Download PrEP Network

NYC’s PrEP Network
Julie Myers, MD, MPH
New York City Department of
Health and Mental Hygiene
% persons at epidemiologic risk
Continuum of HIV Prevention & Care
(Theoretical)
120
100
Undiagnosed
80
60
Diagnosed
40
20
0
HIV-negative
HIV-positive
Strategy: Patient Navigation
for HIV Prevention
• A recognized need for guidance in navigating
complex HIV-prevention options1
• Very recent, promising data from HPTN 073 –
Client-Centered Coordinated Care (C4) model2
– High levels of PrEP acceptance, retention among
black MSM
– Coordinated counseling model highly acceptable in
this group
– Data could support a reduced rate of HIV-infection
for black MSM on PrEP
4 Mutchler, MG et al, AIDS Patient Care STDS. 2015 Sep;29(9):490-502.
1 Mutchler et
al, AIDS
5 Wheeler
et Patient
al., CROICare
2016.STDS. 2015;29(9):490-502.
2 Wheeler et al., CROI 2016.
Network: Goal and Objectives
Engage HIV-negative persons in an HIV prevention
continuum and deliver them to clinical sites, guided
by the following objectives:
1. Increase the number of HIV-negative persons who are
aware of their risk for HIV infection;
2. Maintain the HIV-negative status of these at risk HIVnegative persons through a variety of activities,
including, but not limited to, PrEP and PEP; and
3. Combine biological and behavioral HIV prevention into
a more complete package of services to address the
complexity of HIV risk
NYC DOHMH
1. Build organizational capacity
2. Provide opportunities and strengthen
collaborative partnerships
3. Support streamlined service delivery
“Network for HIV Prevention”
Provision of
HIV Prevention services
“Network for HIV Prevention”
Category 1: CommunityBased HIV Testing Site
• Identification of clients from HIV
testing
• PrEP/PEP Education
• Linkage to PrEP/PEP provider
Category 2: Outreach
and Education in CBOs
• Identification of clients through
outreach
• PrEP/PEP Education
• Linkage to PrEP/PEP provider
Category 3: Biomedical
Prevention in Clinical Settings
• Acceptance of referrals from other sites,
including Cat. 1 or Cat. 2 sites
• PrEP/PEP clinical services, mainly for adults
Adolescent PrEP
Pilot
• Identification of adolescent
clients through outreach
• PrEP/PEP Education for
adolescents
• Acceptance of referrals
from other sites, including
Cat. 1 or Cat. 2 sites
• PrEP/PEP clinical services
for adolescents
Funding for PrEP Network
Payment model
• Performance-based payment (fee-for-service)
• NYC DOHMH as payer of last resort for clinical services
(category 3)
• Leverage NYS’s PrEP-AP program and manufacturer’s program
as needed
– Both programs for uninsured (medication assistance) and insured
(co-pay assistance)
Category
Coverage
Category 1 (Testing sites)
All services fully covered by
NYC DOHMH regardless of
insurance status
Category 2 (CBOs)
Category 3 (Clinics)
Coverage varies depending on
service and insurance status
Blended Coverage/Payers
in Category 3 of PrEP Network
Service
element
Clinical
care (visits,
labs)
PrEP
medications
Patient
navigation
services
Uninsured
Underinsured
Income
<435%
FPL
Income
<500%
FPL
Income
<435%
FPL
Income
<500%
FPL
NYS PrEPAP
NYC
DOHMH
NYS PrEPAP
NYC
DOHMH
Manufacturer’s
medication assistance
program
Patient’s insurance, with
manufacturer’s copay
assistance program as
needed
NYC DOHMH
*Agencies receive nominal amount for data entry.
Insured
Patient’s
insurance*
Patient’s
insurance, with
manufacturer’s
copay
assistance
program as
needed
NYS PrEP-AP Program
• Client eligibility:
– NYS residence
– Uninsured or underinsured
– Income <435% of FPL
• Covers:
– Clinical provider visits (including counseling)
– Laboratory testing (including HIV, STI testing)
• Doesn’t cover: medications
– Providers should leverage the manufacturer
patient assistance programs (PAP)
PrEP Network
Continuum of HIV Prevention
(Theoretical)
120
Structural/behavioral
prevention
Social marketing/
Training for front-line staff
100
311/Network
MSM City Health Information
Percentage
80
Public health detailing/
Implementation workshop
60
40
20
0
All MSM
High
behavioral
risk
Aware of
PrEP
Linked to
Sexual
Discussed
clinical history taken PrEP with
prevention
Doctor
On PrEP
Opportunities
• Effort is unprecedented
• Blended funds allow resources to be
stretched further
4 Mutchler, MG et al, AIDS Patient Care STDS. 2015 Sep;29(9):490-502.
5 Wheeler et al., CROI 2016.
Challenges
• Overall
- Accepting a new paradigm
- Training on new knowledge and skills
• Operational
- Integrating model into variety of settings
- Ensuring program fidelity and measurable outcomes on a
large scale
- Fostering collaboration when payment is performancebased and capacity for information-sharing limited
• Resources
- Reimbursement through a variety of mechanisms leads to
administrative burden
- Dependence on manufacturer’s program for uninsured
Timeline/Next Steps
•
•
•
•
Proposals submitted, under review
Awards announced June 2016
Contracts begin July 1, 2016
Current NYC DOHMH activities
–
–
–
–
–
Developing trainings
Drafting program manual
Creating materials to support branding of network
Strategizing about how best to foster collaboration
Collaborating closely with our colleagues in
Care/Treatment to learn from their experiences
4 Mutchler, MG et al, AIDS Patient Care STDS. 2015 Sep;29(9):490-502.
5 Wheeler et al., CROI 2016.
Thank you!
Julie Myers, MD, MPH
Director of HIV Prevention
NYC DOHMH
[email protected]
Funding for Network
Network: Target Populations
• MSM, including young MSM (MSM up to
29 years old), and black and Hispanic
MSM
• Transgender women/men who have sex
with men
• Individuals engaging in transactional sex
• Persons with HIV-positive partners
• Black and Hispanic men and women in
high prevalence neighborhoods