Development of a Mission-Driven Research Agenda to Support Efforts to End Epidemics.

CONTEXT: New York State continues efforts to end the AIDS and hepatitis C epidemics and reduce new infections of sexually transmitted infections. PROGRAM: In 2022, the New York State Department of Health AIDS Institute released its first-ever Research Agenda. This Research Agenda was systematically developed following input from internal and external research and community stakeholders. We used a participatory and iterative process to prioritize research knowledge gaps related to HIV/AIDS; sexual health and sexually transmitted infections; hepatitis C; lesbian, gay, bisexual, transgender health; drug user health; health equity; and emerging issues such as COVID-19. Questions were prioritized on the basis of the alignment with the following 5 criteria: magnitude of impact; funding and resources; feasibility of conducting research; translatability; and addresses an internal priority area. Findings are anticipated to generate actionable results that can be readily translatable into programs, policies, and practices. IMPLEMENTATION: This Research Agenda includes 79 research and program evaluation questions prioritized for internally led and collaborative research. Efforts on 35 of the 61 internally led questions and funding of 11 collaborative research projects related to Research Agenda priorities began in 2022. EVALUATION: An evaluation survey was conducted among all stakeholders involved in the prioritization process. All were satisfied or very satisfied with the process, and results yielded recommendations for future processes including weighting of questions relative to one another within each focus area and other suggestions to streamline the process. In year 1, 10 of the 35 questions were completed. DISCUSSION: Lessons learned include use of a participatory process to facilitate support and completion of Research Agenda, prioritize research questions to maximize impact and translatability, streamline the prioritization process by restricting proposed questions to those with clear potential for innovative research, emphasize anticipated resources necessary to implement the Research Agenda to set a realistic and actionable plan, and adaptability toward shifting priorities.

Geospatial Prioritization to Reach Hispanic or Latino and Other Priority Populations Through HIV Home Testing Services.

CONTEXT: Hispanic or Latino men who have sex with men (HLMSM) are disproportionately affected by the HIV/AIDS epidemic in New York State (NYS) and nationally. In 2019, HLMSM comprised 13% of all new diagnoses and 21% of new diagnoses among men who have sex with men (MSM) in NYS excluding New York City. HIV home testing programs are effective methods for increasing HIV testing. OBJECTIVE: This pilot sought to determine whether the NYS HIV Home Test Giveaway (HHTG) can effectively reach priority populations, specifically HLMSM/transgender/gender nonconforming persons who have sex with men, to increase uptake of HIV home testing services and identify new HIV infections. DESIGN/SETTING: We recruited participants using media campaigns linked to a brief self-administered eligibility survey. Eligible participants provided their e-mail address to receive a code for a free HIV home test and were sent a self-administered follow-up survey 4 to 11 weeks after eligibility survey completion. PARTICIPANTS: The 2018 and 2019 NYS HHTG reached 1214 and 1340 participants, respectively. A total of 606 participants in 2018 and 736 participants in 2019 were eligible to receive the HHTG home test kit. MAIN OUTCOME MEASURES: HHTG utilization and test results. RESULTS: Hispanic or Latino persons participated at higher rates (34.8% and 25.4% in 2018 and 2019, respectively) than the percentage of Hispanic men in prioritized zip codes (15.7% and 15.6% in 2018 and 2019, respectively). The majority of participants who received HHTG test kits used them to test themselves (87.5% in 2018 and 90.6% in 2019). Across both rounds, 4 participants reported new HIV-positive results, for a seropositivity rate of approximately 1%. CONCLUSION: Geospatial prioritization was successful in reaching Hispanic or Latino priority populations for HIV testing. HIV self-testing programs such as the HHTG are beneficial methods to reach priority populations for state and national Ending the HIV Epidemic initiatives.

Assessing the Impact of a PrEP Aware Week Campaign on PrEP Prescription Fills in NYS.

CONTEXT: The New York State (NYS) Department of Health AIDS Institute engaged stakeholders across NYS to participate in the state's first "PrEP Aware Week" (PAW). PAW sought to increase the knowledge, interest, and number of PrEP (pre-exposure prophylaxis) prescriptions filled across NYS. PAW activities were designed to be easy to implement, with minimal cost. Stakeholders were provided activities to implement, along with a social media tool kit featuring videos, graphic ads, and sample social media posts in English and Spanish to use as is or modify. PAW included more than 750 distinct events and activities undertaken by more than 250 participating providers. OBJECTIVE: To assess the impact of PAW on PrEP prescription filling patterns in NYS. DESIGN: An interrupted time-series analysis was conducted to estimate the impact of PAW on overall and new PrEP prescription filling patterns. Separate models were developed by sex (male, female), race and ethnicity (White non-Hispanic, Black non-Hispanic, Hispanic, other, unknown), and region (New York City, rest of NYS). SETTING: PAW took place across NYS during the week beginning October 20, 2019. PARTICIPANTS: PAW was undertaken by more than 250 health care providers, nonmedical health & human services providers, local and state health department staff, and colleges and universities. MAIN OUTCOME MEASURES: The number of overall and new PrEP prescriptions. RESULTS: PAW was associated with modest increases (6%-9%) in the number of PrEP prescription fills in NYS. The PAW impact lasted for about 2 months, generated an estimated 2727 additional PrEP prescription fills statewide, and was realized across sex, region, and racial and ethnic subgroups. Increased prescription fills were driven by those previously prescribed PrEP. Increases in new prescriptions were noted among Latinx individuals (21% increase, 55 additional prescriptions) but not overall or across other groups. CONCLUSION: NYS's PAW was effective at increasing PrEP prescription refills in NYS.

Improving Retention in HIV Care Through New York's Expanded Partner Services Data-to-Care Pilot.

CONTEXT: Data to Care (DTC) represents a public health strategy using HIV surveillance data to link persons living with diagnosed HIV infection (PLWDHI) to HIV-related medical care. OBJECTIVE: To investigate the feasibility of the DTC approach applied to a Partner Services program serving a geographically diffuse area of New York State. DESIGN: Disease intervention specialists received training to function as Expanded Partner Services (ExPS) advocates. HIV surveillance data identified PLWDHI presumed to be out of care (OOC). ExPS advocates attempted to locate and reengage OOC individuals in HIV-related care. The pilot ran from September 1, 2013, to August 31, 2014. SETTING: Four upstate New York counties, home to one-third of all PLWDHI in upstate New York. PARTICIPANTS: A total of 1155 PLWDHI presumed to be OOC. MAIN OUTCOME MEASURES: Linked to HIV medical care-cases verified as attending 1 or more HIV medical appointments subsequent to case assignment; reengaging in HIV care-any HIV laboratory test in the 6 months following case closure; and retention in HIV care-2 or more HIV laboratory tests in the 6 months following case closure. RESULTS: The majority of assigned cases (85.3%) were located; 23.7% (n = 233) of located cases confirmed as OOC; and 71.2% of OOC cases (n = 166) were successfully relinked into care. Relinkage success did not differ by gender, transmission risk, or major race/ethnicity categories; however, there was a direct relationship between age and successful relinkage (P < .001). Ninety-five percent of relinked cases reengaged in medical care, and 63.3% were retained in care. Individuals relinked by ExPS advocates were more likely to reengage in care (95%) than individuals interviewed but not relinked to care by advocates (53.7%) and individuals ineligible for the ExPS intervention (34.2%). CONCLUSION: DTC can be effective when conducted outside large metropolitan areas and/or closed health care systems. It can also be effectively incorporated into existing Partner Services programs; however, the relative priority of DTC work must be established in this context.

COVID-19 Vaccination and Hospitalization Among Persons Living With Diagnosed HIV in New York State.

BACKGROUND: Persons living with diagnosed HIV (PLWDH) have higher COVID-19 diagnoses rates and poorer COVID-19-related outcomes than persons living without diagnosed HIV. The intersection of COVID-19 vaccination status and likelihood of severe COVID-19 outcomes has not been fully investigated for PLWDH. SETTING: New York State (NYS). METHODS: We matched HIV surveillance, immunization, and hospitalization databases to compare COVID-19 vaccination and COVID-19-related hospitalizations among PLWDH during B.1.617.2 (Delta) and B.1.1.529 (Omicron) predominance. RESULTS: Through March 4, 2022, 69,137 of the 101,205 (68%) PLWDH were fully vaccinated or boosted for COVID-19. PLWDH who were virally suppressed or in care were more often to be fully vaccinated or boosted compared with PLWDH who were not virally suppressed (77% vs. 44%) or without evidence of care (74% vs. 33%). Overall hospitalization rates were lower among virally suppressed PLWDH. During Delta predominance, PLWDH with any vaccination history who were in care had lower hospitalization rates compared with those not in care; during Omicron predominance, this was the case only for boosted PLWDH. CONCLUSIONS: Approximately 28% (28,255) of PLWDH in NYS remained unvaccinated for COVID-19, a rate roughly double of that observed in the overall adult NYS population. PLWDH of color were more often than non-Hispanic White persons to be unvaccinated, as were the virally unsuppressed and those without evidence of HIV-related care, threatening to expand existing disparities in COVID-19-related outcomes. Vaccination was protective against COVID-19-related hospitalizations for PLWDH; however, differences in hospitalization rates between fully vaccinated and unvaccinated PLWDH were smaller than those among all New Yorkers.

Impact of COVID-19 on HIV Testing Among AIDS Institute-Funded Providers in New York State-A Time Series Analysis.

BACKGROUND: New York State (NYS) was at the intersection of the HIV epidemic and coronavirus disease 2019 (COVID-19) pandemic leading to a disruption in HIV-preventive services. This study sought to determine the impact of the COVID-19 pandemic and mitigation efforts on HIV-testing trends in NYS among AIDS Institute (AI)-funded providers. METHODS: We analyzed weekly testing data from the AI Reporting System from January 1, 2017, to June 27, 2021, to fit an interrupted time series model that predicted the expected number of HIV tests among AI-funded providers in NYS had the COVID-19 pandemic not occurred. The actual observed numbers of HIV testing that occurred from weeks beginning March 15, 2020, to June 30, 2021, were compared with the number of HIV tests predicted by the model. RESULTS: In the absence of the COVID-19 pandemic, our model predicted that there would have been 45,605 HIV tests among AI-funded providers between the weeks beginning March 15, 2020, to June 27, 2021. We observed 20,742 HIV tests, representing a 54.5% reduction. We observed percent decreases of greater than 50% for HIV testing among AI-funded providers for New York City (52.9%) and rest of state (59.8%) regions, male (50.6%) and female (66.8%) genders, as well as Black (59.2%), Hispanic (52.8%), mixed race (57.5%), other (50.3%), and White (50.1%) race and ethnicities. CONCLUSION: HIV testing among AI-funded providers in NYS has declined substantially following the COVID-19 pandemic, reflecting decreased access to, and/or demand for, testing among persons at elevated risk for HIV. Initiatives to increase HIV testing and maintain access to HIV prevention services need to be explored following COVID-19.

A randomized controlled trial to evaluate a structural intervention to promote the female condom in New York state.

We conducted a structural intervention to promote the female condom (FC), comparing 44 agencies randomized to a Minimal Intervention (MI) [developing action plans for promotion and free access] or an Enhanced Intervention (EI) [with the addition of counselor training]. Intervention effects were evaluated via surveys with agency directors, counselors and clients at baseline and 12 months. Agency-level outcomes of the FC did not differ between the two interventions at follow-up. Counselors in the EI showed significantly greater gains in FC knowledge and positive attitudes, although there was no difference in the proportion of clients counseled on the FC, which significantly increased in both conditions. There was a greater increase in intention to use the FC among clients in EI agencies. Intervention effects were stronger in medical agencies. Findings suggest that making subsidized FCs available and assisting agencies to formulate action plans led to increased FC promotion. Limitations and implications for future research and intervention efforts are discussed.

COVID-19 Outcomes Among Persons Living With or Without Diagnosed HIV Infection in New York State.

Importance: New York State has been an epicenter for both the US coronavirus disease 2019 (COVID-19) and HIV/AIDS epidemics. Persons living with diagnosed HIV may be more prone to COVID-19 infection and severe outcomes, yet few studies have assessed this possibility at a population level. Objective: To evaluate the association between HIV diagnosis and COVID-19 diagnosis, hospitalization, and in-hospital death in New York State. Design, Setting, and Participants: This cohort study, conducted in New York State, including New York City, between March 1 and June 15, 2020, matched data from HIV surveillance, COVID-19 laboratory-confirmed diagnoses, and hospitalization databases to provide a full population-level comparison of COVID-19 outcomes between persons living with diagnosed HIV and persons living without diagnosed HIV. Exposures: Diagnosis of HIV infection through December 31, 2019. Main Outcomes and Measures: The main outcomes were COVID-19 diagnosis, hospitalization, and in-hospital death. COVID-19 diagnoses, hospitalizations, and in-hospital death rates comparing persons living with diagnosed HIV with persons living without dianosed HIV were computed, with unadjusted rate ratios and indirect standardized rate ratios (sRR), adjusting for sex, age, and region. Adjusted rate ratios (aRRs) for outcomes specific to persons living with diagnosed HIV were assessed by age, sex, region, race/ethnicity, transmission risk, and CD4+ T-cell count-defined HIV disease stage, using Poisson regression models. Results: A total of 2988 persons living with diagnosed HIV (2109 men [70.6%]; 2409 living in New York City [80.6%]; mean [SD] age, 54.0 [13.3] years) received a diagnosis of COVID-19. Of these persons living with diagnosed HIV, 896 were hospitalized and 207 died in the hospital through June 15, 2020. After standardization, persons living with diagnosed HIV and persons living without diagnosed HIV had similar diagnosis rates (sRR, 0.94 [95% CI, 0.91-0.97]), but persons living with diagnosed HIV were hospitalized more than persons living without diagnosed HIV, per population (sRR, 1.38 [95% CI, 1.29-1.47]) and among those diagnosed (sRR, 1.47 [95% CI, 1.37-1.56]). Elevated mortality among persons living with diagnosed HIV was observed per population (sRR, 1.23 [95% CI, 1.07-1.40]) and among those diagnosed (sRR, 1.30 [95% CI, 1.13-1.48]) but not among those hospitalized (sRR, 0.96 [95% CI, 0.83-1.09]). Among persons living with diagnosed HIV, non-Hispanic Black individuals (aRR, 1.59 [95% CI, 1.40-1.81]) and Hispanic individuals (aRR, 2.08 [95% CI, 1.83-2.37]) were more likely to receive a diagnosis of COVID-19 than White individuals, but they were not more likely to be hospitalized once they received a diagnosis or to die once hospitalized. Hospitalization risk increased with disease progression to HIV stage 2 (aRR, 1.29 [95% CI, 1.11-1.49]) and stage 3 (aRR, 1.69 [95% CI, 1.38-2.07]) relative to stage 1. Conclusions and Relevance: In this cohort study, persons living with diagnosed HIV experienced poorer COVID-related outcomes relative to persons living without diagnosed HIV; Previous HIV diagnosis was associated with higher rates of severe disease requiring hospitalization, and hospitalization risk increased with progression of HIV disease stage.

Smoking among HIV positive New Yorkers: prevalence, frequency, and opportunities for cessation.

Tobacco use presents unique health risks for persons living with HIV/AIDS (PLWHA). There is an urgent need to characterize tobacco use among PLWHA, and to assess the capacity of HIV/AIDS service providers to deliver smoking cessation interventions. Questionnaires were administered to PLWHA in care in New York State (n = 1,094) and to State-funded HIV/AIDS service providers (n = 173) from 2005 to 2007. Current PLWHA smoking prevalence was 59%, three times the general population rate. Over 50% of current smokers were moderately or highly dependent on nicotine. Three-quarters of smokers indicated an interest in quitting, and 64% reported a least one quit attempt during the past year. Less than half of HIV/AIDS service providers reported always assessing tobacco use status, history, dependence, or interest in quitting at intake. Medical care providers were more likely to conduct assessments and provide services. Although 94% of providers indicated a willingness to incorporate tobacco cessation services, 65% perceived client resistance as a barrier to services. HIV/AIDS service providers are inadequately addressing the high smoking rate among PLWHA, despite being uniquely suited to do so. Efforts are needed to educate providers about the need for, and interest in, tobacco cessation.

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

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.

Assessing racial and ethnic disparities using a COVID-19 outcomes continuum for New York State.

PURPOSE: Heightened COVID-19 mortality among Black non-Hispanic and Hispanic communities (relative to white non-Hispanic) is well established. This study aims to estimate the relative contributions to fatality disparities in terms of differences in SARS-CoV-2 infections, diagnoses, and disease severity. METHODS: We constructed COVID-19 outcome continua (similar to the HIV care continuum) for white non-Hispanic, Black non-Hispanic, and Hispanic adults in New York State. For each stage in the COVID-19 outcome continua (population, infection experience, diagnosis, hospitalization, fatality), we synthesized the most recent publicly available data. We described each continuum using overall percentages, fatality rates, and relative changes between stages, with comparisons between race and ethnicity using risk ratios. RESULTS: Estimated per-population COVID-19 fatality rates were 0.03%, 0.18%, and 0.12% for white non-Hispanic, Black non-Hispanic, and Hispanic adults, respectively. The 3.48-fold disparity for Hispanic, relative to white, communities was explained by differences in infection experience, whereas the 5.38-fold disparity for non-Hispanic Black, relative to white, communities was primarily driven by differences in both infection experience and in the need for hospitalization, given infection. CONCLUSIONS: These findings suggest the most impactful stages on which to intervene with programs and policies to build COVID-19 health equity.

Simulating the End of AIDS in New York: Using Participatory Dynamic Modeling to Improve Implementation of the Ending the Epidemic Initiative.

OBJECTIVES: In 2014, the governor of New York announced the Ending the Epidemic (ETE) plan to reduce annual new HIV infections from 3000 to 750, achieve a first-ever decrease in HIV prevalence, and reduce AIDS progression by the end of 2020. The state health department undertook participatory simulation modeling to develop a baseline for comparing epidemic trends and feedback on ETE strategies. METHODS: A dynamic compartmental model projected the individual and combined effects of 3 ETE initiatives: enhanced linkage to and retention in HIV treatment, increased preexposure prophylaxis (PrEP) among men who have sex with men, and expanded housing assistance. Data inputs for model calibration and low-, medium-, and high-implementation scenarios (stakeholders' rollout predictions, and lower and upper bounds) came from surveillance and program data through 2014, the literature, and expert judgment. RESULTS: Without ETE (baseline scenario), new HIV infections would decline but remain >750, and HIV prevalence would continue to increase by 2020. Concurrently implementing the 3 programs would lower annual new HIV infections by 16.0%, 28.1%, and 45.7% compared with baseline in the low-, medium-, and high-implementation scenarios, respectively. In all concurrent implementation scenarios, although annual new HIV infections would remain >750, there would be fewer new HIV infections than deaths, yielding the first-ever decrease in HIV prevalence. PrEP and enhanced linkage and retention would confer the largest population-level changes. CONCLUSIONS: New York State will achieve 1 ETE benchmark under the most realistic (medium) implementation scenario. Findings facilitated framing of ETE goals and underscored the need to prioritize men who have sex with men and maintain ETE's multipronged approach, including other programs not modeled here.

Cumulative incidence and diagnosis of SARS-CoV-2 infection in New York.

PURPOSE: New York State (NYS) is an epicenter of the SARS-CoV-2 pandemic in the United States. Reliable estimates of cumulative incidence in the population are critical to tracking the extent of transmission and informing policies. METHODS: We conducted a statewide seroprevalence study in a 15,101 patron convenience sample at 99 grocery stores in 26 counties throughout NYS. SARS-CoV-2 cumulative incidence was estimated from antibody reactivity by first poststratification weighting and then adjusting by antibody test characteristics. The percent diagnosed was estimated by dividing the number of diagnoses by the number of estimated infection-experienced adults. RESULTS: Based on 1887 of 15,101 (12.5%) reactive results, estimated cumulative incidence through March 29 was 14.0% (95% confidence interval [CI]: 13.3%-14.7%), corresponding to 2,139,300 (95% CI: 2,035,800-2,242,800) infection-experienced adults. Cumulative incidence was highest in New York City 22.7% (95% CI: 21.5%-24.0%) and higher among Hispanic/Latino (29.2%), non-Hispanic black/African American (20.2%), and non-Hispanic Asian (12.4%) than non-Hispanic white adults (8.1%, P < .0001). An estimated 8.9% (95% CI: 8.4%-9.3%) of infections in NYS were diagnosed, with diagnosis highest among adults aged 55 years or older (11.3%, 95% CI: 10.4%-12.2%). CONCLUSIONS: From the largest U.S. serosurvey to date, we estimated >2 million adult New York residents were infected through late March, with substantial disparities, although cumulative incidence remained less than herd immunity thresholds. Monitoring, testing, and contact tracing remain essential public health strategies.

Elevated COVID-19 outcomes among persons living with diagnosed HIV infection in New York State: Results from a population-level match of HIV, COVID-19, and hospitalization databases.

BACKGROUND: New York State (NYS) has been an epicenter for both COVID-19 and HIV/AIDS epidemics. Persons Living with diagnosed HIV (PLWDH) may be more prone to COVID-19 infection and severe outcomes, yet few population-based studies have assessed the extent to which PLWDH are diagnosed, hospitalized, and have died with COVID-19, relative to non-PLWDH. METHODS: NYS HIV surveillance, COVID-19 laboratory confirmed diagnoses, and hospitalization databases were matched. COVID-19 diagnoses, hospitalization, and in-hospital death rates comparing PLWDH to non-PLWDH were computed, with unadjusted rate ratios (RR) and indirect standardized RR (sRR), adjusting for sex, age, and region. Adjusted RR (aRR) for outcomes among PLWDH were assessed by age/CD4-defined HIV disease stage, and viral load suppression, using Poisson regression models. RESULTS: From March 1-June 7, 2020, PLWDH were more frequently diagnosed with COVID-19 than non-PLWDH in unadjusted (RR [95% confidence interval (CI)]: 1.43[1.38-1.48), 2,988 PLWDH], but not in adjusted comparisons (sRR [95% CI]: 0.94[0.91-0.97]). Per-population COVID-19 hospitalization was higher among PLWDH (RR [95% CI]: 2.61[2.45-2.79], sRR [95% CI]: 1.38[1.29-1.47], 896 PLWDH), as was in-hospital death (RR [95% CI]: 2.55[2.22-2.93], sRR [95%CI]: 1.23 [1.07-1.40], 207 PLWDH), albeit not among those hospitalized (sRR [95% CI]: 0.96[0.83-1.09]). Among PLWDH, hospitalization risk increased with disease progression from HIV Stage 1 to Stage 2 (aRR [95% CI]:1.27[1.09-1.47]) and Stage 3 (aRR [95% CI]: 1.54[1.24-1.91]), and for those virally unsuppressed (aRR [95% CI]: 1.54[1.24-1.91]). CONCLUSION: PLWDH experienced poorer COVID-related outcomes relative to non-PLWDH, with 1-in-522 PLWDH dying with COVID-19, seemingly driven by higher rates of severe disease requiring hospitalization.

Who purchases nonprescription syringes? Characterizing customers of the Expanded Syringe Access Program (ESAP).

This study represents the first attempt in the USA to survey pharmacy nonprescription syringe customers at their point of purchase. We surveyed 62 individuals purchasing nonprescription syringes in seven pharmacies located in NYC and Albany, NY, USA. Three quarters of respondents purchased for illicit use, and 36% purchased for medical use, with differences found by race and gender. Half got their syringes from pharmacies "most of the time." Half had ever been refused a syringe purchase in a NYS pharmacy, with men, Blacks, and Hispanics reporting higher levels of refusals than women or whites. Two thirds reported syringe reuse but very few reported sharing. While approximately one quarter safely obtained and disposed of syringes "most of the time," two thirds used both safe and unsafe methods. Pharmacy-based syringe access programs are essential in areas not served by syringe exchanges.

Expanding access to sterile syringes through pharmacies: assessment of New York's Expanded Syringe Access Program.

OBJECTIVES: To investigate the evolution of pharmacist practices, attitudes, and experiences with the Expanded Syringe Access Program (ESAP), which permits over-the-counter sale of syringes by registered pharmacies in New York State. DESIGN: Longitudinal study. SETTING: New York State in 2002 and 2006. PARTICIPANTS: 506 (2002) and 682 (2006) managing pharmacists (response rates approximately 70%) at ESAP-registered pharmacies (n = 346 in both years). INTERVENTION: Mailed surveys (2002 and 2006). MAIN OUTCOME MEASURES: Pharmacist practices, attitudes, and experiences with ESAP over time. RESULTS: Approximately 75% of pharmacists reported that ESAP had facilitated timely/emergency access to syringes, and more than 90% in each year reported no problems or very few problems administering ESAP. The practice of placing additional requirements on the sale of syringes decreased from 2002 (51.4%) to 2006 (45.1%), while a 55% increase in syringe sales was reported between 2002 (43.3/month) and 2006 (67.1/month). The sale of sharps containers also increased between 2002 (85.2%) and 2006 (92.8%). Community independent pharmacies and those located outside New York City generally expressed more favorable attitudes and experiences with ESAP, although these differences decreased over time. CONCLUSION: Pharmacy-based syringe access is a viable harm-reduction alternative in the fight against blood-borne diseases, with ESAP now equaling the number of syringes being distributed by syringe exchange programs in New York State. Continued education/training is necessary to increase participation in ESAP and to further reduce barriers to ESAP use.

Data to Care Opportunities: An Evaluation of Persons Living With HIV Reported to Be "Current to Care" Without Current HIV-Related Labs.

BACKGROUND: Data to care (D2C) is an effective strategy using HIV surveillance data to link/relink persons living with HIV into medical care. However, some appearing to be not in care (NIC) report being in care (persons "current to care"). SETTING: New York State's Expanded Partner Services (ExPS) D2C program has identified many persons reported as "current to care." This evaluation describes these persons after 24 months of follow-up and identifies HIV-related laboratory-based testing patterns and results to determine whether this cohort could benefit from further programmatic intervention. METHODOLOGY: Data from ExPS assignments from September 2013 to May 2016 were used. Persons "current to care" were compared with persons NIC on demographics, subsequent HIV-related laboratory-based testing, and viral load suppression status. Persons "current to care" receiving subsequent HIV-related laboratory-based testing were compared with those who did not receive HIV-related labs. RESULTS: Persons "current to care" significantly differed from persons NIC on demographics and subsequent HIV-related laboratory-based testing (82% of persons "current to care" had subsequent HIV-related labs, versus 99% of those NIC who were relinked to care). Persons "current to care" were more likely to be virally suppressed at their subsequent lab than persons NIC who were relinked to care (72% vs. 47%). Minor differences were noted for persons "current to care" receiving subsequent HIV-related labs compared with those who did not. CONCLUSIONS: Persons "current to care" reflect a unique cohort who might benefit from further programmatic intervention. Although most received additional HIV-related labs, some were without labs for the duration of follow-up.

Cross-Jurisdictional Data to Care: Lessons Learned in New York State and Florida.

BACKGROUND: Data-to-Care (D2C) programming is an important strategy in locating and relinking persons with HIV who are not in care (NIC), back to care. However, Health Department D2C programs have found a large proportion of individuals who seem NIC are living outside of their jurisdiction. Jurisdictions are limited in ability to cross-communicate regarding such individuals. SETTING: Two D2C programs [New York State (NYS) and Florida (FL)] funded through the Partnerships-for-Care Demonstration Project, partnered to conduct a feasibility pilot project to test cross-jurisdictional D2C reciprocity. METHODS: Jurisdictions made efforts to set up infrastructure for cross-jurisdictional D2C, and NYS worked to identify persons reported in NYS presumed in need of linkage/relinkage efforts in FL using 3 years of NYS D2C program outcomes. RESULTS: One hundred forty NYS NIC individuals were presumed to need linkage/relinkage efforts in FL. However, case dispositions for these individuals were not able to be advanced beyond determining HIV care status due to 4 critical challenges: (1) Local legal and regulatory permissibility for sharing identifiable HIV surveillance information outside of a specific jurisdiction varies; (2) Electronic infrastructure in place does not support public health follow-up of individuals who are not within a jurisdiction's HIV surveillance system; (3) An individual's verifiable current residence is not easily attained; and (4) Roles, responsibilities, and case prioritization within each state, and across jurisdictions vary and require clear delineation. CONCLUSIONS: Although programmatic challenges during this D2C feasibility pilot project were unsurmountable for NYS and FL, potential solutions presented may facilitate broader national cross-jurisdictional D2C reciprocity.