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Pre-Exposure Prophylaxis (PrEP): NYC Implementation Strategy
Demetre Daskalakis, MD, MPHAssistant Commissioner, Bureau of HIV/AIDS Prevention and Control
New York City Department of Health & Mental Hygiene (DOHMH)
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NYC DOHMH PrEP/nPEP Activities and Programs
• Promoting PrEP to potential users– Media and Social Marketing– Provider Directory
• Promoting PrEP to potential providers– Public Health Detailing Program– Technical assistance with PrEP Programing– Implementation Workshop– Training for Front-Line Staff
• Supporting PrEP in diverse service models– Municipal Sexual Health Clinics– Non-governmental organizations– NY State PrEP Assistance Program
• Monitoring awareness and uptake
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Promoting PrEP to Potential Users
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Combination Prevention HIV Neutral Social Marketing Campaign
• Launched a new combination prevention social marketing campaign on World AIDS Day 2015
• NYC Ending the Epidemic funds to support expansion of placement and social marketing
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The #PlaySure Kit: Find the Combination for You
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Promoting PrEP to Providers
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PrEP/PEP Detailing Campaign• 5 trained DOHMH representatives
visited clinical facilities citywide to promote PrEP and PEP
• Facilities chosen via data-driven approach, primarily through HIV Surveillance
• Preference was given to facilities that:─ Diagnosed at least one man who
had sex with men (MSM) of color or
─ Were located in a designated high-need neighborhoods─ South Bronx, East and Central
Harlem, Central Brooklyn
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Change in Key Practices
* p < 0.05
**
Sexual History Taking by Round
Edelstein et al. NHPC 2015 Abstract #1344; Edelstein et al, CROI 2016. Abstract #892
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PrEP Implementation WorkshopDescription and Evaluation
• Full-day work session for clinic administrators & medical directors
• Developed with academic partner Dr. Sarit Golub
• Covers components of optimal PrEP program; sample protocols and implementation tools
• Multiple workshops held since October 2014
• Attendees rated confidence in PrEP implementations skills before vs. after workshop; significant increases in all skills measured
• Follow-up survey planned; will evaluate successes and challenges to PrEP implementation
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Supporting PrEP in Diverse Service Models
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Transforming STD Clinics to Hubs of HIV Care and Prevention
SOCIAL WORK ASSESSMENT FOR SOCIAL DETERMINANTS OF
RISK OR DISEASE PROGRESSION + INSURANCE CONNECTION
BIOMEDICAL EVALUATION AND INTERVENTION:
INSTANT STARTS OF ARV TREATMENT AND PREVENTION
NAVIGATION TO LONGITUDINAL CARE FOR
BOTH HIV NEGATIVE AND POSITIVE CLIENTS
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NY State PrEP- Assistance Program
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Monitoring PrEP Awareness and Uptake
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17
FDA Approval, July 2012
PrEP Awareness and Use among MSM*, NYC Sexual Health Survey, Online Sample, 2012-2014
Mensah N, et al. NHPC, 2015 Abstract #2087. Scanlin K, et al. CROI, 2016 Abstract #888.
*Sexually active MSM, HIV-negative/unknown status and aged 18-40
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HIV Prevention Continuum in NYC
†Sexually active MSM, HIV-negative/unknown status and aged 18-40‡PrEP candidates defined as reporting diagnosis of an anal STI in the past year or any of the following in the previous 6 months: unprotected anal intercourse, transactional sex, use of cocaine, crack, methamphetamines, or injection drugs, using PEP or having had an HIV-positive partner. Mirrors NYS PrEP guidance.*PrEP candidates represent 71 % of all HIV-negative/unknown respondents.
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Q1 2012
Q2 2012
Q3 2012
Q4 2012
Q1 2013
Q2 2013
Q3 2013
Q4 2013
Q1 2014
Q2 2014
Q3 2014
Q4 2014
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All NYC
PrEP Prescription per 100,000 Patients Seen at Ambulatory Care Practices (n=538), NYC, 2012-2014
Logarithmic scale
Edelstein et al. IAPAC 2015 Abstract #126; Salcuni P et al. NYCEF, 2016.
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