Single Source Procurement: Pre-Exposure Prophylaxis (PrEP) Program - End of AIDS - Clinics Serving High Risk Populations

Pursuant to New York State Finance Law § 163.10(b), The New York State Department of Health is presenting the following summary of relevant circumstances, and material and substantial reasons why a competitive procurement was not feasible.

On June 29, 2014, Governor Cuomo made an important announcement, in which he detailed a three-point plan to "Bend the Curve" and move us closer to the end of the AIDS epidemic in New York State. The goal is to reduce the annual number of new HIV infections to just 750 (from an estimated 3,000) by 2020.

The three-point plan includes:

  1. Identifying persons with HIV who remain undiagnosed and linking them to health care;
  2. Linking and retaining persons diagnosed with HIV in health care and maintaining them on antiretroviral therapy to maximize HIV viral load suppression so they remain healthy and to prevent further transmission; and
  3. Facilitating access to Pre-Exposure Prophylaxis (PrEP) for high-risk HIV negative persons.
Facilitating access to Pre-Exposure Prophylaxis (PrEP) for high-risk HIV negative persons.

With Governor Cuomo's June 29th announcement (www.governor.ny.gov/press/06292014-end-aids-epidemic), New York is the first state in the nation to establish the goal of ending the AIDS epidemic by 2020. PrEP is one of the three key points of the Governor's plan.

A PrEP implementation program is being established to address the third point of the Governor's plan. This program seeks to fund a number of approaches to implementing PrEP as part of health care for high risk sexually active individuals. The focus of this demonstration program includes finding strategies that will reach the highest risk populations. This is the third PrEP program waiver submitted and seeks to fund three programs known to serve the highest risk populations.

PrEP is a science that is in its infancy. However, the efficacy of PrEP has been established in the scientific community and new studies continue to support PrEP for high risk individuals who are HIV negative. The evidence is clear that this approach will be a fundamental driver in the effort to end this epidemic and finding the most effective way to approach hard to reach populations in a timely manner is essential. The requests contained in this waiver allow us to take immediate steps with regard to the implementation of PrEP, determine how the science applies to the real world and develop a model that can be adapted to meet changing needs. The proposed pilot project will inform future procurement efforts by providing the basis for the development of program standards and expectations. An RFA will be issued upon completion of these contracts.

It must be noted that there is a level of difficulty in implementing PrEP due to reluctance on the part of many providers to furnish PrEP services. Providers who do not serve people with HIV are frequently unwilling to provide PrEP services because they believe they lack the expertise with HIV-related medications. Providers who serve people with HIV are frequently unwilling to provide PrEP services because their practices do not serve HIV-negative persons. This PrEP program includes three providers who are willing and able to develop the infrastructure necessary to deliver PrEP services as part of their mission and, as stated, who are serving the highest risk populations.

Two of the highest risk populations which must be included in all "End of AIDS" initiatives, and particularly with PrEP, are men of color who have sex with men (MSM) and transgender individuals, specifically transwomen. Gay men and MSM continue to be disproportionately affected by HIV/AIDS, making up nearly two-thirds of new diagnoses in New York State. This waiver serves these two groups by funding clinics that have experience and proven success in serving either one or both of these highest risk populations. Facilitating access to PrEP for these populations is a critical component of the plan to end AIDS as an epidemic in New York State by preventing transmission of HIV.

Procurement / Program Name Pre-Exposure Prophylaxis (PrEP) Program - End of AIDS - Clinics Serving High Risk Populations
Contractor Name(s) Multiple – Please see attached.
Contract Period 10/1/2014 – 3/31/2019
Contract Number(s) C029983, C029984, C029991