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Findings 11 findings
F1
“Getting to Zero,” “Ending the Epidemic,” and “Live Well San Diego,” share common objectives and rely on collaboration between local organizations and healthcare providers.
F2
Because three concurrent initiatives share similar goals and strategies, stakeholders disagree whether “Getting to Zero” continues to serve as the County’s central HIV initiative. Fact: Of San Diego’s most recent HIV infection rates, 63% were among young people between the ages of 20-39. Fact: With the advent of ART, HIV has shifted from a medical emergency to chronic disease management.
F3
The shift to chronic disease management and the high percentage of HIV infection rates comprised of young people means the County’s goal of achieving zero new infections is at best a stretch goal. Fact: Several County RWHAP services like mental health in the North Coastal Region, housing Partial Assistance Rental Subsidy, and specialty dental care have consumer waiting lists. Fact: The County had a Supplemental UOB of $1,300,468 last year. Fact: Supplemental Funds are not eligible to be carried over and must be returned to the U.S. Government.
F4
The $1,300,468 in County Supplemental Funds returned to HRSA, could have been used for other RWHAP services like mental health in the North Coastal Region, housing Partial Assistance Rental Subsidy, and specialty dental care. Fact: With four months left in the 2024 Grant Year, the County's RWHAP Primary Care utilization was 70%. Fact: Between November 2024 and January 2025, HSHB asked HPG to reallocate $826,112 from other RWHAP services to shore up Primary Care funding. Fact: Underutilization of Primary Care between Dec 2024 and Feb 2025 contributed to roughly half of the County’s UOB and forfeited funds. Fact: The County's contract with United Healthcare (dba AmeriChoice) requires monthly utilization reporting to HSHB.
F5
The County's failure to closely monitor monthly Primary Care utilization contributed to about half of the County's UOB and forfeited funds. Fact: The first documented reference to the County's RWHAP 2024 UOB was in the June 2025 HPG Meeting Minutes, four months after the 2024’s February 28 close. Fact: Both HPG and HSHB reported they were shocked by the amount of 2024 UOB. Fact: Several in HPG leadership were not advised of the County's forfeiture of $1.3 million in Supplemental funds.
F6
HSHB's lack of both transparency and promptness in reporting RWHAP forfeited and carry-over funds has contributed to HPG distrust toward HSHB. Fact: Los Angeles County is a RWHAP grant recipient. Fact: Los Angeles received $46.4 million in 2024 RWHAP award. Fact: Los Angeles’ 2024 RWHAP award was more than three times larger than San Diego County’s 2024 award. Fact: Los Angeles did not have a carryover request for Grant Years 2023 and 2024.
F7
Los Angeles spent all of its RWHAP award for the last two years. Fact: The County (HSHB, Epidemiology) provide critical decision-making data, consumer survey results, and service utilization rates to HPG to complete its RWHAP priority setting for the succeeding year. Fact: HPG needs this data by the end of May. Fact: For Grant Year ‘25, the County was still providing data to HPG in August.
F8
The County's late delivery of critical data to HPG has caused frustration among HPG members and rushed the priority setting process. Fact: The County’s “HHSA HIV Needs Assessment Survey” is 71 questions long for those younger than 50-years-of-age, and 87 questions for those older than 50-years -of-age. Fact: The Survey is conducted every three years. Fact: Last year the County received 310 Survey responses, 65 fewer than the responses needed to achieve the industry standard 95% confidence level. Fact: The Survey is available online and in providers’ offices. Fact: Many survey questions are multilayered, containing multiple questions.
F9
The length and complexity of the Survey leads to survey fatigue and contributes to the County's failure to get enough returns for a 95% confidence level.
F10
Lack of any survey incentive suppresses completed survey numbers.
F11
Many consumers lack convenient access or the skills to navigate an online survey. REQUIREMENTS AND INSTRUCTIONS The California Penal Code §933(c) requires any public agency which the Grand Jury has reviewed, and about which it has issued a final report, to comment to the Presiding Judge of the Superior Court on the findings and recommendations pertaining to matters under the control of the agency. Such comment shall be made no later than 90 days after the Grand Jury publishes its report (filed with the Clerk of the Court); except that in the case of a report containing findings and
Recommendations 8
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R1Sunset “Getting to Zero,” in favor of the federal initiative “Ending the Epidemic.”
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R2Call for the Board to meet jointly with leaders of HSHB and HPG for strategic planning and accounting of RWHAP service run-rates and guard against surprise swings in utilization. Such a review can be done in time for a course correction. HPG can adjust its spending recommendations to the Board and provide for other categories that may have waiting lists. HSHB should also report to the Board on carryover and forfeited amounts.
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R3Appoint a “Program Delegate” to work with Los Angeles County Health and Human Services to leverage LA’s best practices on how they achieve zero RWHAP Part A UOB.
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R4Set a hard May 15 deadline for transferring KPI and all relevant data to HPG to facilitate timely planning, analysis, and consumer input in the planning process.
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R5Provide an HPG-data specific dashboard to facilitate real- time priority setting and funding recommendations throughout the year as needed. This will lessen reliance on in-person data exchanges.
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R6Simplify the “County of San Diego HHSA HIV Needs Assessment Survey” with fewer, less complicated questions. The Grand Jury also recommends testing different versions of the survey in off years to determine which achieves highest return rates.
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R7Reinstate offering gift cards for survey completion.
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R8Explore using the USPS to mail hard-copies of the Survey to HPG consumers, including a self-addressed stamped envelope for returning completed surveys. Such an approach may increase return numbers to reach the 95% confidence level for meaningful feedback.