AIDS, STD, Tuberculosis, and Hepatitis programs, and collects and manages data on disease-specific programs and services.
OBJECTIVE 1: Reduce transmission/prevent new infections of HIV, STD, TB, and Hepatitis through early diagnosis and treatment, harm reduction, and behavior change interventions (One City Action Plan Action 3.23).
INITIATIVE 1.1: Increase efforts to identify individuals newly infected with HIV or STDs.
Routine, opt-out HIV testing is a key component of HAHSTA’s strategy to prevent new infections. HAHSTA has worked to incorporate this policy as a standard of care in all facilities in the District. By September 30, 2013, HAHSTA will build toward full implementation of routine testing by focusing in a number of areas: Managed Care provider networks, unaffiliated physicians and practices (educate 400 physicians) and expanded partner services (community provider training). Additionally, HAHSTA has proposed a new initiative, pending federal funding, to equip up to 25 hospitals and medical providers with new technology to provide confirmatory tests rapidly, which will improve immediate linkage into HIV medical care and identifying acute infection, which can be more easily transmitted.
INITIATIVE 1.2: Reduce the Prevalence of STDs and HIV in Youth.
It is critical that the District support young people to develop awareness, skills, and behaviors that lead to a reduction of risk for STDs and HIV throughout their lifetime. Activities to achieve this goal include: mainstreaming of STD/HIV information into youth activities; training all school nurses working in DC Public Schools to integrate routine STD and HIV prevention and screening; education for in-school and out-of-school youth to build skills that allow them to reduce their risk of infection; and expanding youth outreach and STD/HIV testing and treatment services to venues other than the school. By September 30, 2013, HAHSTA will increase the number of youth screened for STDs.
OBJECTIVE 2: Improve care and treatment outcomes, as well as quality of life, for HIV-infected individuals through increased access to, retention in, and quality of care and support services, as part of the District’s adoption of the National HIV/AIDS strategy, with targets to be accomplished by 2015 (One City Action Plan Action 3.23).
INITIATIVE 2.1: Increase the Number of People in quality HIV medical care. (One City Action Plan Action 3.23)
HAHSTA will work to increase the utilization of HIV care services by DC residents and ensure the availability of critical and effective support services to maximize retention in care and health outcomes. In FY12, HAHSTA implemented the Red Carpet Entry program (expedited appointments for HIV medical care for newly diagnosed and those returning to treatment) to increase the number of providers and duration of recapture activities to identify and reenter individuals into HIV medical care. By September 30, 2013, HAHSTA will increase the percentage of clients linked to care within 3 months of diagnosis.
KEY PERFROMANCE INDICATORS - HIV/AIDS, Hepatitis, STD, and TB Administration
Measure / FY2011Actual / FY2012
Target / FY2012
Actuals / FY2013
Projection / FY2014
Projection / FY2015
Projection
# of new HIV/AIDS cases reported within the fiscal year [One City Action Plan Action 3.23] / 1,205 / 1,300 / 721 / 1,300 / 1,300 / 1,200
#of publicly supported HIV tests reported [One City Action Plan Action 3.23] / 122,356 / 125,000 / 138,317 / 125,000 / 125,000 / 125,000
# of needles off the streets through DC NEX Program [One City Action Plan Action 3.23] / 341,879 / 400,000 / 549,464 / 400,000 / 425,000 / 430,000
# of condoms (female and male) distributed by DC DOH Condom Program [One City Action Plan Action 3.23] / 5,186,340 / 4,500,000 / 5,747,000 / 4,500,000 / 5,000,000 / 5,000,000
# of youth (15-19 years) screened for STDs through youth outreach programs / 4,274 / 5,000 / 5,870 / 7,500 / 7,500 / 8,000
% of clients linked to care within 3 months of diagnosis [One City Action Plan Action 3.23] / N/A / 70% / 87% / 50% / 60% / 70%
Q5: Please complete a Program and Activity Detail Worksheet for each program and activity within HAHSTA.
See attachment Q5 for the HAHSTA Program and Activity Detail Worksheets.
Q6: Please describe the impact of federal health care reform on HAHSTA’s programs and activities including any identified potential cost savings.
The District of Columbia began implementation of health care reform with the expansion of Medicaid on July 1, 2010. The impact of health care reform is most evident in the AIDS Drug Assistance Program.
Since July 1, 2010, more than half of beneficiaries of the HAHSTA AIDS Drug Assistance Program (ADAP) have enrolled in Medicaid and continue to receive services.