Office of Minority Health

Grant Program: STATE PARTNERSHIP INITIATIVE TO ADDRESS HEALTH DISPARITIES (SPI)

Grantee Information

Organization: Wisconsin Department of Health Services, Wisconsin Minority Health Program and Wisconsin AIDS/HIV Program

Organization Address: 1 West Wilson Street, PO Box 7850, Madison, WI, 53707

Phone Number: 608-266-1865

Organization website URL (if any): https://www.dhs.wisconsin.gov/

Brief Description of the Organization: The Wisconsin Department of Health Services (DHS) is a governmental agency of the U.S. state of Wisconsin responsible for maintaining public health. The Wisconsin Minority Health Program (MHP) was created in 1999 and is located within the Office of Policy and Practice Alignment (OPPA), Division of Public Health (DPH), Wisconsin Department of Health Services. The mission of the MHP is to “provide a persistent and continuing focus on the elimination of health disparities and build effective partnerships to improve the health of disadvantaged and vulnerable communities” in the state. MHP provides leadership and expertise in addressing health equity, providing technical assistance regarding cultural, linguistic, and literacy needs, and creating linkages to racial and ethnic communities. The MHP traditionally looks to engage and collaborate with partners to close gaps and provide capacity building to community-based organizations serving racial and ethnic minority communities, and more recently to LGBT communities and persons with disabilities. The Wisconsin AIDS/HIV Program is located in the Bureau of Communicable Diseases, Division of Public Health, Wisconsin Department of Health Services. For the last 30 years, the AIDS/HIV Program has coordinated the public health response to HIV infection in Wisconsin by coordinating statewide HIV efforts with local health departments, community-based organizations, and clinics. The Program's approach to HIV prevention and care emphasizes community coordination and engagement across multiple disciplines and partners. The Program has a strong working relationship with educational and research institutions, including the University of Wisconsin - Madison and the Medical College of Wisconsin in Milwaukee. The Program also works in partnership with a statewide network of community-based organizations and HIV/AIDS specialty health care providers.

Grant Project Information

Title of Grant Project: Wisconsin Minority Health HIV Partnership Initiative

Amount of OMH Award: $200,000

Name of Project Director: Evelyn Cruz

Phone Number of Project Director: 608-261-9308

E-mail Address of Project Director: evelyn2.cruz@wisconsin.gov

Abstract

The Wisconsin Minority Health HIV Partnership Initiative is a partnership between the Wisconsin Minority Health Program and the Wisconsin AIDS/HIV Program. Both the Minority Health and AIDS/HIV Programs are located in the Division of Public Health, Wisconsin Department of Health Services. This partnership initiative is focused on increasing knowledge of serostatus among African American, Latino, and Native American people who are HIV-positive in the Milwaukee, Wisconsin metropolitan area. Milwaukee is the “geographic hotspot” of new HIV infections in Wisconsin. It is estimated that almost 1 in 7 HIV-positive persons in the United States are unaware of their infection. Undiagnosed infection remains a significant factor fueling the HIV epidemic, and while HIV testing is now easier to access and testing technologies have improved, many persons avoid HIV testing for a variety of reasons. Knowing one’s HIV status is the most important part of preventing and controlling the HIV epidemic. People who know they are infected are far less likely to have unprotected sex than those who do not know. Early diagnosis of HIV infection and linkage to care enable people to start treatment sooner, leading to better health outcomes and longer lives while reducing the risk of spreading HIV to others. HIV continues to disproportionately affect minority communities in the United States. In Wisconsin, HIV infection is a disease that disproportionately impacts racial, ethnic, and sexual minorities. While individuals of minority racial/ethnic groups make up just 17% of Wisconsin’s population, they account for more than two-thirds of new HIV infections. Within minority communities, youth account for a substantial number of HIV infections. In the age group 13 to 24, gay, bisexual, and other men who have sex with men account for the majority of new infections. Among this population, African American and Latino gay and bisexual men are disproportionately represented and impacted. The objectives of the Partnership Initiative include:

• 1) Increase by 20% from baseline the number of currently HIV-positive Black, Latino, and Native American individuals who are aware of their HIV status and/or are actively participating in adequate medical care;
• 2) Increase number of people among target populations (Black, Latino, and Native American) reached through awareness events around HIV and related topics during the project period; and
• 3) Increase the availability of culturally and linguistically appropriate services (CLAS) for minority populations at risk for HIV provided by local clinical, community health, and support organizations during the project period.

The Partnership Initiative will develop a Health Disparities Profile focused on the Healthy People 2020 Leading Health Indicator on awareness of HIV serostatus among HIV-positive members of the target communities. Primary activities and initiatives implemented to address these objectives include: 1) HIV social networks testing, 2) clinic-based HIV testing, 3) community awareness regarding HIV prevention and care, and 4) organizational leadership development and capacity building of community-based agencies involved in HIV-related prevention and care services. Specific interventions planned targeting each project objective include:

Objective 1:

• Social networks testing targeting young Black, Latino, and Native American MSM (men who have sex with men) and IDU (injection drug users);
• Routine HIV screening of Black, Latino, and Native American persons in Milwaukee at clinics serving persons from the most impacted zip codes in the city; and
• Regular STI testing of young Black, Latino, and Native American MSM, with a focus on HIV-positive individuals.

Objective 2:

• Promotion of community HIV awareness days (National Black HIV Awareness Day, National Latino HIV Awareness Day, etc.) utilizing CDC’s Act Against AIDS campaign and other culturally and linguistically appropriate resources, including use of electronic social media;
• Engagement of partners to serve as lead organizers for HIV Screening and education services at community events (e.g. Juneteenth, Cinco de Mayo) throughout the project period; and
• Development and implementation of awareness campaign on PrEP (Preexposure Prophylaxis) targeting Black, Latino, and Native American risk populations.

Objective 3:

• Collaboration and coordination through regular meetings with community partners, including but not limited to:
• Minority Health Leadership Council;
• Black Health Coalition of Wisconsin;
• Alliance School;
• LGBT Community Center of Milwaukee; and
• Pathfinders, Inc.
• Agency capacity building including:
• Implementing CLAS standards;
• Staff development;
• Financial sustainability; and
• Other areas identified in the Health Disparities Profile.

The overall expected outcome of this project is reduced transmission of AIDS/HIV to and within Black, Latino, and Native American communities in Milwaukee, WI. The grantee expects that, in contributing to this outcome, their project will have numerous impacts at the individual, community, and system level, which include:

• More minority individuals will be aware of their HIV serostatus;
• More persons who are HIV+ will be engaged in care services;
• More minority persons at risk will access HIV prevention services, PrEP, and regular HIV testing.
• Decreased number of HIV+ and at-risk minority individuals who have undiagnosed and/or untreated STIs;
• Reduced incidence of minority persons at risk for HIV unwilling / unable to access needed services due to stigma;
• Increased availability of community leaders and services that effectively advocate for the needs of HIV+ persons and those at risk for HIV in minority communities;
• More individuals within risk population who are insured and empowered to use care services effectively;
• Increased number of agencies providing culturally & linguistically appropriate HIV prevention services;
• Increased number of clinicians able and willing to appropriately provide minority clients with PrEP intervention; and
• Increased number of HIV specialty clinicians providing routine STI screening to HIV+ patients.

Comprehensive evaluation activities will measure the impact of interventions directed at members of the target communities and agencies. Data collection activities will include tracking of process and outcome measures. Data to evaluate Culturally and Linguistically Appropriate Services (CLAS) and leadership development outcomes will be housed in the Minority Health Program SharePoint Evaluation Site. Data to evaluate testing outcomes and capacity building/awareness events will be housed with the secure data management software EvaluationWeb (Luther Consulting, LLC). Data used to evaluate HIV care outcomes will be housed in the AIDS/HIV Program’s secure Enhanced HIV/AIDS Reporting System (eHARS), a browser-based application provided by the Centers for Disease Control and Prevention (CDC) used for HIV surveillance. Epidemiologists in the AIDS/HIV Program will analyze care data using SAS® 9.3 for Windows® (SAS Institute) and will consult with Initiative staff in the development of surveillance reports and related publications. In order to ensure the work plan is fully executed and effective in its goals, the following intermediate and long-term performance measures for the five year project time span were identified by the grantee:

Objective 1:

• Number of Black, Latino, and Native American persons tested for HIV through routine screening; (Reported via EvaluationWeb)
• Number of young Black, Latino, and Native American MSM (men who have sex with men) and IDU (injection drug users) tested for HIV through social network testing; (Reported via EvaluationWeb)
• Number of newly diagnosed Black, Latino, and Native American persons with immediate access to HIV specialty medical services; (Reported via EvaluationWeb, and identified via record matching between eHARS and lab reports.)
• Number of previously diagnosed Black, Latino, and Native American persons defined as "out of care" that consistently access care; and (Identified via record matching between eHARS and lab reports.)
• Number of HIV-positive young Black, Latino, and Native American MSM who are screened for syphilis, gonorrhea, and chlamydia during the project period. (Reported via EvaluationWeb and identified via record matching between eHARS and lab reports)

Objective 2:

• Number of materials distributed;
• Number of newly developed materials in Spanish and/or revised to address health literacy and/or cultural appropriateness;
• Number of persons from target populations attending awareness events;
• Number of persons from target populations linked to HIV services at awareness events;
• How comfortable are clinicians with prescribing PrEP (Pre-exposure Prophylaxis);
• How comfortable are potential clients with PrEP (Pre-exposure Prophylaxis) as an intervention; and
• % of clients that know where they could get PrEP (Pre-exposure Prophylaxis) if they wanted it.

Objective 3:

• Mid-project and post-project CLAS assessment of partner agencies;
• Twice-yearly review of progress on intervention process objectives reported via EvaluationWeb, including but not limited to
• number of program participants;
• age, race and ethnicity demographics of program participants;
• number of materials translated from English to Spanish, or otherwise revised to be more culturally and linguistically appropriate for the target populations;
• Mid-project and post-project assessment of leadership capacity of partner agencies involved in leadership trainings;
• Mid-project and post-project assessment of proportion of agency client education and promotional materials available in Spanish (including web-based materials) among agencies serving Spanish speakers;
• Annual review of additional CLAS accessibility marker(s) identified in the first year; and
• Tools created/identified to aid CLAS implementation.

NATIONAL PARTNERSHIP FOR ACTION TO END HEALTH DISPARITIES GOALS

None identified by grantee.

RELATED HEALTHY PEOPLE 2020 OBJECTIVES & SUBOBJECTIVES

• HIV-13: Knowledge of serostatus among HIV-positive persons