Single Source Procurement: Expanded Training in Support of ETE Blueprint Recommendations

Pursuant to New York State Finance Law ยง 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.

In 2014, Governor Cuomo convened a task force to create a "Blueprint" to implement his three point plan to end the epidemic. In addition to the three pillars of the Governor's Plan, the Blueprint outlines additional recommendations to minimize new infections and inhibit disease progression. This program will expand current training initiatives to specifically support the following blue print recommendations:

  • BP 1: Making routine HIV testing truly routine
  • BP: Addressing acute HIV infection
  • BP15: Increasing Momentum in promoting the health of people who use drugs

The two components of this expanded training initiative are:

  1. Targeted Training to increase HIV testing and diagnosis of Acute HIV;
  2. Enhanced Opioid Overdose Training and Community Consultation.

Targeted Training to increase HIV testing and diagnosis of Acute HIV

HIV testing is a central pillar to the AIDS Institute's (AI) "Ending the Epidemic" (ETE) Initiative. Since 2010, New York State law requires primary care providers as well as hospitals and emergency departments to offer HIV testing to all persons between the ages of 13 and 64, with certain exceptions. This law was modified in 2014 to streamline the consent process, remove the requirement for written consent except in correctional settings.

In addition to making HIV testing part of routine care, early detection of persons with acute HIV infection is critical to ending the epidemic. Acutely-infected persons are HIV's most highly-efficient transmitters when having unprotected sex or sharing drug injection equipment. Strategic efforts are needed to make clients and providers aware of signs and symptoms of acute HIV infection and enhance provider understanding of state of the art 4th generation HIV diagnostic testing which can detect most cases of acute HIV infection.

Despite efforts to simplify and routinize HIV testing, compliance with regulations requiring the offer of the test remains below optimal levels. This leads to missed opportunities for identifying persons with undiagnosed infection while they are in the health care system. While the AIDS Institute has developed a number of resources to support provider adoption of both routine HIV testing and detection of acute HIV infection, including provider toolkits, narrated PowerPoints and provider webinars, additional targeted provider education is needed to make HIV testing truly routine.

The AI has contracted with IPRO to conduct an assessment of the extent to which hospitals in NYS are truly engaged in routine HIV testing. Results of this assessment will guide the selection of low performing sites for targeted technical assistance and training. A specific TA plan will be developed for each site.

Targeted Technical assistance and Training by Regional Training Centers:

AIDS Institute funded Regional Training Centers will be charged with providing technical assistance and training to identified low performance sites to:

  • increase routine offer of HIV testing, incompliance with NYS law; and
  • enhance provider capacity to address acute HIV infection.

Each Regional Training Center will offer the equivalent of 6.5 days of technical assistance and/or training. Regional Training Centers have pre-existing curricula regarding HIV testing in NYS, HIV Testing Skills Practice, Updates HIV Testing Algorithm and Screening and Diagnosis of Acute Infection that can be readily tailored to meet the specific needs of targeted sites being served.

Enhanced Opioid Overdose Training and Community Consultation

Tremendous success has already been seen in reducing new HIV infections among persons who inject drugs. However, the recent rise in misuse of prescription opioids, heroin use, and associated opioid overdoses across New York State, suggest the continued efforts are needed to address the evolving needs of persons who use drugs statewide.

Since 2006, NYS supports an Opioid Overdose Prevention program aiming to make naloxone, an opioid antagonist the can prevent an opioid/heroin overdose from becoming fatal opioid, more widely available. The AIDS Institute currently funds the Harm Reduction Coalition to build the capacity of a wide range of health, social service and first responder agencies to educate communities about opioid overdose prevention resulting in the registration of 20 agencies annually as NYS Opioid Overdose Prevention Program. In the past 9 months, more than 33,000 individuals were trained. In an effort to ensure that the medications is available as early as possible when an overdose occurs, the program was expanded to include the training and equipment of emergency responders and law enforcement officials with intranasal naloxone administration. To date, more than 5,300 law enforcement officials and equipped them with naloxone resulting in more than 600 reversals.

There is a need to further expand efforts to ensure access to naloxone, targeting communities at risk for overdose as well as professionals likely to be in proximity when an overdose occurs. Specifically, additional capacity building training and technical assistance services are needed to:

  • Continue to train and equip firefighters with naloxone;
  • Train and equip school personnel;
  • Build capacity of pharmacists to dispense and administer naloxone; &
  • Build capacity of DOCCS to train incarcerated individuals that will soon be released, providing the option of naloxone free-of charge.

Furthermore, ongoing community consultation is necessary to guide program development and improvement around the following area: Hepatitis C prevention and care services; HIV prevention and care services; Safer Injection strategies; and Opioid Overdose Prevention.

As recognized experts in the field of drug user health and opioid overdose prevention, the Harm Reduction Coalition is uniquely positioned to meet these needs, however all of these activities require additional time and staff resources.

Contractors were awarded contract(s) as a result of the competitive procurement process.

Procurement / Program Name Expanded Training in Support of ETE Blueprint Recommendations
Contractor Name(s) Cicatelli Associates, SUNY Research Foundation, University of Rochester, The Harm Reduction Coalition
Contract Period 4/1/2015-3/31/2020
Contract Number(s) C30275GG-C30277GG, C30286GG