HIV/STI Epidemiology Evaluation and Partner Services

HIV/AIDS Epidemiology

The Bureau of HIV/AIDS Epidemiology (BHAE) provides mission critical functions to the New York State Department of Health (NYSDOH) related to the conduct of HIV surveillance and supplemental activities. These activities include, but are not limited to, the facilitation and monitoring of all HIV-related laboratory and clinician reporting in New York State (NYS). In compliance with State law, HIV surveillance is conducted by the state rather than localities.

Comprehensive electronic laboratory reporting via the NYSDOH Electronic Clinical Laboratory Reporting System (ECRLS) is the foundation of HIV surveillance for NYS. Annually, over 190 laboratories serving NYS residents and/or NYS clinicians electronically report 1.3 million HIV-related laboratory test results, including results of diagnostic and disease monitoring test types (any laboratory test, tests or series of tests approved for the diagnosis of HIV or for the periodic monitoring of HIV). Medical providers also have statutory reporting requirements and are to report, by name, individuals with diagnosed HIV using the Medical Provider HIV/AIDS and Partner/Contact Report Form (PRF). Completion of the PRF within 7 days of diagnosis is required and should be completed electronically using the Provider Portal on the NYSDOH Health Commerce System. This system is also the mechanism by which clinicians submit inquiries for their patients with diagnosed HIV who they think require assistance with linkage to or retention in HIV medical care.

NYS HIV surveillance data are augmented through linkage to a variety of supplemental sources, including administrative data (e.g., Medicaid, NYS Department of Corrections and Community Supervision (DOCCS) System), disease registries for co-morbidity assessment (e.g., STI, cancer, congenital malformations, TB, viral hepatitis), NYS vital statistics birth and death data, as well as national death sources for death ascertainment (e.g., Social Security Master Death File and National Death Index). BHAE collaborates with Healthix, the largest regional health information organization (RHIO) in NYS, to collect ongoing care and treatment outcomes for Healthix members with diagnosed HIV. Extensive effort is dedicated to interstate and intrastate deduplication to ensure accurate case counts.

Bureau-collected data are used to evaluate linkage and retention in care and to identify persons in need of initial or ongoing Health Department Partner Services intervention. HIV surveillance data are used programmatically to identify persons living with diagnosed HIV who have fallen out of HIV medical care. The AIDS Institute uses these data to facilitate re-engagement of individuals in the HIV health care system for continued treatment.

The Bureau participates in the NYSDOH public health intervention efforts to identify and respond to clusters of HIV transmission. In addition to Epidemiologic support, Bureau- collected data are used to identify clusters of HIV transmission using space/time and molecular HIV methods. The data are also analyzed to identify instances of transmitted or multiclass antiretroviral drug resistance for public health follow up.

Through mutual agreement, the New York City Department of Health and Mental Hygiene (NYCDOHMH) acts as an agent of the State for the conduct of HIV surveillance and provision of partner services in the five boroughs. Records are returned to NYS BHAE after surveillance investigation to allow construction of a statewide dataset for analysis.

NYS is unique in the nation in that all liveborn infants are tested for HIV antibodies through the NYSDOH Newborn Screening program. The Bureau’s maternal and perinatal surveillance team follows the approximately 300-400 HIV-exposed infants annually to determine infection status and to calculate maternal-to-child transmission metrics. Most diagnostic testing for infants born HIV exposed is provided by the Wadsworth Center Pediatric Diagnostic Testing Service, and enhanced medical record review occurs for all HIV-exposed infants to identify missed opportunities or best practices. Routine linkage to NYSDOH and NYCDOHMH vital statistics birth data is used to identify women with diagnosed HIV giving birth in NYS.

Described below are the BHAE- conducted enhanced surveillance projects and special studies that monitor the course of the HIV epidemic.

For over two decades, the Bureau has conducted the HIV and HCV Seroprevalence Study among Inmates Entering the DOCCS, which provides the only seroprevalence estimate for persons incoming to the NYS prison system. It is the longest and largest HIV and HCV seroprevalence study of an incoming population to a state prison system. Recent findings highlight the increasing HCV burden to correctional health and the opportunities related to addressing HCV and HIV treatment needs, both during and after incarceration.
BHAE participates in the Center for Disease Control and Prevention (CDC)- sponsored Medical Monitoring Project (MMP), an expanded surveillance project that collects information on persons with diagnosed HIV. Data from this interview-based and medical record review project are used to measure the quality of HIV health care, the occurrence of mental health disorders, drug and alcohol usage, stigma, barriers to care, and clinical outcomes. MMP also uses this information to provide participants with referrals to health care and supportive services.

NYS participates in the National HIV Behavioral Surveillance project (NHBS), an anonymous multi-state personal interview survey of persons at high risk for HIV. BHAE implements NHBS on Long Island. Participants are identified through a peer sampling methodology known as respondent- driven sampling or through venue-based sampling. The 2021 cycle, the last year of data collection for the NYSDOH, focuses on gay, bisexual, and other men who have sex with men (MSM).

Bureau- collected data is disseminated to assist health care professionals, HIV prevention and care programs, and community health planners in their efforts to provide impactful and cost-effective interventions. The analysis and presentation of these data form the foundation on which decisions about services and programs for the HIV-positive and affected population of NYS are based and includes producing the HIV care continuum/cascade measures and the surveillance Ending the Epidemic metrics.

The data collected through the New York HIV Surveillance System are used by the CDC to track the State and national epidemic, and by the Health Resources and Services Administration (HRSA) to monitor HIV care and treatment and provide a basis for determining the amount of federal funds New York receives for HIV-related prevention and treatment programs. The HIV Surveillance System is supported partially through CDC cooperative agreement funds, state funds, and other state in kind support. The Bureau functions directly support all major components of the New York State Ending the Epidemic initiative.

Contact:

Carol-Ann Swain, PhD
Director, Bureau of HIV/AIDS Epidemiology
518-474-4284
carol-ann.swain@health.ny.gov

HIV/STI Field Services

The primary goal of the Bureau of HIV/STD Field Services (BHSFS) is to prevent and reduce the incidence of HIV and other sexually transmitted infections (STI). Critical to achieving this goal is the delivery of a broad array of disease prevention services by Department of Health (DOH) staff including education, disease screening, case investigation, patient interview, partner notification, risk reduction counseling, referrals to care, and condom distribution. Utilizing the surveillance system, cases of HIV, Syphilis, Gonorrhea and Chlamydia are assigned to DOH staff for the purpose of disease intervention, case management and ensuring linkage to care, treatment, and partner services. Partner services is an evidence-based intervention that has been successful in identifying persons unaware of their HIV or STI status and reducing disease transmission.

Field staff offer free confidential and anonymous HIV disease screening, risk reduction counseling, condoms, and other public health services for community members to prevent acquiring HIV and other STIs. HIV testing and linkage to care is a key intervention offered through partner services to assist partners of people living with diagnosed HIV and/or recently testing positive for other STIs in learning their HIV status and accessing HIV medical care, pre-exposure prophylaxis (PrEP) and other needed prevention and care services. Anonymous HIV counseling, testing and partner services are also provided for those in custody of the NYS Department of Corrections and Community Services.

DOH partner services staff are located in six regional offices statewide and coordinate with local county public health departments to ensure individuals diagnosed with HIV or STIs receive disease intervention services, HIV testing and active PrEP referrals. In addition, the BHSFS contracts with 11 local county health departments for disease intervention and partner services.

Some individuals diagnosed with HIV experience barriers to regularly accessing medical care or adhering to treatment. Adherence to HIV treatment lowers the patient’s viral load, leading to better health outcomes and reducing the likelihood of transmission. Division of Epidemiology, Evaluation and Partner Services (DEEP)-coordinated AIDS Institute Data to Care (DTC) projects bring together a range of partners—public health officers, managed care organizations, criminal justice professionals, community health centers, community-based organizations—to ensure every New Yorker diagnosed with HIV has facilitated access to medical care. DOH partner services staff offer expanded partner services to patients and their health care providers by assisting newly diagnosed and previously diagnosed individuals who have fallen out of care to engage in medical care and other services. Partner services staff also provide ongoing partner services to people living with HIV who acquire new STIs. Partner services staff utilize behavioral interventions and conduct outreach to re-engage people living with diagnosed HIV in primary HIV care.

Through innovative health informatics techniques, the AIDS Institute leverages reported surveillance data to identify individuals diagnosed with HIV who have no laboratory evidence of having received recent medical care. The AIDS Institute then facilitates scientifically proven, cost-effective, and scalable interventions to help patients re-engage with care, test and treat partners, and deliver risk reduction counseling and prevention supplies. This approach enhances the impact of HIV and STI prevention efforts in New York State, and it is an essential step in achieving the goals of the National HIV/AIDS Strategy and the Governor’s Plan to End the AIDS Epidemic in NYS.

Contact:

Megan Johnson, MPH
Bureau of HIV/STI Field Services
518-474-3671
megan.johnson@health.ny.gov

Medical Monitoring Project

The Bureau of HIV/AIDS Epidemiology (BHAE) conducts the Medical Monitoring Project (MMP) for New York State (excluding NYC), a Centers for Disease Control and Prevention (CDC) funded project conducted in 23 jurisdictions nationwide. MMP is designed to learn more information about the experiences and needs of persons living with HIV.  Data are collected via an interview and medical chart abstraction for people living in New York State (outside of NYC) with diagnosed HIV.  The data are used to measure the quality of medical care received, health-related behaviors, and other variables such as quality of life resulting in data that are used at the national level for policy decisions and resource allocation related to prevention and treatment initiatives.  Locally MMP data are used to measure the quality of HIV health care, the occurrence of mental health disorders, drug and alcohol usage, stigma, barriers to care, and clinical outcomes.  MMP also uses this information to provide participants with referrals to health care and supportive services.  Recent changes in the MMP methodology have expanded the sample to include known in care and presumed out of care individuals.  The New York City Department of Health and Mental Hygiene is separately funded for this activity, though the New York State Department of Health conducts whole state analyses of MMP data via mutual agreement

Contacts:

Beth Weir, BA, BS, RN
Senior Project Coordinator
Bureau of HIV/AIDS Epidemiology
518-474-4284
beth.weir@health.ny.gov

Data to Care

Some individuals diagnosed with HIV experience barriers to regularly accessing medical care or adhering to treatment.  Adherence to HIV treatment lowers the patient’s viral load, leading to better health outcomes and reducing the likelihood of transmission.  Data to Care (DTC) projects bring together a range of partners—public health officers, managed care organizations, criminal justice professionals, community health centers, community-based organizations—to ensure every New Yorker diagnosed with HIV has facilitated access to medical care.

Through innovative health informatics techniques, the AIDS Institute leverages reported surveillance data to identify individuals diagnosed with HIV who have no laboratory evidence of having received recent medical care. The AIDS Institute then facilitates scientifically proven, cost-effective, and scalable interventions to help patients re-engage with care, test and treat partners, and deliver risk reduction counseling and prevention supplies. This approach enhances the impact of HIV and STI prevention efforts in New York State, and it is an essential step in achieving the goals of the National HIV/AIDS Strategy and the Governor’s Plan to End the AIDS Epidemic in New York State.

Contact:

Carol-Ann Swain, PhD
Director, Bureau of HIV/AIDS Epidemiology
518-474-4284
carol-ann.swain@health.ny.gov

National HIV Behavioral Surveillance (NHBS) System

The New York State Department of Health (NYSDOH) participated in the National HIV Behavioral Surveillance project (NHBS) from 2004 through 2021, conducting activities in Nassau and Suffolk counties on Long Island. NHBS is a Center for Disease Control and Prevention (CDC)-sponsored anonymous, multi-state personal interview survey of persons at high risk for HIV. NHBS is conducted in rotating, annual cycles among gay, bisexual, and other men who have sex with men (MSM), heterosexuals living in poverty (HET), and persons who inject drugs (IDU). Trained interviewers collect information on HIV-related risk behaviors, HIV testing, alcohol and recreational drug use, and the use of HIV prevention services. Participants in the NYSDOH project area were also offered voluntary, anonymous HIV and HCV testing. NHBS data are used to develop and direct the evaluation of national and local HIV prevention services and programs, including targeted testing initiatives, PrEP utilization, and syringe exchange programs. The project is on-going in New York City and other United States jurisdictions.

Contact:

Carol-Ann Swain, PhD
Director, Bureau of HIV/AIDS Epidemiology
518-474-4284
carol-ann.swain@health.ny.gov