Health Care Services

HIV Uninsured Care Programs: ADAP, ADAP PLUS, HIV Home Care, ADAP Plus Insurance Continuation, Pre-Exposure Prophylaxis Assistance Program, RapidTx

The AIDS Institute has established six program components for New Yorkers living with HIV/AIDS who are uninsured or underinsured with the aim to provide access to medical services and medications to improve their health and quality of life.  The AIDS Drug Assistance Program (ADAP) provides life-saving medications; ADAP Plus provides HIV primary care services; the Home Care Program provides care in the home; the ADAP Plus Insurance Continuation (APIC) program provides assistance in paying health insurance premiums to support access to comprehensive health care coverage in a cost-effective manner; the Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) provides access to primary care services and monitoring to support the use of Pre-Exposure Prophylaxis (PrEP) to prevent HIV infection; and the Rapid Treatment (RapidTx) pilot provides immediate access to care and treatment for persons newly diagnosed with HIV or returning to HIV care. 

The mission of these programs is to provide access to medical services and medications for all New York State residents with or at risk of acquiring HIV/AIDS.  The programs' dual goals are to empower individuals to seek, access, and receive medical care and prescription drugs without cost and to supply a stable and timely funding stream to health care providers, enabling them to use the revenues to develop program capacity to meet the needs of the uninsured HIV population.

The AIDS Drug Assistance Program (ADAP) began in 1987 as part of a national initiative to provide free HIV/AIDS drugs to low-income individuals not covered by Medicaid or without adequate third­-party insurance.  In November 1991, the HIV Home Care Program, modeled after ADAP, was implemented through a federal demonstration grant.  The ADAP Plus primary care initiative was developed with cooperative funding through a unique partnership between New York City and New York State and was implemented statewide in October 1992.  The ADAP Plus Insurance Continuation Program (APIC) began July 1, 2000.  PrEP-AP began in January 2015.  RapidTx began as a pilot program in 2016 and will be disseminated across the state to the highest diagnosing providers in 2017. All six programs are integrated, centrally administered, use a unified application form, and coordinate outreach activities.
The programs serve New York State residents who are HIV infected or at risk of acquiring HIV and are uninsured or under-insured and meet established residency, financial, and medical criteria.  The programs serve as a transition to Medicaid by providing interim assistance to individuals eligible for but not yet enrolled in Medicaid, or assistance in meeting spend-down requirements.  Individuals with third-party insurance who cannot meet the deductibles or co-payments are eligible to enroll in the programs.  Adolescents who do not have access to the financial or insurance resources of their parents/guardians are also eligible.

As of April 2017, the ADAP formulary consists of more than 500 drugs, including:  antiretrovirals, antineoplastics, prophylaxis and treatments for opportunistic infections, and medications for related conditions.  ADAP Plus covers a full range of HIV primary care services, provided on an outpatient ambulatory basis, including:  annual comprehensive medical evaluation, clinical HIV disease monitoring, treatment of both HIV-related and non-HIV related illness, mental health and dental services, ambulatory surgery, laboratory services, and nutritional counseling and supplements.  Services covered through the Home Care Program include:  skilled nursing, personal care, homemaker and home health aide services, adult day health care, intravenous administration and supplies, and durable medical equipment.  APIC pays the premiums of individuals who lose their employment and are eligible to continue their insurance, or working individuals who cannot afford their insurance premiums. PrEP-AP provides reimbursement for necessary primary care services for eligible individuals seen by enrolled providers who are experienced providing services to HIV-negative, high-risk individuals who are engaged in HIV Pre-Exposure Prophylaxis.  RapidTx provides an immediate access card through participating providers to facilitate “same day” access to antiretroviral medications, lab services and care for people who are newly diagnosed with HIV or returning to care after a lapse. Coverage of drugs and services is revised based on available funding and the changing clinical profile of the epidemic.

The HIV Uninsured Care Programs use the AIDS Institute's network of programs and providers and those of other New York State agencies as a comprehensive referral system and distribution network for applications and promotional materials.  The Programs provide federal Ryan White Minority AIDS Initiative funding to eleven community based organizations throughout New York State to support outreach and educational activities to increase minority participation in care and ADAP.  In cooperation with state, federal, and local corrections authorities, program applications and information are provided to HIV-positive inmates nearing release from correctional facilities.  The programs are coordinated with Medicaid to assure non-duplication of coverage, continuity of care and an easy transition to Medicaid when participants meet Medicaid eligibility criteria.  An advisory workgroup provides input, guidance, and recommendations to the programs from a wide variety of perspectives on coverage elements and integration with other HIV services.  The workgroup is comprised of persons living with HIV/AIDS, representatives of Part A Planning Councils, local and state government officials, health care providers, agencies, associations, and clinicians.

The programs serve all populations affected by HIV in New York State.  New York State's ADAP/ADAP Plus has the most comprehensive drug and service coverage of any state in the country.

Contact:

Christine A. Rivera
Director, Office of HIV Uninsured Care Programs
(518) 459-1641 or 1-800-542-2437 (In New York State Only)
christine.rivera@health.ny.gov

Back to top of page

AIDS Nursing Facilities

The AIDS Nursing Facilities Initiative began in 1988 to provide appropriate nursing home care for people with HIV/AIDS.  

Nursing facilities providing services to residents with AIDS must ensure special services are provided including: medical services by a physician who has experience in the care and clinical management of persons with AIDS; sub-specialty physician services; nursing services supervised by a registered professional nurse with experience in the care and management of persons with AIDS; substance abuse services; HIV risk/harm reduction education; comprehensive case management; and pastoral care.

There are 10 facilities with the distinct AIDS Nursing Facility licensure designation (denoting a particular number of beds exclusively designated for people with an AIDS defining diagnosis) for with a total of 833 beds, located primarily in New York City. One facility is located in Nassau County.   

An additional 13 facilities across New York State are approved for AIDS scatter beds.  These facilities have the ability to admit up to ten AIDS residents at any point in time. The AIDS Institute will continue to monitor the need for AIDS nursing home beds, and will encourage the development of AIDS Scatter beds in nursing facilities in Upstate New York as necessary to ensure sufficient access to nursing home care for persons with HIV/AIDS.   

Contact:

Joe Losowski
Director, Chronic Care Section
Office of Medicaid Policy and Programs
(518) 474-8162
joseph.losowski@health.ny.gov

Back to top of page

AIDS Adult Day Health Care Programs

AIDS Adult Day Health Care Programs (ADHCPs) were originally designed for a frail population that required a greater range of comprehensive health care services than could be provided in any single ambulatory setting, but did not require the level of services provided in a hospital or a skilled nursing facility.  While the original intent of the program model -- to assist individuals with AIDS and HIV disease live more independently in the community and prolong or eliminate the need for residential health care services -- continues to be a major objective, ADHCPs have evolved over the years to meet the emerging needs of the population. Treatment advances have, in many cases, transformed HIV disease from a terminal illness to a chronic condition. As a result, the HIV infected population is living longer, and along with this trend has seen an increase in concomitant chronic medical conditions such as cardiovascular disease, hypertension, hepatitis and diabetes.

In order to achieve optimal results from the treatment advances that have occurred since the start of the HIV epidemic, it is critically important for individuals to be adherent to their treatment regimes. Clearly, medication adherence can be a major challenge associated with any disease. For individuals infected with HIV, adherence is often further compromised by the commonly occurring co-morbidities of substance use, mental illness, and other chronic conditions. This comprehensive care model has evolved to address the challenges and complexity of managing multiple comorbidities. 

The intent of the ADHCPs is to complement or enhance the existing continuum of medical services through on-going coordination with primary care providers and other service providers.  ADHCPs are designed to provide a comprehensive and integrated model of service delivery in a cost-effective manner by avoiding duplication of services and minimizing the need for patients to receive additional off-site services.

ADHCPs provide a comprehensive range of services in a community-based, non-institutional setting.  General medical care including treatment adherence support, nursing care, rehabilitative services, nutritional services, case management, HIV risk reduction, substance abuse, and mental health services are among the services provided.  Health maintenance/wellness activities such as supervised exercise and structured socialization are adjunct components of the program model, but cannot be the sole reason for admission/continued stay in the program.

ADHCP services are primarily located in the Greater New York Metropolitan area.  Services are also located in Monroe County in Upstate New York.

Currently, there are 11 licensed programs with a capacity to serve 822 clients per day.

Contact:

Joe Losowski
Director, Chronic Care Section
Office of Medicaid Policy and Programs
(518) 474-8162
joseph.losowski@health.ny.gov

Back to top of page

Retention and Adherence Programs in Medical Settings

The Retention and Adherence Program (RAP) provides a framework for continuous HIV/AIDS treatment and care in a medical setting designed to increase the number of People Living with HIV/AIDS (PLWHA) adherent to ART, thereby diminishing their viral load, improving their quality of life, and reducing their ability to transmit the virus to others. Grant funds support RAP services in a range of settings throughout New York State, including Community Health Centers, hospital ambulatory clinics, and drug treatment programs.

RAP focuses on three groups of patients:

  • Those who are newly diagnosed and/or treatment naïve;
  • Those who have been unable to achieve sustained viral suppression;
  • Those who have missed appointments and are in danger of falling out of care.

The intent of RAP is to provide services that support PLWHA in achieving viral load suppression and building the capacity to independently manage their health care. The program seeks to address the individual barriers preventing some PLWHA from engaging and adhering to HIV treatment. The RAP is a vital part of the clinical model. A team approach is used to provide support to the patient on implementing and sustaining their clinical treatment plan. Interventions are intensive and highly individualized. The support provided increases the ability of the patient to improve personal health outcomes, with the ultimate goal of patient self-management.

Contacts:

Lilian Lee
Director, Retention and Adherence Programs
Bureau of HIV Ambulatory Care Services
Division of HIV and Hepatitis Health Care
(212) 417-4530
lilian.lee@health.ny.gov

Janice Bigler
Assistant Section Director
(212) 417-4523
Janice.bigler@health.ny.gov

Jill Dingle
Assistant Section Director
(212) 417-4531
jill.dingle@health.ny.gov

Back to top of page

Designated AIDS Centers

Designated AIDS Centers (DACs) are State-certified, hospital-based programs that serve as the hubs for a continuum of hospital and community-based care for persons with HIV infection and AIDS.  AIDS Centers provide state-of-the-art, multi-disciplinary inpatient and outpatient care coordinated through hospital-based case management.  DACs with pediatric and obstetrical departments also provide specialized HIV care to infants, children, and pregnant women.

The AIDS Center program was developed and remains a patient-centered program model that can evolve with the needs of the patient in the changing health care environment.  AIDS Centers provide a primary care home for the person with HIV.  Patient outcomes improve when care is seamless, coordinated by a care manager utilizing multi-agency, multi-disciplinary health care teams.

HIV-specific care standards developed for DACs are intended to ensure uniformly high quality care for HIV patients.  AIDS Centers usually have a dedicated team and are required to provide or arrange for inpatient care; coordinated outpatient services including a broad array of subspecialty services; long-term care, as necessary; and counseling and testing services.  AIDS Centers must make arrangements for patients' personal or home care as required, and arrange for patients to participate in clinical trials.  AIDS Centers must enhance coordination with their community-based partners to identify patients at risk, help patients access and remain in care, and understand and adhere to their complicated regimens.

The quality of care is monitored and evaluated by the HIV Quality of Care Program described in a separate section of this document.  Each AIDS Center is required to have an active quality program including a broadly inclusive quality improvement committee as well as a consumer advisory group and other mechanisms to involve consumers in improving services for PLWHA.

With the Statewide implementation of Medicaid managed care plans for persons with HIV/AIDS over the last few years, AIDS Centers continue to maintain state-of-­the-art HIV treatment and serve geographic areas with the highest HIV/AIDS prevalence.

Currently, there are thirty-nine AIDS Centers statewide treating approximately 44,000 persons with HIV/AIDS as outpatients and inpatients.

Contact:

Joe Losowski
Director, Chronic Care Section
Office of Medicaid Policy and Programs
(518) 474-8162
joseph.losowski@health.ny.gov

Back to top of page

HIV Special Needs Plans (SNPs) / Managed Care

HIV Special Needs Plans (SNPs), as defined in the New York State Medicaid Managed Care Act of 1996, are intended to provide an alternate source of capitated managed care to Medicaid-eligible persons with HIV infection.

Specialized managed care plans to address the health and medical needs of persons with HIV/AIDS first began to be explored by New York State in 1994 with the award of a Special Projects of National Significance (SPNS) grant from the federal Health Resources and Services Administration and concluded after a planning and study phase with passage of legislative language authorizing the creation and licensure of HIV SNPs. These activities culminated in federal approval of the Department of Health’s application to implement SNPs.

HIV SNPs, fully operational since 2003, provide an alternative option for managed care to Medicaid­ eligible persons in New York City with HIV/AIDS. In New York City approximately 25,000 HIV+ Medicaid individuals must choose either an HIV SNP or a mainstream managed care plan to receive their Medicaid benefits. Three SNPs are currently licensed and enrolling eligible individuals throughout New York City. In January, 2014 SNPs began to enroll homeless people who are HIV negative as a new population.   Eligible residents who qualify through New York State of Health marketplace can choose from three HIV SNPs.

HIV SNP networks include the full continuum of HIV services currently available in New York State. Inclusion of health and human service providers with experience in the provision of HIV services enables SNPs to meet the complex medical and psychosocial needs of enrollees, either through direct service provision or by referral. SNP experience with HIV population has helped them expand networks to support the new population of negative homeless members.  SNPs have well developed care and benefit coordination procedures and relationships with Health Homes to support needs of members with complex medical, behavioral and psychosocial needs. Plan members with significant behavioral health needs may be eligible for additional Home and Community Based Services to meet those needs. Clinical care provided by SNPs is in accordance with AIDS Institute established standards for HIV care and assessed through continuous quality improvement techniques.

Because most Medicaid beneficiaries in NYS must enroll in a Medicaid managed care plan, the AIDS Institute is working to assure that all Medicaid-eligible persons with HIV infection have appropriate access to health care services delivered in a managed care setting. To assure that services offered by mainstream managed care plans provide access to quality HIV and other covered care, the AIDS Institute participates in the development of programmatic standards for mainstream managed care plans, conducts quality of care reviews, and participates in Article 44 surveys. The AIDS Institute also provides technical assistance to managed care plans regarding prevention activities and establishing coordinated systems of care that are appropriate to the specific health care needs of enrollees with HIV/AIDS.

Contact:

Mundy Zullo
Section Director, Medicaid Managed Care / HIV SNP
Office of Medicaid Policy and Programs
(518) 486-1383
aims@health.ny.gov

Back to top of page

HIV Enhanced Fees for Physicians Program

The Enhanced Fees for Physicians Program (EFP) was established in 1991 by the New York State Department of Health to give private practice physicians enhanced Medicaid rates for HIV Primary Care Visits. These visits include:

  • HIV Testing
  • HIV Post-test positive counseling
  • HIV monitoring

Physicians who participate in the HIV Enhanced Fees for Physicians Program must:

  • be in private practice and enrolled in the New York State Medicaid Program;
  • have active hospital admitting privileges;
  • be Board certified (preferably in infectious disease, internal medicine, family practice, pediatrics or obstetrics/gynecology);
  • provide 24-hour coverage; and
  • manage patient medical services, including hospital admissions, referrals for specialty care and social services.

Contact:

Joe Losowski
Director, Chronic Care Section
Office of Medicaid Policy and Programs
(518) 474-8162
joseph.losowski@health.ny.gov

Back to top of page

HIV Primary Care Medicaid Program

The HIV Primary Care Medicaid Program (HPCMP) was established in 1989 by the New York State Department of Health to provide enhanced Medicaid rates to Article 28 facilities for HIV primary care and HIV testing visits.

Medicaid reimbursement methodology began a change in December 2008 that ultimately required 85% of the HPCMP providers to adopt new procedure-specific Ambulatory Patient Groups (APGs).  Since the full implementation of APGs, only Federally Qualified Health Centers (FQHC) that have NOT opted into the new APG methodology, continue access to the HPCMP rate structure. FQHCs who meet enrollment criteria can access enhanced reimbursement for HIV testing and HIV treatment.

Enrollment Criteria includes: 

  • The facility must be a FQHC (Article 28 facility hospital OR diagnostic and treatment center); and
  • The facility must sign an agreement with the New York State Department of Health to provide comprehensive services and coordination of care for persons with HIV.

Contact:

Joe Losowski
Director, Chronic Care Section
Office of Medicaid Policy and Programs
(518) 474-8162
joseph.losowski@health.ny.gov

Back to top of page

Outreach and Linkage to Care for Substance Users

The intent of outreach and linkage to care for substance users is to support the plan to End the Epidemic through the provision of outreach and HIV, Hepatitis C and STI testing services.  Funded providers identify HIV-positive substance users not currently diagnosed, substance users previously diagnosed but out of care, and individuals at high risk of acquiring HIV infection because of their substance use and co-occurring conditions.  The intent of the program is to link active substance users to appropriate medical and behavioral health services. 

Programs provide enhanced outreach and linkage to care for active substance users not currently in drug treatment through the following services:

  • Enhanced, evidence-based outreach and/or in-reach;
  • On-site rapid HIV testing;
  • On-site Hepatitis C education and rapid testing and linkage to further evaluation and treatment for clients testing positive;
  • Hepatitis A and B education and linkage for testing, vaccination and referral for acute and chronic treatment;
  • Assisted referral to recovery, addiction and mental health services for active substance users;
  • Assisted referral to Partner Services for persons testing HIV positive;
  • Assisted referral to HIV health care services for clients testing HIV positive and follow-up to ensure service acquisition;
  • Education and skills training for clients and staff regarding opioid overdose prevention including information about the administration of Naloxone;
  • Education and training for clients and staff regarding access to sterile syringes and disposal of used syringes including SEPS and the Expanded Syringe Access Program (ESAP) on-site or by referral;
  • Educating clients about PrEP and making appropriate referrals;
  • Education on sexually transmitted infections and linkages for testing and treatment.

Contact:

Margaret Smalls
Assistant Section Director
Bureau of HIV Ambulatory Care Services
Division of HIV and Hepatitis Health Care
(518) 486-6048
margaret.smalls@health.ny.gov

Back to top of page

Family-Focused HIV Health Care for Women

Women affected by HIV, experience poverty, substance use, domestic violence, mental illness, family disruption, and are often survivors of trauma. The medical care of women with HIV is further complicated by cultural/gender inequality and family issues that are distinct from those seen in their male counterparts. Traditionally, women have the primary responsibility for care of their children. Concerns regarding family and children often take precedence over their own health issues. In addition to addressing their health care concerns, HIV-positive women often face compounding issues such as custody arrangements, daily child care, disclosure, elder care, stigma and discrimination.

Engaging and retaining HIV-positive pregnant women and women with dependent children in the health care system requires holistic, family-focused services that recognize the women’s role as primary caregivers and address the multiple needs of their children.  For women with HIV, gynecologic and reproductive health services, including family planning, must be coordinated with adult HIV primary care. Family-Focused HIV Health Care is a comprehensive model designed to meet the needs of the HIV-positive women. The initiative seeks improved access to care and a reduction in barriers within the health care system, with the overall goal of improving health outcomes through support and adherence to treatment regimens. In addition, a paramount goal of this initiative is to reduce the risk of perinatal HIV transmission.

Family-Focused HIV Health Care is an integrated model of service that coordinates HIV primary care, women’s health services, and pediatric care for infants exposed to HIV.  Multicultural, multidisciplinary teams combine HIV specialty care, mental health counseling, prevention with positives, medical case management and other HIV-related support services to address the complex medical and social issues faced by women and HIV-affected families. The model ensures ongoing communication among all team members and community partners that promotes coordination of services and resources.  All efforts contribute to the goal of timely interventions and include aggressive engagement and re-engagement, support for addressing family issues, optimal early treatment and continuous care. These services are especially important for HIV-positive postpartum women who are at-risk for postpartum depression and more likely to delay returning to HIV care after delivery.

Contact:

Diane Grace
Assistant Section Director, Family and Youth Services
Bureau of HIV Ambulatory Care Services
Division of HIV and Hepatitis Health Care
(518) 486-6048
diane.grace@health.ny.gov

Back to top of page

Adolescent/Young Adult HIV Specialized Care Centers

Adolescents/Young Adults, ages 13-24 years, in New York State have a high percentage of newly diagnosed HIV, especially among young men who have sex with men (MSM), and a disproportionate percentage with a late HIV diagnosis.

Perinatally HIV-infected children who have aged into adolescence/young adulthood have significant risk reduction, developmental, mental health and self-management needs. With a lifetime of medical monitoring, treatment regimens and potentially life threatening illness, they are also confronted with the physical, cognitive, psychosocial and emotional challenges of adolescence.

Adolescents and young adults may engage in risk behavior that leads to HIV and/or STIs.  Education about sexually transmitted diseases, risk reduction services and PrEP/PEP education and screening are critical to this population during this vulnerable phase of development. Adolescent and young adult friendly interventions are needed to engage and maintain them in primary care, promote optimal health outcomes, and provide support for transition to adult service systems.

Specialized Care Centers provide comprehensive and coordinated HIV and primary health care, medical case management and supportive services using a multidisciplinary team model.   Serving HIV-positive and high-risk youth, SCC programs utilize an approach that enhances the health and well-being of youth using a health literate model. Programs are accessible to adolescents and young adults who engage in high-risk behaviors for HIV, or who may have been exposed to HIV, and have clinic hours suitable for adolescents and young adults, particularly evening and/or weekend hours.

The primary intent of the SCC is to serve HIV-positive youth; however, programs also reach and provide low-threshold clinical services to high-risk adolescents and young adults who are MSM, transgender, or other young people at high risk (e.g., runaway/homeless, involved in “street economy”/sex trafficking, substance use, victims of physical, emotional, and/or sexual abuse, gang-involved or involved with the criminal justice system).  

High-risk youth receive psychosocial, medical and social services assessments and receive assisted referrals.  High-risk youth are counseled to receive low threshold clinical services such as: HIV counseling/testing and risk reduction services; care for acute illness and immediate access to pharmaceuticals for uninsured youth; pregnancy testing, family planning and reproductive health care; STI screening and treatment, PrEP/PEP screening/education and referral for treatment of tuberculosis and hepatitis A, B, and C. Those identified as HIV-positive are immediately linked to HIV care. High-risk youth who are not HIV-positive, or who choose not to test for HIV, are referred for ongoing primary care and navigated to other needed services.   

Contact:

Beth Bonacci Yurchak
Director, Family and Youth Services
Bureau of HIV Ambulatory Care Services
Division of HIV and Hepatitis Health Care
(518) 486-6048
beth.yurchak@health.ny.gov

Back to top of page

Adolescent and Young Adult Youth Access Programs

Adolescents/Young Adults in general are not high users of health care and frequently avoid health care settings that are unfamiliar or not youth-friendly. The stigma of HIV, possibly combined with mental illness, substance use, poverty, violence and other forms of trauma, may present further barriers to seeking help through health care settings.

Many youth engage in risky activities, such as drug and alcohol use, which often lead to sexual risk-taking. For high-risk youth, the frequency and intensity of risk-taking behavior contribute to an increased potential for HIV, STIs and unintended pregnancy, necessitating intensive program outreach and integrated risk reduction efforts. Contributing factors related to high risk-taking behaviors may include multiple life stressors, such as exposure to violence, trauma, substance use, mental health issues or engaging in sex for money, drugs or life sustaining needs.

The major goal of the Youth Access Program (YAP) is to reach young men who have sex with men (YMSM), transgender, and other high-risk youth whose HIV status is unknown or who are HIV-positive but not in care and connect them promptly to HIV/AIDS care. Young people who are HIV-positive are immediately engaged in HIV care via navigation activities or case management. An important focus of this model is to connect high-risk youth to ongoing primary health care and to needed psychosocial and supportive services (e.g., child abuse/domestic violence, mental health, substance use treatment, etc.).  Referrals for HIV-negative youth include ongoing primary care services and needed psychosocial services.  Follow-up is provided on critical referrals (e.g., PrEP, PEP, etc.) with navigation provided as needed. 

Youth Access Programs provide low threshold clinical services to high-risk youth (ages 13-24 years) in targeted and accessible community-based settings to meet their immediate health care and social service needs using a health literate program model.  Low threshold clinical services include: HIV counseling and testing and risk reduction services, Partner Services, STI testing and treatment, PrEP/PEP education and screening, pregnancy testing, family planning/contraceptive counseling, screening and referral for tuberculosis and hepatitis A, B, and C, and provision of or referral for immunizations. Care for acute illness identified through medical examination is required.  Services include immediate access to medications for STIs or other infections and contraceptives for those without insurance.  A psychosocial assessment is completed to identify each young person’s unique needs and to offer appropriate services and referrals, as needed.  In many cases, these needs must be met before or concurrent with addressing issues related to HIV testing and treatment. 

Client recruitment/outreach efforts are targeted to YMSM and high-risk populations in venues where young people congregate. Youth social networks and social media are used as part of the outreach strategy. Community partnerships with LGBT and adolescent-friendly health and supportive services providers are critical for facilitating access to the services needed at the point of entry into care. 

Youth Access Programs are available at times suitable for young people’s schedules, particularly evenings and/or weekend hours, and at consistent community locations on a regular schedule. In addition to acceptable hours, methods to implement low threshold clinical services in community settings include: 

  • medically equipped vans
  • part-time clinics in high-risk community-based settings where youth congregate
  • mobile multidisciplinary teams.

Generally, six months is the recommended time frame for high-risk youth in the program.  However, this may be extended for individuals who need additional time to successfully transition to a medical home, PrEP candidates not connected to primary care, or for clients with continued risk behavior that have not transitioned to an appropriate primary care provider.

Contact:

Beth Bonacci Yurchak
Director, Family and Youth Services
Bureau of HIV Ambulatory Care Services
Division of HIV and Hepatitis Health Care
(518) 486-6048
beth.yurchak@health.ny.gov

Back to top of page

Transgender Health Care

The Governor’s Ending the Epidemic Task Force identified transgender men and women as one of the populations that experience high rates of health disparities. Three transgender programs were provided resources to increase emphasis on prevention, treatment and care. The programs provide increased outreach to engage transgender adolescents and adults who are not connected to ongoing care and provide HIV/HCV/STD testing, health care services including hormone therapy, mental health, medical case management and other supportive services in a transgender-friendly setting.  The programs link those who are HIV positive to ongoing HIV care and treatment.  Transgender individuals can receive ongoing transgender-friendly primary care services, including PEP and PrEP education and initiation of regimens as appropriate.

Program design requires enhanced non-traditional work hours, mobile medical outreach, and/or use of peers, social networks and social media as means to engage transgender individuals in care.  This project promotes adolescent and adult program collaboration to reach both transgender adolescents and adults and ensure coordinated and population-specific services.

Contact:

Beth Bonacci Yurchak
Director, Family and Youth Services
Bureau of HIV Ambulatory Care Services
Division of HIV and Hepatitis Health Care
(518) 486-6048
beth.yurchak@health.ny.gov

Back to top of page

Viral Hepatitis Section

The Bureau of Hepatitis Health Care is responsible for the development and maintenance of a comprehensive hepatitis C (HCV) program. Program activities include HCV prevention (including HCV screening), education, medical care and treatment, and policy and planning activities. The overall program goals are to:

  • Prevent the acquisition and transmission of HCV;
  • Build knowledge and awareness of HCV disease, prevention, risk, treatment and medical management;
  • Develop and maintain an infrastructure to provide the highest quality of HCV care and treatment;
  • Foster an effective policy and planning environment at the local, state and national levels and;
  • Conduct epidemiologic, program evaluation, and quality improvement studies to guide program and policy decisions.

The Bureau of Hepatitis Health Care collaborates and coordinates with the New York State Department of Health (NYSDOH) Bureau of Communicable Disease Control, which is responsible for hepatitis surveillance and outbreak activities, and the Bureau of Immunization, which is responsible for the coordination of the Adult Hepatitis Vaccination Program.

The Bureau of Hepatitis Health Care is responsible for the following activities:

Hepatitis C Care and Treatment Programs  The Bureau of Hepatitis Health Care currently funds fifteen programs statewide to increase the number of people with HCV that get linked to care and initiate and complete treatment.  All programs provide linkage to care activities and on-site HCV medical care, care coordination, treatment and supportive services in primary care settings (i.e., community health centers, drug treatment programs and hospital based clinics).  Four of the 15 programs also provide these same services to HIV/HCV coinfected persons.

Hepatitis C Screening Program  The Bureau of Hepatitis Health Care provides HCV rapid antibody test kits and controls to programs serving at-risk populations, such as syringe exchange programs, STD clinics and HIV counseling and testing sites.  Individuals screened for HCV are provided appropriate counseling messages and receive referrals for HCV diagnostic testing (HCV RNA), medical care and treatment. The Screening Program also covers the costs of HCV diagnostic testing for persons with a reactive HCV antibody test at prequalified agencies with the capacity to offer this service on-site.

Hepatitis C Continuity Program   The Hepatitis C Continuity Program makes it possible to initiate treatment for HCV within New York State Department of Corrections and Community Supervision without regard to the incarceration time remaining.  It enables inmates who initiate HCV treatment prior to release to receive timely referral to appropriate clinics for continuation of treatment following release.

Hepatitis C Quality of Care Program (eHEPQUAL) eHEPQUAL is a web-based application designed to capture data and generate reports that enable the health care provider to assess the quality of care provided to patients living with HCV.  eHEPQUAL is designed for all primary care providers caring for and treating persons living with HCV.
 
Hepatitis C Epidemiologic and Research Studies  The Bureau of Hepatitis Health Care conducts epidemiologic, program evaluation, and quality improvement studies to better understand the burden of HCV and to evaluate programs overseen by the Bureau.  These studies support and promote the work done by the Bureau as well as other programs in the department.

Viral Hepatitis Strategic Plan The mission of the 2016-2020 New York State Viral Hepatitis Strategic Plan is to outline a coordinated, comprehensive and systematic approach that will decrease the incidence and reduce the morbidity and mortality of viral hepatitis.  The vision is to eliminate new hepatitis A, B and C infections and to improve the quality of life of those living with chronic hepatitis B and C.

Contact:

Colleen Flanigan, RN, MS
Director, Bureau of Hepatitis Health Care
Division of HIV and Hepatitis Health Care
518-486-6806
colleen.Flanigan@health.ny.gov

Back to top of page

Health Home Care Management

A product of New York State’s Medicaid Redesign and the Affordable Care Act, Health Homes were initiated across New York beginning in 2012 to provide comprehensive care management for Medicaid recipients with complex chronic illnesses and high needs.

Each enrolled Health Home member is assigned a dedicated care manager to assess their needs and help navigate, coordinate, and integrate the individual’s behavioral health, medical health, and social services. The goals of the Health Home program are to improve the health of enrolled members, improve the delivery of health care services, and reduce health care costs (in particular by reducing unnecessary emergency room use and hospitalizations).

Health Homes are networks of providers administrated by a Lead agency. Networks include hospital systems, ambulatory care services (physical and behavioral), managed care plans, and community based organizations providing housing, nutrition, legal, and other social services. Agencies providing health home care management include 45 former HIV Targeted Case Management (COBRA) providers, which in 2012 transitioned to become Health Home care management providers when this initiative began.

A key component of Health Home Care Management is outreach and engagement activities. Designed to find high-need, high-cost utilizers of unnecessary emergency care and Medicaid services, Health Home Care Management providers utilize a variety outreach methods including peers to engage eligible Medicaid recipients. 

Contact:

Joseph Kerwin, Director
Health Home/DSRIP Unit
518-486-1383
joseph.kerwin@health.ny.gov

Pre-Exposure Prophylaxis (PrEP)

PrEP Services in General and HIV Primary Care Settings

Pre-exposure Prophylaxis (PrEP) is a biomedical intervention to prevent HIV infection among individuals at highest risk of acquiring HIV.  PrEP is a six-prong intervention for people who are HIV negative that includes: 1) taking one pill once a day; 2) periodic HIV testing; 3) counseling about the use of condoms to prevent STIs; 4) education about harm reduction options; 5) STI screening; and 6) counseling to promote adherence to the once-a-day PrEP medication.

In 2015, the AIDS Institute facilitated the establishment of PrEP services in general and HIV primary care settings.  This initiative uses a statewide prevention strategy that aligns with the Ending the Epidemic Blueprint goal of reducing the number of new HIV infections to just 750 by the end of 2020.

Grant-funded services are provided within general primary care settings that reach and engage individuals within communities most vulnerable to HIV infection.  These populations include, but are not limited to: men who have sex with men, transgender persons, injection drug users (IDUs), HIV-negative partners in a sero-discordant sexual relationship; persons that have had multiple courses of non-occupational post-exposure prophylaxis (nPEP); and heterosexual women in areas of elevated seroprevalence. 

PrEP services programs offer a comprehensive scope of services provided to ensure robust engagement for individuals most vulnerable to HIV infection. Programs are designed to increase PrEP awareness, facilitate access to PrEP and non-occupational post-exposure prophylaxis (nPEP), expand the number of PrEP prescribers, and provide patient navigation to reduce barriers to accessing PrEP services and care.  

Successful widespread implementation of PrEP requires collaboration between clinical providers, HIV testing programs, prevention programs and support services providers. Funded agencies are charged with establishing and maintaining a community network tasked with developing a PrEP care continuum that is responsive to community need, solidifies area capacity, and effectively and efficiently leads potential clients to engagement in PrEP services.

Contacts:

Joanna Palladino
Director, PrEP Services Program
Bureau of HIV Ambulatory Care Services
Division of HIV and Hepatitis Health Care 
(518) 486-6048
Joanna.palladino@health.ny.gov

Margaret Smalls
Assistant Section Director 
Bureau of HIV Ambulatory Care Services
Division of HIV and Hepatitis Health Care 
Margaret.smalls@health.ny.gov

Carolyn Cazer
Assistant Section Director 
(518) 473-3786
Carolyn.cazer@health.ny.gov