Form 29 FY2020 Ending the HIV Epidemic Primary Care HIV Preventi

FY2020 Ending the HIV Epidemic – Primary Care HIV Prevention (PCHP)

Progress Reporting

OMB No.: 0915-0285. Expiration Date: XX/XX/20XX

PCHP Staffing Positions by Major Service Category
Enter the number of FTEs hired or contracted by your health center to support the expansion of HIV prevention services from 3/1/2020 to the end of the current reporting period. Report only the FTE increases supported by PCHP funds. For example, if you hired a 1.0 FTE PrEP navigator and increased a 0.5 FTE internist to full time using PCHP funds, you would report 1.0 FTE under Case Managers and 0.5 FTE under Internists.
Enabling Services		Hired	Contracted
Case Managers (e.g., PrEP navigators)
Patient/Community Education Specialists
Patient Advocates
Outreach Workers
Transportation Staff
Eligibility Assistance Workers
Interpretation Staff
Community Health Workers
Other Enabling Services
Physicians		Hired	Contracted
Family Physicians
General Practitioners
Internists
Obstetricians/Gynecologists
Pediatricians
Licensed Medical Residents
Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives		Hired	Contracted
Nurse Practitioners
Physician Assistants
Certified Nurse Midwives
Medical		Hired	Contracted
Nurses
Other Medical Personnel (e.g. Medical Assistants, Nurse Aides)
Laboratory Personnel
Mental Health		Hired	Contracted
Psychiatrists
Physicians (other than psychiatrists)
Nurse Practitioners
Physician Assistants
Certified Nurse Midwives
Nurses - psychiatric, mental health
Nurse Counselors
Licensed Clinical Psychologists
Licensed Clinical Social Workers
Family Therapists
Unlicensed Mental Health Providers, including trainees and certified staff
Other Licensed Mental Health Providers
Other Mental Health Staff
Substance Use Disorder
Psychiatrists
Physicians (other than psychiatrists)
Nurse Practitioners
Physician Assistants
Certified Nurse Midwives
Nurse Counselors
Licensed Clinical Psychologists
Licensed Clinical Social Workers
Family Therapists
Alcohol and Drug Abuse Counselors
Other Licensed Substance Use Disorder Providers
Professional Services		Hired	Contracted
Other Professional Health Services Staff (e.g., physical therapists, occupational therapists, acupuncturists)
Pharmacy		Hired	Contracted
Pharmacy Personnel
Other Programs and Services		Hired	Contracted
Quality Improvement Staff
Information Technology Staff
Patient Services Support Staff
Other Programs and Services Staff (e.g., staff who support outreach, care coordination, transportation)
SUBTOTAL
TOTAL (Hired and Contracted)
HIV Prevention Services
Enter patients and visits from 3/1/2018 to the end of the current reporting period. Report all patients and visits, regardless of funding source (do not limit responses to activities supported by PCHP funding).
2a.	Number of health center visits during which an HIV test was performed
2b.	Number of patients tested for HIV
2c.	Percentage of patients with a documented HIV test performed between the ages of 15 and 65 years
2d.	Number of patients at risk for HIV who were prescribed PrEP
2e.	Percentage of patients newly diagnosed with HIV who were seen for follow-up treatment within 30 days of HIV diagnosis
2f.	Personnel FTE added to support HIV prevention services
2g.	Number of patients newly diagnosed with HIV
3.    Issues and Barriers
What new or ongoing issues/barriers have you encountered in implementing the activities supported with the PCHP supplemental funding over the past four months?
Required field; Minimum 500 characters up to 2500 characters (1 page)
4.    Successes and Lessons Learned
What new or ongoing success and/or lessons learned have you experienced in implementing the activities supported with the PCHP supplemental funding over the past four months?
Required field; Minimum 500 characters up to 2500 characters (1 page)

Public Burden Statement: Health centers (section 330 grant funded and Federally Qualified Health Center look-alikes) deliver comprehensive, high quality, cost-effective primary health care to patients regardless of their ability to pay. The Health Center Program application forms provide essential information to HRSA staff and objective review committee panels for application evaluation; funding recommendation and approval; designation; and monitoring. The OMB control number for this information collection is 0915-0285 and it is valid until XX/XX/XXXX. This information collection is mandatory under the Health Center Program authorized by section 330 of the Public Health Service (PHS) Act (42 U.S.C. 254b). Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or [email protected].