FOCUS PROPOSAL TEMPLATE_RENEWAL_FINAL_ 06 2019_MARICOPA COUNTY CORRECTIONAL HEALTH SERVICES_FINAL.DOCX

FOCUS
Frontlines of Communities in the United States
Request for Partner Renewal
Partnerships – HIV, HCV & HBV Screening
Part I NARRATIVE
1. Applicant Information
 Name of applicant organization: Maricopa County Correctional Health Services
 Legal name of applicant organization: Maricopa County
 Renewal application date: June 9, 2019
 Total Budget Requested: $308,177
 Previous Year Budget: $436,032
Only complete the below section if it has changed from the current year.
 Contact Name: Dr. Grant Phillips
 Title: Medical Director
 E-mail: G.Phillips@mail.maricopa.gov
 Telephone: 602-876-7114
Organization Metrics
 Unique Number of Patients: 10,000
 Total Number of Sites/Locations: 6
 Total Number of Sites/Locations where FOCUS will be implemented: 6
Location Name Location Address Site Type
Fourth Ave 201 S. 4th Avenue Corrections- Clinical
Phoenix, AZ 85003

Durango 3225 West Gibson Lane, Corrections-Clinical
Phoenix, AZ 85009
Estrella 2939 W. Durango Road, Corrections- Clinical
Phoenix, AZ 85009
Lower Buckeye 3250 W. Lower Buckeye Road, Corrections- Clinical
Phoenix, AZ 85009
Towers Jail 3127 West Gibson Lane, Corrections- Clinical
Phoenix, AZ 85009
2. Project Summary for the Current Year and Proposed Year
a. Please summarize your organization’s key accomplishments for current year. Limit 200
words
Over the past two years Correctional Health Services (CHS) has implemented procedures to
offer Hepatitis C testing to all inmates remaining in the jail for at least 5 days. Testing is being
conducted between incarceration days 3 thru 5. From July 2018 through March 2019, of the
HCV tests conducted, 20% of the patients were identified as Hepatitis C positive. We have
improved provider proficiency at educating patients about the implications of a HCV diagnosis,
engaging patients in substance use/abuse counseling/treatment, and coordinating release
planning.
Improved testing has also identified an increase in the number of patients being identified as
RNA Positive (4.2%) and the number attending their first medical appointment has improved
by 5.1% since last year. In part this is due to coordination with community partners where a
“reach-in” service type of support is being used to schedule first medical appointments and
social services (not funded by FOCUS award) when released from incarceration. CHS has
been able to continue to offer HIV opt-out screening for over 7 years now with no funds for
staffing. This includes having patients attending a first medical appointment with a provider for
all positive results. CHS is requesting a new Hep C Case Manager to focus on higher risk
individuals and link to a first medical appointment with a community provider because they did
not have time to link with CHS. CHS feels this will help patients attend a first medical
appointment when they leave custody.
The number of daily bookings into jail is up to 300 inmates per day, with an average daily
census of 7,500.
Screening:
b. Was your organization able to establish formal screening policies for any of the following?
 HIV screening? Yes
 HCV screening? Yes
o Was your organization able to establish a reflex to RNA for HCV screening? Yes
 HBV screening? N/A
If NO to any questions above, please explain any challenges that your organization experienced and
the plans for the proposed year partnership. Limit 100 words
c. Please indicate if your EMR was modified in the following ways:

 Programmed to determine patient eligibility? Yes
 Lab orders auto populated based on eligibility? Yes
 Lab results transmitted electronically to the patient chart? Yes
 Lab results automatically sent to the linkage to care team? Yes
If NO to any questions above, please explain why below and discuss the plans for the proposed year
partnership? Limit 300 words
Linkage to Care:
d. If Linkage to Care rates were low for any disease area please indicate areas of opportunity and
improvement strategies for proposed year. Limit 300 words
A dedicated Hep C Coordinator has been added to the FOCUS award for Year 3. This individual will
assist with linking inmates to care if they leave custody prior to linkage to care in the correctional
facility. Staff will continue to work with multiple community providers to link recently released
inmates to care.
Please indicate if your EMR was modified to support Linkage to Care and areas of opportunity for
improvement. Limit 300 words
Providers and staff receive a message stating patient has screened positive and needs to be linked
to care. Patient navigators are also notified of patients testing positive through the EMR. In addition,
additional navigation support (not funded through FOCUS award) is available through community
support services. These efforts have helped improve the number of patients linked to care who
have departed from custody.
e. Please explain your continuous quality improvement (CQI) approach from the current year if your
partnership experienced any of these challenges: (1) reflexing did not occur for all HCV Ab positive
tests to HCV RNA tests; (2) EMR modifications did not work properly (3) at least 25% of the eligible
patient population was not screened, for any site; and/or (4) if there were other major issues that
you want to address. For all partners, if the planned CQI process for the proposed year partnership
is different than the current year please explain what it will be. Limit 400 words
CQI efforts continue to focus on linkage to care to first medical appointment if inmates are released
before they can link to a first medical appointment in correctional care. Maricopa Jail is continuing to
work with community providers and community support groups to facilitate these efforts. Secondly,
2-3% of reflex labs are rejected due to collection issues. Staff members are provided with training
and follow-up for any collection errors.
f. Please describe any key innovations or enhancements planned for this continuation request. Limit
400 words
Coordination with community providers has been important in efforts to address linkage to care.
Maricopa Jail is continuing to build these “in-reach” activities by community groups to help facilitate
linkage to care if the individual is being released from custody.
Proposed Reach: Proposed Year and Current Year Outcomes
Please complete the below tables by combining the totals across all screening sites.

PROPOSED YEAR CURRENT YEAR CURRENT YEAR
HIV
GOAL ACTUAL GOAL
# Eligible Patients 9,289 9,952
# HIV Tests Conducted 9,289 9,952
# and % HIV Positives Identified 63/0.7% 50/0.5%
If data available, include seropositivity breakdown of 23 Unk
newly identified positives
If data available, include seropositivity breakdown of 40 Unk
previously known positives
# Acute HIV Cases Identified 0 0
# and % HIV+ LTC 44/70% 45
If data available, include seropositivity breakdown of 10 Unk
newly identified positives linked to care
If data available, include seropositivity breakdown of 34 Unk
previously identified positives linked to care
# NOT Tested/Known HIV Positive Individuals Out of Care 0 0
# NOT Tested/Known HIV Positive Individuals Out of Care 0 0
Linked to Medical Care
PROPOSED YEAR CURRENT YEAR CURRENT YEAR
HCV
GOAL ACTUAL GOAL
# Eligible Patients 9,000 9,289 9,952
# HCV Ab Tests Conducted 9,000 9,289 9,952
# and % HCV Ab+ Identified 1,800/20% 1,862/20% 2,268
# and % HCV RNA Tests Conducted 1,800/100% 1,862/100% 2,268
# and % HCV RNA + Identified 1,260/70% 1,441/77% 1,905
# and % HCV RNA+ LTC 873/70% 659/46% 1,121
(ALTC- 58%)
# NOT Tested/Known HCV RNA Positive Individuals Out of 75 80 Unk
Care
# NOT Tested/Known HCV RNA Positive Individuals Out of 20 25 Unk
Care Linked to HCV Care
PROPOSED YEAR CURRENT YEAR CURRENT YEAR
HBV
GOAL ACTUAL GOAL
# Eligible Patients
# HBsAg Tests
# and % HBsAG+
# and % HBsAG+ LTC
3. Dissemination Plan
A key aspect to FOCUS is sharing lessons learned and best practices to a variety of stakeholders.
Indicate how your organization plans to disseminate FOCUS best practices internal to the organization,
with local/state partners and national stakeholders. (Examples of areas of dissemination could be other
providers, patient advocacy groups, planning councils and/or conferences.)
Planned Conferences/Meetings, Presentations, and Publications
Internal Content area/Description of
Frequency of meeting
Committees/Meetings Committee

(add rows as needed)
Local or Regional
Opportunities to Share Presentation Title/ Content area Submission Timeline
Best Practices
Arizona Infectious Disease HIV and HCV Screening Linkage at
July 2019
Update Maricopa Jail*
(add rows as needed)
Conference or Publication Abstract or Manuscript Title
Timeline
Name /content area
National Commission on Tackling Hepatitis C and HIV in a
October 2019
Correctional Health Care Large Urban Jail System*
(add rows as needed)
* “The FOCUS Program is a public health initiative that enables partners to develop and share best practices in routine blood-borne virus (HIV, HCV, HBV) screening, diagnosis, and linkage to care in
accordance with screening guidelines promulgated by the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Preventive Services Task Force (USPSTF), and state and local public health
departments. FOCUS funding supports HIV, HCV, and HBV screening and linkage to the first medical appointment after diagnosis. FOCUS partners do not use FOCUS awards for activities beyond
linkage to the first medical appointment.”
4. Project Management
Describe who will do day-to-day project management and who will provide oversight: Limit 200 words
Dr. Grant Phillips- Maricopa County Correctional Health Services Medical Director
 He joined Maricopa Correctional Health Services in January 2011 and serves as Medical
Director. He also chairs the Alcohol and Substance Abuse Initiative and Clinical Practice
Committee. In addition, he is currently undergoing training to be an NCCHC accreditation
surveyor.
 Dr. Phillips will provide project oversight and strategic thought to the project over the year. Dr.
Phillips also oversees all staff to ensure they are following FOCUS goals/objectives
Cody Johnson- Maricopa Correctional Care Finance Administrator
 Cody is responsible for overall finances for the organization and providing grant support
 Cody will ensure all FOCUS reports, budgets and timelines are kept. Cody works with Dr.
Phillips to ensure the project goals and objectives are on track
5. Linkage to Care
Please describe your current protocols, successes and challenges with identifying known out of care
patients and the ability to link them to care. Appendix 2 and Appendix 3 of this document describe the
process for linkage. Limit 200 words
Linking patients to a first medical appointment after release from custody (if they were not able to link to
a first medical appointment in the jail) is a challenge. Maricopa Jail works to schedule an appointment
with correctional care staff or with an outside community provider before they depart custody.
Occasionally, the inmate will be released before correctional care has the opportunity to meet with
patient. These instances can be challenging to reconnect with the patient. Approximately 30% of
individuals screening positive are previously known. Many of these individuals struggle with mental
health, drug addiction and/or recidivism. These often lead to challenges in attending a first medical
appointment.

Part II BUDGET
Important Notice- This Award and any ancillary project support are not provided as an inducement or
reward for the purchase, use or recommendation of any product manufactured or marketed by Gilead or to
promote such products and Organization shall not promote Gilead products, directly or indirectly. Gilead may
be required to post or report to government entities all amounts disbursed to your organization under this
partnership including any salaries, consultant fees, travel, and meal expenses paid to physicians and total
grants to teaching hospitals.
The interim and final reports will contain, in addition to a compilation of the project data, an accounting of all
FOCUS program expenditures as compared to budgeted amounts.
Budget Instructions
 Line-item budget
 All personnel listed on the project are expected to dedicate the projected amount of time on the project.
(see notice above regarding payments to physicians and teaching hospitals); the following should be
attached to each proposal that includes personnel expenses:
o Verification of salary of any existing personnel
o A detailed FTE analysis (sample analysis follows) for each individual employee describing the
specific tasks and time commitments expected
 Office supplies are considered part of the total allowable indirect costs/administrative overhead and are
not allowed as a separate line item.
 EHR modifications should be limited to the minimum necessary to accomplish the limited purpose of
automating screening reminders and pre-populating screening forms based on patient risk factors and
supported by guidelines.
 Indirect rate is limited to a maximum of 10%.
 FOCUS supports the use of alternative funding streams for testing supplies or other program costs.
Please note in the appropriate column any expenses related to the project which will be covered by non-
FOCUS funds.
Budget Justification (Please provide a brief narrative of each budget item including staff descriptions and how
they will be contributing to the project; in particular, please describe in detail any budget line-items dedicated to
EHR modifications or upgrades).

Budget
Dates of Project Legal Organization Name
07/19-07/20 Maricopa County Correctional Health Services
Budget Item Justification Gilead Program Budget Non-Gilead Funding Support for FOCUS
Personnel
Total Requested from Gilead If no non-Gilead Support, keep as $0
Add Rows as Necessary
N/A N/A $0 $0
Sub-Total Medical Provider $0 $0
• Medical Assistant
• 100% full time equivalency supported by Gilead (FTE); 12 months
To Be Hired • Individual will collect blood samples and work with health care team on screening $37,293 $0
• FOCUS Admin Manager
• 20% full time equivalency supported by Gilead (FTE); 12 months
• Cody works with clinical staff to ensure goals are met and provides the
Cody Johnson administration support for the award $12,515 $0
• Linkage to Care Navigator
• 20% full time equivalency supported by Gilead (FTE); 12 months
• Cynthia works directly with patients on testing and linkage to care. She also works
Cynthia Quinn with linkage to care staff and clinical staff to ensure linkage to care $17,537 $0
• HCV Linkage to Care Navigator
• 100% full time equivalency supported by Gilead (FTE); 12 months
• Individual will provide direct linkage to care for all inmates screening positive for
Hepatitis C. Individual will work with clinical teams and community providers to
To Be Hired ensure linkage to care $53,242 $0
Sub-Total Non-Medical Provider $120,587 $0
• Health insurance (32%),retirement (25%), FICA (15%), County administration
Fringe Benefit (26.2% of salary) (25%)
• 19.45% Variable benefits ($37,094) Fixed Benefit per FTE ($32,504) $52,395 $0
Sub-Total Personnel (Medical Provider+ Non-Medical Provider+ Fringe) $172,982 $0
OTHER DIRECT PROJECT COSTS Add Rows as Necessary
Hepatitis C Ab Test 8,991 tests for inmates @ $7.22 $64,915 $0
Hepatitis C RNA Test 1,800 tests for inmates @ $23.48 $42,264 $0
Sub-Total Other Direct Costs $107,179 $0
PURCHASED SERVICES Add Rows as Necessary
N/A N/A $0 $0
Sub-Total Purchased Services $0 $0
Sub-Total Budget Request $280,161 $0
Indirect Rate Indirect 10% for facility maintance, county administration, supplies $28,016 $0
Total Program Budget $308,177 $0
Please provide a brief biography sketch below for each individual on the project who is not medical provider.
 Medical assistants- have 3-5 years of experience in the health care field. They have obtained state licensing for their clinical activities. They
operate under the guidance of the medical provider and assist in various health care services (including phlebotomy).
 Cody Johnson is a Maricopa Correctional Care Finance Administrator. Cody is responsible for overall finances for the organization and providing
grant support. Cody has his MBA in finance.

 Cynthia Quinn, RN- Cynthia has worked with Maricopa CHS for the past 8 years. Cynthia works with newly
diagnosed individuals to discuss linkage to first medical appointment and case management. Cynthia has worked
in public health for the previous 25 years.
FTE Analysis for Physicians
For each healthcare provider with prescriptive authority (MD, NP, PA, etc.) on the budget, please use
the below table to complete an FTE analysis. The descriptions should include tasks completed on a
monthly basis for the FOCUS partnership. Such tasks include, but are not limited to, weekly
meetings with staff, data and CQI analysis, monitoring EMR modifications, etc. The following
provides a sample calculation.
EXAMPLE: Provider, Title: Dr. Jane Smith, M.D., MPH, Physician Leader / Project Director
Description of Task(s) Hours Per Month
Example: Staff Supervision N/A
Example: Review of data and outcome, Continuous Quality Improvement Analysis N/A
Example: Team Meetings N/A
Example: Coordinating IT team, EMR modifications, Testing Protocols N/A
Example: Meetings with C Level Staff for Policy Change and Protocol Implementation N/A
Example: Education of Residents and Staff N/A
Total Hours N/A
Total FTE (Hours divided by 160 hour work month)

Appendix 1
Blood
Provider Draw

Appendix 2
Maximize Screening Infrastructure
Individuals identified through routine screening
Newly Diagnosed Previously Diagnosed
Acute Chronic EMR Identification of
Out-of-Care Positives
OR
Patient Self-Report
New Diagnoses as Sentinel Event Assess and Link to Care
Activate Linkage to Care

Appendix 3
EMR Algorithm + LTC Intervention
EMR Notification to LTC Team
Identification LTC Team Engages Patient
• Use of smart • Notification of known • Assessment of
screening EMR positives sent to positives to identify if
algorithm to identify linkage to care (LTC) they are in care/out of
known positives staff care
• Inbox notification or • Follow-up and LTC as
page to LTC per institutional
coordinator protocol