Estimating HCV prevalence at the state level: a call to increase and strengthen current surveillance systems.

The degree to which case surveillance captures persons ever infected with HCV is unknown. We determined the discrepancy between HCV seroprevalence, estimated from national survey data, among adults in New York State in 2008 (n = 286 262, or 1.95%) and the number of infected persons reported to the state's surveillance hepatitis registries (n = 144 015). Findings suggest the need to strengthen the existing surveillance system.

Projections of diagnosed HIV infection in children and adolescents in New York State.

Decreasing mother-to-child transmission is changing the population of children and adolescents with HIV. This project used recent epidemiological data to develop short-term projections of children and adolescents living with diagnosed HIV infection in New York State. A population simulation model was created to project prevalence of diagnosed HIV cases aged 0-19 years by age, sex, race/ethnicity and risk for years 2007-2014. Using 2006 data as the baseline population and 2001-2006 diagnosis and death data, annual diagnoses and deaths were calculated for each age/sex/race/risk category and known cases were 'aged' into the next year. The model produced annual estimates until 2014. The model predicts a decline in the number of persons aged 0-19 years living with diagnosed HIV in New York from 2810 in 2006 to 1431 in 2014, a net decrease of 49%. Living cases with paediatric risk continue to decrease. Cases aged 13-19 with non-paediatric risk increase slowly, leading to a shift in the risk composition of the population. The dominant effect seen in the model is the ageing out of perinatally infected children born before measures to prevent mother-to-child transmission were broadly implemented in the mid- to late 1990s. Changing trends in the young HIV-infected population should be considered in developing public health programmes for HIV prevention and care in New York State for the coming years.

An expenditure analysis of high-cost Medicaid recipients with HIV disease in New York State.

A retrospective analysis was conducted of federal fiscal year (FFY) 2007 New York State Medicaid claims and expenditure data to examine variation in expenditures among New York State Medicaid recipients with HIV disease and the extent to which this variation could be attributed to the prevalence of comorbidities and other chronic conditions unrelated to HIV disease. Median expenditures per person for the period for a high-cost group (those for whom expenditures exceeded $100,000 for the period) were over $157,000, with 40% of total expenditures for this group for treatment unrelated to their HIV disease. The prevalence of comorbidities in the high-cost population is very high, the most common being substance abuse and mental illness.

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.

Training HIV clinicians and building a clinical workforce: the experience in New York State.

In the late 1980s, New York State faced projected shortages in the supply of clinicians to meet the burgeoning HIV epidemic. In 1990, the New York State Department of Health AIDS Institute (AI), in collaboration with selected academic, medical center-based Designated AIDS Centers, responded by developing a two-year fellowship training program that provides skills training in the management of HIV disease and the public health aspects of the HIV epidemic. Its primary goal is to increase the number of highly qualified, broadly trained physicians, nurse practitioners, physician assistants, and dentists who can assume leadership roles in HIV-related direct care and program administration in New York State. In May 2002, each of the 74 scholars who had completed the full two-year program was mailed a survey that assessed the degree to which program goals had been met. Of the 48 survey respondents, 96 percent (46) had worked in HIV care at some time after completing the program and 90 percent were employed in HIV clinical settings. Of the 25 respondents with no HIV care experience prior to entering the program, 22 (88 percent) pursued careers in the field of HIV care after completing the program and remained in those jobs at the time of the survey. Of the 48 respondents, 42 (88 percent) held leadership positions (as program directors or medical directors), filled leadership roles as members of advisory boards, had published articles in professional journals, or had made presentations at national and international HIV/AIDS conferences; 91 percent of the respondents rated the overall quality of their training experience as "good" or "very good," the highest possible rating. The survey results indicate that this clinical training and leadership development program successfully met its primary goal of building the HIV/AIDS clinical healthcare workforce in New York State. Its success demonstrates that a state-funded, targeted clinical education program can address acute shortages in the public healthcare professional workforce in the absence of other privately or publicly funded professional development initiatives.