In a major first, a new grant from the NYC Department of Health and Mental Hygiene (DOHMH) will allow GMHC to zero in on helping clients living with HIV get to an undetectable level of viral load suppression, so they can live a long, healthy life without transmitting the virus to others.
The NYC DOHMH has awarded GMHC $240,000 annually over three years for its Undetectables Viral Load Suppression Program.
“It’s groundbreaking,” said GMHC’s Chief Human Resources and Strategy Officer Rhonda Harris. “We’ve never had a dedicated team that will truly help a person who is newly diagnosed as HIV positive to get to U=U,” as an “undetectable = untransmittable” viral level is known.
The new funding, Harris said, gives the agency the capacity to focus on the U=U status of clients living with HIV, and to more effectively coordinate its wraparound supportive services addressing hunger, housing, mental health, and other psychosocial needs to help them achieve and maintain U=U.
The National Institutes for Health in 2019 validated the science for U=U. While there’s still no cure for HIV, antiretroviral medications can suppress the viral load of people living with HIV to under 200 copies of virus per milliliter of blood. Maintaining that viral level for at least six months means they can’t transmit HIV via sexual contact.
But, that can be a big if for many GMHC clients living with HIV because they are struggling with getting basic needs met. That can derail them from staying in medical care and on their medication regimen.
Fully 67% of GMHC’s clients living with HIV live under the federal poverty line; 65% are food insecure; 52% struggle with their mental wellbeing; and 20% report having unstable housing. Most of GMHC’s clients are long-term HIV survivors, Harris said.
The COVID-19 pandemic has been an additional stressor that’s disrupted care. The viral suppression rate at three months for newly diagnosed New Yorkers in 2020 dropped to just 40%, from 53% in 2019. Overall, the viral suppression rate for New Yorkers living with HIV was 78%.
Dedicated to U=U
Until now, Harris said, GMHC has lacked the capacity to individually monitor each client’s U=U status.
The Undetectables grant program, which starts July 1, will fund a dedicated case manager, a program coordinator and a part-time outreach worker, she said. The goal is to enroll 70 clients per year.
“It’s the first program of its kind for us,” Harris said, because it allows GMHC to hire an Undetectables case manager “whose entire job is to guide newly diagnosed clients through the process and say, ‘We are going to get you to undetectable.’”
“It ties into everything we’re doing—but a lot of our programs operate in silos,” she explained. “We’ve needed the connector—someone whose job it is to focus solely on U=U and do this work.”
That is beyond the purview of a frontline program like the Meals Program, Harris said. “Their focus is on feeding people. There is only so much you can do to help someone get to undetectable if you are packing pantry bags and making sure people are getting food.”
For many clients, the entry point to GMHC is through the Testing Center. “Most folks come in from off the street, get an HIV test and, if it’s positive, are walked over to Mount Sinai” for HIV-related medical care, Harris said, referring to GMHC’s longstanding partnership with Mount Sinai Hospital.
The Undetectables grant will allow GMHC to monitor the adherence of newly diagnosed clients to their HIV treatment plan. This enables the agency to connect each client to the right combination of care services needed to reach U=U, Harris said.
Besides meals and testing services, GMHC provides mental health and substance use services, housing assistance, health insurance and health care assistance, workforce development, and legal services for family law, housing, immigration, as well as peer support groups focused on the communities we serve.
While each program collects data on clients’ primary care status, HIV lab tests, and medication adherence, Harris said, until now there hasn’t been a mechanism for acting on the data. The Undetectables program adds that capacity.
Relatedly, GMHC has been retooling its client intake process over the past six months, she said, to centralize it at a single point of entry, instead of having each program handle its own intake.
GMHC has also launched a Partnership Generation unit to expand client enrollment by building on existing community partnerships and developing new ones.
Breaking Through Silos
Harris said that Paulyn Sarmiento, who oversees the intake unit, “will be instrumental in streamlining the process and breaking through as many silos as we can.”
When people are newly diagnosed with HIV, Sarmiento said, they often don’t know what resources are available. “They hear our name and come in with questions.”
GMHC has “a plethora of resources, along with people to guide and help them,” she said. “We want to provide a safe haven where people can come and talk to us.”
Social barriers like food and housing can be the biggest obstacles to staying on an HIV treatment plan, Sarmiento said. “Clients may be in and out of shelters or living on the street. In that situation, it’s really hard to prioritize your health,” she explained. “If you’re trying not to get evicted, you may not be going to a doctor for a prescription refill.”
A lot of GMHC’s clients are immigrants, she added. “They often don’t have health insurance and don’t know how to get medication.”
One Undetectables program priority is to reach youth newly diagnosed with HIV. New Yorkers ages 13 to 19 have one of the lowest rates of viral suppression at three months after diagnosis, at just 34% in 2020. A big obstacle is that most young people “aren’t interested in learning about health insurance on top of having to go to a doctor,” Sarmiento said.
Harris is particularly excited by the grant’s focus on mental health services. “When you’re newly diagnosed, your whole world is shaken,” she said.
Each Undetectables program participant will receive at least two mental health appointments per month, but Harris expects the agency to exceed that. “We want to seize this opportunity to treat clients holistically,” she said.