NYC$Strategy$to$ Ending$the$HIV$ Epidemic$ Bisrat'Abraham,'MD,'MPH' Ac2ng'Assistant'Commissioner,'' Bureau'of'HIV/AIDS'Preven2on'and'Control' New'York'City'Department'of'Health'
History$of$the$Epidemic$$ 2,493'
New$HIV$Diagnoses$ $NYC,$2015$ N=$2,493$HIV$Diagnoses$ Gender$ Age$ Borough$ Transmission$Risk$ Poverty$
Geographic$DistribuPon$of$HIV$ $NYC,$2015$ Poverty$ Diagnoses$ Prevalence$ Deaths/$ Mortality$
HIV$Diagnoses$by$Transmission$Category$ NYC,$2001 2015$ New$HIV$diagnoses$ 2000$ 1942 1866 1900$ 1793 1796 1809 1788 1805 1800$ 1746 1736 1704 1683 1658 1700$ 1609 1609 1600$ MSM 1500$ 1469 1491 1400$ 1300$ 1200$ 1159 1100$ 987 1000 1040 1047 1000$ 975 923 936 900$ 856 800$ Heterosexual 749 740 700$ 682 609 600$ 512 544 469 508 500$ 395 343 336 412 400$ 300$ 280 198 200$ 185 163 IDU 146 110 100$ 95 76 0$ 2001$ 2002$ 2003$ 2004$ 2005$ 2006$ 2007$ 2008$ 2009$ 2010$ 2011$ 2012$ 2013$ 2014$ 2015$ Year$of$Diagnosis$ IDU'includes'persons'repor2ng'both'MSM'and'injec2on' drug'use'history.'risk'categories'are'based'on'sex'at'' birth.'as'reported'to'the'new'york'city'department'' of'health'and'mental'hygiene'by'june'30,'2016.'
Perinatal$HIV$InfecPon$by$Year$of$Birth$$ &$Vital$Status$ $NYC,$1977 2015$ ''''''''''' As'reported'to'the'New'York'City'Department'of'' Health'and'Mental'Hygiene'by'June'30,'2016.'
HIV$Diagnoses$by$Gender$and$$ Race/Ethnicity$ $NYC,$2015$ Male$(N$=$2,011)$ Female'includes'transgender'women'and'male' includes'transgender'men.'' As'reported'to'the'New'York'City'Department'of' Health'and'Mental'Hygiene'by'June'30,'2016.'
HIV$Diagnoses$by$Gender$and$ Transmission$Risk$ $NYC,$2015$ Male$(N$=$2,011)$ Female'includes'transgender'women'and'male' includes'transgender'men.'' As'reported'to'the'New'York'City'Department'of' Health'and'Mental'Hygiene'by'June'30,'2016.'
HIV$Diagnoses$by$Age$ $NYC,$2015$ 0.1%$ 12%$ 6%$ 3%$ 0]12$years$ 13]19$years$ 17%$ 36%$ 20]29$years$ 30]39$years$ 40]49$years$ 50]59$years$ 60+$years$ 26%$ N$=$2,493$ As'reported'to'the'New'York'City'Department'of'' Health'and'Mental'Hygiene'by'June'30,'2016.'
ProporPon$Of$PLWHA$in$NYC$in$Selected$ Stages$of$The$HIV$Care$ConPnuum,$2015' 100%$ 80%$ 60%$ 100%$ 94%$ 86%$ 82%$ 74%$ 40%$ 20%$ 0%$ HIV]infected$ HIV]diagnosed$ Retained$in$care$ Prescribed$ART$ Virally$suppressed$ Of$approximately$87,600$PLWHA$in$NYC$in$2015,$74%$had$a$suppressed$viral$load.$ As'reported'to'the'New'York'City'Department'of' Health'and'Mental'Hygiene'by'June'30,'2016.'
Ending$the$Epidemic$(EtE):$A$Recipe$ Community$ Science$ PoliPcal$Will$ April$2015$ December$2015$
What$Does$Ending$the$Epidemic$Mean?$! Iden2fy'persons'with'HIV'who'' remain'undiagnosed'and'link'them'' to'health'care.'! Link'and'retain'persons'diagnosed'with' HIV'in'health'care'to'maximize'viral' suppression'so'they'remain'healthy'and' prevent'further'transmission.'! Facilitate'access'to'PreWExposure' Prophylaxis'(PrEP)'for''HIV'nega2ve' persons'at'risk'of'exposure.' D.'Holtgrave'
The$New$York$City$EtE$Plan:$$ Strategies$to$Address$DispariPes$ 1. Transform'City'STD'clinics'into:' a. Des2na2on'Clinics 'for'sexual'health'services' b. Efficient'Hubs'for'HIV'Treatment'and'Preven2on' 2. Launch'PrEP'and'Repair'the'nPEP'Delivery'System' 3. Support'Priority'Popula2ons'Using'Novel'Strategies' 4. Take'NYC'Viral'Suppression'from'Good'to'Excellent' 5. Make'NYC'Status'Neutral'
Strategy$#1:$ Transform$NYC$$ STD$Clinics$
Why$the$STD$Clinics$Mafer$for$HIV$
STD$Clinics$Are$the$Front$Line$of$EtE$ Epidemiologic'Considera2ons:'' NYC'HIV'Incidence'Studies:' 1'in'42'MSM'abending'NYC'STD'Clinics'were'diagnosed'with' HIV'within'a'year 1' 1'in'20'MSM'diagnosed'with'P&S'Syphilis'in'NYC'were' diagnosed'with'hiv'within'a'year 2 ' 1'in'15'MSM'diagnosed'w/'anorectal'chlamydia/gonorrhea' in'nyc'std'clinics'were'diagnosed'with'hiv'within'a'year 3 ' 1' Pathela'P,'AIDS%Behav.%2016''[Epub'ahead'of'print] ' 2' Pathela'P,''Clin%Infect%Dis%2015;'61(2)281W7.'% 3' Pathela'P,'Clin%Infect%Dis'2013;'57(8)'1203W9.'
Expanded$STD$Services$will$Make$Sexual$ Health$$Clinics$DesPnaPon$Clinics$ " Expand$hours$and$triage$to$improve$access$ MWF'schedule'for'all'clinics;'Saturdays,'select'clinics' Corona'clinic'expands'to'5'days' Triage'Nurses'at'ALL'clinics' ' " Restore$screening$services$for$asymptomaPc$clients' " Modernize$STD$diagnosPcs$ HSV'tes2ng' Hepa22s'C' Trichomonas'tes2ng' ' " Enhance$HPV]related$services$ Anal/cervical'screening'(PAPs)' Colposcopy' High'Resolu2on'Anoscopy' HPV'vaccines' ' " Quick$Start$contracepPves$for$women' " CreaPon$of$new$ Welcome$to$the$Clinic $video$ ' '
State$of$the$Art$HIV$IntervenPons$in$$ Sexual$Health$Clinics$ FULL COURSES BIOMEDICAL EVALUATION IMMEDIATE AND INTERVENTION: jumpstart INSTANT OF npep STARTS OF ARV PrEP TREATMENT STARTS AND PREVENTION SAME DAY ART SOCIAL WORK ASSESSMENT FOR SOCIAL DETERMINANTS OF RISK OR DISEASE PROGRESSION + INSURANCE CONNECTION NAVIGATION TO LONGITUDINAL CARE FOR BOTH HIV NEGATIVE AND POSITIVE CLIENTS
Not$Just$a$Plan$Any$More!$$ NYC$Sexual$Health$Centers$are$HIV$Hubs!!$ PrEP$NavigaPon$ Launched'10/31/16' ALL'CLINICS' Over$4,700$Encounters$ PEP$28$ Started'10/31/16' ALL'CLINICS' 1,172$PaPents$ 59%$Black/La,nx$ JumpstART $ $ Launched'11/23/16' ' STARTED'IN'ONE'CLINIC' NOW'AT'7'CLINICS' $ 193$JumpstARTs$$ 69%$Black/La,nx$ PrEP$IniPaPon$ $ Started'12/22/16' ' STARTED'IN'ONE'CLINIC' NOW'AT'5'CLINICS' ' $641$PrEP$Starts$ 58%$Black/La,nx$
Strategy$#2:$ Launch$PrEP$ &$Repair$nPEP$ Delivery$System$
The$PlaySure$Network$
Repair$PEP$Delivery$in$NYC$ 24$HR$PEP$LINE$ $ Clinician'staffed' ' Free'starter'packs'' prescribed'without'a'visit'' at'a'24h'pharmacy' ' Link'to'PEP'Center'' next'business'day' PEP$CENTERS$OF$ EXCELLENCE$ ' Urgent'Care'Model' ' Immediate'starts'regardless' of'insurance'status' ' PrEP'Linkage'
Strategy$#3:$ Support$Priority$ PopulaPons$ Using$Novel$ Strategies$
HIV$is$the$Symptom$NOT$the$Disease$ Address$Gaps$in$ Methamphetamine$ Services$ Support$for$Grassroots$ Transgender$Led$and$ Focused$OrganizaPons$ Improve$Health$ Equity$for$$ LGBTQ$People$
Strategy$#4:$$ Move$NYC$Viral$ Suppression$from$ Good$to$Excellent$
The$Undetectables$ Scale'up'of'CBO/clinic'' based'interven2on' Use'of'mul2ple'domains'of' support'(social,'medical,'' and'behavioral)' Use'of'financial'incen2ves'' for'suppression'
Housing$=$Healthcare$$ Homelessness,'unstable'or'inadequate' housing'is'linked'to'higher'viral'loads' and'failure'to'abain'or'sustain'vls*' NYC'HIV/AIDS'Service'Administra2on' (HASA)W'Housing'for'poor'PLWH'with' disease'progression' HASA'for'ALL:'HASA'criteria'are'now' INDEPENDENT'of'disease'state' Since'Fall'2016W1000'clients'housed' who'would'not'have'previously' qualified' *Aidala'et.'al.'AJPH,'106:1'2016.'''
Molecular$Epidemiology$ Resistance'tes2ng'for'HIV'is' reportable'to'dohmh'and'allows' for'molecular'linkage'of'cases' Close'to'realW2me'use'of' molecular'data'for'iden2fying' outbreak'clusters'and' transmission'groups.' The'HIV'Field'Services'Unit'(FSU)' conducts'contact'tracing'for'all' new'hiv'diagnoses'and'work'to' connect'virally'unsuppressed' people'to'care'
Strategy$#5:$$ Get$NYC$to$$ Status$ Neutral$
THANK$YOU!$
HIV$Diagnoses$by$Gender$ $$ NYC,$2001$vs.$2015$ 2001 2015$ Female, 34% Male, 66% N$=$5,902$ Female'includes'transgender'women'and'male' includes'transgender'men.'' As'reported'to'the'New'York'City'Department'of' Health'and'Mental'Hygiene'by'June'30,'2016.'
New$HIV$Diagnoses$ $NYC,$2011 2015$ New$HIV$diagnoses$(N)$ 3,500$ 3,000$ 2,500$ 2,000$ 1,500$ 1,000$ 500$ 3,386$ 40.9$ 3,112$ 37.2$ 2,858$ 33.9$ 2,754$ 32.4$ 2,493$ 29.2$ 50$ 40$ 30$ 20$ 10$ New$HIV$diagnosis$rate$$per$$ 100,000$populaPon 0$ 2011$ 2012$ 2013$ 2014$ 2015$ Year$of$Diagnosis$ 0$ Diagnosis'rates'calculated'using'the'intercensal'' 2011W2015'NYC'popula2on'es2mates.'' As'reported'to'the'New'York'City'Department'of'' Health'and'Mental'Hygiene'by'June'30,'2016.'
HIV$Diagnoses$among$Transgender$by$Gender$ IdenPty$and$Year$of$Diagnosis$ $NYC,$2011 2015$ New$HIV$diagnoses$(N)$ 60$ 50$ 40$ 30$ 20$ 10$ 0$ 50$ 43$ 45$ 1$ 1$ 0$ 1$ 1$ 2011$ 2012$ 2013$ 2014$ 2015$ Year$of$Diagnosis$ 47$ Transgender$women$ Transgender$men$ 41$ As'reported'to'the'New'York'City'Department'of'' Health'and'Mental'Hygiene'by'June'30,'2016.'
Rates$of$HIV$Diagnoses$by$Gender$ $ NYC,$2011 2015$ 80$ New$HIV$diagnosis$rate$per$$ 100,000$populaPon$ 60$ 40$ 20$ 65.9$ 18.2$ 61.3$ 15.3$ 56.4$ 53.9$ 13.4$ 12.9$ 49.3$ 10.8$ Male$ Female$ 0$ 2011$ 2012$ 2013$ 2014$ 2015$ Year$of$Diagnosis$ Female'includes'transgender'women'and'male'includes' transgender'men.'as'reported'to'the'new'york'city'' Department'of'Health'and'Mental'Hygiene'by' June'30,'2016.'
PrevenPon=Treatment$
Treatment=PrevenPon$