NJ PrEP Initiative Update New Jersey Department of Health Division of HIV, STD and TB Services (DHSTS) Annual Hiv testing site coordinators’ meeting May 16, 2017 Steven Saunders, MS Director, HIV Prevention, DHSTS

Integrating PrEP Services into NJ’s HIV Prevention Portfolio PrEP involves taking one pill (Truvada) daily by high risk HIV negative individuals to prevent the acquisition of HIV infection First and foremost, appropriateness of PrEP is completely dependent upon HIV status. An individual must test negative for HIV prior to initiating PrEP, and free of recent potential exposure Therefore, PrEP Service Integration occurs at two levels: At the time HIV testing occurs at a CTS or other testing venue, or by the PrEP Counselor When PrEP Counselors provide specialized PrEP counseling to those identified by HIV Test Counselors as negative, but at significant risk of HIV infection; self-identified walk in clients may also result from PrEP project marketing efforts

Integrating PrEP Services into NJ’s HIV Prevention Portfolio Training DIS CBOs No PrEP HRN PrEP Counselor PrEP PrEP Prescriber Clients Who May Choose PrEP HIV TEST HRN HIV+ HIV Care Navigator Partners Tested HIV+ Description of the workflow: Anyone accessing an HIV test site is screened for PrEP eligibility. These testing sites probably look very similar to the entities in your communities. Individuals that test positive for HIV are referred to HIV care, and partner testing is encouraged. For clients that test HIV negative but deemed to be high risk for acquiring HIV, they are referred to the PrEP counselor. If clients are ready to initiate PrEP, they are referred to a PrEP prescribing clinician. Clients who do no wish to take PrEP are encouraged to continue return for subsequent HIV testing, as well as other services. CTS STD/PP Clinics HIV Clinics DIS = Disease Intervention Specialists (DHSTS Partner Services staff) CBOs = Community-based organizations CTS = Counseling and testing sites, non-targeted HRN = High-risk negatives STD/PP = Sexually transmitted disease/Planned parenthood

The New Jersey HIV PrEP Counselor Initiative By early 2016, eight geographically dispersed HIV PrEP Demonstration Projects were established. Following two RFAs in 2016, an additional nine new PrEP Counselor projects were added in July, 2016 and seven more in January, 2017. As a result, there are now 24 funded PrEP Counselors located across the state, nine of which are co-located at HIV prevention projects that serve gay and bisexual men, 11 in HIV clinics, one in an Adolescent/Young Adult Medical Clinic, one in an STD clinic and two in planned parenthoods that are women-focused PrEP projects.

PrEP Counselor Sites Asbury Park - VNA Atlantic City – Atlanticare Medical Center and South Jersey AIDS Alliance Camden - AHEC and Cooper Health Systems Cumberland County - Complete Care Health Network (Millville, Vineland and Bridgeton) Elizabeth – Trinitas Regional Medical Center Hackensack - Buddies of NJ Jersey City - Hudson Pride and Jersey City Medical Center Morristown – Morristown Medical Center Neptune- Jersey Shore Medical Center Newark- Newark Beth Israel Medical Center, St Michaels Medical Center, Rutgers University Hospital IDP and DAYAM, North Jersey AIDS Alliance Perth Amboy – PP of Northern, Central and Southern NJ Paterson- Hyacinth AIDS Foundation, PP of Metropolitan NJ, Paterson Health Department STD Clinic Plainfield - Hyacinth AIDS Foundation Trenton - Henry J. Austin Health Center and Hyacinth AIDS Foundation

PrEP Counselors.... Provide PrEP education and general HIV risk reduction counseling Conduct in-depth HIV risk assessment to determine benefit of a PrEP referral Assess client readiness for PrEP regimen and medical follow-up Provide initial rapid HIV testing to screen out HIV+ (referred to Navigator) Assess client insurance status and complete insurance pre-authorization paperwork Refer client to medical professional to prescribe PrEP and do initial medical exam Provide additional supportive referrals Assist clients with adherence plans and monitor adherence between visits Develop local social media and social marketing campaigns to create awareness of PrEP and the PrEP Counselor services at each of their programs

PrEP Counselor Data Jan-Dec, 2016 WHO WERE THE PrEP CLIENTS IN 2016? 563 new clients seen by 17 PrEP Counselors 80% male, 19% female and 1% Transgender 46% Black, 45% White, 1% API, 8% other or not reported 29% Latino 30% 18-25 years old, 33% 26-35 years old 72% Gay/Bi/Other MSM, 17% Women, 8% Discordants, 1% TG, 1% IDU, 1% Other

PrEP Counselor Data Jan-Dec, 2016 WHAT WERE THE OUTCOMES FOR THESE CLIENTS? 545 (97%) referred to medical practitioner for PrEP prescription & initial exam 31 (6%) “failed” the risk assessment but wanted PrEP anyway and were referred – why is this important? client-centered, not provider-centered 145 (27%) required two or more PrEP Counselor visits before linking to PrEP – why is this important? PrEP Case Management vs. PrEP Counseling 477 (87%) kept or had a pending first appt with prescriber; 13% failed to keep their appt 239 (44%) kept a second 90-day medical appt for refill (data loss for clients on own) 273 (50%) on PrEP for six months; 41 (8%) for a year (incl. clients prior to 1/1/16) 47 (9%) deactivated; 1 seroconversion in a non-adherent client

Counselors provided 1,663 sessions in addition to initial PrEP Counseling sessions by topic:

Program Activities for 2017 Continue to provide PrEP Counselor Training Integrate PrEP into HIV Test Counselor Training Continue to hold quarterly PrEP Counselor Meetings Develop a list of PrEP Prescribers in New Jersey Implement new web-based client-level data collection system to replace current aggregate data collection methods All existing HIV Test Counselors to complete the on-line PrEP training module from Rutgers.

on-line PrEP training module from Rutgers link for registration: http://hiv.rutgers.edu/training/

New Jersey HIV PrEP Counselor Initiative THANK YOU & QUESTIONS