HIV/STI Epidemiology Evaluation and Partner Services
HIV/AIDS Epidemiology
The Bureau of HIV/AIDS Epidemiology (BHAE) provides mission critical functions to the New York State Department of Health (NYSDOH) through the conduct of HIV surveillance and supplemental activities. These activities include, but are not limited to, enumeration and monitoring of the HIV epidemic in New York State (NYS). In compliance with State law, HIV surveillance is conducted by the state rather than localities.
Comprehensive electronic laboratory reporting via the NYSDOH Electronic Clinical Laboratory Reporting System (ECRLS) is the foundation of HIV surveillance for NYS. Annually, over 190 laboratories serving NYS residents and/or NYS clinicians electronically report 1.2 million HIV-related laboratory test results, including results of diagnostic and disease monitoring test types (any laboratory test, tests or series of tests approved for the diagnosis of HIV or for the periodic monitoring of HIV). Medical providers also have statutory reporting requirements and are to report, by name, individuals with diagnosed HIV using the Medical Provider HIV/AIDS and Partner/Contact Report Form (PRF, DOH-4189). Completion of the PRF within 7 days of diagnosis is required and should be completed electronically using the HIV/AIDS Provider Portal on the NYSDOH Health Commerce System. This system is also the mechanism by which clinicians submit inquiries for their patients with diagnosed HIV who they think require assistance with linkage to or retention in HIV medical care.
NYS HIV surveillance data are augmented through linkage to a variety of supplemental sources, including administrative data (e.g., Medicaid, NYS Department of Corrections and Community Supervision (DOCCS) System), disease registries for co-morbidity assessment (e.g., STI, cancer, congenital malformations, TB, viral hepatitis), NYS vital statistics birth and death data, as well as national sources for death ascertainment (e.g., Social Security Master Death File and National Death Index). BHAE collaborates with Healthix, the largest regional health information organization (RHIO) in NYS to collect ongoing care and treatment outcomes for Healthix members with diagnosed HIV. Extensive effort is dedicated to interstate and intrastate deduplication to ensure accurate case counts.
Bureau-collected data are used to evaluate linkage and retention in HIV care and to identify persons in need of initial or ongoing Health Department Partner Services intervention. HIV surveillance data are used programmatically to identify persons living with diagnosed HIV who have fallen out of HIV medical care. The AIDS Institute uses these data to facilitate re-engagement of individuals in the HIV health care system for continued treatment.
The Bureau participates in the NYSDOH public health intervention efforts to identify and respond to clusters of HIV transmission. In addition to Epidemiologic support, Bureau- collected data are used to identify clusters of HIV transmission using space/time and molecular HIV methods. The data are also analyzed to identify instances of transmitted or multiclass antiretroviral drug resistance for public health follow up.
Through mutual agreement, the New York City Department of Health and Mental Hygiene (NYCDOHMH) acts as an agent of the State for the conduct of HIV surveillance and provision of partner services in the five boroughs. Records are returned to NYS BHAE after surveillance investigation to allow construction of a statewide dataset for analysis.
NYS is unique in the nation in that all liveborn infants are tested for HIV antibodies through the NYSDOH Newborn Screening program. The Bureau’s maternal and perinatal surveillance team follows the approximately 300-400 HIV-exposed infants annually to determine infection status and to calculate maternal-to-child transmission metrics. Most diagnostic testing for infants born exposed to HIV is provided by the Wadsworth Center Pediatric Diagnostic Testing Service. Enhanced medical record review occurs for all HIV-exposed infants to identify missed opportunities or best practices for prevention. Routine linkage to NYSDOH and NYCDOHMH vital statistics birth data is used to identify women with diagnosed HIV giving birth in NYS.
The BHAE participates in the Center for Disease Control and Prevention (CDC)- sponsored Medical Monitoring Project (MMP), an expanded surveillance project that collects information on persons with diagnosed HIV.
The Bureau participated in the National HIV Behavioral Surveillance project (NHBS) for roughly 18 years, conducting interview-based activities in Nassau and Suffolk counties. NHBS is a CDC sponsored, anonymous, multi-state, personal interview survey of individuals at high risk for HIV. It is conducted in rotating, annual cycles among gay, bisexual, and other men with a history of male-to-male sexual contact, heterosexuals living in poverty, and persons with a history of injection drug use. Participants are identified through a peer sampling methodology known as respondent-driven sampling or through venue-based sampling. While our participation ended in 2021, the project is on-going in New York City and other United States jurisdictions; we continue to participate in local and national data analyses.
Bureau collected data is disseminated to assist health care professionals, HIV prevention and care programs, and community health planners in their efforts to provide impactful and cost-effective interventions. The analysis and presentation of these data form the foundation on which decisions about services and programs for the HIV-positive and affected population of NYS are based and includes producing the HIV care continuum/cascade measures and the surveillance Ending the Epidemic metrics.
The data collected through the New York HIV Surveillance System are used by the CDC to track the State and national epidemic, and by the Health Resources and Services Administration (HRSA) to monitor HIV care and treatment and provide a basis for determining the amount of federal funds New York receives for HIV-related prevention and treatment programs. The HIV Surveillance System is supported partially through CDC cooperative agreement funds, state funds, and other, in kind, state support.
Contact:
Carol-Ann Swain, PhD
Director, Bureau of HIV/AIDS Epidemiology
518-474-4284
carol-ann.swain@health.ny.gov
HIV/STI Field Services
The primary goal of the Bureau of HIV/STI Field Services (BHSFS) is to prevent and reduce the incidence of HIV and other sexually transmitted infections (STI) using a status-neutral approach. Critical to achieving this goal is the delivery of a broad array of disease prevention services by including education, disease screening, case investigation, risk reduction counseling, referrals to care and treatment, promotion of pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), expedited partner therapy (EPT), and condom and harm reduction supply distribution. Anonymous HIV counseling, testing and partner services are also provided for those in custody of the NYS Department of Corrections and Community Services.
Partner Services is an evidence-based intervention that has been successful in identifying persons unaware of their HIV or STI status and reducing disease transmission. Utilizing the surveillance system, cases of HIV, Syphilis, Gonorrhea and Chlamydia are assigned to DOH staff for the purpose of disease intervention, case management and ensuring linkage to care, treatment, and partner services. Additionally, partner services staff offer expanded partner services, also known as data to care, to patients and their health care providers by assisting persons newly diagnosed and previously diagnosed with HIV who have fallen out of care to engage in medical care and other services. Partner services staff also provide ongoing partner services to people living with HIV who acquire new STIs, individuals at increased risk for acquiring HIV and linking them to PrEP services, and pregnant persons who screen positive for an STI during pregnancy to reduce congenital syphilis and its associated morbidity.
DOH partner services staff are located in six regional offices statewide and coordinate with local county public health departments to ensure individuals diagnosed with HIV or STIs receive disease intervention services. In addition, the BHSFS contracts with 11 local county health departments and the New York City Department of Health and Mental Hygiene for disease intervention and partner services.
Partner services enhances the impact of HIV and STI prevention efforts in New York State, and it is an essential step in achieving the goals of the National HIV/AIDS Strategy and the Governor’s Plan to End the AIDS Epidemic in NYS.
Contact:
Megan Johnson, MPH
Director, Bureau of HIV/STI Field Services
518-474-3671
megan.johnson@health.ny.gov
Data Analysis and Research Translation
The Data Analysis and Research Translation Team (DART) is responsible for the analysis, reporting, and dissemination of findings related to HIV in New York State (NYS). This is achieved through translating data into useful annual reports, statistical briefs, public presentations, and data products, including the HIV care continuum/cascade measures and the Ending the Epidemic (ETE) metrics. Data are disseminated to assist health care professionals, HIV prevention and care programs, and community health planners in their efforts to provide impactful and cost-effective interventions. DART communicates these findings with various units in the AIDS Institute (AI), as well as community groups, to articulate the epidemiology of HIV in NYS. The publication and presentation of these data form the foundation on which decisions about services and programs are based. DART develops, calculates, and monitors the ETE metrics for NYS which are published on the ETE Dashboard. Staff analyze the ETE metrics to identify disparities, assess the impact of social determinants of health, and monitor progress towards ending the epidemic. Staff focus on identifying disparities in linkage to care and viral suppression to promote the development of equitable intervention programs that would improve health outcomes for all residents of NYS.
DART conducts surveillance of HIV and HCV among individuals entering correctional facilities in NYS through a HIV/HCV Seroprevalence Study. The HIV/HCV Seroprevalence Study has been an DEEP coordinated study in partnership with NYS Department of Corrections and Community Supervision (DOCCS) since 1988 having completed over 14 cycles since its inception. It is the longest and largest HIV and HCV seroprevalence study of an incoming population to a state prison system and the only seroprevalence estimate for persons incoming to the NYS prison system. The study coordinates with DOCCS contracted labs to evaluate the seroprevalence of HIV and HCV for individuals entering the NYS Prison System. Analysis of the demographics within each study cycle along with the descriptive trends across cycles is completed after each cycle.
DART staff continuously monitor new HIV diagnoses to identify groups of people and communities experiencing rapid HIV transmission, through routine identification and monitoring of emerging space-time and molecular clusters. DART is responsible for detecting clusters of concern and alerting other units of AI, so that prevention and treatment services are quickly given to people who need them. Additionally, DART works on publishing Health Advisories for providers located in NYS in areas of concern and reporting clusters of concern to the CDC.
Contact:
Randall Collura, PhD
Director, Data Analysis and Research Translation
518-473-3379
randall.collura@health.ny.gov
Medical Monitoring Project
The Bureau of HIV/AIDS Epidemiology (BHAE) conducts the Medical Monitoring Project (MMP) for New York State (excluding NYC), a Centers for Disease Control and Prevention (CDC) funded project conducted in 23 jurisdictions nationwide. MMP is designed to learn more information about the experiences and needs of persons living with HIV. Data are collected via an interview and medical chart abstraction for people living in New York State (outside of NYC) with diagnosed HIV. The data are used to measure the quality of medical care received, health-related behaviors, and other variables, such as quality of life and stigma, resulting in data that are used at the national level for policy decisions and resource allocation related to prevention and treatment initiatives. Locally, MMP data are used to measure the quality of HIV health care, the occurrence of mental health disorders, drug and alcohol use, stigma, barriers to care, and clinical outcomes. MMP also uses this information to provide participants with referrals to health care and supportive services. MMP sampling methodology includes both known in care and presumed out of care individuals. The New York City Department of Health and Mental Hygiene is separately funded for this activity, though the New York State Department of Health conducts whole state analyses of MMP data via mutual agreement.
Contact:
Carol-Ann Swain, PhD
Director, Bureau of HIV/AIDS Epidemiology
518-474-4284
carol-ann.swain@health.ny.gov
Data to Care
Some individuals diagnosed with HIV experience barriers to regularly accessing medical care or adhering to treatment. Adherence to HIV treatment lowers the patient’s viral load, leading to better health outcomes and reducing the likelihood of transmission. Data to Care (DTC) projects bring together a range of partners—public health officers, managed care organizations, criminal justice professionals, community health centers, community-based organizations—to ensure every New Yorker diagnosed with HIV has facilitated access to medical care.
Through innovative health informatics techniques, the AIDS Institute leverages reported surveillance data to identify individuals diagnosed with HIV who have no laboratory evidence of having received recent medical care. The AIDS Institute then facilitates scientifically proven, cost-effective, and scalable interventions to help patients re-engage with care, test and treat partners, and deliver risk reduction counseling and prevention supplies. This approach enhances the impact of HIV and STI prevention efforts in New York State, and it is an essential step in achieving the goals of the National HIV/AIDS Strategy and the Governor’s Plan to End the AIDS Epidemic in New York State.
Contact:
Carol-Ann Swain, PhD
Director, Bureau of HIV/AIDS Epidemiology
518-474-4284
carol-ann.swain@health.ny.gov
