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New York Knows How to End the Epidemic

January 5, 2017

HIV testing is essential to the Governor's three-point plan to end the AIDS epidemic in New York State by 2020. Testing is a gateway to health care, and knowing your status is the first step in getting linked to care and HIV prevention services. But ensuring that all New York City residents have access to a voluntary HIV test is no easy task. So, since 2008 the NYC Health Department has partnered with community agencies, including hospitals, health centers, community organizations, elected officials, faith-based organizations, and businesses, through large-scale borough-wide HIV testing initiatives, known as Bronx Knows and Brooklyn Knows.

New York Knows, an expansion of these previous successful initiatives, has grown into the largest HIV testing initiative in the nation. New York Knows aims to help all NYC residents learn their HIV status and facilitate access to the city's HIV care and prevention services. On World AIDS Day, December 1, 2014, the Health Department officially launched New York Knows and introduced #beHIVsure, a public education and social marketing campaign encouraging all New Yorkers to get tested.

Through community partnerships, New York Knows works to:

  • Provide a voluntary HIV test to every NYC resident who has never been tested. (Testing is done at Health Department clinics, partnering hospitals, community-based organizations, and universities.)
  • Make HIV testing a routine part of health care in NYC.
  • Identify undiagnosed HIV-positive people in NYC and link them to medical care.
  • Connect at-risk people who test HIV negative to prevention services, including PrEP.
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To reach these objectives, New York Knows uses collective impact, a framework in which cross-sector partnerships collaborate to achieve lasting social change in making HIV testing routine in NYC. New York Knows activities include:

  • Developing borough-wide steering committees which meet monthly and guide the initiative
  • Organizing borough-specific subcommittees to meet needs identified by partners
  • Strengthening relationships between agencies, developing linkages, and sharing information and resources
  • Coordinating borough and city-wide testing and linkage events commemorating national HIV awareness days such as National Gay Men's HIV/AIDS Awareness Day, National HIV Testing Awareness Day, National Latinx AIDS Awareness Day, and National Black HIV/AIDS Awareness Day

Borough-specific HIV testing goals are based on the residents who have never been tested for HIV. To date, over 230 New York Knows partners have conducted over 2.9 million HIV tests, identified 7,295 people newly diagnosed with HIV and linked 79% of those to care. This work would not have been possible without the dedication and support of community partners.

Community engagement and collaboration does not occur in a vacuum and requires constant communication, passion, and commitment. As Henry Ford has said, "Coming together is a beginning. Keeping together is progress. Working together is success." The success of New York Knows relies on the work and support of its partners, which can be challenging due to varying agency capacities, resources, and funding.

To continue moving the needle forward, it is critical that New York Knows partners regularly participate in steering committee and subcommittee meetings, submit quarterly testing data, coordinate events, and most importantly work to grow the initiative by being New York Knows advocates. HIV testing is a vital step in ending the epidemic, and an "all hands on deck" endeavor as we work to end AIDS in New York.

New York Knows is aligned with the following Blueprint Recommendations:

"Identify persons with HIV who remain undiagnosed and link them to health care."

  • BP 1: Make routine HIV testing truly routine
  • BP 2: Expand targeted testing
  • BP 3: Address acute HIV infection
  • BP 4: Improve referral and engagement
  • BP 29: Expand & enhance the use of data to track and report progress

"Link and retain persons diagnosed with HIV in care to maximize virus suppression so they remain healthy and prevent further transmission."

  • BP 9: Provide enhanced services for patients within correctional and other institutions and specific programming for patients returning home from corrections or other institutional
  • BP 10: Maximize opportunities through the Delivery System Reform Incentive Payment (DSRIP) process to support programs to achieve goals related to linkage, retention and viral suppression

"Provide access to PrEP for high-risk persons to keep them HIV-negative."

  • BP 11: Undertake a statewide education campaign on PrEP and PEP
  • BP 12: Include a variety of statewide programs for distribution and increased access to PrEP and PEP
  • BP 13: Create a coordinated statewide mechanism for persons to access PrEP and PEP and prevention-focused care
  • BP 4: Improve referral and engagement
  • BP 29: Expand & enhance the use of data to track and report progress


Goals and Accomplishments

Looking forward to 2017 and reflecting on 2016's accomplishments, New York Knows partners have done amazing work to bend the curve in reducing new HIV infections. The goal of the Ending the Epidemic plan -- to reduce the annual number of new HIV infections in New York State to 750 and those in NYC to 600 -- is a tremendous undertaking. (The graph below shows estimates of how we might achieve that.)

The mission of New York Knows in 2017 continues with getting people tested and linked to care or prevention services. New York Knows must continue to evaluate its efforts and reflect on the changing landscape of HIV prevention that will end the epidemic.


Goal of Ending the Epidemic


Routine Testing

Making HIV testing routine is key. Patients receive routine labs for many medical conditions, and HIV testing should be no different. The NYS HIV testing Law (27-F) has been amended over the past several years to reflect the changes in HIV prevention, care, and treatment. But new changes continue to support efforts to streamline and routinize testing. Here are some important recent changes to NYS HIV testing law:

  • NYS requires that an HIV test be offered to every individual age 13 years and older in health care settings, including inpatient wards or emergency departments of a general hospital, outpatient departments of hospitals offering primary care, and free-standing diagnostic and treatment centers offering primary care.
  • Written consent for an HIV test is no longer required. A provider only needs to advise the patient that an HIV test will be provided and give the 7 points of information about the test either orally or in writing.

All of these provisions have been put in place to streamline HIV testing and increase the number of people getting tested. NYC clinical sites that offer lab-based testing can adopt the following steps for streamlined HIV testing:

  1. Notify the patient that testing will occur, and document this in the patient's record
  2. Provide required pieces of information, either orally or in writing, and answer any questions
  3. Perform the test
  4. Provide the results to the patient

If the patient has a non-reactive (negative) test, they must be given the result by email, mail, or phone, as well as information about PrEP and PEP, and the risk of infection. If an HIV test is reactive (positive), the same counseling requirements remain, but the provider or site staff must arrange for a follow-up medical appointment if the patient consents to care. The case must be reported using the provider reporting form and domestic violence screening must be done. Partner services from the Health Department should also be considered. Questions regarding Provider Report Forms and Partner Services can be answered at 212-442-3388 and 212-693-1419, respectively.

The NYS HIV testing law can be difficult to understand at times and challenging for larger institutions to implement at first, but making testing routine can help reduce new infections and assist in connecting those in need to appropriate care.


The New HIV Neutral Continuum of Care

The New HIV Neutral Continuum of Care


Combination Prevention

The "New HIV Neutral Continuum of Care" helps to reduce the stigma associated with HIV. This theoretical Neutral Continuum of Care proposes the idea that treatment is treatment, treatment is prevention, and prevention is treatment. This not only reduces stigma, but also supports the importance of routine health care by recognizing that HIV care and prevention are equal in ending the epidemic.

People who test positive should be linked to HIV medical care, start antiretroviral therapy, and be supported to stay in care. This will not only improve their health outcomes but also help prevent further transmission. Studies show that HIV treatment leads to a 96% reduction of sexual transmission of HIV in serodiscordant couples. People who engage in high-risk behavior and test negative should be connected to medical care and introduced to PrEP to keep them HIV-negative. Current research indicates that if PrEP is taken daily, the risk of HIV through sexual contact is reduced by up to 99%.


Increasing Access to PrEP and PEP

HIV testing needs to go beyond just giving a result by connecting those at higher risk to care and treatment. PrEP is a daily pill taken by people who are HIV negative to protect them against HIV. PEP is emergency medication that can prevent HIV infection if started as soon as possible after exposure to HIV, ideally within 36 hours, but within no more than 72 hours of exposure.

PrEP and PEP are effective medical interventions that have the potential to bend the curve of the epidemic. To increase their use among New Yorkers who would benefit the most, providers must embrace these interventions. Agencies need to increase PrEP awareness, patient assessments, and should have the resources to provide referrals to prescribing providers.


Next Steps

Ending the epidemic is a shared responsibility that goes beyond HIV service organizations and advocacy groups. We need to approach the end of the epidemic through a social justice and health equity lens. Working together in NYC, we must continue to adapt our strategies and grow by ensuring policies are up-to-date and adequately implemented. We must use combination prevention messages to help reduce the stigma around HIV. And we must increase the use and awareness of medical interventions like PrEP and PEP.

For more information regarding New York Knows, or how to get involved, please email NewYorkKnows@health.nyc.gov. Amanda Phi is the Manhattan liaison for New York Knows. Paul Santos is the Queens liaison for New York Knows.


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This article was provided by AIDS Community Research Initiative of America. It is a part of the publication Achieve. Visit ACRIA's website to find out more about their activities, publications and services.
 

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