Preexposure Prophylaxis Monitoring in New York City: A Public Health Approach

Abstract

The scale-up of preexposure prophylaxis (PrEP) represents a paradigm shift in HIV prevention that poses unique challenges for public health programs. Monitoring of PrEP implementation at the population level is a national priority, with particular significance in New York City (NYC) given the substantial HIV burden and the prominence of PrEP in state and local Ending the Epidemic program plans. We highlight the importance of local monitoring and evaluation of PrEP implementation outcomes and describe the experience at the NYC Health Department, which includes engaging communities, triangulating a variety of data sources regarding PrEP implementation, and leveraging those data to help guide programming. In NYC, we used data from national surveillance systems and incorporated PrEP-related indicators into existing local data collection systems to help illustrate gaps in PrEP awareness and use. Ultimately, ensuring that PrEP achieves the desired impact at the population level depends on identifying disparities through appropriate and accurate measurement, and addressing them through evidence-based programs.

Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men

“…This collaboration became the cornerstone for a larger PrEP strategy in NYC characterized by four major activities to support PrEP, including (1) promoting PrEP to potential users (e.g., social marketing/media and an online directory of PrEP providers citywide); (2) promoting PrEP to potential providers (e.g., public health detailing to clinicians, plus trainings); (3) supporting PrEP provision in diverse practice models through patient navigation and establishing intersite referral net-works; and (4) comprehensive PrEP-related monitoring and evaluation. 87 We believe that the marked increase in PrEP prescribing in the jurisdiction that outpaces implementation elsewhere 88 can be attributed, at least in part, to the success of this partnership. This model for research-practice partnership that develops training and concrete materials to facilitate implementation and then disseminates those resources through networks could be replicated across different jurisdictions to accelerate diffusion of empirical findings into clinical settings, although modifications to this model, such as telementoring of community medical providers, 89 may be more appropriate in other contexts where geography limits inperson support.…”

PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure

“…PWID face stigma in their exclusion from PrEP marketing, which can translate into lack of PrEP awareness and knowledge, and thus halt engagement in subsequent care continuum stages. In 2014, the NYC Department of Health and Mental Hygiene (NYC DOHMH) launched inclusive PrEP campaigns [ 114 ] but they focused mainly on sexual transmission. Although these campaigns may have contributed to greater PrEP awareness amongst NYC participants, the exclusion of drug use messaging likely operated as a barrier to PrEP.…”

Trends in HIV prevalence by self-report among MSM diagnosed and reported with gonorrhea in six United States jurisdictions from 2010 to 2019

“…This is a promising finding that may reflect early and intensified public health efforts in these jurisdictions to reduce the incidence of HIV through interventions including PrEP and TasP, in New York City's 'Undetectable¼Untransmittable' (U¼U) and San Francisco's 'Getting to Zero' campaigns. Key concepts of these campaigns are now an integral part of the national Ending the Epidemic (EHE) initiative [15][16][17][18][19][20][21][22]. Gonorrhea transmission may also have peaked among MSM living with HIV in these areas and shifted toward HIV-negative MSM.…”