NYC s PrEP Network Julie Myers, MD, MPH New York City Department of Health and Mental Hygiene
% persons at epidemiologic risk Continuum of HIV Prevention & Care (Theoretical) 120 100 80 60 40 20 0 Undiagnosed Diagnosed HIV-negative HIV-positive
Strategy: Patient Navigation for HIV Prevention A recognized need for guidance in navigating complex HIV-prevention options 1 Very recent, promising data from HPTN 073 Client-Centered Coordinated Care (C4) model 2 High levels of PrEP acceptance, retention among black MSM Coordinated counseling model highly acceptable in this group Data could support a reduced rate of HIV-infection for black MSM on PrEP 4 Mutchler, MG et al, AIDS Patient Care STDS. 2015 Sep;29(9):490-502. 5 Wheeler et al., CROI 2016. 1 Mutchler et al, AIDS Patient Care STDS. 2015;29(9):490-502. 2 Wheeler et al., CROI 2016.
Network: Goal and Objectives Engage HIV-negative persons in an HIV prevention continuum and deliver them to clinical sites, guided by the following objectives: 1. Increase the number of HIV-negative persons who are aware of their risk for HIV infection; 2. Maintain the HIV-negative status of these at risk HIVnegative persons through a variety of activities, including, but not limited to, PrEP and PEP; and 3. Combine biological and behavioral HIV prevention into a more complete package of services to address the complexity of HIV risk
NYC DOHMH 1. Build organizational capacity 2. Provide opportunities and strengthen collaborative partnerships 3. Support streamlined service delivery Network for HIV Prevention Provision of HIV Prevention services
Network for HIV Prevention Category 1: Community- Based HIV Testing Site Identification of clients from HIV testing PrEP/PEP Education Linkage to PrEP/PEP provider Category 2: Outreach and Education in CBOs Identification of clients through outreach PrEP/PEP Education Linkage to PrEP/PEP provider Category 3: Biomedical Prevention in Clinical Settings Acceptance of referrals from other sites, including Cat. 1 or Cat. 2 sites PrEP/PEP clinical services, mainly for adults Adolescent PrEP Pilot Identification of adolescent clients through outreach PrEP/PEP Education for adolescents Acceptance of referrals from other sites, including Cat. 1 or Cat. 2 sites PrEP/PEP clinical services for adolescents
Funding for PrEP Network Payment model Performance-based payment (fee-for-service) NYC DOHMH as payer of last resort for clinical services (category 3) Leverage NYS s PrEP-AP program and manufacturer s program as needed Both programs for uninsured (medication assistance) and insured (co-pay assistance) Category Category 1 (Testing sites) Category 2 (CBOs) Category 3 (Clinics) Coverage All services fully covered by NYC DOHMH regardless of insurance status Coverage varies depending on service and insurance status
Blended Coverage/Payers in Category 3 of PrEP Network Service element Clinical care (visits, labs) PrEP medications Patient navigation services Income <435% FPL NYS PrEP- AP Uninsured Underinsured Insured Income <500% FPL NYC DOHMH Manufacturer s medication assistance program Income <435% FPL NYS PrEP- AP Income <500% FPL NYC DOHMH Patient s insurance, with manufacturer s copay assistance program as needed NYC DOHMH Patient s insurance* Patient s insurance, with manufacturer s copay assistance program as needed *Agencies receive nominal amount for data entry.
NYS PrEP-AP Program Client eligibility: NYS residence Uninsured or underinsured Income <435% of FPL Covers: Clinical provider visits (including counseling) Laboratory testing (including HIV, STI testing) Doesn t cover: medications Providers should leverage the manufacturer patient assistance programs (PAP)
PrEP Network
Percentage Continuum of HIV Prevention (Theoretical) 120 100 80 60 Structural/behavioral prevention Social marketing/ Training for front-line staff 311/Network MSM City Health Information Public health detailing/ Implementation workshop 40 20 0 All MSM High behavioral risk Aware of PrEP Linked to clinical prevention Sexual history taken Discussed PrEP with Doctor On PrEP
Opportunities Effort is unprecedented Blended funds allow resources to be stretched further 4 Mutchler, MG et al, AIDS Patient Care STDS. 2015 Sep;29(9):490-502. 5 Wheeler et al., CROI 2016.
Challenges Overall - Accepting a new paradigm - Training on new knowledge and skills Operational - Integrating model into variety of settings - Ensuring program fidelity and measurable outcomes on a large scale - Fostering collaboration when payment is performancebased and capacity for information-sharing limited Resources - Reimbursement through a variety of mechanisms leads to administrative burden - Dependence on manufacturer s program for uninsured
Timeline/Next Steps Proposals submitted, under review Awards announced June 2016 Contracts begin July 1, 2016 Current NYC DOHMH activities Developing trainings Drafting program manual Creating materials to support branding of network Strategizing about how best to foster collaboration Collaborating closely with our colleagues in Care/Treatment to learn from their experiences 4 Mutchler, MG et al, AIDS Patient Care STDS. 2015 Sep;29(9):490-502. 5 Wheeler et al., CROI 2016.
Thank you! Julie Myers, MD, MPH Director of HIV Prevention NYC DOHMH jmyers@health.nyc.gov
Funding for Network
Network: Target Populations MSM, including young MSM (MSM up to 29 years old), and black and Hispanic MSM Transgender women/men who have sex with men Individuals engaging in transactional sex Persons with HIV-positive partners Black and Hispanic men and women in high prevalence neighborhoods