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Prevention Agenda 2019-2024: Prevent Communicable Diseases Action Plan

Prevent Communicable Diseases Action Plan (PDF, 901KB, 23pp.)

Overview
Focus Area 1. Vaccine Preventable Diseases
Focus Area 2. Human Immunodeficiency Virus (HIV)
Focus Area 3. Sexually Transmitted Infections (STIs)
Focus Area 4. Hepatitis C Virus (HCV)
Focus Area 5. Antibiotic Resistance and Healthcare-Associated Infections

Overview

A communicable disease is an illness or infection that can be spread from person to person, animal to person, animal to animal or person to animal. Communicable diseases contribute to sickness and death in New York State and are preventable. Additional information about the burden of communicable diseases, underlying risk factors and associated disparities can be found at: Link to the burden documents

Focus Area 1. Vaccine Preventable Diseases

Goal 1.1 Improve vaccination rates

Objectives: By December 31, 2024

Objective 1.1.1 Increase the rates of immunization among NYS 24-35-month-olds with the 4:3:1:3:3:1:4 series (4 DTaP, 3 polio, 1 MMR, 3 Hep B, 3 Hib, 1 varicella, 4 PCV13) by 10% to 70.5%

Target	70.5%
Baseline	64.1%
Baseline Year	2018
Data Source	New York State Immunization Information System (NYSIIS) and Citywide Immunization Registry (CIR)
Data Level	NYS, county

Objective 1.1.2 Increase the percentage of NYS 13-year-old adolescents with a complete HPV vaccine series by 10% to 37.4%

Target	37.4%
Baseline	34.0%
Baseline Year	2018
Data Source	NYSIIS and CIR
Data Level	NYS, county

Objective 1.1.3 Increase influenza immunization rates of New Yorkers aged 6 months and older by 10% to 54.8%.

Target	54.8%
Baseline	49.8%
Baseline Year	Influenza season 2016-2017
Data Source	FluVaxView
Data Level	Statewide

Objective 1.1.4 Increase the age-adjusted pneumococcal vaccination rate of New Yorkers aged 65 years and older by 10% to 76.2%.

Target	76.2%
Baseline	69.3%
Baseline Year	2016
Data Source	BRFSS
Data Level	Statewide

Interventions

Intervention 1.1.1 Ensure and enforce strong immunization requirements for child care, school and post-secondary institution entry and attendance.

Evidence and Resources	Community Preventive Services Task Force Finding and Rationale Statement: Vaccination Requirements for Child Care, School, and College Attendance
Age Range	May impact all ages, but primarily impacts: Children up to age 12 Adolescents (13-21)
Social Determinants Addressed	Education
Lead Sectors	Governmental Public Health Agencies Colleges and Universities Schools (K-12) Policy makers and elected officials
Contributing Sectors	Healthcare Delivery system Insurers Media Community or neighborhood residents CBOs and Human service agencies
Intermediate-level Measure Example	Increased annual school immunization coverage rates
Additional Intermediate-level Measure Example(s)	Decreased annual school medical and religious exemption rates

Intervention 1.1.2 Maximize use of the New York State Immunization Information System (NYSIIS) and the Citywide Immunization Registry (CIR) for vaccine documentation, assessment, decision support, reminders and recall. Increased use of the registries can better inform assessments of vaccine coverage, missed vaccination opportunities and help address disparities in vaccine coverage including those for specific age groups.

Evidence and Resources	Community Preventive Services Task Force Finding and Rationale Statement: Immunization Information Systems
Age Range	All ages
Social Determinants Addressed	Health Care
Lead Sectors	Governmental Public Health Agencies Healthcare Delivery system Policy makers and elected officials
Contributing Sectors	Insurers Media Colleges and Universities Schools (K-12) CBOs and Human service agencies
Intermediate-level Measure Example	Increased proportion of immunizations reported to NYSIIS within 14 days of administration
Additional Intermediate-level Measure Example(s)	Increased number of reminder/recall reports run in NYSIIS each year

Intervention 1.1.3 Implement and promote use of standing orders for vaccine administration.

Evidence and Resources	Community Preventive Services Task Force Finding and Rationale Statement: Standing Orders
Age Range	All ages
Social Determinants Addressed	Health Care
Lead Sectors	Healthcare Delivery system
Contributing Sectors	Governmental Public Health Agencies Insurers Colleges and Universities CBOs and Human service agencies Policy makers and elected officials
Intermediate-level Measure Example	Increased number of clinics utilizing standing orders for vaccine administration
Additional Intermediate-level Measure Example(s)	Increased proportion of vaccines administered by the clinic for which standing orders have been implemented

Goal 1.2 Reduce vaccination coverage disparities

Objectives: By December 31, 2024

Objective 1.2.1 Reduce the disparity measured by the difference in the 4:3:1:3:3:1:4 vaccine series coverage between NYS 19-35-month-olds living in households below the federal poverty level compared with those living in households at or above the federal poverty level by 50% to 4.90%.

Target	4.9%
Baseline	9.7%
Baseline Year	2016
Data Source	National Immunization Survey
Data Level	Statewide

Objective 1.2.2 Reduce the difference in HPV vaccine series completion between NYS adolescent boys and girls by 50% to 5.50%.

Target	5.5%
Baseline	11.0%
Baseline Year	2016
Data Source	National Immunization Survey - Teen
Data Level	Statewide

Interventions

Intervention 1.2.1 Minimize client out-of-pocket costs for vaccinations.

Evidence and Resources	Community Preventive Services Task Force Finding and Rationale Statement: Reducing Client Out-of-Pocket Costs for Vaccinations
Age Range	All ages
Social Determinants Addressed	Economic Stability Health Care
Lead Sectors	Governmental Public Health Agencies Healthcare Delivery system Insurers Policy makers and elected officials
Contributing Sectors	Media CBOs and Human service agencies
Intermediate-level Measure Example	Increased number of no-cost or reduced-cost vaccine doses administered
Additional Intermediate-level Measure Example(s)	Increased number of patients referred to health insurance navigators

Intervention 1.2.2 Offer vaccines in locations and hours that are convenient to the public including pharmacies, vaccine only clinics, and other sites that are accessible to people of all ages.

Evidence and Resources	Stinchfield PK. Practice-proven interventions to increase vaccination rates and broaden the immunization season. The American Journal of Medicine. 2008;121(7):S11-S21.
Age Range	All ages, especially important for older adults.
Social Determinants Addressed	Economic Stability Education Transportation Health Care
Lead Sectors	Healthcare Delivery system Employers, businesses and unions
Contributing Sectors	Governmental Public Health Agencies Insurers Media Colleges and Universities Schools (K-12) CBOs and Human service agencies Policy makers and elected officials
Intermediate-level Measure Example	Improved patient/parent satisfaction with clinic locations and hours
Additional Intermediate-level Measure Example(s)	Increased number of patients seen per clinic date and location

Focus Area 2. Human Immunodeficiency Virus (HIV)

Goal 2.1 Decrease HIV morbidity (new HIV diagnoses)

Objectives: By December 31, 2024

Objective 2.1.1 Reduce the number of new HIV diagnoses by 70% to 1,020 diagnoses or 5.2 per 100,000 population.

Target	1,020 diagnoses or 5.2 per 100,000 population
Baseline	3,391 diagnoses or 17.3 per 100,000 population
Baseline Year	2013
Data Source	HIV Surveillance
Data Level	OBJ targets will be Statewide only, but data will be presented by Statewide and county level

Objective 2.1.2 Reduce the newly diagnosed HIV case rate among African Americans by 70% to 13 new diagnoses per 100,000 population.

Target	13 new diagnoses per 100,000 population
Baseline	43 new diagnoses per 100,000 population
Baseline Year	2013
Data Source	HIV Surveillance
Data Level	Statewide

Objective 2.1.3 Reduce the newly diagnosed HIV case rate among Hispanics by 70% to 10 new diagnoses per 100,000 population.

Target	10 new diagnoses per 100,000 population
Baseline	32 new diagnoses per 100,000 population
Baseline Year	2013
Data Source	HIV Surveillance
Data Level	Statewide

Interventions

Intervention 2.1.1
Facilitate access to Pre-Exposure Prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) for high-risk persons to keep them HIV-negative. Access can be facilitated by the following:

Statewide education campaign on PrEP and nPEP

Expanding funded programming for PrEP

Creating a statewide mechanism for persons to access PrEP and nPEP

Determining a method for measuring the number of New Yorkers on PrEP and nPEP

Evidence and Resources	Evidence Base: PrEP is a targeted biomedical intervention to facilitate "health care as prevention," a six-pronged intervention for people who are HIV-negative and at high risk for infection. The intervention includes a once daily pill; periodic HIV testing; periodic STD screening; counseling about the use of condoms to prevent STDs; education about harm reduction options; and, counseling to promote adherence to the once-a-day PrEP medication. PrEP has been studied in multiple randomized controlled and open-label trials in several populations, including MSM [Grant et al. 2010; McCormack et al. 2016], heterosexual serodiscordant couples [Baeten et al. 2012], heterosexual men and women [Thigpen et al. 2012; Van Damme et al. 2012; Marrazzo et al. 2015], transgender women [Grant et al. 2014], and PWID [Choopanya et al. 2013]. A recent meta-analysis suggests >70% protection across all studies in which >70% adherence was reported [Fonner et al. 2016]. Implementation Resources: NYS Medicaid, along with most insurance plans, covers the only currently FDA-approved PrEP medication, Truvada®. Uninsured individuals may receive Truvada® through the Gilead patient assistance program: ( https://start.truvada.com/). The NYS PrEP Assistance Program can also help to cover the costs of clinical visits and lab testing for uninsured and underinsured individuals who qualify: https://www.health.ny.gov/diseases/aids/general/prep/docs/prep_payment_options.pdf . The NYS DOH website on PrEP has useful information on PrEP and nPEP programming, as well as links to additional resources: https://www.health.ny.gov/diseases/aids/general/prep/consumers.htm
Age Range	New Yorkers of all ages at highest risk for acquiring HIV
Social Determinants Addressed	Health Care
Lead Sectors	Healthcare Delivery system State and local health departments STI service providers
Contributing Sectors	Insurers Colleges and Universities Community or neighborhood residents CBOs and Human service agencies
Intermediate-level Measure Example	Number of New Yorkers prescribed PrEP, by patient demographic factors to ensure equal access.

Goal 2.2 Increase viral suppression

Objectives: By December 31, 2024

Objective 2.2.1 Increase the percentage of all persons living with diagnosed HIV infection (PLWDHI) who receive care with suppressed viral load by 17% to 95%.

Target	95.0%
Baseline	81.0%
Baseline Year	2013
Data Source	HIV Surveillance
Data Level	Statewide

Objective 2.2.2 Increase the percentage of African American persons living with diagnosed HIV infection (PLWDHI) who receive care with suppressed viral load by 23% to 95%.

Target	95.0%
Baseline	77.0%
Baseline Year	2013
Data Source	HIV Surveillance
Data Level	Statewide

Objective 2.2.3 Increase the percentage of Hispanic persons living with diagnosed HIV infection (PLWDHI) who receive care with suppressed viral load by 17% to 95%.

Target	95.0%
Baseline	81.0%
Baseline Year	2013
Data Source	HIV Surveillance
Data Level	Statewide

Interventions

Intervention 2.2.1
Link and retain persons diagnosed with HIV in care to maximize virus suppression so they remain healthy and prevent further transmission. Linkage and retention to be facilitated by the following activities:

Promoting the message that individuals with a sustained undetectable viral load will not sexually transmit HIV;

Expanding Data to Care (DTC) activities, which uses HIV surveillance data to identify previously-known, HIV-positive individuals who appear to be out of care, with the specific objectives of re-engaging these individuals in medical care and notifying, testing and treating partners;

Expand funded programming aimed at improving outcomes for persons with HIV/AIDS by increasing linkage to care, improving retention in care, and promoting adherence to ART;

Leverage NY Links and other regionally based collaboratives to identify innovative solutions for improving linkage and retention in HIV care services.

Evidence and Resources	Evidence Base: Clinical trials and cohort studies have long supported the fact that adherence to Antiretroviral Therapy (ART) reduces the risk of transmitting HIV. Today, treatment as prevention (TasP) has become a widely-accepted strategy for addressing the HIV epidemic and reducing new infections. Most recently, results from the HIV Prevention Trials Network 052 [Cohen et al. 2011] and PARTNER [Rodger et al. 2016] studies demonstrate that, not only does effective antiretroviral treatment improve the health of each person living with HIV, it also prevents transmission of HIV to sexual partners. Thus, individuals with a sustained undetectable viral load will not sexually transmit HIV, or "Undetectable equals Untransmittable" (U=U). Please visit https://health.ny.gov/endingtheepidemic to view a recent webinar on the topic of U=U and to receive updates as they become available. Data to Care (D2C) is a public health strategy that uses HIV surveillance and other data to support the HIV Care Continuum, by identifying persons living with HIV who are in need of HIV medical care or other services and facilitating linkage to those services. Some examples of D2C activities include using HIV surveillance data to identify persons who are not in care (NIC) and then link or re-engage them in care; and identifying persons who are in care but are not virally suppressed and work with clients and their providers to support attaining viral suppression. D2C has been show to: Improve linkage to or re-engagement in care for persons living with HIV; Improve viral suppression; Improve surveillance data quality; and Promote better collaboration between surveillance, prevention and care and treatment staff. More information on DTC is available at: https://effectiveinterventions.cdc.gov/en/2018-design/data-to-care/group-1/data-to-care/data-to-care-essential-elements Implementation Resources: Strategies and Resources for Retention in Care resource has been posted to the NYSDOH website. It can be found at: http://www.health.ny.gov/diseases/aids/general/standards/docs/strategies_resources_retention_in_care.pdf
Age Range	New Yorkers living with diagnosed HIV infection who are not virally suppressed (or who are risk of becoming unsuppressed)
Social Determinants Addressed	Health Care
Lead Sectors	Healthcare Delivery system State and local health departments including partner services programs MCOs
Contributing Sectors	Colleges and Universities Community or neighborhood residents CBOs and Human service agencies
Intermediate-level Measure Example	Viral suppression, by patient demographic factors to ensure equity across all groups

Focus Area 3. Sexually Transmitted Infections (STIs)

Goal 3.1 Reduce the annual rate of growth for STIs

Objectives: By December 31, 2024

Objective 3.1.1 Reduce the annual rate of growth for early syphilis by 50% to 10%.

Target	10.0%
Baseline	20.0%
Baseline Year	2012-2016 average 5 year percent change
Data Source	STI surveillance
Data Level	NYS, county

Objective 3.1.2 Reduce the annual rate of growth for gonorrhea by 50% to 4%.

Target	4.0%
Baseline	8.0%
Baseline Year	2012-2016 average 5 year percent change
Data Source	STI surveillance
Data Level	NYS, county

Objective 3.1.3 Reduce the annual rate of growth for chlamydia by 50% to 1%.

Target	1.0%
Baseline	2.0%
Baseline Year	2012-2016 average 5 year percent change
Data Source	STI surveillance
Data Level	NYS, county

Objective 3.1.4 Keep the age-adjusted diagnosis rate of gonorrhea no more than 242.6 per 100,000 population

Target	242.6 per 100,000 population
Baseline	149.8 per 100,000 population
Baseline Year	2016
Data Source	STI surveillance
Data Level	NYS, county

Objective 3.1.5 Keep the age-adjusted diagnosis rate of chlamydia no more than 676.9 per 100,000 population

Target	676.9 per 100,000 population
Baseline	567.0 per 100,000 population
Baseline Year	2016
Data Source	STI surveillance
Data Level	NYS, county

Objective 3.1.6 Keep the age-adjusted diagnosis rate of early syphilis no more than 79.6 per 100,000 population

Target	79.6 per 100,000 population
Baseline	31.2 per 100,000 population
Baseline Year	2016
Data Source	STI surveillance
Data Level	NYS, county

Interventions

Intervention 3.1.1 Increase Partner Services: Partner Services is the front-line public health intervention for interrupting HIV and STI transmission in the community. Trained state/local health department workers work with persons newly diagnosed with HIV and STIs to ensure they and their partners are linked to care, treatment, and prevention. Any provider who diagnoses STIs should work with their local health department partner services program to ensure their patients have access to this free, confidential service.

Evidence and Resources	https://www.health.ny.gov/diseases/communicable/std/partner_services/index.htm https://www.cdc.gov/std/program/partners.htm https://nysptc.org/ https://www.health.ny.gov/diseases/aids/ending_the_epidemic/docs/std_workgroup_strategies.pdf
Age Range	People of all ages
Social Determinants Addressed	Health Care
Lead Sectors	Governmental Public Health Agencies Healthcare Delivery system Not applicable
Contributing Sectors	Insurers Colleges and Universities Community or neighborhood residents CBOs and Human service agencies
Intermediate-level Measure Example	number of patients offered and accepting Partner Services
Additional Intermediate-level Measure Example(s)	number of patients naming at least one partner number of partners linked to testing and treatment

Intervention 3.1.2 Increase STI testing and treatment: Ensuring that all persons at risk for STIs have access to affordable, accessible, convenient, and culturally-responsive STI testing and treatment services is the bedrock of any STI prevention and control strategy. While STIs are increasing, testing and treatment are effective methods for reducing transmission and promoting sexual health at the individual level. STI testing should be offered in venues and at times that are convenient for population groups most affected by STIs. Providers should ask their patients about which body parts they and their partners use during sex and offer STI testing of the throat and rectum (in addition to genitals) as appropriate.

Evidence and Resources	https://www.cdc.gov/std/tg2015/screening-recommendations.htm
Age Range	People of all ages
Social Determinants Addressed	Health Care
Lead Sectors	Healthcare Delivery system Not applicable
Contributing Sectors	Governmental Public Health Agencies Insurers Colleges and Universities Schools (K-12) CBOs and Human service agencies
Intermediate-level Measure Example	number of patients testing for STIs;
Additional Intermediate-level Measure Example(s)	number of patients positive for STIs number of patients diagnosed with an STI who receive treatment

Intervention 3.1.3 Promote distribution of Condoms: While new methods for preventing HIV have garnered attention over the last several years, the foremost primary prevention method for sexually active people remains condoms. New approaches for increasing condom utilization, and making condoms a regular part of sexual health, will be important for reducing STI impact in NYS. Providers of sexual health services can partner with the NYS Condom program to make condoms more available within their local community.

Evidence and Resources	https://www.cdc.gov/condomeffectiveness/index.html https://www.health.ny.gov/diseases/aids/consumers/condoms/nyscondom.htm https://www.health.ny.gov/diseases/aids/ending_the_epidemic/ https://www.health.ny.gov/diseases/aids/ending_the_epidemic/docs/std_workgroup_strategies.pdf
Age Range	People of all ages
Social Determinants Addressed	Health Care
Lead Sectors	Healthcare Delivery system Not applicable
Contributing Sectors	Governmental Public Health Agencies Insurers Media Colleges and Universities Schools (K-12) Community or neighborhood residents CBOs and Human service agencies Housing agencies
Intermediate-level Measure Example	number of condoms distributed
Additional Intermediate-level Measure Example(s)	percentage of sexually active people who report using condoms

Intervention 3.1.4 Promote Expedited Partner Therapy: Expedited Partner Therapy (EPT) is a practice that allows health care providers to provide a patient with either antibiotics or a written prescription, intended for the patients' sexual partner(s). In New York State, EPT is used for treatment of exposure to chlamydia. Broad implementation of EPT across multiple provider types will be an important population-level intervention for chlamydia control, given this STI's prevalence in the state (with over 110,000 diagnoses annually it is the most commonly reported communicable disease). Providers of sexual health services should take steps to ensure EPT is offered to patients who they diagnose with chlamydia.

Evidence and Resources	https://www.health.ny.gov/diseases/communicable/std/ept/ https://www.health.ny.gov/diseases/aids/ending_the_epidemic/docs/std_workgroup_strategies.pdf
Age Range	People of all ages
Social Determinants Addressed	Health Care
Lead Sectors	Healthcare Delivery system Not applicable
Contributing Sectors	Governmental Public Health Agencies Insurers Media Colleges and Universities CBOs and Human service agencies Policy makers and elected officials
Intermediate-level Measure Example	number of providers who offer EPT
Additional Intermediate-level Measure Example(s)	number of patients who receive an EPT prescription number of EPT prescriptions filled

Focus Area 4. Hepatitis C Virus (HCV)

Goal 4.1 Increase the number of persons treated for Hepatitis C Virus (HCV)

Objectives: By December 31, 2024

Objective 4.1.1 Increase the cumulative number of Medicaid enrollees treated for HCV by 497% - 724% from 6,560 in 2017 to 32,611 — 47,466.

Target	32,611 — 47,466
Baseline	6,560
Baseline Year	2017
Data Source	NYS Medicaid
Data Level	Statewide

Interventions

Intervention 4.1.1 Conduct educational campaign promoting testing and treatment for HCV.

Evidence and Resources	Evidence Base: CDC Know More Hepatitis Campaign Implementation Resources: CDC Know More Hepatitis Campaign ; NYSDOH Hepatitis Web Site NY Cures Hepatitis C Web Site
Age Range	People of all ages
Social Determinants Addressed	Community Cohesion Health Care
Lead Sectors	Governmental Public Health Agencies Healthcare Delivery system
Contributing Sectors	Employers, businesses and unions Insurers Media Colleges and Universities Schools (K-12) Community or neighborhood residents CBOs and Human service agencies Policy makers and elected officials Transportation agencies Housing agencies
Intermediate-level Measure Example	Availability of HCV educational materials
Additional Intermediate-level Measure Example(s)	Client awareness of Hepatitis C

Intervention 4.1.2 Increase capacity for HCV treatment across NYS by increasing provider knowledge and skills for prescribing HCV medications.

Evidence and Resources	Evidence Base: New York State Department of Health, Treatment of Hepatitis C Virus with Direct-Acting Antivirals AASLD/IDSA HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C Implementation Resources : The New York State Department of Health AIDS Institute Clinical Education Initiative (CEI) enhances the capacity of New York's diverse health care workforce to deliver clinical services to improve health outcomes related to HIV, sexually transmitted diseases (STDs) and hepatitis C (HCV).
Age Range	People of all ages
Social Determinants Addressed	Community Cohesion Health Care
Lead Sectors	Governmental Public Health Agencies Healthcare Delivery system
Contributing Sectors	Employers, businesses and unions Insurers Media Colleges and Universities Schools (K-12) Community or neighborhood residents CBOs and Human service agencies Policy makers and elected officials Transportation agencies Housing agencies
Intermediate-level Measure Example	MOUs with HCV providers for timely linkage to care
Additional Intermediate-level Measure Example(s)	Provider knowledge of HCV treatment

Goal 4.2 Reduce the number of new HCV cases among people who inject drugs

Objectives: By December 31, 2024

Objective 4.2.1 Increase the number of individuals with a syringe transaction at an AIDS-Institute registered syringe exchange program by 3% annually to 33,781 clients in 2024.

Target	33,781
Baseline	28,291 individuals with a syringe transaction at SEPS in 2018
Baseline Year	2018
Data Source	AIDS Institute Reporting System (AIRS)
Data Level	Statewide, ROS/NYC

Interventions

Intervention 4.2.1 Increase access to HCV screening among injection drug users < 30 years of age by providing onsite HCV rapid testing.

Evidence and Resources	Evidence Base: Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease(https://www.cdc.gov/mmwr/PDF/RR/RR4719.pdf) New York State Department of Health, Treatment of Hepatitis C Virus with Direct-Acting Antivirals AASLD/IDSA HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C CDC Recommendations for Hepatitis C Screening Among Adults in the United States Implementation Resources: NYSDOH Hepatitis C Rapid Testing Implementation Guide
Age Range	All New Yorkers with special focus on those < 30 years of age
Social Determinants Addressed	Education Health Care
Lead Sectors	Governmental Public Health Agencies Healthcare Delivery system CBOs and Human service agencies
Contributing Sectors	Employers, businesses and unions Insurers Media Colleges and Universities Schools (K-12) Community or neighborhood residents Policy makers and elected officials Transportation agencies Housing agencies
Intermediate-level Measure Example	Establish MOU with agencies that conduct HCV screening.

Intervention 4.2.2 Expand capacity for harm reduction services.

Evidence and Resources	Evidence Base: Based on existing evidence, the U.S. Surgeon General has determined that Syringe Service Programs, when part of a comprehensive prevention strategy, can play a critical role in preventing HIV among persons who inject drugs (PWID); can facilitate entry into drug treatment and medical services; and do not increase the unsafe illegal injection of drugs. These programs have also been associated with reduced risk for infection with hepatitis C virus (HCV). Implementation Resources: NYSDOH AIDS Institute Policies and Procedures for Syringe Exchange Program. CDC Syringe Services Program Guidance and Resources Syringe Services Program (SSP) Development and Implementation Guidelines for State and Local Health Departments, NASTAD.
Age Range	New Yorkers of all ages
Social Determinants Addressed	Community Cohesion Health Care
Lead Sectors	Governmental Public Health Agencies
Contributing Sectors	Healthcare Delivery system Employers, businesses and unions Insurers Media Colleges and Universities Schools (K-12) Community or neighborhood residents CBOs and Human service agencies Policy makers and elected officials Transportation agencies Housing agencies
Intermediate-level Measure Example	Increases in syringe distribution, provision of HCV screening and linkage to care.

Focus Area 5. Antibiotic Resistance and Healthcare-Associated Infections

Goal 5.1 Improve infection control in healthcare facilities

Objectives: By December 31, 2024

Objective 5.1.1 100% of hospitals and 85% of long-term care facilities implement an interfacility communication system regarding patient multidrug-resistant organism (MDRO) infection or colonization history.

Target	NA
Baseline	NA
Baseline Year	2019
Data Source	NYS Health Commerce System (HCS) survey
Data Level	Statewide

Objective 5.1.2 Reduce central line-associated blood stream infections (CLABSIs) in hospital intensive care units and wards by 25% to 0.70 infections per 1,000 central line days.

Target	0.70 infections (CLABSI) per 1,000 central line days
Baseline	0.92 CLABSI per 1,000 central line days
Baseline Year	2017
Data Source	National Healthcare Safety Network
Data Level	Statewide

Interventions

Intervention 5.1.1

Regularly review healthcare facility lead Infection Prevention and Control NYS HCS roles in order for infection prevention and control staff to receive important health notices about infection prevention and control, healthcare-associated infections, and antibiotic resistance and to report healthcare-associated outbreaks.

Ensure staff who lead infection prevention and control at long-term care facilities have appropriate infection prevention and control training.

Ensure all staff are educated on infection prevention and control measures.

Ensure hospital evaluation of CLABSI rates and submission of an improvement plan, as appropriate.

Evidence and Resources	Evidence Base and Resources: New York State (NYS) HCS User Account Request: https://apps.health.ny.gov/pub/ctrldocs/paperless_edoc2.pdf NYS HCS: https://commerce.health.state.ny.us/public/hcs_login.html The Centers for Disease Control and Prevention (CDC) Infection Control: https://www.cdc.gov/infectioncontrol/index.html The CDC Inter-Facility Infection Control Transfer Form: https://www.cdc.gov/hai/pdfs/toolkits/InfectionControlTransferFormExample1.pdf The NYS Department of Health (NYSDOH) Hospital-Acquired Infection Rates in NYS Hospitals: https://www.health.ny.gov/statistics/facilities/hospital/hospital_acquired_infections/ NYSDOH Infection Control: https://www.health.ny.gov/professionals/diseases/reporting/communicable/infection/
Age Range	All ages; however, given the focus on improved infection prevention and control and patient safety in hospitals and long-term care facilities, these interventions will measure progress related to healthy aging.
Social Determinants Addressed	Health Care
Lead Sectors	Healthcare Delivery system
Contributing Sectors	Governmental Public Health Agencies Insurers
Intermediate-level Measure Example	Long-term care facilities with an Infection Preventionist in the HCS role.
Additional Intermediate-level Measure Example(s)	An Infection Preventionist with completed specialized training in infection prevention and control. Number of infection prevention and control training and education materials provided to all staff in healthcare facility. Number of hospitals flagged with CLABSI rates significantly higher than the state average submitting improvement plans to the NYSDOH Hospital Associated Infection Reporting Program reporting program in time recommended.

Goal 5.2 Reduce infections caused by multidrug resistant organisms and C. difficile

Objectives: By December 31, 2024

Objective 5.2.1 Expand surveillance of healthcare associated multidrug-resistant organisms (MDROs).

Target	NA
Baseline	NA
Baseline Year
Data Source	NHSN
Data Level	Statewide

Objective 5.2.2 Reduce hospital onset CRE bloodstream infections (BSIs) by 25% to 0.14 infections per 10,000 patient days.

Target	0.14 infections per 10,000 patient days
Baseline	0.18 infections per 10,000 patient days
Baseline Year	2017
Data Source	NHSN
Data Level	Statewide

Objective 5.2.3 Reduce admission prevalent CRE BSIs by 25% to 0.30 infections per 10,000 hospital admissions.

Target	0.30 infections per 10,000 hospital admissions
Baseline	0.40 infections per 10,000 hospital admissions
Baseline Year	2017
Data Source	NHSN
Data Level	Statewide

Objective 5.2.4 Reduce hospital-onset CDIs by 25% to 3.91 cases per 10,000 patient days.

Target	3.91 cases per 10,000 patient days
Baseline	5.21 cases per 10,000 patient days
Baseline Year	2017
Data Source	NHSN
Data Level	Statewide

Objective 5.2.5 Reduce admission prevalent CDIs by 25% to 2.90 cases per 1,000 admissions.

Target	2.90 cases per 1,000 admissions
Baseline	3.87 cases per 1,000 admissions
Baseline Year	2017
Data Source	NHSN
Data Level	Statewide

Objective 5.2.6 Reduce the total number of CRE infections/colonizations identified statewide by 10% .

Target	NA
Baseline	NA
Baseline Year	2020
Data Source	NYS Electronic Clinical Laboratory Reporting System (ELCRS) and NHSN)
Data Level	Statewide and County level

Objective 5.2.7 Improve identification of Candida auris (C. auris) infection and colonization.

Target	NA
Baseline	NA
Baseline Year
Data Source
Data Level	Statewide

Interventions

Intervention 5.2.1

Institute healthcare facility surveillance system for MDROs, such as by use of the NHSN MDRO module beyond CRE and CDI.

Ensure hospital evaluation of hospital onset CDI rates and submission of an improvement plan, as appropriate.

Expand laboratory testing capability for C. auris.

Evidence and Resources	Evidence Base and Resources: The CDC NHSN: https://www.cdc.gov/nhsn/index.html The NYSDOH Hospital-Acquired Infection Rates in NYS Hospitals: https://www.health.ny.gov/statistics/facilities/hospital/hospital_acquired_infections/
Age Range	All ages; however, given a higher prevalence of antimicrobial resistant infections found in individuals with comorbid conditions and exposure to healthcare, these interventions will measure progress related to healthy aging.
Social Determinants Addressed	Health Care
Lead Sectors	Healthcare Delivery system
Contributing Sectors	Governmental Public Health Agencies Insurers
Intermediate-level Measure Example	Number of healthcare facilities using the NHSN MDRO module for expanded MDRO surveillance beyond CRE and CDI.
Additional Intermediate-level Measure Example(s)	Number of hospitals identified with hospital onset CDI rates significantly higher than the state average submitting improvement plans to the NYSDOH HAI reporting program in time recommended. Number of clinical laboratories with a rapid test for C. auris.

Goal 5.3 Reduce inappropriate antibiotic use

Objectives: By December 31, 2024

Objective 5.3.1 Reduce potentially avoidable antibiotic prescribing rates for adult outpatient acute upper respiratory infections by 25% to 30%

Target	30.0%
Baseline	40.0% among adults 18 to 64 in Medicaid
Baseline Year	2016
Data Source	NYS Medicaid https://health.data.ny.gov/Health/Potentially-Avoidable-Antibiotic-Prescribing-Rates/vg7a-h5ss)
Data Level	Statewide and County level

Objective 5.3.2 100% of hospitals and long-term care facilities will have an antimicrobial stewardship program (ASP) that meets the seven CDC core elements of antimicrobial stewardship.

Target	100.0%
Baseline	88.0%
Baseline Year	2017
Data Source	Health Commerce System Survey
Data Level	Statewide

Interventions

Intervention 5.3.1

Use healthcare provider-level feedback data to inform antibiotic prescribing.

Conduct an educational campaign for the public on antimicrobial resistance and appropriate antibiotic use.

Offer healthcare provider education and public health detailing to prescribers.

Evidence and Resources	Evidence Base and Resources: The CDC Antibiotic Prescribing https://www.cdc.gov/antibiotic-use/community/improving-prescribing/evidence/systematic-reviews.html The CDC Core Elements of Outpatient Antibiotic Stewardship: https://www.cdc.gov/antibiotic-use/community/improving-prescribing/core-elements/core-outpatient-stewardship.html The CDC 6/18 Initiative https://www.cdc.gov/sixeighteen/
Age Range	All ages; however, however, given higher rates of antimicrobial prescribing and use in older age groups, these interventions will measure progress related to healthy aging.
Social Determinants Addressed	Health Care
Lead Sectors	Healthcare Delivery system
Contributing Sectors	Governmental Public Health Agencies Insurers
Intermediate-level Measure Example	Provision of antimicrobial prescribing data to all primary and acute care providers with comparison of their antibiotic prescribing patterns to benchmark.
Additional Intermediate-level Measure Example(s)	Number of healthcare providers reached with education and tools on antimicrobial resistance.

Intervention 5.3.2 Evaluate the impact of the healthcare facility ASP (or an element of the program) to determine areas for improvement.

Evidence and Resources	The CDC 6/18 Initiative https://www.cdc.gov/sixeighteen/ The CDC Core Elements of Hospital Antibiotic Stewardship Programs: https://www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements.html The CDC Core Elements of Antibiotic Stewardship for Nursing Homes: https://www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.html The CDC NHSN: https://www.cdc.gov/nhsn/index.html
Age Range	All ages; however, however, given higher rates of antimicrobial prescribing and use in older age groups, these interventions will measure progress related to healthy aging.
Social Determinants Addressed	Health Care
Lead Sectors	Healthcare Delivery system
Contributing Sectors	Governmental Public Health Agencies Insurers
Intermediate-level Measure Example	Number of hospitals reporting antibiotic use data through NHSN Antibiotic Use and Resistance (AUR) Module.

Department of Health

Prevention Agenda 2019-2024: Prevent Communicable Diseases Action Plan

Table of Contents

Overview

Focus Area 1. Vaccine Preventable Diseases

Goal 1.1 Improve vaccination rates

Objectives: By December 31, 2024

Objective 1.1.1 Increase the rates of immunization among NYS 24-35-month-olds with the 4:3:1:3:3:1:4 series (4 DTaP, 3 polio, 1 MMR, 3 Hep B, 3 Hib, 1 varicella, 4 PCV13) by 10% to 70.5%

Objective 1.1.2 Increase the percentage of NYS 13-year-old adolescents with a complete HPV vaccine series by 10% to 37.4%

Objective 1.1.3 Increase influenza immunization rates of New Yorkers aged 6 months and older by 10% to 54.8%.

Objective 1.1.4 Increase the age-adjusted pneumococcal vaccination rate of New Yorkers aged 65 years and older by 10% to 76.2%.

Interventions

Intervention 1.1.1 Ensure and enforce strong immunization requirements for child care, school and post-secondary institution entry and attendance.

Intervention 1.1.3 Implement and promote use of standing orders for vaccine administration.

Goal 1.2 Reduce vaccination coverage disparities

Objectives: By December 31, 2024

Objective 1.2.1 Reduce the disparity measured by the difference in the 4:3:1:3:3:1:4 vaccine series coverage between NYS 19-35-month-olds living in households below the federal poverty level compared with those living in households at or above the federal poverty level by 50% to 4.90%.

Objective 1.2.2 Reduce the difference in HPV vaccine series completion between NYS adolescent boys and girls by 50% to 5.50%.

Interventions

Intervention 1.2.1 Minimize client out-of-pocket costs for vaccinations.

Intervention 1.2.2 Offer vaccines in locations and hours that are convenient to the public including pharmacies, vaccine only clinics, and other sites that are accessible to people of all ages.

Focus Area 2. Human Immunodeficiency Virus (HIV)

Goal 2.1 Decrease HIV morbidity (new HIV diagnoses)

Objectives: By December 31, 2024

Objective 2.1.1 Reduce the number of new HIV diagnoses by 70% to 1,020 diagnoses or 5.2 per 100,000 population.

Objective 2.1.2 Reduce the newly diagnosed HIV case rate among African Americans by 70% to 13 new diagnoses per 100,000 population.

Objective 2.1.3 Reduce the newly diagnosed HIV case rate among Hispanics by 70% to 10 new diagnoses per 100,000 population.

Interventions

Goal 2.2 Increase viral suppression

Objectives: By December 31, 2024

Objective 2.2.1 Increase the percentage of all persons living with diagnosed HIV infection (PLWDHI) who receive care with suppressed viral load by 17% to 95%.

Objective 2.2.2 Increase the percentage of African American persons living with diagnosed HIV infection (PLWDHI) who receive care with suppressed viral load by 23% to 95%.

Objective 2.2.3 Increase the percentage of Hispanic persons living with diagnosed HIV infection (PLWDHI) who receive care with suppressed viral load by 17% to 95%.

Interventions

Focus Area 3. Sexually Transmitted Infections (STIs)

Goal 3.1 Reduce the annual rate of growth for STIs

Objectives: By December 31, 2024

Objective 3.1.1 Reduce the annual rate of growth for early syphilis by 50% to 10%.

Objective 3.1.2 Reduce the annual rate of growth for gonorrhea by 50% to 4%.

Objective 3.1.3 Reduce the annual rate of growth for chlamydia by 50% to 1%.

Objective 3.1.4 Keep the age-adjusted diagnosis rate of gonorrhea no more than 242.6 per 100,000 population

Objective 3.1.5 Keep the age-adjusted diagnosis rate of chlamydia no more than 676.9 per 100,000 population

Objective 3.1.6 Keep the age-adjusted diagnosis rate of early syphilis no more than 79.6 per 100,000 population

Interventions

Focus Area 4. Hepatitis C Virus (HCV)

Goal 4.1 Increase the number of persons treated for Hepatitis C Virus (HCV)

Objectives: By December 31, 2024

Objective 4.1.1 Increase the cumulative number of Medicaid enrollees treated for HCV by 497% - 724% from 6,560 in 2017 to 32,611 — 47,466.

Interventions

Intervention 4.1.1 Conduct educational campaign promoting testing and treatment for HCV.

Intervention 4.1.2 Increase capacity for HCV treatment across NYS by increasing provider knowledge and skills for prescribing HCV medications.

Goal 4.2 Reduce the number of new HCV cases among people who inject drugs

Objectives: By December 31, 2024

Objective 4.2.1 Increase the number of individuals with a syringe transaction at an AIDS-Institute registered syringe exchange program by 3% annually to 33,781 clients in 2024.

Interventions

Intervention 4.2.1 Increase access to HCV screening among injection drug users < 30 years of age by providing onsite HCV rapid testing.

Intervention 4.2.2 Expand capacity for harm reduction services.

Focus Area 5. Antibiotic Resistance and Healthcare-Associated Infections

Goal 5.1 Improve infection control in healthcare facilities

Objectives: By December 31, 2024

Objective 5.1.1 100% of hospitals and 85% of long-term care facilities implement an interfacility communication system regarding patient multidrug-resistant organism (MDRO) infection or colonization history.

Objective 5.1.2 Reduce central line-associated blood stream infections (CLABSIs) in hospital intensive care units and wards by 25% to 0.70 infections per 1,000 central line days.

Interventions

Goal 5.2 Reduce infections caused by multidrug resistant organisms and C. difficile

Objectives: By December 31, 2024

Objective 5.2.1 Expand surveillance of healthcare associated multidrug-resistant organisms (MDROs).

Objective 5.2.2 Reduce hospital onset CRE bloodstream infections (BSIs) by 25% to 0.14 infections per 10,000 patient days.

Objective 5.2.3 Reduce admission prevalent CRE BSIs by 25% to 0.30 infections per 10,000 hospital admissions.

Objective 5.2.4 Reduce hospital-onset CDIs by 25% to 3.91 cases per 10,000 patient days.

Objective 5.2.5 Reduce admission prevalent CDIs by 25% to 2.90 cases per 1,000 admissions.

Objective 5.2.6 Reduce the total number of CRE infections/colonizations identified statewide by 10% .

Objective 5.2.7 Improve identification of Candida auris (C. auris) infection and colonization.

Interventions

Intervention 5.2.1 Institute healthcare facility surveillance system for MDROs, such as by use of the NHSN MDRO module beyond CRE and CDI. Ensure hospital evaluation of hospital onset CDI rates and submission of an improvement plan, as appropriate. Expand laboratory testing capability for C. auris.

Goal 5.3 Reduce inappropriate antibiotic use

Objectives: By December 31, 2024

Objective 5.3.1 Reduce potentially avoidable antibiotic prescribing rates for adult outpatient acute upper respiratory infections by 25% to 30%

Objective 5.3.2 100% of hospitals and long-term care facilities will have an antimicrobial stewardship program (ASP) that meets the seven CDC core elements of antimicrobial stewardship.

Interventions

Intervention 5.3.1 Use healthcare provider-level feedback data to inform antibiotic prescribing. Conduct an educational campaign for the public on antimicrobial resistance and appropriate antibiotic use. Offer healthcare provider education and public health detailing to prescribers.

Intervention 5.3.1

Use healthcare provider-level feedback data to inform antibiotic prescribing.

Conduct an educational campaign for the public on antimicrobial resistance and appropriate antibiotic use.

Offer healthcare provider education and public health detailing to prescribers.