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Confidential information not subject to disclosure under FOIA or state freedom of information/open records laws.
fi GILEAD
RENEWAL FOCUS AWARD LETTER
October 4,2019
Dr. Grant Phillips
Medical Director Correctional Health Services
Maricopa County Correctional Health Services
3250 West Lower Buckeye Road
Phoenix, AZ 85009
Dear Dr. Phillips:
On behalf of Gilead Sciences, Inc. ("Gilead"), I am pleased to inform Maricopa County Correctional
Health Services ("Organization") that your request for an FOCUS award ("Award") to support HIV and/or
hepatitis C testing and testing-related services ("Project"), as set forth in greater detail in your proposal and
budget dated May 02, 2019, has been approved in the amount of Three Hundred Thousand One Hundred
Seventy Seven Dollars ($308,177).
PROSPECTIVE AWARD FUNDS WILL BE DISBURSED ONCE: 1) GILEAD HAS RECEIVED A SIGNED COPY OF THIS
FOCUS AWARD LETTER ("AWARD LETTER") AND 2) GILEAD AND ORGANIZATION HAVE RECENTLY AND MUTUALLY
EXECUTED AN FOCUS AGREEMENT ("AGREEMENT"). Subject to the above, Gilead will disburse the Award to
Organization as follows: (a) sixty percent (60%) of the Award funds within thirty (30) business days of the date
on which Organization has executed this Award Letter; (b) thirty percent (30%) of the Award funds upon
Gilead's approval of the interim Report (as defined in the Agreement) detailing the progress of the Project from
October 1, 2019 through April 30, 2020 and submitted to Gilead no later than May 31, 2020; and (c) ten
percent (10%) of the Award funds upon Gilead's approval of the final Report (as defined in the Agreement)
detailing the full scope of the Project through September 30, 2020 and submitted to Gilead no later than
October 31, 2020.
This Award Letter and Organization's use of Award funds shall be governed by the terms and
conditions contained in the Agreement, entered into by and between Gilead and Organization on r r, the
terms of which are hereby expressly incorporated as Exhibit B.3..
Please sign below to indicate agreement to this Award Letter, make a copy for your files, and return a
signed copy to Jeff Eggert via email at Jeff.Eggert@gilead.com .
Sincerely,
Michael Boyd, Vice President, Government Affairs
& Policy
Acknowledged and Agreed to:
IVIARICOPA COUNTY/ CORRECTIONAL
HEAL T
,RVICES
By: C.,./
Name:
Title:
e (1.0 4
x_rc),
305970.1
Date:10/04/19
Maricopa County Correctinnal
Health-Services
By:
Name:
BILL GATES
Title: Chairman, Board of Supervisors
Date:
NOV 0 0/ 2019
ATTEST:
c72t--17-
RENEWAL FOCUS AWARD LETTER — SIGNATURE PAGE
IN WITNESS WHEREOF, the parties have executed this Agreement as of the respective
dates written below.
MCC of AZ
Authorized Individual:
By:
ELECTRONIC SIGNATURE—Previous Page
Name: Michael Boyd
Title: Vice President
MARICOPA COUNTY
BOARD OF SUPERVISORS
_
Clerk of the Board
Date:
NOIr 06 2019
APPROVED AS TO FORM:
Name: ,ba8J1.i.,
Title: Deputy County Attorney
Date:
R
Part I
FOCUS
Frontlines of Communities in the United States
f- GILEAD
Request for Partner Renewal
Partnerships — HIV, HCV & HBV Screening
NARRATIVE
1. Applicant Information
•
Name of applicant organization:
Maricopa Count/ Correctional Health Services
•
Legal name of applicant organization: 1 Maricopa Count/
•
Renewal application date: I 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: 11 G.PhillipsRmail.maricopa.gov
•
Telephone:
602-876-7114
Organization Metrics
•
Unique Number of Patients: 10,000
•
Total Number of Sites/Locations: r6
•
Total Number of Sites/Locations where FOCUS will be implemented: 5
Fourth Ave
201 S. 4th Avenue
Corrections- Clinical
Phoenix, AZ 85003
Durango
3225 West Gibson Lane,
Phoenix, AZ 85009
Corrections-Clinical
Estrella
2939 W. Durango Road,
Phoenix, AZ 85009
Corrections- Clinical
Lower Buckeye
3250 W. Lower Buckeye Road,
Phoenix, AZ 85009
Corrections- Clinical
Towers Jail
3127 West Gibson Lane,
Phoenix, AZ 85009
Corrections- Clinical
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. OHS 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 (COI) 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.
HIV
PROPOSED YEAR
GOAL
CURRENT YEAR
ACTUAL
CURRENT YEAR
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
newly identified positives
23
Unk
If data available, include seropositivity breakdown of
previously known positives
40
Unk
# Acute HIV Cases Identified
0
0
# and % HIV+ LTC
44/70%
45
If data available, include seropositivity breakdown of
newly identified positives linked to care
10
Unk
If data available, include seropositivity breakdown of
previously identified positives linked to care
34
Unk
# 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
# 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%
(ALTC- 58%)
1,121
# 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
'A„', ,/
HIV,
# Eligible Patients
# HBsAg Tests
# and % HBsAG-F
# 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
Committees/Meetings
Content area/Description of
Committee
Frequency of meeting
(add rows as needed)
Local or Regional
Opportunities to Share
Best Practices
Presentation Title/ Content area
Submission Timeline
Arizona Infectious Disease
Update
HIV and HCV Screening Linkage at
Maricopa Jail*
July 2019
(add rows as needed)
Conference or Publication
Name
Abstract or Manuscript Title
/content area
Timeline
National Commission on
Correctional Health Care
Tackling Hepatitis C and HIV in a
Large Urban Jail System*
October 2019
(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).
Budge
Dates of Pro"ect
Le al Or anization Name
07/19-07/20
Maricopa County Correctional Health Services
Budget Item
Justification
Gilead Program Budget
Non-Gilead Funding Support for FOCUS
Personnel
Add Rows as Necessary
Total Requested from Gilead
If no non-Gilead Support, keep as $0
N/A
N/A
$0
$0
Sub-Total Medical Provider
$0
$0
To Be Hired
• Medical Assistant
• 100% full time equivalency supported by Gilead (FTE); 12 months
• Individual will collect blood samples and work with health care team on screening
$37,293
$0
Cody Johnson
• 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
administration support for the award
$12,515
$0
Cynthia Quinn
• 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
with linkage to care staff and clinical staff to ensure linkage to care
$17,537
$0
To Be Hired
• 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
ensure linkage to care
$53,242
$0
Sub-Total Non -Medical Provider
$120,587
$0
Fringe Benefit (26.2% of salary)
• Health insurance (32%),retirement (25%), FICA (15%), County administration
(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 CAb 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 OHS 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
Total FTE (Hours divided by 160 hour work month)
N/A
Appendix '1
HIV/HCV/HBV Routine Screening Process Flow:
Verbal Notification of Test
Notification and
written
documentation
of decline
Determines
eligible
patients and
prepopulates
the lab order
form; alerts
staff
Opt out
verbal
notification
followed by
automated
process
P re-test info
LAB
Appendix 2
Maximize Screening Infrastructure
Individuals identified through routine screening -1
r
Newly Diagnosed
Acute
Chronic
V
New Diagnoses as Sentinel Event
I
Activate Linkage to Care
Previously Diagnosed
EMR Identification of
Out-of-Care Positives
OR
Patient Self-Report
I
Assess and Link to Care
Appendix 3
EMR Algorithm + LTC Intervention
EMR
Identification
Notification to
LTC Team
LTC Team
Engages Patient
Use of smart
screening EMR
algorithm to identify
known positives
Notification of known
positives sent to
linkage to care (LTC)
staff
Inbox notification or
page to LTC
coordinator
Assessment of
positives to identify if
they are in care/out of
care
Follow-up and LTC as
per institutional
protocol