Ending the AIDS Epidemic in New York City

Transcription

1 Ending the AIDS Epidemic in New York City Demetre C Daskalakis MD MPH Assistant Commissioner NYC DOHMH Disease Control Bureau of HIV Prevention and Control

2 Disclosure Dr Daskalakis has no relevant financial affiliations to disclose.

3 Learning objectives After attending this presentation, participants will be able to: Identify the three pillars of the plan to End the Epidemic in New York State Describe the epidemiology of HIV in NYC Identify targeted components to achieve each of the pillars of the plan to End the Epidemic

4 HIV in New York City HIV Epidemiology and Field Services Program. HIV Surveillance Annual Report, New York City Department of Health and Mental Hygiene: New York, NY. December 2014.

5 Geographic Distribution of HIV HIV Epidemiology and Field Services Program. HIV Surveillance Annual Report, New York City Department of Health and Mental Hygiene: New York, NY. December 2014.

6 HIV Diagnosis Rates among year old males and females, in NYC by race/ethnicity, 2013 Males Females HIV Epidemiology and Field Services Program. HIV Surveillance Annual Report, New York City Department of Health and Mental Hygiene: New York, NY. December 2014.

7 Epidemic among MSM, 2013 Overall, 2,832 new HIV diagnoses in NYC 1,609 new HIV diagnoses among MSM (57% of all diagnoses; 71% of male diagnoses) 767 new AIDS diagnoses among MSM Almost 44,000 MSM living with HIV/AIDS (37% of all PLWHA) Almost 300 deaths among MSM HIV Epidemiology and Field Services Program. HIV Surveillance Annual Report, New York City Department of Health and Mental Hygiene: New York, NY. December 2014.

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9 Number and proportion of persons with HIV in New York City and engaged in selected stages of the continuum of care at the end of 2013 Percentage 100% 80% 60% 40% 20% 0% 136, % Estimated HIVinfected 117,618 86% of infected Ever HIVdiagnosed 100,615 74% of infected 86% of diagnosed Ever linked to HIV care 54% of infected 74% of linked to care Retained in HIV care in 2013 Engagement in HIV care 51% of infected 94% of retained in care Presumed ever started on ART 43% of infected 84% of started on ART Suppressed viral load ( 200 copies/ml) in 2013 Of all persons estimated to be infected with HIV in NYC, 43% have a suppressed viral load. 74,196 70,006 58,515 As reported to the New York City Department of Health and Mental Hygiene by June 30, 2014.

10 Number of HIV-infected persons New York City continuum of care at the end of 2013, showing where we lost the 57% of persons not achieving suppression 140, , ,000 80,000 60,000 14% 19,147 12% 17,003 19% 26,419 Persons achieving each step Persons lost from previous step 3% 4,190 8% 11,491 40,000 20,000 0 Estimated HIVinfected Ever HIVdiagnosed Ever linked to HIV care Retained in HIV care in 2013 Engagement in HIV care The largest group of persons not achieving suppression is those linked to care but not retained in care, who comprise 19% of all infected persons. As reported to the New York City Department of Health and Mental Hygiene by June 30, Presumed ever started on ART Suppressed viral load ( 200 copies/ml) in 2013

11 % persons at epidemiologic risk The The Continuum New Treatment=Prevention of Care for People Continuum with HIV of Care Undiagnosed Diagnosed HIV-negative HIV-positive HIV CARE AND PREVENTION ARE THE SAME=GETTING TO HIV NEUTRAL

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13 Ending the Epidemic Identifying persons with HIV who remain undiagnosed and linking them to health care Linking and retaining persons with HIV to health care, getting them on antiretroviral therapy to improve their health and prevent transmission Providing Pre-Exposure Prophylaxis (PrEP) to high-risk persons to keep them HIV-negative.

14 Ending the Epidemic: Perceived Reality Identifying MSM with HIV who remain undiagnosed and linking them to health care Linking and retaining MSM persons with HIV to health care, getting them on antiretroviral therapy to improve their health and prevent transmission Providing Pre-Exposure Prophylaxis (PrEP) to MSM persons at-risk to keep them HIV-negative

15 Ending the Epidemic: The Challenge Identifying black and Hispanic LGBTQ youth and other men and women of color not served by healthcare with HIV who remain undiagnosed and linking them to health care Linking and retaining black and Hispanic LGBTQ youth and other men and women of color not served by healthcare with HIV to health care, getting them on antiretroviral therapy to improve their health and prevent transmission Providing Pre-Exposure Prophylaxis (PrEP) to black and Hispanic LGBTQ youth and other men and women of color not served by healthcare at-risk to keep them HIVnegative

16 Ending the Epidemic: Identify & Linkage to Care

17 % NYC Adults Ever Tested New Yorkers Know Their HIV Status % NYC Adults Ever Tested for HIV is Increasing NYC Community Health Survey, , accessed from

18 Grand Total since 2008 # Tested 1,819,093 #Newly Diagnosed with HIV 4,582 #Newly Diagnosed HIV Positives Linked to Care 3,620 Newly Diagnosed Linkage Rate 79%

19 New York Knows Goals Provide a voluntary HIV test to every New York City resident who has never been tested Make HIV testing a routine part of health care in New York City Identify undiagnosed HIV-positive people in New York City and link them to medical care Connect people who test negative for HIV to prevention services, including PrEP

20 #behivsure

21 Ending the Epidemic: Retention in Care & Viral Load Suppression

22 Ryan White and Other Services Medical Care Coordination Non-Medical Care Coordination Transitional Care Coordination Housing Support Food and Nutrition Services Drug Harm Reduction Services

23 HIV Care Campaign

24 HIV Care Status Reports (CSR): Surveillance for Care Sharing of limited patient-specific data from HIV Surveillance allowed by 2010 NYS HIV Testing law CSR is a web-based application that will allow approved providers to submit their out-of-care patien ts (>12 months) for query against the Registry to determine whether additional outreach is needed to engage patient in care Outcomes provided: follow-up needed or no follow-up needed Launched: Spring 2015

25 HIV Care Continuum Dashboards (CCD) Facility-specific data provided to key members of the organization (CEO, CMO, Clinic Medical Director) regarding timely linkage to care of newly diagnosed patient and viral load suppression among patients in care for that particular facility December 2012: first release of CCD to 21 sites; biannually since 2014 releases: increase in number of sites receiving CCDs June: 35 sites December: 46 sites (67% PLWHA in NYC) December 2015: public release

26 New Innovations in Care and Treatment Data will be used more to guide assistance to clinics with a collaborative approach with New York State Expansion of testing initiative in some areas to full continuum spectrum New emphasis on mortality both on population and clinic level Smoothing of the divide between treatment and prevention as a stigma neutralizer

27 Navigate Assess & Start Service Check PEP Start Referred by BSTD PrEP Candidate Referred by BSTD New HIV Diagnosis Referred by BSTD Established HIV Referred by BSTD/Surveillance? Navigate to BSTD Dose #1 Insurance check Insurance Initiate check Initiate ACA/Medicaid/ADAP ACA/Medicaid/ADAP paperwork paperwork Referral (Mental Health, Referral (Mental Health, Substance Use, Housing, Food, Substance etc.) Use, Housing, PAP Food, paperwork etc.) PAP paperwork Insurance check Insurance Initiate check Initiate ACA/Medicaid/ADAP ACA/Medicaid/ADAP paperwork paperwork Referral (Mental Health, Referral (Mental Health, Substance Use, Housing, Food, Substance etc.) Use, Housing, PAP Food, paperwork etc.) PAP paperwork Insurance check Insurance check Initiate Initiate ACA/Medicaid/ADAP ACA/Medicaid/ADAP paperwork paperwork Referral (Mental Health, Substance Referral (Mental Use, Housing, Health, Food, Substance etc.) Use, Housing, Food, etc.) Insurance check Insurance check Initiate Initiate ACA/Medicaid/ADAP ACA/Medicaid/ADAP paperwork paperwork Referral (Mental Health, Substance Referral (Mental Use, Housing, Health, Food, Substance etc.) Use, Housing, Food, etc.) Service Check HIV Screen STD Screen PEP Labs Same day PEP PEP start PrEP/Condom education Skip to Navigation if done HIV Screen STD Screen Creatinine/UA Screen for for PrEP Same day day PrEP rx rx PrEP/Condom education STD Screen CD4 and VL VL Same day Medication Phylo/Genotype STD Screen CD4 and VL VL Same day Medication Genotype for for Naïves Stage need for for prophylaxis Assess & Start Provider navigation to to PEP PEP Confirm adherence Mental Health/SUD navigation Harm reduction navigation Health Promotion/Self care- carecondoms/prep Provider navigation Assemble Clinic Clinic Package Mental Health/SUD navigation Harm reduction navigation Confirm Connection Confirm adherence Health Promotion/Self-care care Condoms/PrEP Provider navigation Assemble Clinic Package White glove delivery to to care-rw Program/FSU Mental Health/SUD navigation Harm reduction navigation Health Promotion/Self-care care Condoms/disclosure Provider navigation Assemble Clinic Package White glove delivery to care- RW Program/FSU Mental Health/SUD navigation Harm reduction navigation Health Promotion/Selfcare Condoms/Adherence Navigate ONE-STOP

28 Ending the Epidemic: Pre-Exposure Prophylaxis & Other Primary Prevention

29 City Health Information: Comprehensive Care for MSM Provide a welcoming environment for MSM Take a sexual history as a routine part of primary care Routinely screen for alcohol, drug use, depression, HIV and other STIs Counsel on consistent condom use and PEP and PrEP

30 NYC Condom Availability Program Highlights: In 2014, distributed over: 37 million male condoms ~1.2 million female condoms Currently distribute condoms at: Over 3,500 locations throughout NYC 220 (96%) of gay venues stocked In 2014, participated in a total of 13 Gay Pride events Condom education specialists conduct about 500 condom education trainings/presentations per year Launch of new packaging and styles Oct Feb 2015

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32 Increasing PrEP & PEP Awareness

33 PrEP and PEP Detailing/Action Kit

34 PrEP Awareness and Use Black Party Survey: Preliminary Analysis Sample Description (n=197) Average age, 40 years 49% White, 19% Hispanic, 15% Black 74% college educated 84% have public or private medical insurance 14% HIV-positive PrEP Awareness and Use 90% of all respondents were aware of PrEP 33% of HIV-negative respondents used PrEP in the past 6 months Program Evaluation and Behavioral Surveillance (PEBS) Unit, HIV Prevention Program. Black Party Survey, New York City Department of Health and Mental Hygiene: New York, NY.

35 % persons at epidemiologic risk The The Continuum New Treatment=Prevention of Care for People Continuum with HIV of Care Undiagnosed Diagnosed HIV-negative HIV-positive HIV CARE AND PREVENTION ARE THE SAME=GETTING TO HIV NEUTRAL

36 Ending the Epidemic is a shared responsibility that goes beyond HIV service organizations and advocacy groups We need to approach the end of the epidemic as part of a vision of social justice and health equity

37 Thank You

38 Activity Code FA983