Ryan White Title IV Women, Infants, Children, Youth and Affected Family Members AIDS Healthcare - Hope & Help Center of Central Florida respectfully requests Ryan White HIV/AIDS Program (RWHAP) Part D funding ($1,700,119.52 total 4yr) to provide comprehensive, family-centered HIV primary medical care and support services for women, infants, children, and youth (WICY) living with HIV throughout Orange, Osceola, Seminole, Brevard, Lake, and St. Lucie Counties. As a new Part D applicant, Hope & Help seeks to expand access to coordinated HIV care for low-income, uninsured, and underinsured WICY populations while strengthening regional systems of care through multidisciplinary partnerships and integrated service delivery. The proposed program will serve women of reproductive age, pregnant women, infants, children, adolescents, and young adults living with HIV who experience barriers to care, including poverty, housing instability, transportation challenges, behavioral health conditions, limited English proficiency, lack of insurance, and geographic disparities in access to HIV specialty services. Based on regional epidemiologic data and projected service utilization, Hope & Help anticipates serving approximately 120 WICY clients during Year 1, with enrollment increasing throughout the four-year project period. Targeted HIV counseling, testing, linkage, and re-engagement activities will also identify individuals who are newly diagnosed or have fallen out of HIV medical care. The proposed service area encompasses six Central Florida counties where HIV disease burden and unmet healthcare needs demonstrate the need for expanded family-centered HIV services. Care will be delivered through Hope & Help's primary medical clinic in Winter Park and a coordinated network of Ryan White Parts A and B providers, the Florida Department of Health HIV/AIDS Program, pediatric and obstetrical specialists, behavioral health providers, hospitals, pharmacies, and community-based organizations. Clinic-based services will be complemented by telehealth, community outreach, patient navigation, home and community visits, and virtual case management to improve equitable access throughout the region. The project's primary objectives are to increase timely access to comprehensive HIV primary medical care; link at least 90 percent of newly diagnosed WICY clients to HIV medical care within 30 days of diagnosis; improve retention in care through comprehensive medical case management and patient navigation; increase antiretroviral therapy adherence and viral suppression; and reduce health disparities by addressing social determinants of health through coordinated medical, behavioral health, and supportive services. Hope & Help will implement an integrated, family-centered model of care that combines outpatient ambulatory HIV medical care, medical case management, patient navigation, behavioral health coordination, reproductive and prenatal care referrals, pediatric specialty care, treatment adherence counseling, oral health referrals, medical nutrition services, transportation assistance, insurance enrollment, housing referrals, and other Ryan White-allowable support services. Individualized care plans will be developed for every client and coordinated through a multidisciplinary team to ensure seamless service delivery across the HIV care continuum. Program performance will be monitored through a comprehensive Clinical Quality Management Program using CAREWare, electronic health records, Ryan White Services Report (RSR) data, and HRSA HIV/AIDS Bureau performance measures. Continuous quality improvement activities will evaluate linkage to care, retention in care, treatment adherence, viral suppression, service utilization, and health equity outcomes to ensure program effectiveness and accountability. Consistent with Ryan White HIV/AIDS Program Part D requirements, Hope & Help will educate eligible clients about HIV/AIDS-related clinical research opportunities and facilitate referrals to affiliated research institutions and clinical trial networks.
