Queens NYLinks Evaluation Dissemination Slide Set August

Contents 1.NYS, NYC and Queens maps 2.Facility-level measures 3.Surveillance-based measures 2

Updates to NYLinks Maps 3 Glossary of key terms Data suppression rules utilized for cells (geographic units) with low numbers (marked by grey shading and diagonal lines) Actual case count numbers (e.g. plwhdi, new diagnoses, etc.) included at the county and UHF level for NYLinks regional maps Site names listed on all NYLinks regional maps Numbers of sites by type of services added to map legends Site locations added to Mid and Lower Hudson regional group map ‘Inactive’ sites removed from NYC maps Areas exceeding 2015 NHAS target 85% of linkage to care highlighted on linkage to care map Definitions of linkage, retention and viral load suppression added as footnotes where applicable NYC region added to NYS Ryan White Region HIV care outcome maps Map showing HIV viral suppression among all PLWDHI added for NYC and NYS (pending) State and city-wide rates added to NYS/NYC HIV care outcome maps(pending)

Glossary of Key Map Terms Linkage to Care: Percentage of newly diagnosed PLWH during the time period of interest (e.g., 2013) that had evidence of HIV care (≥ 1 CD4 or viral load test) reported within 90 days of the date of diagnosis. *Note for NYC linkage maps only: CD4 and viral load tests within 7 days of a patient’s diagnosis do not count towards linkage. NYS Prison Inmates: Prison inmates refer to persons incarcerated in state correctional facilities at the time of diagnosis (even if they are no longer in prison). The county of residence at diagnosis reflects the county of incarceration at the time of diagnosis or first report, which may be different from the individual’s home county and later county of incarceration. PLWHA: Persons Living with HIV/AIDS PLWDHI: Persons Living with Diagnosed HIV Infection Prevalence: The number or proportion of people with a particular disease or condition in a given population and at a specific time. For this set of maps, living HIV/AIDS cases per 100,000 population. Retention in Care (among newly diagnosed PLWH): Percentage of newly diagnosed PLWH during the time period of interest (e.g., 2013) who had evidence of care (≥ 1 CD4 or viral load test) at least three times during the 12 months following diagnosis, with at least one event occurring in each 4-month period. 4

Glossary of Key Map Terms (2) UHF: United Hospital Fund neighborhood corresponds to a geographic area within New York City that is an aggregate of between 1 and 9 zip codes but that is smaller than a borough. UHF neighborhoods reflect catchment areas for certain healthcare facilities. Viral Suppression (among newly diagnosed PLWH): Percentage of newly diagnosed with HIV during the time period of interest (e.g., 2013) whose last viral load test in the 12 months after diagnosis was <200 copies/mL (NYS) or ≤200 copies/mL (NYC). Viral Suppression (among all PLWDHI): Percentage of all PLWDHI at a specific point in time (e.g. 2013), whose most recent viral load test was <200 copies/mL (NYS) or ≤200 copies/mL (NYC). Viral Suppression (among PLWDHI in care): Percentage of PLWDHI with evidence of care (CD4/VL test) during the year (e.g. 2013) whose most recent viral load test was <200 copies/mL (NYS) or ≤200 copies/mL (NYC). 5

NYLinks Regional Groups 6

NYLinks Regions and HIV/AIDS Prevalence by County of Residence at Diagnosis: New York State,

HIV Diagnosis Rates by UHF Neighborhood New York City,

Prevalence of HIV/AIDS by UHF Neighborhood of Residence: New York City,

NYLinks Queens New HIV Diagnoses and HIV/AIDS Prevalence

Queens, 2013 New HIV Diagnoses and HIV/AIDS Prevalence Queens Sites: NYC DOHMH-Rikers Island Transitional Services Project, Women’s Prison Association, Elmhurst HHC, Jamaica Hospital, Damian Family Care Center, Queens Hospital, AIDS Center of Queens County, North Shore University Hospital/LIJ 11

NYLinks HIV Care Outcomes New York City,

Linkage to Care among Newly Diagnosed Persons by UHF Neighborhood at Diagnosis New York City, % linked out of 2,521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 74% linked out of 2,521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 13

Retention in Care among Newly Diagnosed Persons by UHF Neighborhood at Diagnosis New York City, % retained out of 2,521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 54% retained out of 2,521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 14

Viral Suppression among Newly Diagnosed Persons by UHF Neighborhood at Diagnosis New York City, % virally suppressed within 12 months out of 2,521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 65% virally suppressed within 12 months out of 2,521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 15

Viral Suppression among PLWDHI with Evidence of Recent Care by UHF Neighborhood New York City, % virally suppressed among 65,555 PLWDHI in care in NYC, 2013 Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 80% virally suppressed among 65,555 PLWDHI in care in NYC, 2013 Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 16

Viral Suppression among All PLWDHI by UHF Neighborhood: New York City, % virally suppressed among 101,848 PLWDHI in NYC, 2013 Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 52% virally suppressed among 101,848 PLWDHI in NYC, 2013 Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 17

Queens Regional Group Facility-level measures 18

Major Changes to Facility-Level Measure Slides Added list of NYLinks agencies Added data summary for facility-level measures Both retention measures show measurement period on the x-axis 19

Facility-level Measure Definitions 20 Linkage to care among newly diagnosed persons Percentage of newly diagnosed persons in the reporting period who had their first HIV clinical care visit within 30 days of the date of their confirmatory HIV test result Retention Percentage of patients with at least one HIV clinical care visit during the first six months of the 24-month measurement period, who had at least one HIV clinical care visit in each 6- month period of the remaining 18 months of the measurement period with a minimum of 60 days between HIV clinical care visits New patient retention Percentage of new patients who have their initial HIV clinical care visit during their first four months of the 12-month measurement period who had an HIV clinical care visit in each of the subsequent 4-month periods in the measurement period

Queens Group Members Queens 1.Elmhurst Hospital 2.HELP/PSI 3.Jamaica Hospital 4.North Shore/LIJ 5.Safe Space 6.Queens Hospital 21

Queens—Linkage to care (1): proportion of newly diagnosed persons linked to care within 30 days Data Source: NYLinks facility-level measures, updated: June 23, 2015 Start of Q/SI collaborative Feb client 1 site

Queens—Retention(2a): proportion of patients retained in care over 24 months Data Source: NYLinks facility-level measures, updated: June 23,

Queens—New patient retention(2b): proportion of new patients retained in care over one year Data Source: NYLinks facility-level measures, updated: June 23, pts 2 sites Eligible patients

NYC Surveillance-Based Measures: Queens July

Queens NYLinks Providers Included in Surveillance Slides HHC Elmhurst Hospital Center HHC Queens Hospital Center NY Hospital Queens Queens Village Committee for Mental Health for J-CAP HHC Jamaica Hospital Center Flushing Hospital Medical Center Voces Latinas Corp. Joseph P. Addabbo Family Health Center HELP/Project Samaritan/Damian Family Care Center Community Healthcare Network Episcopal Health Services/St. John’s Episcopal Hospital ACQC 26

Newly Diagnosed Indicators 27

Total Number of Newly Diagnosed Persons: Queens and rest of NYC Data Source: NYC HIV/AIDS Surveillance data, updated July 2015 with data reported by March 31, 2015 Diagnosed by Queens NYLinks Provider Diagnosed by Provider in the Rest of NYC TOTAL 2011Jan-Mar26 (3.0%) Apr-Jun37 (4.0%) Jul-Sep31 (3.8%) Oct-Dec30 (3.9%) Jan-Mar40 (5.0%) Apr-Jun38 (4.5%) Jul-Sep32 (4.1%) Oct-Dec29 (4.4%) Jan-Mar30 (4.2%) Apr-Jun 30 (4.0%) Jul-Sep30 (4.0%) Oct-Dec27 (4.4%) Queens collaborative begins 28

CONCURRENT DIAGNOSIS and MEDIAN CD4 AT DIAGNOSIS Data SourceHIV/AIDS Surveillance Registry Measure Concurrent HIV/AIDS diagnosis: Proportion of new HIV diagnoses during the reporting period of interest (e.g., 1 st quarter 2009) with an AIDS diagnosis that occurred within 31 days of the HIV diagnosis. Median CD4 cell count at diagnosis: median CD4 cell count of patients newly diagnosed during the reporting period (e.g., 1 st quarter 2009). The first CD4 cell count within 3 months of diagnosis is used to calculate the median. Example: Proportion of newly diagnosed PLWH during the first quarter of 2009 who also have an AIDS diagnosis within 31 days of their initial HIV diagnosis. Median CD4 count of those diagnosed in the first quarter of 2009 among those with a CD4 count available within 3 months of diagnosis. Numerator Number of PLWH diagnosed with HIV during the time period with a concurrent AIDS diagnosis. DenominatorTotal number of newly diagnosed PLWH in the time period. Patient Numerator and Denominator Exclusions PLWH who have no CD4 cell count within 3 months of diagnosis will not contribute to the median calculation. 29

Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 *Concurrent diagnosis: AIDS diagnosis within 31 days of HIV diagnosis Queens collaborative begins February

Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 *Concurrent diagnosis: AIDS diagnosis within 31 days of HIV diagnosis Queens collaborative begins February

Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 Queens collaborative begins February

LINKAGE TO CARE Data SourceHIV/AIDS Surveillance Registry Measure Linkage: Percentage of newly diagnosed PLWH during the time period of interest (e.g., 1 st quarter 2009) that had evidence of HIV care reported within 30 days, 60 days, 3 months, and 12 months of the date of diagnosis. Example: Percentage of newly diagnosed PLWH during the first quarter of 2009 that had evidence of HIV care within 30 days, 60 days, 3 months, and 12 months of the date of diagnosis. Numerator Number of newly diagnosed PLWH during the time period who had evidence of care reported within 8-30 days, 8-60 days, 8 days - 3 months, and 8 days - 12 months of the date of diagnosis. Denominator Total number of newly diagnosed PLWH during the time period. Patient Numerator and Denominator Exclusions CD4 and viral load tests within 7 days of a patient’s diagnosis do not count towards linkage as these may be associated with a diagnostic event only, and not a specific HIV care visit. Important definitions and conventions Evidence of care is defined as ≥ 1 CD4 or viral load test. 33

Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 *Labs (CD4/VL) within 7 days of diagnosis removed. Queens collaborative begins February 2013 Linked 30 days Linked 60 days Linked 90 days Linked 12 months 34

*Labs (CD4/VL) within 7 days of diagnosis removed. Bottom numbers=(# linked by providers / total # diagnosed by providers) Data Source: NYC HIV/AIDS Surveillance data, updated March 2015 with data reported through June 30, /12496/ % NHAS Linkage Goal by 2020

*Labs (CD4/VL) within 7 days of diagnosis removed. Bottom numbers=(# linked by providers / total # diagnosed by providers) Data Source: NYC HIV/AIDS Surveillance data, updated March 2015 with data reported through June 30, /124140/256 36

*Labs (CD4/VL) within 7 days of diagnosis removed. Bottom numbers=(# linked by providers / total # diagnosed by providers) Data Source: NYC HIV/AIDS Surveillance data, updated March 2015 with data reported through June 30, % NHAS Linkage Goal by /124167/256 37

*Labs (CD4/VL) within 7 days of diagnosis removed. Bottom numbers=(# linked by providers / total # diagnosed by providers) Data Source: NYC HIV/AIDS Surveillance data, updated March 2015 with data reported through June 30, /124206/256 38

RETENTION IN CARE AMONG NEWLY DIAGNOSED PLWH Data SourceHIV/AIDS Surveillance Registry Measure Retention among newly diagnosed PLWH: Percentage of newly diagnosed PLWH during the time period of interest (e.g., Q1 2009) who had evidence of care at least three times during the 12 months following diagnosis, with at least one event occurring in each 4- month period. Example: Percentage of newly diagnosed PLWH during the first quarter of 2010 who had evidence of care during each 4 month period during the 12 months following diagnosis. Numerator Number of newly diagnosed PLWH during the time period that had evidence of care in each 4 month period during the 12 months following diagnosis. DenominatorTotal number of newly diagnosed PLWH during the time period. Patient Numerator and Denominator Exclusions Important definitions and conventions Evidence of care is defined as ≥ 1 CD4 or viral load test. 39

Retention in Care among Newly Diagnosed PLWH in Queens and Rest of NYC Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 Queens collaborative begins February

VIRAL SUPPRESSION AMONG NEWLY DIAGNOSED PLWH Data SourceHIV/AIDS Surveillance Registry Measure Viral suppression among newly diagnosed PLWH: Percentage of newly diagnosed PLWH during the time period of interest (e.g., 1 st quarter 2009) whose most recently reported VL in the first 6 or 12 months post diagnosis was ≤200 copies/mL. Example: Percentage of patients newly diagnosed during the first quarter of 2009 whose most recent VL during the 6 and 12 month period following diagnosis was ≤200 copies/mL. Numerator Number of patients newly diagnosed during the time period whose most recent VL in the 6 or 12 months period following diagnosis was ≤200 copies/mL. Denominator Total number of patients newly diagnosed during the time period. Patient Numerator and Denominator Exclusions Patients who are documented to be deceased at any time during the time period. Important definitions and conventions Patients with no VL reported are considered not suppressed. 41

Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, months 42

PLWDHI Indicators 43

44 Upper Manhattan QueensStaten Island Received care by non-NYLinks provider in NYC Total10,6103, ,089 Sex Male68%64%58%71% Age (median, quartile range)34 (27-42)35 (28-43)34 (27-41)35 (28-42) Race/Ethnicity Black48%47%43%45% White14%8%22%21% Hispanic36%40%33%32% Asian/Pacific Islander1%5%1%2% Native American<1% Multiracial<1% - Transmission Risk Men who have sex with men34%31%14%39% Injection drug use history17%13%29%16% Heterosexual22%34%30%21% Perinatal4%2%4%2% Other<1% - Unknown23%20%23%22% CD4 count (median,quartiles)527 ( )534 ( )549 ( )547 ( ) Viral Load Quantity(median,quartiles)22 (0-621)60 (0-5246)351 ( ) not available Persons Living with Diagnosed HIV as of December 31, 2013 that received any care in NYC in 2013 Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015

EVIDENCE OF RECENT HIV CARE AMONG ALL PLWDHI Data SourceHIV/AIDS Surveillance Registry Measure Evidence of recent care among PLWDHI: Percentage of PLWDHI with any evidence of care during the reporting period of interest (e.g., 1 st quarter 2009). Example: Percentage of PLWDHI who had any evidence of care during the 1 st quarter of NumeratorNumber of PLWDHI with any evidence of care during the time period. DenominatorTotal number of PLWDHI during the time period. Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the time period. Important definitions and conventions Evidence of care is defined as ≥ 1 CD4 or viral load test. 45

Evidence of Recent Care Among all PLWDHI in NYC Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 UMRG collaborative begins January 2012 Q/SI collaborative begins February

RETENTION AMONG ALL PLWDHI IN CARE Data SourceHIV/AIDS Surveillance Registry Measure Retention among all PLWDHI: Percentage of PLWDHI with evidence of care during the time period of interest (e.g., 1 st quarter 2009) who had subsequent evidence of care days after the most recent care event in the time period of interest. Example: Percentage of PLWDHI in care during the 1 st quarter of 2010 who had evidence of care days after the most recent care event in the 1 st quarter of Numerator Number of PLWDHI with evidence of care during the time period of interest who had subsequent evidence of care days after the most recent care event in the time period of interest. Denominator Total number of PLWDHI, with evidence of care during the time period of interest. Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the time period. Important definitions and conventions Evidence of care is defined as ≥ 1 CD4 or viral load test. 47

Retention Among all PLWDHI in Care by a Queens NYLinks provider or another provider in Rest of NYC Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 *Data reporting issue due to Hurricane Sandy Queens collaborative begins February 2013 * 48

VIRAL SUPPRESSION AMONG PLWDHI IN CARE Data SourceHIV/AIDS Surveillance Registry Measure Viral Suppression among PLWDHI in care: Percentage of PLWDHI with evidence of care during the time period of interest (e.g., 1 st quarter 2009) whose most recent viral load test result during the time period was ≤200 copies/mL. Example: Percentage of PLWDHI with evidence of care during the 1 st quarter of 2009 for whom the whose most recent viral load result in the time period was ≤200 copies/mL. Numerator Number of PLWDHI whose most recent viral load results in the time period was ≤200 copies/mL. Denominator Total number of PLWDHI with evidence of care during the time period. Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the time period. Important definitions and conventions Patients with no VL reported are considered not suppressed. 49

Viral Suppression among all PLWDHI in Care by a Queens NYLinks provider or another NYC provider Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 Queens collaborative begins February

SUSTAINED VIRAL SUPPRESSION AMONG ALL PLWDHI IN CARE Data SourceHIV/AIDS Surveillance Registry Measure Sustained viral suppression among all PLWDHI: Percentage of diagnosed PLWDHI living and in care during the time period of interest (e.g. Q1 2009) whose VL quantities reported during the 12 months following evidence of care in the time period were all ≤200 copies/mL. Example: Percentage of diagnosed PLWH alive and in care Q whose VL quantities drawn through Q were all ≤200copies/mL. Numerator Number of diagnosed PLWH alive as of a specific point in time (e.g., March 31, 2009), test whose VL quantities reported during the 12 months following the point in time were all ≤200copies/mL. Denominator Total number of diagnosed PLWH alive as of a specific point in time (e.g., March 31, 2009) with ≥1 VL test over 12 months following the time point. Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the time period. Important definitions and conventions Patients with no VL reported are considered not suppressed. 51

Sustained Viral Suppression among PLWDHI in Care by a Queens NYLinks provider or another NYC provider Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 Queens collaborative begins February

VIRAL SUPPRESSION AMONG ALL PLWDHI Data SourceHIV/AIDS Surveillance Registry Measure Viral suppression among all PLWDHI: Percentage of diagnosed PLWDHI alive as of a specific point in time (e.g., June 30, 2010), whose most recent VL during the prior 6 months (January 1-June 29, 2010) was ≤200 copies/mL. Example: Percentage of diagnosed PLWH alive as of June 30, 2010 whose most recent viral load during the prior 6 months (January 1-June 29, 2010) was ≤200 copies/mL. Numerator Number of diagnosed PLWH alive as of a specific point in time (e.g., June 30, 2010), whose most recent VL during the prior 6 months (January 1-June 29, 2010) was ≤200 copies/mL. Denominator Total number of diagnosed PLWH alive as of a specific point in time (e.g., June 30, 2010). Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the 6 month window period leading up to the specific point in time 53

Viral Suppression among all PLWDHI in NYC Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 UMRG collaborative begins January 2012 Q/SI collaborative begins February

Queens HIV care cascades 55

Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, % unlinked 55% not retained 59% not suppressed by 6 months 44% not suppressed by 12 months

57 1 As reported to the New York City HIV Surveillance Registry (NYC HSR) by June 30, Timely linkage to care is defined as ≥1 CD4/VL reported to the NYC HSR days post diagnosis. 3 Retention in care is defined as ≥ 1 CD4/VL test reported to the NYC HSR during each 4 month period in the 12 months immediately following diagnosis. 4 Suppressed viral load is defined as a patient's most recent viral load quantity reported to the NYC HSR within 6 or 12 months of diagnosis was ≤200 copies/mL.

Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31,

Other related data sources NYLinks website: NYLinks database: NYLinks blog: linkandretain.wordpress.comlinkandretain.wordpress.com ETE dashboard: etedashboardny.orgetedashboardny.org 59