Implementing Combination Prevention Technologies:

The New York City Experience

M. Monica Sweeney, MD, MPHAssistant CommissionerBureau of HIV/AIDS Prevention & ControlSYNChronicityThe State of the Science: Combination Prevention TechnologiesApril 20, 2012

New Prevention Strategies for a New Era

IBM, 1980s iPad 3, 2012

We must use, deliver and bring to scale the full range of tools available for addressing HIV prevention

Note: PMTCT, Screening transfusions, Harm reduction, Universal precautions, etc. have not been included – this is focused on reducing sexual transmission

LargestImpact

SmallestImpact

Structural Interventions that Impact Health OutcomesExamples

Socioeconomic Factors

Changing the Contextto make individuals’ default

decisions healthy

Long-lasting Protective Interventions

ClinicalInterventions

Counseling &

Education

Condoms, eat healthy, be physically active

Rx for high blood pressure, high cholesterol, depression

Poverty, education, housing

Immunizations, brief intervention, cessation treatment, colonoscopy

Fluoridation, 0g trans fat, iodization, smoke-free laws, tobacco tax

Health Belief Model

Perceived Susceptibility to Disease “X”

Perceived Severity of Disease “X”

Perceived Susceptibility to Disease “X”

Perceived Severity of Disease “X”

Demographic variable(age, sex, race, ethnicity, etc.)Socio-psychological variables

Demographic variable(age, sex, race, ethnicity, etc.)Socio-psychological variables

Perceived benefits of preventative action

minus Perceived barriers to preventative action

Perceived benefits of preventative action

minus Perceived barriers to preventative action

Perceived Threat of Disease “X”

Perceived Threat of Disease “X” Likelihood of Taking

Recommended Preventative Health Action

Likelihood of Taking Recommended Preventative

Health Action

Cues to Action•Mass Media Campaign•Advice from others•Illness of family member or friend•Newspaper/magazine article

Cues to Action•Mass Media Campaign•Advice from others•Illness of family member or friend•Newspaper/magazine article

Individual Perceptions

Modifying Factors Likelihood of Action

General Media Campaigns National

General Media Campaigns Local

Targeted Media Campaigns for sub-populations

*Community Level Interventions (CLI’s)

(e.g., DEBI’s: Community Promise, Popular Opinion Leader,)

General Audience *Group Level Interventions (GLIs)

(e.g., General Awareness workshops)

Targeted GLIs for sub-populations (e.g., Health Relationships, SISTA, Street Smart, Safety Counts)

Brief *Individual Level Intervention (ILIs) –trained providers

Ongoing ILIs- trained provider(e.g., Counseling with a trusted expert)

Number of people reached

Extent of Tailoring for Personal Impact

A Model: The Perceived Potential Reach and Impact of Various Prevention Strategies

(Adapted from model by Robert Zielony, Ph.D. 2010)

Social Media & HIV Prevention at the New York City Department of Health and Mental Hygiene

NYC Condom Finder Application

• Available on Apple iPhone, Android Phone, Microsoft Phone, and BlackBerry

Youth Risk Behavior Survey,Condom Use at Last Sex, 1999-2009

U.S. data adapted from: Centers for Disease Control and Prevention (CDC). 1991-2009 High School Youth Risk Behavior Survey Data. Available at http://apps.nccd.cdc.gov/youthonline. Accessed on April 16, 2012; *sample limited to public school students attending school the day survey was administered

Remember to Visit & Download…

The NYC Condom Finder Application→Search “find condoms”

facebook.com/NYCcondom

HIV Testing Technologies

HIV Tests That Produces Results in 60 Minutes or Less

• Rapid point-of-care test

• Enzyme Immunoassays (EIAs)

Testing for HIV VirusNucleic acid amplification tests (NAAT)

• Aptima HIV-1 RNA Qualitative Assay– Only FDA-approved test to diagnose Acute HIV Infection

• Other HIV NAAT/PCR tests can detect HIV virus– Quantitative tests (HIV viral load tests)– FDA-approved for monitoring status of HIV disease and for

guiding therapeutic recommendations

Treatment Recommendations

NYT article: http://www.nytimes.com/2011/12/01/nyregion/to-stop-aids-nyc-wants-drugs-given-sooner-for-hiv.html?_r=1

Offer Treatment, Regardless of CD4 Count

nPEPnon- occupational Post Exposure Prophylaxis

Acknowledgments

THANK YOU!