Upper Manhattan NYLinks Evaluation Dissemination Slide Set August 2015 This slide set contains only those slide identified as potentially “useful” by providers in the NYLinks Upper Manhattan Group 1

Contents 1.NYS, NYC and Upper Manhattan maps 2.Facility-level measures 3.Surveillance-based measures 2

Updates to NYLinks Maps 3 Glossary of key terms NYLinks Long Island region highlighted in NYS Regions Prevalence map Data suppression rules utilized for cells (geographic units) with low numbers (marked by grey shading and diagonal lines) Actual case count numbers (e.g. plwhdi, new diagnoses, etc.) included at the county and UHF level for NYLinks regional maps Site names listed on all NYLinks regional maps Numbers of sites by type of services added to map legends Rochester and Buffalo inset maps added to better display site locations/site types Site locations added to Mid and Lower Hudson regional group map ‘Inactive’ sites removed from NYC maps Areas exceeding 2015 NHAS target 85% of linkage to care highlighted on linkage to care map Definitions of linkage, retention and viral load suppression added as footnotes where applicable NYC region added to NYS Ryan White Region HIV care outcome maps Map showing HIV viral suppression among all PLWDHI added for NYC and NYS (pending) State and city-wide rates added to NYS/NYC HIV care outcome maps(pending)

Glossary of Key Map Terms Linkage to Care: Percentage of newly diagnosed PLWH during the time period of interest (e.g., 2013) that had evidence of HIV care (≥ 1 CD4 or viral load test) reported within 90 days of the date of diagnosis. *Note for NYC linkage maps only: CD4 and viral load tests within 7 days of a patient’s diagnosis do not count towards linkage. NYS Prison Inmates: Prison inmates refer to persons incarcerated in state correctional facilities at the time of diagnosis (even if they are no longer in prison). The county of residence at diagnosis reflects the county of incarceration at the time of diagnosis or first report, which may be different from the individual’s home county and later county of incarceration. PLWHA: Persons Living with HIV/AIDS PLWDHI: Persons Living with Diagnosed HIV Infection Prevalence: The number or proportion of people with a particular disease or condition in a given population and at a specific time. For this set of maps, living HIV/AIDS cases per 100,000 population. Retention in Care (among newly diagnosed PLWH): Percentage of newly diagnosed PLWH during the time period of interest (e.g., 2013) who had evidence of care (≥ 1 CD4 or viral load test) at least three times during the 12 months following diagnosis, with at least one event occurring in each 4-month period. 4

Glossary of Key Map Terms (2) UHF: United Hospital Fund neighborhood corresponds to a geographic area within New York City that is an aggregate of between 1 and 9 zip codes but that is smaller than a borough. UHF neighborhoods reflect catchment areas for certain healthcare facilities. Viral Suppression (among newly diagnosed PLWH): Percentage of newly diagnosed with HIV during the time period of interest (e.g., 2013) whose last viral load test in the 12 months after diagnosis was <200 copies/mL (NYS) or ≤200 copies/mL (NYC). Viral Suppression (among all PLWDHI): Percentage of all PLWDHI at a specific point in time (e.g. 2013), whose most recent viral load test was <200 copies/mL (NYS) or ≤200 copies/mL (NYC). Viral Suppression (among PLWDHI in care): Percentage of PLWDHI with evidence of care (CD4/VL test) during the year (e.g. 2013) whose most recent viral load test was <200 copies/mL (NYS) or ≤200 copies/mL (NYC). 5

NYLinks Regional Groups 6

NYLinks Regions and HIV/AIDS Prevalence by County of Residence at Diagnosis: New York State,

HIV Diagnosis Rates by UHF Neighborhood New York City,

Prevalence of HIV/AIDS by UHF Neighborhood of Residence: New York City,

Upper Manhattan, 2013 New HIV Diagnoses and HIV/AIDS Prevalence Upper Manhattan Sites: ARTC, Africa Services committee, AIDS Service Center, Beth Israel-MMTP, Boriken, CCHP, Columbia Presbyterian, Community Healthcare Network, Harlem Hospital, Harlem United, IFH, Iris House, Lenox Hill, Metropolitan HC, Mt. Sinai MC, Renaissance Healthcare, Safe Horizon, Settlement Health, St. Luke’s, William F. Ryan 10

NYLinks HIV Care Outcomes New York City,

Linkage to Care among Newly Diagnosed Persons by UHF Neighborhood at Diagnosis New York City, % linked out of 2,521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 74% linked out of 2,521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 12

Retention in Care among Newly Diagnosed Persons by UHF Neighborhood at Diagnosis New York City, % retained out of 2,521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 54% retained out of 2,521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 13

Viral Suppression among Newly Diagnosed Persons by UHF Neighborhood at Diagnosis New York City, % virally suppressed within 12 months out of 2,521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 65% virally suppressed within 12 months out of 2,521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 14

Viral Suppression among PLWDHI with Evidence of Recent Care by UHF Neighborhood New York City, % virally suppressed among 65,555 PLWDHI in care in NYC, 2013 Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 80% virally suppressed among 65,555 PLWDHI in care in NYC, 2013 Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 15

Viral Suppression among All PLWDHI by UHF Neighborhood: New York City, % virally suppressed among 101,848 PLWDHI in NYC, 2013 Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 52% virally suppressed among 101,848 PLWDHI in NYC, 2013 Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 16

Upper Manhattan Regional Group (UMRG) Facility-level measures 17

Major Changes to Facility-Level Measure Slides Added list of NYLinks agencies Added data summary for facility-level measures Both retention measures show measurement period on the x-axis 18

Facility-level Measure Definitions 19 Linkage to care among newly diagnosed persons Percentage of newly diagnosed persons in the reporting period who had their first HIV clinical care visit within 30 days of the date of their confirmatory HIV test result Retention Percentage of patients with at least one HIV clinical care visit during the first six months of the 24-month measurement period, who had at least one HIV clinical care visit in each 6- month period of the remaining 18 months of the measurement period with a minimum of 60 days between HIV clinical care visits New patient retention Percentage of new patients who have their initial HIV clinical care visit during their first four months of the 12-month measurement period who had an HIV clinical care visit in each of the subsequent 4-month periods in the measurement period

Facility-level Measure Definitions 20 Clinical engagement Percentage of active HIV clients/patients with a supportive service visit, general medical, or dental visit during the reporting period who have a documented or self-reported HIV clinical care visit within the prior 6-months New client clinical engagement Percentage of new clients/patients without an HIV clinical care visit within the 6 months prior to enrollment that subsequently have an HIV clinical care visit within 30 days of enrollment/first visit in the supportive service, general medical or dental program

Facility-level Measure Terminology An HIV clinical care visit is defined as a visit with a medical provider with prescribing privileges. A provider with prescribing privileges is a health care professional who is licensed in their jurisdiction to prescribe ARV therapy (i.e., physician, physician assistant, and/or nurse practitioner). New patients are those who are: – newly diagnosed with HIV/AIDS and new to HIV medical care – patients new to HIV medical care (previously diagnosed with HIV/AIDS and never received HIV medical care) – patients returning to HIV medical care after a 2‐year absence (patients reengaged by the same organization). Reporting period is the time span used to construct the denominator for a measure. Reporting periods are measure-specific. Measurement period is the time span used to construct the numerator for a measure. Measurement periods are also measure-specific. 21

UMRG Members 1.Addiction Research and Treatment Corporation 2.African Services 3.AIDS Service Center 4.Boriken Neighborhood Health Center 5.Beth Israel Medical Center MMTP Clinics 6.Center for Comprehensive Health Practice 7.Community Healthcare Network 8.Harlem United 9.Institute for Family Health 10.Iris House 11.Lenox Hill 12.Mount Sinai Medical Center 13.Columbia University medical center 14.Harlem Hospital Center 15.Metropolitan Hospital 16.Renaissance Healthcare 17.Safe Horizon 18.Settlement Health 19.St. Luke’s Roosevelt 20.William F. Ryan health center 22

% of UMRG Sites Submitting Data on Facility-Level Measures Data Source: NYLinks facility-level measures—through June 2015 submission, updated: June 23, 2015 Measure # of sites expected to submit data % of sites reporting data for every other submission period Apr ‘12 Aug ‘12 Dec ‘12 Apr ‘13 Aug ‘13 Dec ‘13 Apr ‘14 Aug ‘14 Dec ‘14 Apr ‘15 Jun ‘15 Linkage1889%83%78%67%61% 50%22% Retention1567% 80%67%53%60% 53%20% New Pt. Ret1580%73% 80%60% 53%60%53%33% Clinical Eng.888%75%63%50%38%25%38%25%38% 0% New Client Engage. 888%75%63%50%38% 0% Total number of UMRG sites: 20 23

UMRG—Linkage to care(1): proportion of newly diagnosed persons linked to care within 30 days Data Source: NYLinks facility-level measures, updated: June 23, Linked to care: defined as having had an HIV clinical care visit within 30 days of the date of confirmatory HIV test result. -Each data point represents the aggregate bi-monthly data submission from Apr Jun clients 16/18 sites 94 clients 12/18 sites 45 clients 12/18 sites 7 clients 4/18 sites 24

UMRG—Retention (2a): proportion of patients retained in care over 24 months Data Source: NYLinks facility-level measures, updated: June 23, ,913 pts 10/15 sites 25 Sites reporting

UMRG—New patient retention(2b): proportion of new patients retained in care over one year Data Source: NYLinks facility-level measures, updated: June 23, pts 12/15 sites pts 9/15 sites Sites reporting

UMRG—Clinical engagement (3a): proportion of clients engaged in care Data Source: NYLinks facility-level measures, updated: June 23, clients 7/8 sites -Engaged: Number of active HIV clients/patients, who had a supportive service, general medical, or dental visit within the 2‐month reporting period, who had a documented or self‐reported HIV clinical care visit within the prior 6‐month period. -Each data point represents the aggregate bi-monthly data submission from Apr 2012-Jun Sites reporting

UMRG—New client clinical engagement: proportion of new clients engaged in care Data Source: NYLinks facility-level measures, updated: June 23, Engaged: Proportion of new clients/patients to the supportive service, general medical, or dental program in the reporting period, without a documented or self‐reported HIV clinical care visit within the prior 6‐months, who subsequently had at least one HIV clinical care visit with a provider with prescribing privileges within 30 days of enrollment in the supportive service program. -Each data point represents the aggregate bi-monthly data submission from Apr 2012-Jun clients 7/8 sites 28 Eligible clients Sites reporting

UMRG Facility-level Data Summary Data submissions by Upper Manhattan (UM) sites have steadily decreased over time. Difficult to interpret outcome trends for the region without consistent data submissions from most sites in UM. Newly diagnosed linkage to care data for UM has been variable. UM sites have expressed difficulty in identifying truly newly diagnosed persons in their data systems, therefore data submitted to NYLinks includes repeat testers. For clinical care sites that have submitted retention data, retention in care appears to have stayed steady over the past 3 years with approx 70-73% of patients being retained in care. New patient retention continues to be a challenge, however data interpretation is uncertain. 29

NYC Surveillance-Based Measures: Upper Manhattan July

Major Changes to Surveillance-Based Slides (1) Additions List of NYLinks providers in each regional group Linkage to care bar graphs, by year of diagnosis – 30 days, 60 days, 3 months, one year Separate graphs – Median CD4 count at HIV diagnosis – Concurrent diagnosis of HIV and AIDS Retention in care and HIV viral suppression among newly diagnosed persons shown by first provider of care Table-demographic characteristics of regional/NYLinks population 31

Major Changes to Surveillance-Based Slides (2) Additions HIV Care Cascades among newly diagnosed persons – Highlight proportion not linked, not retained, and not virally suppressed (currently shown only for NYC) – Longitudinal outcomes for those diagnosed by a NYLinks provider Data interpretation included in the notes section of the executive summary slide set 32

Limitations of NYC Surveillance Data o Surveillance data reporting lag o Reporting of new diagnoses and HIV-related laboratory tests are considered complete after a 6 month lag time. Data becomes available to surveillance epidemiologists approximately 1-2 months following lag (i.e. complete estimate of new 2014 diagnoses not available until September/October 2015). o What surveillance data can provide and what it cannot o Tricky to compare between surveillance-based indicators and provider self-reported NYLinks indicators because of different definitions/time periods (read the footnotes!!) o Surveillance provides a proxy measure of care o CD4/VL reported=care? o Lack of CD4/VL = lack of care? o No VL reported = not suppressed? o Can track patients across multiple providers o Inability to track out-migration of patients 33

Upper Manhattan NYLinks Providers Included in Surveillance Slides Mt Sinai NY Presbyterian Hospital St. Luke’s Hospital Harlem Hospital Harlem United Institute for Family Health Lenox Hill Hospital Metropolitan Hospital Addiction Research & Treatment NY Harm Reduction Educators Iris House William F. Ryan African Services Center for Comp. Health Practice Citicare, Inc. Renaissance Health Network East Harlem Council- Boriken Heritage Health and Housing Community Healthcare Net. Settlement Healthcare Network 34

Newly Diagnosed Indicators 35

Total Number of Newly Diagnosed Persons: UMRG and rest of NYC Data Source: NYC HIV/AIDS Surveillance data, updated July 2015 with data reported by March 31, 2015 UMRG collaborative begins Diagnosed by UMRG NYLinks Provider Diagnosed by Provider in the Rest of NYC TOTAL 2011Jan-Mar77 (8.9%) Apr-Jun79 (8.5%) Jul-Sep80 (9.7%) Oct-Dec73 (9.4%) Jan-Mar81 (10.0%) Apr-Jun90 (10.7%) Jul-Sep80 (10.3%) Oct-Dec91 (13.9%) Jan-Mar103(14.4%) Apr-Jun107(14.3%) Jul-Sep112 (14.8%) Oct-Dec93 (15.2%)

CONCURRENT DIAGNOSIS and MEDIAN CD4 AT DIAGNOSIS Data SourceHIV/AIDS Surveillance Registry Measure Concurrent HIV/AIDS diagnosis: Proportion of new HIV diagnoses during the reporting period of interest (e.g., 1 st quarter 2009) with an AIDS diagnosis that occurred within 31 days of the HIV diagnosis. Median CD4 cell count at diagnosis: median CD4 cell count of patients newly diagnosed during the reporting period (e.g., 1 st quarter 2009). The first CD4 cell count within 3 months of diagnosis is used to calculate the median. Example: Proportion of newly diagnosed PLWH during the first quarter of 2009 who also have an AIDS diagnosis within 31 days of their initial HIV diagnosis. Median CD4 count of those diagnosed in the first quarter of 2009 among those with a CD4 count available within 3 months of diagnosis. Numerator Number of PLWH diagnosed with HIV during the time period with a concurrent AIDS diagnosis. DenominatorTotal number of newly diagnosed PLWH in the time period. Patient Numerator and Denominator Exclusions PLWH who have no CD4 cell count within 3 months of diagnosis will not contribute to the median calculation. 37

Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 *Concurrent diagnosis: AIDS diagnosis within 31 days of HIV diagnosis UMRG collaborative begins January

UMRG collaborative begins January 2012 Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 *Concurrent diagnosis: AIDS diagnosis within 31 days of HIV diagnosis 39

Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 UMRG collaborative begins January

LINKAGE TO CARE Data SourceHIV/AIDS Surveillance Registry Measure Linkage: Percentage of newly diagnosed PLWH during the time period of interest (e.g., 1 st quarter 2009) that had evidence of HIV care reported within 30 days, 60 days, 3 months, and 12 months of the date of diagnosis. Example: Percentage of newly diagnosed PLWH during the first quarter of 2009 that had evidence of HIV care within 30 days, 60 days, 3 months, and 12 months of the date of diagnosis. Numerator Number of newly diagnosed PLWH during the time period who had evidence of care reported within 8-30 days, 8-60 days, 8 days - 3 months, and 8 days - 12 months of the date of diagnosis. Denominator Total number of newly diagnosed PLWH during the time period. Patient Numerator and Denominator Exclusions CD4 and viral load tests within 7 days of a patient’s diagnosis do not count towards linkage as these may be associated with a diagnostic event only, and not a specific HIV care visit. Important definitions and conventions Evidence of care is defined as ≥ 1 CD4 or viral load test. 41

Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 *Labs (CD4/VL) within 7 days of diagnosis removed. UMRG collaborative begins January

*Labs (CD4/VL) within 7 days of diagnosis removed. Bottom numbers=(# linked by providers / total # diagnosed by providers) Data Source: NYC HIV/AIDS Surveillance data, updated March 2015 with data reported through June 30, /310110/ % NHAS Linkage Goal by 2020

*Labs (CD4/VL) within 7 days of diagnosis removed. Bottom numbers=(# linked by providers / total # diagnosed by providers) Data Source: NYC HIV/AIDS Surveillance data, updated March 2015 with data reported through June 30, /310154/ / / /370122/191 44

*Labs (CD4/VL) within 7 days of diagnosis removed. Bottom numbers=(# linked by providers / total # diagnosed by providers) Data Source: NYC HIV/AIDS Surveillance data, updated March 2015 with data reported through June 30, /310168/ /328143/198261/370130/191 45

*Labs (CD4/VL) within 7 days of diagnosis removed. Bottom numbers=(# linked by providers / total # diagnosed by providers) Data Source: NYC HIV/AIDS Surveillance data, updated March 2015 with data reported through June 30, /310193/ /328166/198 46

RETENTION IN CARE AMONG NEWLY DIAGNOSED PLWH Data SourceHIV/AIDS Surveillance Registry Measure Retention among newly diagnosed PLWH: Percentage of newly diagnosed PLWH during the time period of interest (e.g., Q1 2009) who had evidence of care at least three times during the 12 months following diagnosis, with at least one event occurring in each 4- month period. Example: Percentage of newly diagnosed PLWH during the first quarter of 2010 who had evidence of care during each 4 month period during the 12 months following diagnosis. Numerator Number of newly diagnosed PLWH during the time period that had evidence of care in each 4 month period during the 12 months following diagnosis. DenominatorTotal number of newly diagnosed PLWH during the time period. Patient Numerator and Denominator Exclusions Important definitions and conventions Evidence of care is defined as ≥ 1 CD4 or viral load test. 47

Retention in Care among Newly Diagnosed PLWH in Upper Manhattan and Rest of NYC Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 UMRG collaborative begins January

VIRAL SUPPRESSION AMONG NEWLY DIAGNOSED PLWH Data SourceHIV/AIDS Surveillance Registry Measure Viral suppression among newly diagnosed PLWH: Percentage of newly diagnosed PLWH during the time period of interest (e.g., 1 st quarter 2009) whose most recently reported VL in the first 6 or 12 months post diagnosis was ≤200 copies/mL. Example: Percentage of patients newly diagnosed during the first quarter of 2009 whose most recent VL during the 6 and 12 month period following diagnosis was ≤200 copies/mL. Numerator Number of patients newly diagnosed during the time period whose most recent VL in the 6 or 12 months period following diagnosis was ≤200 copies/mL. Denominator Total number of patients newly diagnosed during the time period. Patient Numerator and Denominator Exclusions Patients who are documented to be deceased at any time during the time period. Important definitions and conventions Patients with no VL reported are considered not suppressed. 49

Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 UMRG collaborative begins January months 50

PLWDHI Indicators 51

52 Upper Manhattan QueensStaten Island Received care by non-NYLinks provider in NYC Total10,6103, ,089 Sex Male68%64%58%71% Age (median, quartile range)34 (27-42)35 (28-43)34 (27-41)35 (28-42) Race/Ethnicity Black48%47%43%45% White14%8%22%21% Hispanic36%40%33%32% Asian/Pacific Islander1%5%1%2% Native American<1% Multiracial<1% - Transmission Risk Men who have sex with men34%31%14%39% Injection drug use history17%13%29%16% Heterosexual22%34%30%21% Perinatal4%2%4%2% Other<1% - Unknown23%20%23%22% CD4 count (median,quartiles)527 ( )534 ( )549 ( )547 ( ) Viral Load Quantity (median,quartiles)22 (0-621)60 (0-5246)351 ( ) not available Persons Living with Diagnosed HIV as of December 31, 2013 that received any care in NYC in 2013 Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015

EVIDENCE OF RECENT HIV CARE AMONG ALL PLWDHI Data SourceHIV/AIDS Surveillance Registry Measure Evidence of recent care among PLWDHI: Percentage of PLWDHI with any evidence of care during the reporting period of interest (e.g., 1 st quarter 2009). Example: Percentage of PLWDHI who had any evidence of care during the 1 st quarter of NumeratorNumber of PLWDHI with any evidence of care during the time period. DenominatorTotal number of PLWDHI during the time period. Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the time period. Important definitions and conventions Evidence of care is defined as ≥ 1 CD4 or viral load test. 53

Evidence of Recent Care Among all PLWDHI in NYC Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 UMRG collaborative begins January 2012 Q/SI collaborative begins February

RETENTION AMONG ALL PLWDHI IN CARE Data SourceHIV/AIDS Surveillance Registry Measure Retention among all PLWDHI: Percentage of PLWDHI with evidence of care during the time period of interest (e.g., 1 st quarter 2009) who had subsequent evidence of care days after the most recent care event in the time period of interest. Example: Percentage of PLWDHI in care during the 1 st quarter of 2010 who had evidence of care days after the most recent care event in the 1 st quarter of Numerator Number of PLWDHI with evidence of care during the time period of interest who had subsequent evidence of care days after the most recent care event in the time period of interest. Denominator Total number of PLWDHI, with evidence of care during the time period of interest. Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the time period. Important definitions and conventions Evidence of care is defined as ≥ 1 CD4 or viral load test. 55

Retention Among all PLWDHI in Care by UM NYLinks provider or another provider in Rest of NYC Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 *Data reporting issue due to Hurricane Sandy UMRG collaborative begins January 2012 * 56

VIRAL SUPPRESSION AMONG PLWDHI IN CARE Data SourceHIV/AIDS Surveillance Registry Measure Viral Suppression among PLWDHI in care: Percentage of PLWDHI with evidence of care during the time period of interest (e.g., 1 st quarter 2009) whose most recent viral load test result during the time period was ≤200 copies/mL. Example: Percentage of PLWDHI with evidence of care during the 1 st quarter of 2009 for whom the whose most recent viral load result in the time period was ≤200 copies/mL. Numerator Number of PLWDHI whose most recent viral load results in the time period was ≤200 copies/mL. Denominator Total number of PLWDHI with evidence of care during the time period. Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the time period. Important definitions and conventions Patients with no VL reported are considered not suppressed. 57

Viral Suppression among all PLWDHI in Care by UM NYLinks provider or another NYC provider Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 UMRG collaborative begins January

SUSTAINED VIRAL SUPPRESSION AMONG ALL PLWDHI IN CARE Data SourceHIV/AIDS Surveillance Registry Measure Sustained viral suppression among all PLWDHI: Percentage of diagnosed PLWDHI living and in care during the time period of interest (e.g. Q1 2009) whose VL quantities reported during the 12 months following evidence of care in the time period were all ≤200 copies/mL. Example: Percentage of diagnosed PLWH alive and in care Q whose VL quantities drawn through Q were all ≤200copies/mL. Numerator Number of diagnosed PLWH alive as of a specific point in time (e.g., March 31, 2009), test whose VL quantities reported during the 12 months following the point in time were all ≤200copies/mL. Denominator Total number of diagnosed PLWH alive as of a specific point in time (e.g., March 31, 2009) with ≥1 VL test over 12 months following the time point. Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the time period. Important definitions and conventions Patients with no VL reported are considered not suppressed. 59

Sustained Viral Suppression among PLWDHI in Care by UM NYLinks provider or another NYC provider Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 UMRG collaborative begins January

VIRAL SUPPRESSION AMONG ALL PLWDHI Data SourceHIV/AIDS Surveillance Registry Measure Viral suppression among all PLWDHI: Percentage of diagnosed PLWDHI alive as of a specific point in time (e.g., June 30, 2010), whose most recent VL during the prior 6 months (January 1-June 29, 2010) was ≤200 copies/mL. Example: Percentage of diagnosed PLWH alive as of June 30, 2010 whose most recent viral load during the prior 6 months (January 1-June 29, 2010) was ≤200 copies/mL. Numerator Number of diagnosed PLWH alive as of a specific point in time (e.g., June 30, 2010), whose most recent VL during the prior 6 months (January 1-June 29, 2010) was ≤200 copies/mL. Denominator Total number of diagnosed PLWH alive as of a specific point in time (e.g., June 30, 2010). Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the 6 month window period leading up to the specific point in time 61

Viral Suppression among all PLWDHI in NYC Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 UMRG collaborative begins January 2012 Q/SI collaborative begins February

Upper Manhattan Regional Group HIV care cascades 63

1 As reported to the New York City HIV Surveillance Registry (NYC HSR) by June 30, Timely linkage to care is defined as ≥1 CD4/VL reported to the NYC HSR days post diagnosis. 3 Retention in care is defined as ≥ 1 CD4/VL test reported to the NYC HSR during each 4 month period in the 12 months immediately following diagnosis. 4 Suppressed viral load is defined as a patient's most recent viral load quantity reported to the NYC HSR within 6 or 12 months of diagnosis was ≤200 copies/mL. 64

Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31,

Other related data sources NYLinks website: NYLinks database: NYLinks blog: linkandretain.wordpress.comlinkandretain.wordpress.com ETE dashboard: etedashboardny.orgetedashboardny.org 67