This document summarizes New York City's experience implementing combination HIV prevention technologies. It discusses using the full range of available tools for HIV prevention, including structural interventions, clinical interventions, long-lasting protective interventions, and socioeconomic factors. It presents models for how various prevention strategies can reach different numbers of people and have varying levels of impact. It also highlights New York City's use of social media, rapid HIV testing technologies, treatment recommendations to offer treatment regardless of CD4 count, and nPEP programs as part of its combination prevention approach.
1. Implementing Combination
Prevention Technologies:
The New York City Experience
M. Monica Sweeney, MD, MPH
Assistant Commissioner
Bureau of HIV/AIDS Prevention & Control
SYNChronicity
The State of the Science: Combination Prevention
Technologies
April 20, 2012
3. 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
4. Structural Interventions that Impact Health Outcomes
Examples
Smallest Counseling Condoms, eat healthy, be
Impact & physically active
Education
Rx for high blood
Clinical pressure, high
Interventions cholesterol, depression
Immunizations, brief
Long-lasting intervention, cessation
treatment, colonoscopy
Protective Interventions
Fluoridation, 0g trans fat,
Changing the Context iodization, smoke-free
to make individuals’ default laws, tobacco tax
decisions healthy
Poverty, education,
housing
Socioeconomic Factors
Largest
Impact
5. Health Belief Model
Individual Modifying Factors Likelihood of Action
Perceptions
Demographic variable Perceived benefits of
(age, sex, race, ethnicity, etc.) preventative action
Socio-psychological variables minus
Perceived barriers to
Perceived Susceptibility to
preventative action
Disease “X”
Perceived Severity of
Disease “X” Perceived Threat of
Disease “X” 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
6. A Model: The Perceived Potential Reach and Impact of
Various Prevention Strategies
Number of people reached
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)
Extent of Tailoring for Personal Impact
(Adapted from model by Robert Zielony, Ph.D. 2010)
7.
8. Social Media & HIV Prevention at the New York
City Department of Health and Mental Hygiene
9. NYC Condom Finder Application
• Available on Apple iPhone, Android Phone, Microsoft Phone,
and BlackBerry
10.
11. 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
12. Remember to Visit & Download…
facebook.com/NYCcondo
m
The NYC Condom Finder Application
→Search “find condoms”
14. HIV Tests That Produces Results in 60
Minutes or Less
• Rapid point-of-care test
• Enzyme Immunoassays (EIAs)
15. Testing for HIV Virus
Nucleic 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
16.
17.
18. 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
Well, some of you may remember way back in 1985, the year of the first licensed HIV test, that the Compaq Portable was another unique tool of the day. It was sleek, it was slick and it was a STRATEGY to get the information you needed. But those days are long gone. You wouldn ’t be caught dead with a compaq portable today. We have been quick to embrace new strategies on the therapeutics side of the equation, but we must equally embrace new strategies on the PREVENTION side.
CLI = Community Level Intervention GLI = Group Level Intervention ILI = Individual Level Intervention As the Interventions become more tailored for personal impact, there may well be greater depth of impact, but less reach in numbers. As the interventions are more designed for population level e.g., media focus, greater numbers may be reached, but there may be less personalized impact, and therefore perhaps less depth of psychological relevance and specificity. COMMENTS: AN EXAMPLE OF A CLI, A GLI AND AN ILI WOULD HELP GROUND THIS DISCUSSION. CAN YOU CITE A FEW GOOD ONES AND SHOW RESULTS? [THIS IS ADAPTED FROM A COLLEAGUE ’S MODEL—MAINLY SHOWN TO ILLUSTRATE THE POWER OF USING LARGER MEDIA CAMPAIGNS; Examples of each are listed underneath and will be discussed—for CLI and GLI—later in the ppt]
Pew Internet & American Life Project: Mobile Health 2010 (October 2010) 83% of internet users have looked online for health information 85% of adults use cell phones, of cell phone users 17% have used their phone to look up health or medical information and 29% of cell owners ages 18-29 have done such searches. This report is based on the findings of a daily tracking survey on Americans' use of the Internet. The results in this report are based on data from telephone interviews conducted by Princeton Survey Research Associates International between August 9 and September 13, 2010, among a sample of 3,001 adults, age 18 and older. “ The Empowered Patient” on CNN asked Google and Yahoo to tell us what health information you’re looking for, both on computers and on mobile phones. There was a pretty clear difference between what you want to know when you’re at your desk versus on your phone. On mobile phones (Yahoo ’s data) Three out of five most popular health searches on cell phones have to do with sex: Pregnancy / Herpes / STD On computers Sex-related searches do not show up on Google or Yahoo ’s list of top five health searches “ Pregnancy” is #7 on Yahoo’s list “ Herpes” is #10 on Google’s list
February 21, 2006
February 21, 2006
-This led us (the Department of Health) to release city-wide recommendations encouraging all medical providers treating HIV patients to offer antiretroviral treatment to all their HIV patients regardless of their CD4 cell counts. New York City has long been the epicenter of HIV and currently has more AIDS cases than Los Angeles, San Francisco, and Washington, D.C., combined. With more than 110,000 New Yorkers currently living with HIV—almost three times the national average—and diseases associated with HIV the 3 rd leading cause of death for NYC residents between 35-54—this new treatment recommendation is one more tool we can utilize to end HIV
nPEP Non-occupational Post-Exposure Prophylaxis (nPEP) is treatment for a possible exposure to HIV outside of a health care setting. nPEP involves the use of antiretroviral drugs as soon as possible after a high-risk exposure to HIV, to reduce (but not eliminate) the possibility of HIV infection. nPEP is not the “morning after pill” for HIV. nPEP is a four-week program of two or three antiretroviral medications, several times a day. The medications have serious side effects that can make it difficult to finish the program. Treatment should be started promptly, preferably within the first several hours after an exposure. It should be administered within 48 hours of a high-risk exposure (not to exceed 72 hours). After 72 hours nPEP is considerably less effective in preventing HIV infection. The sooner nPEP is administered, the more effective it is. NYC DOH—offers @ 3 sites
