harrison_brooklyn onap presentation 8.8.14

8/11/2019 Harrison_Brooklyn ONAP Presentation 8.8.14

1/15

NationalHIV/AIDSStrategyUpdate:

HHSImplementation

TimothyP.Harrison,Ph.D.

SeniorPolicyAdvisor

U.S.DepartmentofHealth&HumanServices

,

August8,2014

NationalHIV/AIDS

Strategy

Reducenewinfections(25%),lower

transmissionrate(30%),andincrease

to 90% awareness of HIV+ serostatus

Improveaccesstoandoutcomesof

carebylinking80%ofPLWHtocare

w/in3moofdiagnosis,increaseto

80%RWclientsincontinuouscare,

andincreaseto86%RWclientswith

permanenthousing

ReduceHIV

related

health

disparities

byincreasingby20%thenumberof

MSM,Blacks,andLatinoswith

undetectableviralload

2


2/15

NHASGoalI:HIVIncidence

By

2015,

lower

the

annual

number

of

new

infections

by

25

percent

47,500newHIVinfectionsoccurredin2010comparedto48,600

in2006

Comparing2008to2010:

21%reductioninnewHIVinfectionsamongAAfemales

22%reductioninnewHIVinfectionsamongM/FIDUs

12%12%increaseincrease innewHIVinfectionsamongMSM;22%amongyoungMSMinnewHIVinfectionsamongMSM;22%amongyoungMSM

(13(1324

yrs)24yrs)

3

(ONAP:NHASProgressReport,2013)

Prom s ngprogress

insomegroups

15%decreaseamong

heterosexuals

22%decreaseamong

IDUs

For 2010 versus 2008.

21%decrease

among

AfricanAmerican

women

4


3/15

FewerPeopleHaveUndiagnosed

HIV

Infection

in

the

U.S.

5

(FromCDC,NationalHIVPreventionProgressReport,2013)

NHASGoal

I:

Knowledge

of

Serostatus

By

2015,

increase

to

90%

the

percentage

of

people

living

with

HIV

who

know

their

serostatus

TotalnumberofPLWH/Aincreased9%from1,045,800in2006to

1,144,500in2010

Atthesametime,numberofpeoplewithundiagnosedHIVinfection

decreased9%(from199,748in2006to180,900in2010)

In2010,84.2% ofPLHknewtheirserostatus,upfrom80.9%in2006

In2010,serostatus awarenesswas90%orhigheramongpersons45

yrsandolderbutalmost60%ofyouthaged1324withHIVwere

unaware

6



4/15

NHASGoalII:

TimelyLinkagetoMedicalCareBy

2015,

increase

to

85%

the

proportion

of

newly

Linkagetocarerate:79.8%in2011

LowerratesoflinkagetocareforBlacksandyoungpersons(13

24yrs)

mos of

their

HIV

diagnosis

Completereportingoflabdataisneededinmoreareasto

providebetter

national

estimates

(19

reporting

sites

in

2011)

7


NHASGoal

III:

Reduce

DisparitiesBy

2015,

increase

by

20%

undetectable

viral

load

among

MSM,

Blacks,

and

Latinos

IncreaseVLSamong: Current(2010) 2015Goal

MSM 41.7% 48.8%

Blacks 34.9% 39.2%

8


Latinos 37.2% 43.9%


5/15

ViralSuppressionAmongBlacks*

353,653blacks

living

with

HIV

from

19

jurisdictions

reporting

CD4+andVL

. ,

Overall35.2%hadSVLatlastvisit

Males


6/15

InterventionsforImprovingHIV

CareEngagement LinkageCaseMgmt(intense,timelimitedinteraction)

e ca ase gm ong u na re a ons p oa ressunme

needs)

IntensiveOutreach(timeandresourceintensive,requires

multiplefollowups)

PeerorParaprofessionalPatientNavigation(sharesfeatures

insocialworkorhomeagency)

Clinicwide

Messaging

(posters,

brochures,

brief

messaginglow

costwithmodestimprovements)

11

(Mugavero etal.Clin InfectDis 201357(8):11641171)

DisparitiesinEngagementinCareandViralSuppressionamongPersonswithHIV

862SanFranciscoresidentsTwomarkersofsocial

20092010

Usingsurveillancedata:

87%(750)enteredcarewithin6mos

ofdx

72%(540)hada2ndvisitinthenext

marginalizationand

decreasedresources

healthinsuranceand

housingstatusemerged

asfactorsassociated

withpoorutilizationof

50%(431)oftotalpopulationhad

suppressedVLin12mos

76% ofthoseretainedfor3visits

hadsuppressedVL

careand

not

achieving

viralsuppression.

(Muthulingam etal.JAIDS2013;63:112119)

12

12


7/15

AffordableCareAct&PersonsLiving

withHIVInfection:KeyProvisions

Ensurescoverageforpeoplewithpreexistingconditions

xpan s e ca coverage

Providesmoreaffordableprivatehealthcoverage

LowersprescriptiondrugcostsforMedicarerecipients

Ensurescoverageforpreventiveservices,includingHIV

testing

Increasescoordinatedcareforpeoplewithchronichealth

conditions

Ensurescoverageofessentialhealthbenefits

13

5recommendations releasedDecember2,2013

1. Support, implement and assess innovative models to

RecommendationstoImproveOutcomes

Alongthe

HIV

Care

Continuum

more effectively deliver care along the care continuum

2. Tackle misconceptions, stigma and discrimination to

break down barriers to care

3. Strengthen data collection, coordination and use of data

to improve health outcomes and monitor use of federal

resources

.

knowledge along the HIV care continuum

5. Provide information, resources, and TA to strengthen the

delivery of services along the care continuum, particularly

at the state and local levels

14


8/15

Partnerships4Care(P4C)

Purposeof

Funding

Three-year project to reduce HIV/AIDS-related morbidityand mortality among racial /ethnic minorities by:

Strengtheningpartnershipsbetweenhealthdepartments

andhealthcenters

IdentifyingpromisingmodelsforHIVservicedelivery

ImproveidentificationofundiagnosedHIVinfection

EstablishnewaccesspointsforHIVservices

ImproveHIVoutcomesalongcontinuumofcare

P4C ThreeFundingMechanisms

CDC/DHAP

war s o s a e ea epar men s s w

healthcenter(HC)partners(Florida,Maryland,

Massachusetts&NewYork)

HRSA/BPHC

upp emen a awar s oup o sContractawardforanHIVtrainingandtechnical

assistancecollaborationcenter(HIVTAC)

16


9/15

P4CHealthDepartmentActivities

UseHIVsurveillancedata&healthcenterpatient

Expandpartnernotification,linkage,retention,and

reengagementwithcareservicesforPLWH

SupporttrainingandTAactivitiesforhealthcenters

(e.g.,

expand

HIV

testing,

prevention

services

for

PLWH

17

P4C Health

Center

Activities

WorkforceDevelopment(e.g.,establishandtrainmulti

disciplinaryHIVcareteam,trainstaffandboard)

. ., , ,

careprotocols)

ServiceDelivery(e.g.,routineHIVtesting,basicHIVcare,

referrals)

DevelopSustainablePartnershipswithStateHealthDepartments

. ., , ,

SupportProjectEvaluationandQualityImprovement(e.g.,

collect,report,utilizepatientdata)

18


10/15

P4CAnticipatedProjectOutcomes ImprovedidentificationofundiagnosedHIVinfection

NewsitesforHIVservicedelivery

PromisingpracticesandmodelsforHIVservice

delivery ImproveHIVoutcomesalongcontinuumofcare

Sustainable

Replicable

Efficientuseofresources

Strengthenedpartnerships

HDsandHCs Acrosspublichealthsafetynet

CDCandHRSA

2020


11/15

BMSMandHIVContinuumofCare

Webinar Takeaways! Anumberofstudieshaveshownaconnectionbetweenemploymentand

improvementsinmentalhealth,decreasesinalcoholanddruguse,

decreasesinunprotectedsex,increasesinretentioninHIVcare,increases

inCD4counts,andincreasesinHIVmedicationadherence.

Upstreamapproachtoengagingblackmeninhealthcare.Thetimeto

startthinkingaboutlinkageandretentionisnotatdiagnosisbutduring

prediagnosistosupporthealthseekingbehaviorearlierandtargetBlack

MSMandothersathighestriskforHIVwithprevention

FutureResearchshouldinclude:

modelsthataddresshealthsysteminnovationsinHIVcare

antiracismandantioppressionframeworksforhealthcareenvironments

opportunitiesforcollaborativeresearchamonghealthdepartments,clinics,

communitybasedorganizationsandthefederalgovernment

21

Dont

Lose

Sight

of

Prevention

(I)

Nationallyrepresentativesampleof

DatafromCDCsMedicalMonitoringProject

4,217adults(>18yrs)incare

Reportingperiod:JanApril2009

23projectareasin16statesand

PuertoRico

71.2%Male,27.2%Femaleand1.6%

41.4%Black,34.6%White,19%

Hispanic/Latino

(MMWR2014;63(SS#5):128)

2222


12/15

DontLoseSightofPrevention(II)

14%ofMSM,9%ofMSWand15%ofWSMhadunprotected

DatafromCDCsMedicalMonitoringProject

Fewerthan20%testedannuallyforSTDs

FewerthanhalfcounseledbyprovideraboutHIV/STD

prevention

1in5womenwithHIVnotscreenedforcervicalcancer

(MMWR2014;63(SS#5):128)

2323

CoreHIVPreventionActivitiesfor

State/LocalHealthDepartments HIVTesting

IncludesoptouttestinginHCsettings(1364yrs)&targeted

ComprehensivePreventionwithHIVpositive

Individuals

Includesinterventionstoimprovelinkageto&retentionincare,referralto substanceabuse&otherneededservices, PMTCT&

riskreductioninterventions

CondomDistribution Promote correct and consistent use amon PLWHA and those at

highrisk

PolicyInitiatives Alignstructures,policiesandregulationstooptimizeHIV

prevention&careandfacilitatesharing/useofdatafordecision

making

24

(CDC)


13/15

CombiningPreventionStrategiesto

IncreaseEffectiveness

Modelingstudyestimating1yrand10yrHIVriskforserodiscordant

M/MandM/Fcouples

Consideredconsistentcondomuse,malecircumcision,PrEP,andART

Modesttransmissionprobabilitiestranslateintosubstantial

cumulativerisksovertime

Condomsreduceriskby80%peractbut1yrand10yrHIVriskforM/Mwas

estimatedat13%and76%

AmongM/MusingARTandcondomsconsistently1yrand10yrHIVrisk

re uce o an

ForM/Fcoupleusingonlycondoms,estimatedriskover10yrwas11%with

ART,

less

than

1%

ARThadthemostsubstantialprotectiveeffectofanystrategy

25

(Lasry etal.AIDS2014;28(10):15211529)

GrowingEvidenceSupportingCHWs inDiabetes

Care:A

Potential

Model

for

HIV

CBOs

Racial/ethnicminoritiesexperiencedisproportionate burdenof

diabetesandmorecomplications

Barrierstooptimaldiabetesmanagementinvolveindividual,

community,andhealthsystemlevelfactors

Communitybasedparticipatoryresearch(CBPR)improves

interventiondevelopmentandevaluation:

Culturallytailoredhealthylifestyletraining

CHWs troubleshoot with artici ants to im rove adherence

IntegrateCHWs intothechroniccareteam:carecoordination&support

Policyissuesincludescopeofpractice,trainingmodels,and

sustainability

26

(seeShahetal.Curr DiabetesRep2013;13(2):163171)


14/15

USDOJ:BestPracticesGuidetoReformHIVSpecific

CriminalLawstoAlignwithScientificallySupported

Factors

Providestechnicalassistance

regardingstatelawsthat

criminalizeengagingincertain

behaviorswithoutdisclosing

knownHIVpositivestatus.

Assistsstatestoensurethattheir

policiesreflectcontemporary

understandingofHIV

transmissionroutesand

assoc a e ene so rea men

anddonotplaceunnecessary

burdenson

individuals

living

with

HIV/AIDS.

27

DOJWeighs

In

...

Whileinitiallywellintentioned,theselawsoftenruncounterto

currentscientificevidenceaboutroutesofHIVtransmission,and

mayruncountertoourbestpublichealthpracticesfor

preventionandtreatmentofHIV,saidActingAssistantAttorney

GeneralJocelynSamuelsfortheCivilRightsDivision.The

departmentiscommittedtousingallofthetoolsavailabletoaddressthestigmathatactsasabarriertoeffectivelyaddressing

thisepidemic.

Source:http://www.justice.gov/opa/pr/2014/July/14crt739.html

28


15/15

VisionoftheNationalHIV/AIDSStrategy

TheUnitedStateswillbecomeaplacewhere

newHIVinfectionsarerareandwhentheydo

occur,everypersonregardlessofage,gender,

race/ethnicity,sexualorientation,genderidentity

orsocioeconomiccircumstance,willhave

unfetteredaccesstohighquality,lifeextending

care,freefromstigmaanddiscrimination.

29

harrison_brooklyn onap presentation 8.8.14

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