overview of ryan white-funded rapid testing services

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Overview of Overview of Ryan White-Funded Ryan White-Funded

Rapid Testing ServicesRapid Testing ServicesBenjamin Tsoi, MD, MPHBenjamin Tsoi, MD, MPHDirector, HIV Testing UnitDirector, HIV Testing Unit

Mara Pillinger, MPHMara Pillinger, MPHTechnical Assistance Coordinator, HIV Testing Technical Assistance Coordinator, HIV Testing

UnitUnit

Ryan White-Funded TestingRyan White-Funded Testing

Ryan White (Ryan White) provides Ryan White (Ryan White) provides testing under:testing under: BASE-funded EIS contractsBASE-funded EIS contracts MAI-funded ESC contractsMAI-funded ESC contracts Harm reduction (HRR) contractsHarm reduction (HRR) contracts

Core services: Core services: Rapid HIV Testing (RHT)Rapid HIV Testing (RHT) Confirmatory TestingConfirmatory Testing**

Linkage to Care (LtC)Linkage to Care (LtC)****

*As of Mar ‘10 for HRR & Aug ‘10 for EIS/ESC **As of Mar ’10 for HRR

Ryan White Testing Ryan White Testing ContractsContracts

35 contracts funding 31 agencies across 35 contracts funding 31 agencies across 5 boroughs5 boroughs

Diverse settingsDiverse settings Community-based organizations (CBOs)Community-based organizations (CBOs) HospitalsHospitals Community health centers (CHCs)Community health centers (CHCs)

Ryan White Testing Ryan White Testing ContractsContracts

Diverse SettingsDiverse Settings CBOs targetCBOs target

MSM (& MSM of color), African Americans, MSM (& MSM of color), African Americans, Latinos, immigrants, the homeless, Latinos, immigrants, the homeless, formerly incarcerated, current/former formerly incarcerated, current/former substance users, etc.substance users, etc.

Hospitals offer testing in ERs, inpatient Hospitals offer testing in ERs, inpatient units (e.g. internal medicine, units (e.g. internal medicine, psych, detox) & outpatient clinics (e.g. psych, detox) & outpatient clinics (e.g. STDs, OB/GYN) STDs, OB/GYN)

Testing Program GoalsTesting Program Goals Identify PLWHA through testing and link them to Identify PLWHA through testing and link them to

medical caremedical care

Provide RHT in communities with high Provide RHT in communities with high prevalence of HIVprevalence of HIV Targeted outreach to at-risk populations and those Targeted outreach to at-risk populations and those

with a high proportions of delayed/concurrent with a high proportions of delayed/concurrent diagnosisdiagnosis

Routinized testing in medical settings in high Routinized testing in medical settings in high prevalence neighborhoodsprevalence neighborhoods

Provide LtC for newly-diagnosed persons or Provide LtC for newly-diagnosed persons or those who have been out-of-care for >9 months those who have been out-of-care for >9 months or have never before been in care in NYCor have never before been in care in NYC

Serve as payer of last resortServe as payer of last resort

Ryan White TestingRyan White TestingContract DistributionContract Distribution

CBOsCBOs HospitalHospitals/s/

CHCsCHCs

TotalsTotals

BronxBronx 55 22 77

BrooklynBrooklyn 44 33 77

ManhattManhattanan

1111 77 1818

QueensQueens 22 00 22

Staten Staten IslandIsland

11 00 11

TotalsTotals 2323 1212 3535

NB: This chart reflects the number of funded agencies with headquarters in each borough. Many agencies test across multiple boroughs.

Ryan White Testing Ryan White Testing ModelsModels

Targeted TestingTargeted Testing Outreach-based—identifying those at Outreach-based—identifying those at

high-riskhigh-risk CBOs & Hospitals/CHCsCBOs & Hospitals/CHCs

Routinized testingRoutinized testing Screening—routine offer of an HIV test to Screening—routine offer of an HIV test to

every patient who sees presents to a every patient who sees presents to a clinical settingclinical setting

Hospitals/CHCsHospitals/CHCs Mandated by new NYS HIV Testing LawMandated by new NYS HIV Testing Law

Ryan White Testing Ryan White Testing FundingFunding

Total funding= ~$ 6.5 million/year Total funding= ~$ 6.5 million/year BASE=~$3.8 million/yearBASE=~$3.8 million/year MAI=~$1 million/yearMAI=~$1 million/year HRR= ~ $1.7HRR= ~ $1.7 million/yearmillion/year

Ryan White Testing Data Ryan White Testing Data (Jan 2008-Oct 2010)(Jan 2008-Oct 2010)

Over 167,000 tests conductedOver 167,000 tests conducted 30% increase in volume of tests between 2008 30% increase in volume of tests between 2008

and 2009; on track to meet/exceed 2009 and 2009; on track to meet/exceed 2009 performance in 2010performance in 2010

~ 2,400 preliminary positives identified~ 2,400 preliminary positives identified

~350 clients linked to care~350 clients linked to care 63% of self-reported “new positives” were linked63% of self-reported “new positives” were linked

Over 1,000 out-of-care previously diagnosed Over 1,000 out-of-care previously diagnosed positives were linked to carepositives were linked to care

Ryan White Testing DataRyan White Testing Data(July 2009-June 2010)(July 2009-June 2010)

EIS/ ESCEIS/ ESC HRRHRR TotalTotal

# tested# tested 52,89352,893 13,88813,888 66,78166,781

% % preliminary preliminary seroprevalseroprevalence ence

1.2% 1.2% (n=625)(n=625)

1.6% 1.6% (n=224)(n=224)

1.3%1.3%(n=849)(n=849)

% % confirmed confirmed

50% 50% (n=310)(n=310)

20%20%(n=44)(n=44)

42%42%(n=342)(n=342)

% linked to % linked to care care

49% 49% (n=151)(n=151)

5%5%(n=2)(n=2)

43%43%(n=153)(n=153)

# known # known +s +s linked to linked to carecare

377377 N/AN/A 377377

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HIV Testing In NYCHIV Testing In NYC

A Complicated PictureA Complicated Picture

HIV Testing in NYCHIV Testing in NYCA Complicated PictureA Complicated Picture

Testing Providers

Clinical SettingsClinical Settings HospitalsHospitals CHCsCHCs STD ClinicsSTD Clinics TB ClinicsTB Clinics Dental ClinicsDental Clinics

Testing Providers


Clinical SettingsClinical Settings CBOsCBOs

Agency- basedAgency- based Mobile TestingMobile Testing Testing Events Testing Events

(fairs, etc.)(fairs, etc.)

Testing Providers


Clinical SettingsClinical Settings CBOsCBOs Correctional Correctional

SettingsSettings

Testing Providers



SettingsSettings Private PracticesPrivate Practices

Testing Providers




Testing Providers Testing Payers




Direct FundersDirect Funders CDCCDC SAMHSASAMHSA NYS DOHNYS DOH HRSA (RW Part C)HRSA (RW Part C)





Direct FundersDirect Funders Third Party PayersThird Party Payers





Direct FundersDirect Funders Third Party PayersThird Party Payers NYC DOHMHNYC DOHMH



HIV Testing Funded by NYC HIV Testing Funded by NYC DOHMHDOHMH

STD ClinicsSTD Clinics TB ClinicsTB Clinics NYC JailsNYC Jails Bureau of HIV/AIDSBureau of HIV/AIDS

Ryan White fundsRyan White funds CDC fundsCDC funds City Tax Levy FundsCity Tax Levy Funds

HIV Testing Funded byHIV Testing Funded byNYC DOHMHNYC DOHMH

STD ClinicsSTD Clinics TB ClinicsTB Clinics NYC JailsNYC Jails Bureau of HIV/AIDSBureau of HIV/AIDS

Ryan White portfolioRyan White portfolio Prevention portfolioPrevention portfolio

Prevention Testing Prevention Testing PortfolioPortfolio

Prevention is the other major portfolio Prevention is the other major portfolio of DOHMH testing contractsof DOHMH testing contracts Funded by CDC & City Tax Levy dollarsFunded by CDC & City Tax Levy dollars

39 contracts in 32 agencies39 contracts in 32 agencies Testing models:Testing models:

ScreeningScreening Targeted TestingTargeted Testing

Social Network StrategySocial Network Strategy Bath houses, homeless shelters, etc.Bath houses, homeless shelters, etc.

Comparing Contract Comparing Contract DistributionDistribution

BoroughBorough CBOsCBOs HospitHospitals/als/

CHCsCHCs

TotalTotal

RW Prev RW

Prev

RW Prev

BronxBronx 55 33 22 44 77 77

BrooklynBrooklyn 44 22 33 55 77 77

ManhattaManhattann

1111 1010 77 1313 1818 2323

QueensQueens 22 00 00 22 22 22

Staten Staten IslandIsland

11 00 00 00 11 00

Total 2323 1515 1212 2424 3535 3939

Comparing Funding Comparing Funding DistributionDistribution

*Post Aug 2010

Ryan Ryan WhiteWhite**

PreventioPreventionn

CBOsCBOs ~$4.2 ~$4.2 millionmillion

~$1.3 mill~$1.3 mill

HospitalsHospitals/ CHCs/ CHCs

~$1.8 ~$1.8 millionmillion

~$4.5 mill~$4.5 mill

A Unified Testing Effort?A Unified Testing Effort? 9 separate contract families result in 9 separate contract families result in

significant overlapsignificant overlap

Overlap in targeted populations (risk groups)Overlap in targeted populations (risk groups) Agencies targeting same populations in same Agencies targeting same populations in same

neighborhoods creates “competition”neighborhoods creates “competition”

Overlap in funded agenciesOverlap in funded agencies Roughly 1/3 of funded agencies have >1 contractRoughly 1/3 of funded agencies have >1 contract Agencies use different contracts to fund the same Agencies use different contracts to fund the same

activities at different timesactivities at different times Creates greater administrative and reporting Creates greater administrative and reporting

burden for agenciesburden for agencies

A Unified Testing Effort?A Unified Testing Effort? Different contract structures with Different contract structures with

different payment points and different different payment points and different reimbursement rates fuels differences in reimbursement rates fuels differences in performanceperformance

Before mid-2010Before mid-2010 Prevention paid for testing, confirmation & Prevention paid for testing, confirmation &

linkagelinkage EIS/ESC paid for testing & linkageEIS/ESC paid for testing & linkage HRR paid for testingHRR paid for testing Only EIS/ESC paid for linkage of “known Only EIS/ESC paid for linkage of “known

positives”positives”

One City, One PlanOne City, One Plan Propose a joint RFP for Ryan White- & Propose a joint RFP for Ryan White- &

Prevention-funded contractsPrevention-funded contracts

Advantages:Advantages: Enables Planning Council to support one Enables Planning Council to support one

unified testing plan for the entire cityunified testing plan for the entire city Allows agencies to submit only one applicationAllows agencies to submit only one application Enables agencies to plan, propose & manage a Enables agencies to plan, propose & manage a

single comprehensive testing programsingle comprehensive testing program Reduces administrative burden and reporting Reduces administrative burden and reporting

burden for agenciesburden for agencies Provides consistent reimbursement structure Provides consistent reimbursement structure

One City, One PlanOne City, One Plan

Advantages, con’t: Advantages, con’t: Enables DOHMH to better coordinate Enables DOHMH to better coordinate

funding, ensuring that all target groups funding, ensuring that all target groups and all areas of the city are covered by and all areas of the city are covered by both CBOs & hospitals/CHCsboth CBOs & hospitals/CHCs

Reduces administrative burden for Reduces administrative burden for DOHMHDOHMH

overview of ryan white-funded rapid testing services

Documents

care377na377hiv testing

hiv testing unitmara

overview of ryan white

number of funded agencies

agencies test

preliminary positives

diagnosed positives

selfreported new positives