Ending the HIV Epidemic: New York’s Quest to Become the First State to Reduce HIV Prevalence

Abstract

In 2014, New York State became the first jurisdiction to launch a statewide initiative to end AIDS by reducing the number of persons living with HIV for the first time since effective HIV treatment became available. The Ending the Epidemic (ETE) initiative encompasses (1) identifying and linking undiagnosed persons with HIV to care, (2) retaining persons with HIV in care, and (3) facilitating access to preexposure prophylaxis for persons at risk for acquiring HIV. We used a framework for public health program implementation to describe key characteristics of the ETE initiative, present progress toward 13 ETE target metrics, and identify areas in need of increased programming. We provide evidence suggesting that New York State is on track to end AIDS as an epidemic by the end of 2020. As of 2017, 76% of progress toward our primary ETE target had been achieved. Substantial progress on several additional metrics critical to decreasing HIV prevalence and to improving the health of persons living with HIV had also been achieved. Lessons learned included the following: (1) ETE-based programming should be tailored to each jurisdiction’s unique political and social climate, HIV epidemiology, fiscal resources, and network of HIV service providers; (2) key stakeholders should be involved in developing ETE metrics and setting targets; (3) performance-based measurement and timely communication to key stakeholders in real time are essential; and (4) examining trends in HIV prevention and care metrics is important for developing realistic ETE timelines.

An overview of programmatic indicators to monitor the roll-out of HIV preexposure prophylaxis

“…Articles described indicators related to preuptake stages ( n = 13) [20–32], PrEP uptake and use ( n = 41) [8,11,14,16,20–56], and PrEP programme impact ( n = 12) [8,11,24–26,40,46,51,57–59]. Most articles described coherent sets of indicators (i.e.…”

“…Here, a 'current PrEP user' was generally defined as someone who received PrEP at least once in the last 12 months. Several countries and international public health initiatives used or suggested the number of current users as key indicator for PrEP monitoring [24,25,27,40,[42][43][44][45]64]. Monitoring current use was perceived to provide key insights into a PrEP programme's ability to reach targeted populations.…”

“…The WHO, UNAIDS and PEPFAR advised to disaggregate data by age, sex and specific key populations [8,44,49]. Other studies and reports also suggested additional factors such as geographic area within a country [33,34,62], ethnicity, nationality or migrant status [11,28,29,34,35,38,45,46,60,62], and socioeconomic status [11,28,39,43,62].…”

Policy and Public Health

“…This supplement also includes informative case studies of multifaceted plans for improving public health services and outcomes. Morne et al 16 studied the implementation of New York State's Ending the Epidemic (ETE) initiative at its halfway point. By using 13 metrics, the authors estimated that the ETE initiative had achieved 42% of the intended progress toward the goal of ending the HIV epidemic.…”

“…By using 13 metrics, the authors estimated that the ETE initiative had achieved 42% of the intended progress toward the goal of ending the HIV epidemic. 16 A case study in Washington, DC, describes early challenges in implementing a change to a unit-cost reimbursement mechanism for HIV prevention and care services, combined with a merger of prevention and care-planning bodies. 17 Finally, a case study from Massachusetts describes the rollout and results of the first 4 years of an approach to managing HIV, viral hepatitis, STD, and TB control services that integrates provider, laboratory, and public health capacities.…”