Ending the HIV epidemic in New York City: Innovations and Progress

Transcription

1 Ending the HIV epidemic in New York City: Innovations and Progress Denis Nash, PhD, MPH Institute for Implementation Science in Population Health City University of New York New York, New York USA cunyisph.org ETEdashboardNY.org

2 I declare no conflicts of interest

3 Outline NYC s progress to ards targets Ending the Epidemic (EtE) in NYC Overview Current epidemiology and targets Strategies

4 HIV is a Public Health Emergency: Treat it That Way! Map: Estimated Lifetime Risk of HIV acquisition Map: CDC NYC 2015 Population 8.5 million New HIV diagnoses 2,493 PLWH 121, % overall 2.1% of males 2.8% of NH Blacks Deaths Total: 1,678 HIV: 628* *2014 data

5 slide Also see: Xia et al. New York City Achieves the UNAIDS Targets for HIV-Infected Whites but Not Latinos/Hispanics and Blacks. JAIDS, 2016; 73 (3): e59-e62.

6 Ending the Epidemic (EtE): A Recipe Science Community Political Will Informed implementation

7 What Does Ending the Epidemic Mean in NY? Identify persons with HIV who remain undiagnosed and link them to health care. Link and retain persons diagnosed with HIV in health care to maximize viral suppression so they remain healthy and prevent further transmission. Facilitate access to Pre-Exposure Prophylaxis (PrEP) for HIV negative persons at risk of exposure. D. Holtgrave

8 New HIV Diagnoses, NYC, % 80% 70% 60% 50% 40% 30% 20% 10% 0% Gender N= 2,493 new HIV Diagnoses Race/Ethnicity Age Borough Transmission Risk Poverty (area based) Source: NYC DOHMH, Bureau of HIV Surveillance Data

9 New HIV diagnoses New HIV Diagnoses By MSM And IDU Transmission Category in NYC, MSM IDU IDU includes persons reporting both MSM and injection drug use history. Risk categories are based on sex at birth. As reported to the New York City Department of Health and Mental Hygiene by June 30,

10 Achieving EtE GOALS: New HIV Diagnoses and Estimated Incident HIV Infections, NYC, Total new HIV diagnoses Incident HIV infections Actual Data Projection The number of new HIV diagnoses from 2010 to 2015 was reported to NYC DOHMH as of June 30, Incident HIV infection estimates from 2010 to 2015 were calculated using the CDC Stratified Extrapolation Approach (SEA). All data from 2016 to 2020 are estimates based on the slope of decline previously observed. 2020

11 The New York City EtE Plan: Strategies to Address Disparities 1. Tra sfor STD Cli i i to Desti atio Cli i s for Se ual Health Services 2. Develop newly branded Sexual Health Clinics as Efficient Hubs for HIV Treatment and Prevention 3. Launch PrEP Service Delivery and Repair the npep Delivery System 4. Support Priority Populations Using Novel Strategies 5. Take NYC Viral Suppression from Good to Excellent 6. Make NYC HIV Status Neutral

12 Wh NYC s Pu li STD Cli i s Matter for HIV

13 NYC s Pu li STD Clinics Are the Front Line of HIV NYC HIV Incidence Studies: 1 Pathela 1 in 42 of all HIV- MSM attending STD Clinics went on to be diagnosed with HIV within a year1 1 in 20 HIV- MSM diagnosed with P&S Syphilis in NYC were diagnosed with HIV within a year2 1 in 15 HIV- MSM diagnosed w/ anorectal chlamydia/gonorrhea were diagnosed with HIV within a year3 P, AIDS Behav [Epub ahead of print] P, Clin Infect Dis 2015; 61(2) Pathela P, Clin Infect Dis 2013; 57(8) Pathela

14 Not Just a Plan Any More! NYC Sexual Health Centers are HIV Hubs!! PEP 28 Started 10/31/16 ALL CLINICS 745 Patients 61% Black/Latinx PrEP Navigation Launched 10/31/16 ALL CLINICS Over 3,000 Encounters JumpstART Launched 11/23/16 STARTED IN ONE CLINIC FIVE MORE NOW ON BOARD 117 JumpstARTs 69% Black/Latinx PrEP Initiation Started 12/22/16 STARTED IN ONE CLINIC NOW AT 3rd CLINIC 262 PrEP Starts 63% Black/Latinx

15 Fix npep Delivery in NYC 24 HR PEP LINE PEP CENTERS OF EXCELLENCE Clinician Staffed Urgent Care Model Free Starter Packs prescribed without a visit at a 24h pharmacy Link to PEP Center next business day Immediate Starts Regardless of Insurance status PrEP Linkage

16 Bare It All Citywide campaign that encourages LGBTQ New Yorkers to speak to their doctors about everything that affects their health This campaign stresses that if LGBTQ New Yorkers are not comfortable with their current provider, that they should seek out a new provider. Directory of 100+ LGBTQ-knowledgeable providers created Accessible via 311 and online from the NYC Health Map

17 LGBTQ Health Care Bill of Rights In New York City, it is illegal to discriminate on the basis of a person s sexual orientation, gender identity or gender expression in public accommodations, including in health care settings. Mobilizes existing health care protections to empower LGBTQ New Yorkers to get the health care they are entitled to Reiterates that health care providers are accountable to their patients and cannot legally provide LGBTQ people with a lower quality of care because of their sexual orientation, gender identity or gender expression Call to Action: Contact the NYC Commission on Human Rights to file a complaint if they believe they have been mistreated, denied care or services because of their sexual orientation, gender identity or gender expression

18 Scale up of intervention developed by Housing Works Multi-domain strategy Social Medical Behavioral DOT and Beyond Use of financial incentives for suppression liveundetectable.org

19 Housing = Healthcare Homelessness, unstable or inadequate housing is linked to higher viral loads and failure to attain or sustain VLS* NYC HIV/AIDS Service Administration (HASA)Housing for poor PLWH with disease progression HASA for ALL: HASA criteria are now INDEPENDENT of disease state Since Fall clients housed who would not have previously qualified *Aidala et. al. AJPH, 106:

20 Prevention=Treatment

21 Treatment=Prevention

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24 ETE Blueprint Recommendation #29 Extend and enhance the use of data to track and report o the ETE I itiati e s progress The reatio of a e -based, public facing, Ending the Epidemic Dashboard system is recommended to broadly disseminate information to stakeholders on the [ETE] i itiati e s progress. ETEdashboardNY.org 24

25 Dashboard slide ETEdashboardNY.org cunyisph.org

26 cunyisph.org ETEdashboardNY.org

27 cunyisph.org ETEdashboardNY.org

28 cunyisph.org ETEdashboardNY.org

29 End AIDS with Love: Some Lessons Dream big and take risks. Government and community advocates must work together and create a unified narrative. One voice is stronger! HIV Programs cannot be greedy! Sexual Health needs to own HIV prevention and treatment. Build services where the people are! Do NOT re-invent the wheel. HIV is the symptom, not the disease. HIV should NOT be the main message for priority populations. Address THEIR priority needs. Treat HIV like the pu li health e erge that it is Adopt a status eutral orld ie. Inform, monitor and rigorously evaluate the impact of implementation Use data to make course corrections as needed

30 Acknowledgements NYC Department of Health and Mental Hygiene Demetre Daskalakis Sarah Braunstein Susan Blank Julia Schillinger NYC DOHMH Bureau of HIV services NYC DOHMH Bureau of STDs New York State AIDS Institute Bruce Agins, John Fuller NYS ETE Task Force CUNY ISPH ETE dashboard team cunyisph.org ETEdashboardNY.org

31 New York ETE Resources NYC documents and links New York State ETE Blueprint and other resources Ne York s ETE Dash oard NYC LGBTQ Health Care Bill of Rights