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An Important Milestone
in
Ending the AIDS
Epidemic
Decreasing new HIV infections to reduce the number of
persons living with HIV in New York State
for the first time.
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BUI LDI NG ON SUCCESS
The nation, The nation,
New York State
 40 percent
reduction over the
as a whole,
has seen no
decrease in
the number
as a whole,
has seen no
decrease in
the number
reduction over the
last decade.
 Decreases seen in
HIV incidence
across all races and
of HIV
diagnoses.
of HIV
diagnoses.
risk groups.
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2
BUI LDI NG ON SUCCESS
H
• Transmission via blood
products – ELIMINATED.
M th t hild t i i H
I
V
• Mother to child transmission ‐
ELIMINATED (per CDC’s
definition) in 2013.
• Injection drug use‐related HIV
DECREASED 90% since 1990s.
V
• To bend the curve, a 3‐point
program to reduce continuing
HIV transmission is needed.
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CASCADE OF HI V CARE
NEW YORK STATE, 2012
154,000
0 50,000 100,000 150,000
Estimated HIV Infected 
P
,
132,000
86,000
Persons
Persons Living w/ Diagnosed 
HIV Infection
Cases w/any HIV Care during 
the year*
Cases w/continuous care
86% of infected
56% of infected
65% of PLWDHI
75,000
68,000
Cases w/continuous care 
during the year**
Virally suppressed ( n.d. or 
<200/ml) at test closest to 
end‐of‐year
* Any VL or CD4 test during the year
** At least 2 tests, at least 3 months apart
48% of infected
56% of PLWDHI
44% of infected
51% of PLWDHI
79% of cases w/any care
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3
Bending
the
• Reduce from 3,000 to
750 new HIV infections
per year by 2020;
• Decrease the number of
New Yorkers living with
HIV for the first time
the
Curve
Reduction in
newHIV
HIV for the first time.
new HIV
infections
Reduce by 50% the rate at which persons diagnosed with HIV
progress to AIDS within two years.
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Bending the Curve
3‐Point Program
1. Identify all persons with HIV who remain undiagnosed and y p g
link them to health care.
2. Link and retain those with HIV in health care, to treat them
with anti‐HIV therapy to maximize virus suppression so
they remain healthy and prevent further transmission.
3. Provide Pre‐Exposure Prophylaxis (PrEP) for high risk
persons to keep them HIV negative.
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4
Bending the curve:
Key policies already enacted
Identify all persons with
HIV h i
2014 amendment to the NYS HIV Testing Law (PHL
2781) th t ll th li i ti f itt t HIV who remain
undiagnosed and link
them to health care.
2781) that allows the elimination of written consent
for HIV testing to promote routine screening.
Link and retain all persons
diagnosed with HIV in
health care to maximize
virussuppressionsothey
2014 amendment to the NYS HIV Testing Law (PHL
2135) that allows for enhanced data sharing between
health departments and current health care providers
for purposes of patient linkage and retention in care virus suppression so they
remain healthy and
prevent further
transmission.
for purposes of patient linkage and retention in care.
30% rent cap to maintain 10,000 HIV infected persons
in stable housing resulting in increased retention and
adherence in care.
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Investment and Outcomes
• Medicaid has successfully negotiated supplemental
rebates with three pharmaceutical companies
representing 70% of the HIV market to enable the State to
stay within the Global Cap.
• Increased HIV medication costs will pay for themselves
over time.
• Each infection averted saves almost $400,000 in
lif ti di l t lifetime medical costs.
• Bending the curve saves the state an additional $317
million by 2020.
• Prevent 3,420 new cases of HIV.
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5
Bendi ng t he Cur ve
Total NewYorkers
Cases
Total New Yorkers
living with HIV/AIDS
New HIV
infections
150,000
3,000
HIV/AIDS deaths 750
2000 2014 2020
2025
Year
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CHANGI NG THE
HEADLI NES: HEADLI NES:
“New York State, where
AIDS Began, Bends the
C f h fi i ” Curve for the first time”
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0
6
Governor Cuomo
Announces Plan to
End the AIDS
Epidemic in
New York State
June 29, 2014
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HIV/AIDS Services:
A Developmental Partnership
• For over 25 years, the AIDS Institute has adapted program For over 25 years, the AIDS Institute has adapted program
models to respond to a changing epidemic based on a wide
range of input from consumer forums, clinical advisory
committees, provider workgroups, government agencies and
other organizations.
• Although improved treatment has resulted in more people
living longer, new challenges include increased care and
treatment needs, late diagnosis, an aging population , g , g g p p
experiencing multiple co‐morbidities, and increased
diagnoses among younger populations, i.e. men who have sex
with men (MSM) in communities of color.
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2
7
Funding the HIV Continuum of Care
• In New York State, over 65% of persons with
HIV disease are either on Medicaid, Medicare
and Medicaid, or are Medicaid pending status. and Medicaid, or are Medicaid pending status.
• A historic and ongoing regulatory framework
has been established through the Medicaid
program that provides a substantial source of
ongoing Statewide support for HIV services. All
services and programs have been incorporated services and programs have been incorporated
into the Medicaid Managed Care benefit
package as part of the MRT care management
for all goals.
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AIDS Institute Medicaid Initiatives
1986 Designated AIDS Centers
1988 AIDS N i F ili i
1990 HIV Primary Care
Medicaid Program
1988 AIDS Nursing Facilities
1989 Pediatric Maternal AIDS
Centers
1989 AIDS Home Care
P
1991 Enhanced Fees for
Physicians Programs
1993 AIDS Adult Day
Health Care Programs
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4
Programs
1990 Community Follow‐Up
Program
g
2003 HIV Special Needs
Plans
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Models of care
• Since 2003, three HIV Special Needs Plans (SNPs) provide an alternative
source of managed care to over 16,000 Medicaid‐eligible persons in New York
City with HIV/AIDS and their dependent children.
• HIV SNP networks are broadly composed, encompassing the full continuum of
HIV services as well as comprehensive health care services. HIV experienced
providers enable SNPs to meet the complex medical and psychosocial needs of
enrollees.
• The Designated AIDS Center (DAC) hospital based medical home program was
the first health care system response to the AIDS epidemic. DAC standards
reflect the evolving systemof HIV/AIDS care serving over 50 000 persons reflect the evolving system of HIV/AIDS care serving over 50,000 persons
living with HIV/AIDS including:
- new priorities of improving early diagnosis;
- increasing focus on retention in care;
- increasing focus on managing co‐morbidities including mental health,
substance abuse, STDs and hepatitis C; and
- expanding the use of health information technology.
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2011 Viral Load Suppression
Statewide average for patients engaged in care and on ART
always suppressed always suppressed.
• Clinic average Viral Load Suppression (VLS) for patients
is 62% Statewide.
• Clinic average VLS for newly treated patients on ART
66%. %
• Similar results for 3 HIV SNPs of 67% always
suppressed.
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Health Care Restructuring Efforts
• HIV Models of Care are expanding to serve other chronic
conditions (Health Homes).
• Medicaid Redesign and DSRIP collaborative projects retain key
features of successful programs of integrated HIV care
including care coordination, treatment decision support,
multidisciplinary care teams, patient retention programs,
adherence counseling and staff training, i.e. Medicaid funding
for Harm Reduction.
• Matching Medicaid claims files with HIV/AIDS Registry • Matching Medicaid claims files with HIV/AIDS Registry
for tracking subset of population not on ARVs.
• New laws eliminate the requirement for written consent to
HIV testing and allow health departments and health care
providers to share patient specific data for linkage and
retention in care.
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THANK YOU.
D O’C ll Dan O’Connell
daniel.oconnell@health.ny.gov
Ira Feldman Ira Feldman
ira.feldman@health.ny.gov
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