1. Brooklyn Regional Group
Meeting
Welcome to the Webinar
Introduction
Chat Room Question
What improvement ideas to you have to advance linkages and retention across agencies and providers?
July 18, 2018
9.30am to 12.00pm
Brooklyn 1

2. Opening Remarks 2 Bruce Agins, Medical Director, NYSDOH AIDS Institute
Gail Burstein, MD, Commissioner of Health Erie County 2

3. Opening Remarks Charles Gonzalez, MD
Medical Director, NYS Department of Health AIDS Institute

4. Opening Remarks Oni Blackstock, MD, MHS
Assistant Commissioner, NYCDOHMH HIV/AIDS Prevention and Control

5. Overview 5 Bruce Agins, Medical Director, NYSDOH AIDS Institute
Gail Burstein, MD, Commissioner of Health Erie County 5

6. Meeting Overview
Introduction of Brooklyn Co-Chairs: Clemens Steinbock, Zeenath Rehana
Meeting Purpose
To strengthen the Brooklyn Regional Group as a platform for peer learning and regional improvements
To better understand Brooklyn Surveillance Data
To learn from presentations from the field

7. Agenda Registration and Networking 9:00 - 9:20 Opening Remarks
9:20 - 9:35
Welcome, Introductions & Meeting Overview
9:35 – 9:45
2016 Surveillance Data for Brooklyn: Community Profile
9:45 – 10:00
Presentations from the Field: Lessons Learned Organizational HIV Cascade, and how providers are involving consumers in QI
10:00 – 10:50
Consumer Engagement: Living Cascade
10:50 – 11:05
QI Exercise and Team Action Plan
11:05 – 11:45
Next Steps & Evaluation
11: :00
Adjourn
12:00

8. 2016 Surveillance Data for Brooklyn: Community Profile
Cristina Rodriguez-Hart,
Epidemiologic Liaison, NYCDOHMH,
Bureau of HIV/AIDS Prevention and Control

9. HIV DIAGNOSES AND CLINICAL STATUS OF PEOPLE DIAGNOSED WITH HIV/AIDS IN BROOKLYN, 2016
Cristina Rodriguez-Hart, PhD
HIV Epi Liaison
HIV Epidemiology and Field Services Program
New York City Department of Health and Mental Hygiene
Presentation at Brooklyn Links Meeting
July 18, 2018

10. What surveillance does
NYC medical providers and laboratories are required by state law to report HIV information to the health department
Positive HIV test results, viral load and CD4 test results, and genotypes
When we receive a report, we check to see if there is an existing match in our HIV Registry and if not then we assign the case for field investigation
Field investigation: patient interview and chart review
Data in the HIV Registry is used to guide service delivery and to ask for funding from the federal government to support HIV services in NYC
First I will give some background on HIV surveillance. Surveillance sits within the HIV epidemiology and field services program in the Bureau of HIV/AIDS Prevention and Control.
We collect data that providers and laboratories are mandated by NY state to report including positive HIV test results, viral load and CD4 results, and genotypes. Our HIV registry goes back to the beginning of the epidemic and currently has about 240,000 people in it although about half are no longer alive.
Our centralized HIV registry, eHARS, is made up of records that come from a variety of sources, such as provider report forms, laboratory records, field investigation forms, and matching with other registries such as vital statistics.
I’ll use myself as an example of the process. A lab sends HIV test results for Cristina Rodriguez-Hart to the state. The state assigns me an ID and then sends my records to the NYC health department. The city then looks to see if they already have a Cristina Rodriguez-Hart in the registry. If they do have a match then my record is updated with the new HIV test result. If they do not find a match then my case is assigned for field investigation as a possible new HIV case.
And on a monthly basis we transfer surveillance data to the state and the CDC.
*If asked:
Data we send to the state is by name but going to CDC its soundex, which is a combination of letters from the first and last name and the DOB. Both data get transferred over a secure data network.

11. Limitations of surveillance data
For all reported clinical outcomes we also collect patient socio-demographics:
Gender, race/ethnicity, age, zip code of residence, area-based poverty, transmission risk (e.g. MSM)
Do not have good information on mental health, incarceration, homelessness, detailed risk behavior
The information tells us which subpopulations are most impacted by the HIV epidemic and trends over time
It does not tell us why we have these clinical outcomes and disparities
We can’t say why individuals are not linked to care in a timely manner or why they were not virally suppressed
What I would say about HIV surveillance data is that it is a mile wide but an inch deep. For each test result we have good data on several socio-demographic variables such as gender, race/ethnicity, and zip code. We do have transmission risk broadly speaking but we often have a considerable about of unknown risk data because that part of reports is left blank or our field investigators are not able to find someone.
In terms of more detailed information, such as mental health or incarceration, our data is not so good and so we generally don’t report this.
Because we believe that we have pretty complete reporting, we feel that we have a good picture of the subpopulations most impacted by HIV and what their trends are over time.
Unfortunately, this level of detail does not allow us to answer questions about why certain subpopulations are more impacted or why certain groups are not moving through the HIV care continuum well. We really rely on what providers on the ground can tell us about this.

12. HIV/AIDS in Brooklyn, 2016 Basic Statistics
29,738 persons living with HIV/AIDS in Brooklyn
1% of Brooklyn population
581 new HIV diagnoses
25% of all HIV diagnoses in NYC
Includes 110 HIV diagnoses concurrent with an AIDS diagnosis (19%)
322 new AIDS diagnoses
369 deaths among persons with HIV/AIDS
8.9 deaths per 1,000 mid-year persons living with HIV/AIDS^
I’ll start by giving the basic HIV statistics we have for Brooklyn overall and which you can find in our annual surveillance report.
In 2016 there were almost 30,000 individuals in Brooklyn diagnosed with HIV/AIDS, representing about 1% of the population of Brooklyn.
There were 581 new HIV diagnoses in Brooklyn. This is the largest number of all NYC boroughs, and it represents a quarter of all diagnoses in the city. About 1 in 5 new HIV diagnoses in Brooklyn were shortly followed by an AIDS diagnosis.
There were 322 new AIDS diagnoses and 369 deaths among people living with HIV/AIDS. This 369 represents a death rate of 8.5 deaths per 1,000 persons living with HIV/AIDS (PLWHA)
Notes to self:
NYC
PLWHA: 123,887
New dx: 2,279
% concurrent: 18%
AIDS dx: 1,265
Deaths: 1,403
Manhattan
PLWHA: 32,476
New dx: 468
% concurrent: 16%
AIDS dx: 245
Deaths: 275
Bronx
PLWHA: 29,803
New dx: 520
% concurrent: 19%
AIDS dx: 326
Deaths: 459
Queens
PLWHA: 18,307
New dx: 415
% concurrent: 21%
AIDS dx: 203
Deaths: 167 2

13. NEW HIV DIAGNOSES IN BROOKLYN and NYC, 2012-2016
Add an overall line for the citywide average rate.
The number and rate of new HIV diagnoses decreased in Brooklyn between 2012 and The rate was lower in Brooklyn than for NYC overall in these five years.
As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

14. AGE-ADJUSTED death rateS AMONG PLWH IN NYC and brooklyn, 2012-2016
Here we have the rate of death among people living with HIV/AIDS. More deaths are now attributed to non-HIV causes such as cancer, or major cardiovascular diseases, than are due to HIV causes.
The rate over the past 5 years in Brooklyn is the red line and the rate for New York City overall is the blue line. The rates have been very similar except that in 2016 the rate was higher for Brooklyn.
The age-adjusted death rate among PLWH decreased in Brooklyn and NYC during , and was lower in Brooklyn than NYC in 2016.
Age-adjusted to the NYC Census 2010 population.
The overall rate includes people with unknown cause of death. Death data and cause of death data for 2016 are incomplete.
As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

15. TIMELY INITIATION OF CARE WITHIN 3 MONTHS AMONG PEOPLE NEWLY DIAGNOSED WITH HIV IN NYC AND BROOKLYN,
Engaging someone newly diagnosed with HIV into care in a timely manner is one of the key clinical indicators we look at because the evidence has shown that it’s important to have PLWHA virally suppressed as soon as possible. We currently define timely initiation of care as linkage within 3 months after diagnosis.
This slide shows the proportion of individuals newly diagnosed with HIV who were linked within 3 months for the past 5 years, comparing Brooklyn the red line to the citywide average which is the blue line.
Overall from the proportion of individuals newly diagnosed with HIV who were linked to HIV care in a timely manner in Brooklyn remained stable, 70% to 71%. But if we look by year we see an increase in 2013, and then it steadily declined after that. In comparison, the citywide timely initiation of care proportion has increased steadily for the same time period.
One thing to note is that we’ve been reporting timely initiation of care as 3 months after diagnoses for a number of years, but the standards are changing and therefore next year we will report this as linkage of care within 1 month of diagnosis.
Timely initiation of care among people newly diagnosed with HIV decreased in Brooklyn since 2013, whereas it increased in NYC from 2012 to 2016.
Timely initiation of care is defined as first CD4 or VL drawn within 3 months (91 days) of HIV diagnosis, following a 7-day lag (Sabharwal CJ, Braunstein SL, Robbins RS, Shepard CW. JAIDS 2014;65(5): )
As reported to the New York City Department of Health and Mental Hygiene by March 31, 2017.

16. TIMELY INITIATION OF CARE AMONG PEOPLE NEWLY DIAGNOSED WITH HIV BY BOROUGH IN NYC, 2016
Among people newly diagnosed with HIV in NYC in 2016, Brooklyn and Staten Island residents were less likely to have timely initiation of care.
Timely initiation of care is defined as first CD4 or VL drawn within 3 months (91 days) of HIV diagnosis, following a 7-day lag (Sabharwal CJ, Braunstein SL, Robbins RS, Shepard CW. JAIDS 2014;65(5): )
As reported to the New York City Department of Health and Mental Hygiene by March 31, 2017.

17. TIMELY INITIATION OF CARE WITHIN 3 MONTHS AMONG PEOPLE NEWLY DIAGNOSED WITH HIV IN BROOKLYN BY UHF NEIGHBORHOOD, 2016
NYC
73%
Among diagnosed PLWHA in Brooklyn, timely initiation of care was lower than the citywide average for 8 of the 11 neighborhoods in 2016.
Proportions based on numerators at or below 10 are marked with an asterisk (*) and should be interpreted with caution.
Timely initiation of care is defined as first CD4 or VL drawn within 3 months (91 days) of HIV diagnosis, following a 7-day lag (Sabharwal CJ, Braunstein SL, Robbins RS, Shepard CW. JAIDS 2014;65(5): )
As reported to the New York City Department of Health and Mental Hygiene by March 31, 2017.

18. VIRAL SUPPRESSION AMONG DIAGNOSED PLWHA BY YEAR IN NYC AND BROOKLYN, 2012-2016
Now I will transition to showing similar data, but for viral suppression. When we looked at timely linkage to care we were just looking out of everyone newly diagnosed in Now with viral suppression we are including everyone diagnosed with HIV, whether they were diagnosed in 2016 or in an earlier year.
Overall from the proportion of diagnosed PLWHA who achieved viral suppression in Brooklyn increased, which is the redline in this graph. The blue line is for all of NYC and like Brooklyn it has been steadily increasing in the past 5 years and is just little higher than for Brooklyn.
Viral suppression among all people diagnosed with HIV/AIDS steadily increased in both Brooklyn and NYC between 2012 and 2016.
Viral suppression is defined as viral load ≤200 copies/mL.
As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

19. VIRAL SUPPRESSION AMONG DIAGNOSED PLWHA IN BROOKLYN BY UHF NEIGHBORHOOD, 2016
NYC
80%
Among diagnosed PLWHA in Brooklyn, viral suppression was lower than the citywide average for 7 of the 11 neighborhoods in 2016.
Viral suppression is defined as viral load ≤200 copies/mL.
As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

20. VIRAL SUPPRESSION WITHIN 3 AND 6 MONTHS OF HIV DIAGNOSIS IN NYC AND BROOKLYN, 2016
The previous slides looked at viral suppression overall for everyone ever diagnosed with HIV in Brooklyn. The objective now is to get PLWHA virally suppressed as soon as possible therefore it’s important to look at timeliness of viral suppression.
In 2016 timely viral suppression at 3 months and 6 months after diagnoses was lower for individuals newly diagnosed with HIV in Brooklyn than for individuals newly diagnosed with HIV in NYC overall.
Among people newly diagnosed with HIV in 2016, a lower proportion achieved viral suppression within 3 months and within 6 months of diagnosis in Brooklyn than in NYC overall.
Viral suppression is defined as viral load ≤200 copies/mL.
As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

21. VIRAL SUPPRESSION WITHIN 6 MONTHS OF HIV DIAGNOSIS BY BOROUGH IN NYC, 2016
Among people newly diagnosed with HIV in NYC in 2016, Brooklyn residents were the least likely to have achieved viral suppression within 6 months of diagnosis.
Viral suppression is defined as viral load ≤200 copies/mL.
As reported to the New York City Department of Health and Mental Hygiene by March 31, 2017.

22. HIV/AIDS in Brooklyn: where we stand in 2016
The rate of new HIV diagnoses continues to decline
MSM, young adults ages 20-29, and blacks continue to account for the largest number of HIV diagnoses
Death rate has steadily declined
Levels of timely initiation of care were lowest in Brooklyn and have not increased in past 4 years
Within Brooklyn, levels were lowest for transgender persons, blacks, adults younger than 50, lower poverty, and US born
Viral suppression overall was similar in Brooklyn as for NYC, but timely viral suppression within 6 months for newly diagnosed individuals was lowest in Brooklyn
Within Brooklyn, viral suppression was lower for transgender persons, blacks, adolescents, those perinatally-infected, and US born
In conclusion, where we stand in 2016 is that the number of new HIV diagnosis in Brooklyn is at its lowest point ever. Once we account for Brooklyn’s large population size, the rate of new diagnoses in Brooklyn is the third highest of the 5 boroughs.
In terms of who’s most affected by HIV in Brooklyn, MSM, young adults in their 20s, and blacks have the highest numbers of diagnoses.
The death rate for Brooklyn and NYC overall has been declining over the past 5 years, but in 2016 it was higher for Brooklyn than citywide.
In comparison to other boroughs, the levels of timely initiation of care and timely achievement of viral suppression among those diagnosed in Brooklyn was lower than it is in other boroughs. The levels were lowest among transgender persons, blacks, younger individuals and those born in the US compared to foreign-born individuals.

23. HOW TO FIND OUR DATA
Our program publishes annual surveillance reports and slide sets, as well as special supplemental reports during the year.
Annual reports:
Slide sets:
Statistics tables:
Care status reports (CSRs):
HIV Care Continuum Dashboards (CCDs):
data requests to:
2 weeks minimum needed for requests to be completed
This presentation just went over some of the highlights of the information available on our website. If you visit the website you can find more. The website is the best place to start when looking for data.
If you want pretty local level information as well, say for a neighborhood, we also have the data for that on the website.
We also can give you information on clinical outcomes of patients through the CSRs and CCDs.
If what you are looking for is not on our website, please send your request to the on this slide. We respond to requests for information in about 2 weeks.

24. Cristina Rodriguez-Hart HIV Epidemiologic Liaison
Thank you!
Cristina Rodriguez-Hart
HIV Epidemiologic Liaison
(347)
Thank you to >160 members of the HIV Epidemiology and Field Services Program staff for collection, management and analysis of these data.

25. DEFINITIONS AND STATISTICAL NOTES
APPENDIX 1:
DEFINITIONS AND STATISTICAL NOTES
Definitions:
“HIV diagnoses” include diagnoses of HIV (non-AIDS) and HIV concurrent with AIDS (AIDS diagnosed within 31 days of HIV), unless otherwise specified.
“New HIV diagnoses” include individuals diagnosed in NYC during the reporting period and reported in NYC.
“Death rates” refer to deaths from all causes, unless otherwise specified.
Data presented by “Transmission risk” categories include only individuals with known or identified transmission risk, except when an “unknown” category is presented.
“PWHA” refers to people with HIV or AIDS during the reporting period (note: includes people with HIV/AIDS who remained alive or died during the reporting period); “PLWHA” refers to people living with HIV or AIDS during the reporting period.
Female includes transgender women and Male includes transgender men. For more information on transgender surveillance in NYC, please see the “HIV among People identified as Transgender” slide set.
Risk information is collected from people’s self-report, their diagnosing provider, or medical chart review. “Heterosexual contact” includes people who had heterosexual sex with a person they know to be HIV-infected, an injection drug user, or a person who has received blood products. For females only, also includes history of sex work, multiple sex partners, sexually transmitted disease, crack/cocaine use, sex with a bisexual male, probable heterosexual transmission as noted in medical chart, or sex with a male and negative history of injection drug use. “Transgender people with sexual contact” includes people identified as transgender by self-report, diagnosing provider, or medical chart review with sexual contact reported and negative history of injection drug use. “Other” includes people who received treatment for hemophilia, people who received a transfusion or transplant, and children with a non-perinatal transmission risk.
The “men who have sex with men” risk category does not include anyone identified as transgender. 26

26. Presentations from the Field

27. Presenters Presenters
Housing Works Community HealthCare: Leslie Pierce
Brightpoint Health: Darshna Dave
SUNY Downstate: Jameela Yusuff

28. Consumer Engagement: Living Cascade

29. Quantum Leap Frog

30. Evaluation

31. Evaluation Please complete the session evaluation form
Complete our contact information sheet

32. Contact Information
Steve Sawicki, NYLinks Lead,
Regional Leads
Upper Manhattan—Susan Weigl,
Lower Manhattan—Susan Weigl
Western NY—Nanette Brey Magnani,
Long Island—Steven Sawicki
Central NY & Southern Tier—Steve Sawicki
Mid & Lower Hudson—Steve Sawicki
Queens—Nova West,
Brooklyn—Clemens Steinbock, and
Zeenath Rehana,
Bronx—Dan Belanger,
Northeastern NY—Steve Sawicki If not sure,