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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, housing, and 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 counseling, housing assistance, and 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 $625,000 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: When total numbers of returned surveys were higher, the County formerly incentivized Survey completion with gift cards. 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 pertaining to a department or agency headed by an elected County official (e.g. District Attorney, Sheriff, etc.), such comment shall be made within 60 days to the Presiding Judge with an information copy sent to the Board of Supervisors. Furthermore, California Penal Code §933.05(a), (b), (c), details, as follows, the manner in which such comment(s) are to be made: (a) As to each grand jury finding, the responding person or entity shall indicate one of the following: (1) The respondent agrees with the finding (2) The respondent disagrees wholly or partially with the finding, in which case the response shall specify the portion of the finding that is disputed and shall include an explanation of the reasons therefor. (b) As to each grand jury recommendation, the responding person or entity shall report one of the following actions: (1) The recommendation has been implemented, with a summary regarding the implemented action. (2) The recommendation has not yet been implemented, but will be implemented in the future, with a time frame for implementation. (3) The recommendation requires further analysis, with an explanation and the scope and parameters of an analysis or study, and a time frame for the matter to be prepared for discussion by the officer or head of the agency or department being investigated or reviewed, including the governing body of the public agency when applicable. This time frame shall not exceed six months from the date of publication of the grand jury report. (4) The recommendation will not be implemented because it is not warranted or is not reasonable, with an explanation therefor. (c) If a finding or recommendation of the grand jury addresses budgetary or personnel matters of a county agency or department headed by an elected officer, both the agency or department head and the Board of Supervisors shall respond if requested by the grand jury, but the response of the Board of Supervisors shall address only those budgetary or personnel matters over which it has some decision-making authority. The response of the elected agency or department head shall address all aspects of the findings or recommendations affecting his or her agency or department. Comments to the Presiding Judge of the Superior Court in compliance with the Penal Code §933.05 are required from the:
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.