Ryan White HIV/AIDS Program Part D Grants for Coordinated HIV Services and Access to Research for Women, Infants, Children, and Youth (WICY)

is being re-competed through this FOA in order to respond to the changing HIV epidemiology and the National HIV/AIDS Strategy with the goal of providing comprehensive health care services for the WICY populations in areas of greatest need for services. Part D grantees are expected to provide HIV primary care, specialty medical care, and support services to the clients they serve. For the purpose of implementing programs funded by Part D, HIV primary medical care refers to outpatient or ambulatory care, including behavioral health, nutrition, and oral health services. Family-centered care refers to services that address the health care needs of the persons living with HIV in order to achieve optimal health outcomes. Specialty care refers to specialty HIV care and specialty medical care such as obstetrics and gynecology, hepatology, and neurology. Support services may include the following: -1 Family-centered care including case management. -2 Referrals for additional services including- (A) referrals for inpatient hospital services, treatment for substance abuse, and mental health services; and (B) referrals for other social and support services, as appropriate. -3 Additional services necessary to enable the patient and the family to participate in the program established by the applicant pursuant to such subsection including services designed to recruit and retain youth with HIV. -4 The provision of information and education on opportunities to participate in HIV/AIDS-related clinical research. National HIV/AIDS Strategy (NHAS) The National HIV/AIDS Strategy (NHAS) has three 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. The NHAS states that more must be done to ensure that new prevention methods are identified and that prevention resources are more strategically deployed. Further, the NHAS recognizes the importance of early entrance into care for people living with HIV (PLWH) to protect their health and reduce their potential of transmitting the virus to others. HIV disproportionately affects people who have less access to prevention, care and treatment services and, as a result, often have poorer health outcomes. Therefore, the NHAS advocates adopting community-level approaches to identify people who are HIV-positive but do not know their serostatus and reduce stigma and discrimination against people living with HIV. To the extent possible, program activities should strive to support the three primary goals of the NHAS. As encouraged by the NHAS, programs should seek opportunities to increase collaboration, efficiency, and innovation in the development of program activities to ensure success of the NHAS. Programs providing direct services should comply with federally-approved guidelines for HIV Prevention and Treatment (see http://www.aidsinfo.nih.gov/Guidelines/Default.aspx as a reliable source for current guidelines). More information can also be found at http://www.whitehouse.gov/administration/eop/onap/nhas Based on the HIV/AIDS Bureau's (HAB's) evaluation and the NHAS, a change in the focus of the Ryan White HIV/AIDS Program Part D is necessitated. The NHAS and recent research findings emphasize the importance of effectively using scarce resources to provide clinical care and treatment to PLWH and to ensure that those resources are being directed to the populations most in need. There have been significant changes in the HIV epidemiologic trends in the U.S. Effective antiretroviral (ARV) drugs for therapy and prophylaxis have been discovered and are widely available. In addition, the Affordable Care Act promises improved healthcare insurance coverage. Transmission of HIV from mother to infant has decreased tremendously with universal prenatal HIV testing and ARV prophylaxis. Today, children comprise only about 1 percent of the HIV epidemic in the United States. Women, especially women of color, now comprise 25 percent of all people living with HIV (PLWH) in the U.S. The greatest increases in HIV incidence are occurring in adolescents and young adults with 34 percent of new HIV infections in those ages 13-29. Additionally young Black males having sex with males (MSM) represent the most impacted racial/ethnic group. (Prejean, PLoS ONE 2011, www.ncbi.nlm.nih.gov/pubmed?term=Prejean%2C%20PLoS%20ONE%202011.) Ryan White-funded services should ensure that newly identified PLWH, especially young African American MSM, are linked into healthcare, provided ARV medications, and retained in care. Minority AIDS Initiative (MAI) Beginning in Fiscal Year 2000, Congress designated a portion of Ryan White HIV/AIDS Program Part D Coordinated Services for Women, Infants, Children, Youth and Families funding for the Minority AIDS Initiative (MAI). The Minority AIDS Initiative (MAI) is intended to address the disproportionate impact that HIV/AIDS has on racial and ethnic minorities and to address the disparities in access, treatment, care, and outcomes for racial and ethnic minorities, including African Americans, Alaskan Natives, Latinos, American Indians, Asian Americans, Native Hawaiians, and Pacific Islanders. The goal of MAI is to help reduce this burden by: o Increasing the number of persons from racial and ethnic populations receiving HIV care o Increasing the number of persons from racial and ethnic populations who stay in care MAI funds are granted to health care organizations that provide culturally and linguistically appropriate care and services to racial and ethnic minorities. Funded Part D WICY programs will be assigned funds under the MAI by the HRSA/HAB Division of Community Based Programs (DCBP), which administers the Part D program. This assignment is based on the percentage of the WICY populations proposed to be served from racial/ethnic minority communities. The amount of MAI funds awarded is noted under the grant specific terms section of the Notice of Award (NOA) which establishes the final funding for the budget period.