Joint EtE/Brooklyn Knows/NYLinks Meeting

Joint EtE/Brooklyn Knows/NYLinks Meeting
October 1, 2019 Brooklyn Borough Hall, 209 Joralemon St, Community Room Brooklyn, NY 11201 1

Opening Remarks 2 Johanne Morne, Director, NYSDOH, AIDS Institute
Benjamin Tso, Deputy Director of Prevention, NYC DOHMH, BHIV 2

Opening Remarks Joan Edwards, Assistant Director Executive (MARO) AIDS Institute, DOH, NYS Benjamin Tsoi, Director of Prevention, DOHMH, NYC

Welcome 4

Picture Consent You allow EtE/Brooklyn Knows/NYLinks to take pictures at this event and to post them on our websites, social media platforms, and marketing materials for an undetermined period of time You have the right to revoke your consent for pictures that are publicly posted At no time will individual names be used to identify you, unless you sign the appropriate release form

“Improvement is a journey of many small steps.”

Shared Vision 7 Bruce Agins, Medical Director, NYSDOH AIDS Institute
Gail Burstein, MD, Commissioner of Health Erie County 7

Public Release of the Blueprint
April 29, 2015 We must add AIDS to the list of diseases conquered by our society, and today we are saying we can, we must and we will end this epidemic ~Governor Cuomo

EtE Goal: To end the HIV Epidemic in Brooklyn by the year 2020
Addressing first 5 Priority Blueprint Points Identify and provide support for the needs and gaps in the HIV Care Continuum Promote HIV awareness through testing Promote routine HIV screening in healthcare settings Linkage to prevention services, including PrEP Engagement in Care Viral Suppression Peer Learning for Providers and Consumers Linkage to Care Steve EtE Steering Committee: Addressing 5 Priority Blueprint Points in Brooklyn #1 – Routinize HIV testing #8 – Enhance services to support non-medical needs of persons with HIV #11 to 14 – All aspects pertaining to PrEP use #23 – Promote comprehensive sexual health education throughout the borough GTZ #1 – Ensure expedited access to essential benefits for all low-income persons with HIV in New York State

Mission Statement Steve 10

Brooklyn Shared Mission 2019
Through collaborative, targeted, and passionate alliance we can increase HIV testing, decrease stigma, promote early linkage and adherence to care, regardless of status, and determine the needs and gaps by working with partners and consumers toward ending the epidemic among all Brooklyn Communities. It was the final Mission statement decided by the group Steve

Report Back from 2018 Dave 12

Meeting Overview 13

Meeting Overview Meeting Co-Chairs: Meeting Purpose:
Steven Sawicki (NYSDOH AIDS Institute) Thierry Amegnona Ekon (NYCDOHMH) Zeenath Rehana, (NYCDOHMH) David Matthews, EtE, Bedford-Stuyvesant Family Health Center Meeting Purpose: Strengthen the coordination of improvement efforts to ultimately end the HIV epidemic in Brooklyn Align the efforts of EtE/Brooklyn Knows/Brooklyn NYLinks Create a platform for peer learning and regional improvements

Initiative Updates Bruce Agins, Medical Director, NYSDOH AIDS Institute Gail Burstein, MD, Commissioner of Health Erie County 15

New York/Brooklyn Knows Mission
New York Knows is a collaboration between New York City Department of Health and Mental Hygiene and community organizations, clinics, hospitals, colleges/universities, faith-based organizations and businesses, which aims to coordinate efforts to encourage all NYC residents to learn their HIV status and facilitate access to the city’s HIV prevention and treatment services.

New York Knows Key Components
Collectively we can make a greater impact. Our advocacy is amplified through coordination to serve NY residents better Develop borough-wide steering committees which meet monthly and guide the work – Brooklyn Knows Organize other subcommittees to meet needs identified by partners Strengthen relationships between agencies, develop linkages, and share information and resources Coordinate borough and city-wide testing and linkage events.

Goals of Brooklyn Knows
Provide a voluntary HIV test for every Brooklyn resident who has never been tested– with special attention to higher risk populations. Identify undiagnosed HIV-positive people in Brooklyn and link them to medical care. Make HIV testing a routine part of health care in Brooklyn. Connect HIV-negative people to preventative services, including PrEP and PEP HIV testing is the gateway to HIV treatment and prevention and is also a vital step in ending the epidemic.

What do we request of partners?
Pledge to support the goals of New York Knows Participate in monthly steering committee meetings Submit testing data quarterly Keep us updated on staff and program changes Coordinate and attend events

What do we offer our partners?
Event coordination, promotion, and support Technical assistance Weekly Newsletter/Promotional materials Opportunities to collaborate and network Online resource database – New York Knows Directory Event: HIV Awareness days, Atlantic Antic, Collaboration and Networking: All Partners Meetings, Regular Coalition Meetings, Co-chair meetings TA: expert subject matter presentations, referral to trainings, problem solving regarding testing programs, TA on testing technology etc…

Contact Information Brooklyn Borough Liaison Thierry Amegnona Ekon, Director of Jurisdictional Testing Initiatives Donovan Jones, Additional information,

NYLinks NYLinks began as a HRSA Special Project of National Significance and was subsequently adopted by the NYSDOH AIDS Institute Goals: End the Epidemic by 2020 by Improving linkage to care Engagement in Care Viral Suppression Peer Learning for Providers and Consumers Zeena/ Steve

NYLinks Strategies: Involve providers and consumers in planning and implementing regional networks that improve outcomes along the HIV treatment cascade Strengthen partnerships and peer learning through regional improvement networks Increase the use of quality improvement on an organizational and regional level Enhance understanding of how facility and local data have regional and statewide impact Zeena/ Steve

Existing Regional Group Locations
Zeena/ Steve

Regional Groups Engage all medical and non-medical organizations within a geographic area to improve linkage to care, retention in care, and viral suppression Involve all types of organizations—hospitals, community health centers, CBOs, local health departments, NYS staff Involve all levels of individuals—consumers, front line staff, administrators, data staff, QI staff, CEOs, medical directors, medical providers Develop both an organizational and a regional approach to improvement Use data to improve performance Use QI strategies to design and assess performance Use peer learning to spread innovation Zeena/ Steve

NY Links Website www.NewYorkLinks.org
Zeena/ Steve

Contacts Steven Sawicki, steven.sawicki@health.ny.gov
Zeenath Rehana,

Brooklyn Ending the Epidemic (EtE) Regional Steering Committee
David W. Matthews Program Manager Bedford-Stuyvesant Family Health Center Reed Vreeland Director of NYC Community Mobilization Housing Works October 1, 2019

New York State EtE Plan In June 2014, Governor Cuomo detailed a three-point plan to move us closer to ending the HIV epidemic in the state The goal of the initiative is to reduce the number of new cases of HIV from 3,000 to 750 annually by the year 2020 The three points: Identify persons with HIV who remain undiagnosed and link them to healthcare Link and retain persons diagnosed with HIV in healthcare to maximize viral suppression so they remain healthy and prevent further transmission Facilitate access to Pre-Exposure Prophylaxis (PrEP) for high-risk persons to help keep them HIV negative On October 14, 2014, Governor Cuomo announced members of the Ending the Epidemic Task Force. The Task Force was established to support Governor Cuomo's three-point plan. The Task Force developed and synthesized recommendations, presented in New York's Blueprint to end the epidemic.

Purpose of the Brooklyn Ending The Epidemic Regional Steering Committee
To provide a forum to develop and execute on-going EtE-related efforts in the Brooklyn region To eliminate duplication and enhance coordination among regional clinical and non-clinical service providers, faith-based initiatives, non-traditional partners, consumers and networks including Brooklyn Knows and NYLinks To develop and implement a strategic plan to address identified needs and gaps in the Brooklyn region in alignment with the Regional Action Plan To identify and address new emerging regional issues

Brooklyn EtE Priority Blue Print Points
Five prioritized Blue Print Points: BP#23: Promote comprehensive sexual health education BP#8: enhance and streamline services to support the non-medical needs of persons with HIV BP#’s 11 – 14: All items that facilitate access to pre-exposure prophylaxis BP#1: Make routine HIV testing truly routine, and GTZ#1: Single point of entry across all NYS for all low income persons with HIV/AIDS

Best Practices and Next Steps of the Brooklyn Ending The Epidemic Regional Steering Committee
All partners of the existing Brooklyn Knows and Brooklyn NYLinks initiatives are invited to attend all Brooklyn EtE Steering Committee meetings going forward Brainstorming has begun for planning the first EtE borough-wide event in Brooklyn with a focus on BP23 – To promote comprehensive sexual health education Next meeting scheduled for November 2019

Thank you. Please join us. David W. Matthews dmatthews@bsfhc
Thank you! Please join us!! David W. Matthews and Reed Vreeland etedashboardny.org NYS ETE Dashboard

Interactive Introduction
39

Please Tell us your name Tell us where you work
Tell us what you do there Share with us your favorite place in Brooklyn 40

Key Brooklyn HIV Data 41

HIV/AIDS IN BROOKLYN, NEW YORK CITY, 2017
HIV Epidemiology and Field Services Program New York City Department of Health and Mental Hygiene Published November

WHAT HIV SURVEILLANCE DOES
NYC medical providers and laboratories are required by state law to report HIV information to the health department Positive HIV test results, viral load and CD4 test results, and genotypes When we receive a report, we check to see if there is an existing match in our HIV Registry and if not then we assign the case for field investigation Patient interview and chart review Data in the HIV Registry is used to guide service delivery and to ask for funding from the federal government to support HIV services in NYC 4343

LIMITATIONS OF SURVEILLANCE DATA
For all reported clinical outcomes we also collect patient socio-demographics: Gender, race/ethnicity, age, zip code of residence, area- based poverty, transmission risk (e.g. MSM) Do not have good information on mental health, incarceration, homelessness, detailed risk behavior The information tells us which subpopulations are most impacted by the HIV epidemic and trends over time It does not tell us why we have these clinical outcomes and disparities 4444

NEW HIV DIAGNOSES 4

NUMBER OF NEW HIV DIAGNOSES BY BOROUGH IN NYC, 2013-2017
800 707 691 733 639 575 494 651 640 Brooklyn 576 600 534 New HIV diagnoses (N) 503 500 457 456 464 Bronx 459 417 460 411 400 402 Manhattan 435 400 Queens 308 269 Outside NYC/Unknown 200 212 39 53 60 42 43 Staten Island 2015 Year of Diagnosis 2013 2014 2016 2017 In NYC, the number of new HIV diagnoses decreased in all boroughs between 2013 and 2017. 5 As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

RATES OF NEW HIV DIAGNOSES BY BOROUGH IN NYC, 2013-2017
50 42.8 New HIV diagnosis rate per 100,000 population 40.2 40 37.4 35.0 35.4 34.3 31.8 Bronx 34.1 28.1 28.3 30 27.2 24.3 24.7 Manhattan Brooklyn 24.3 17.1 Queens 21.9 17.5 19.8 19.7 18.6 20 12.6 11.2 8.9 9.1 10 8.2 Staten Island 2013 2014 2015 Year of Diagnosis 2016 2017 The rate of new HIV diagnoses decreased in all boroughs between 2013 and 2017. New diagnoses in people residing outside of NYC or with an unknown borough of residence (N = 212 in 2017) are not shown. Rates are calculated using DOHMH population estimates, modified from US Census Bureau intercensal population estimates, updated September 2017. 6 As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

RATES OF NEW HIV DIAGNOSES BY ZIP CODE IN NYC, 2017
HIV diagnosis rate per 100,000 population¹ by ZIP code Non-residential zones NYC neighborhoods with the highest rates of new HIV diagnoses in 2017 were Chelsea-Clinton and Central Harlem-Morningside Heights. Rates calculated using DOHMH 2016 population estimates, modified from US Census Bureau intercensal population estimates, updated September 2017. 7 As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

NUMBER OF NEW HIV DIAGNOSES BY GENDER IN BROOKLYN, 2013-2017
600 548 529 498 490 500 Men New HIV diagnoses (N) 413 400 300 178 185 200 163 150 141 Women 100 2013 2014 2015 Year of HIV diagnosis 2016 2017 Between 2013 and 2017, the number of new HIV diagnoses among both men and women decreased in Brooklyn, with men having the highest numbers. Women include transgender women and men include transgender men. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 7

NUMBER OF NEW HIV DIAGNOSES BY RACE/ETHNICITY IN BROOKLYN, 2013-2017
500 443 447 400 372 354 352 Black New HIV diagnoses (N) 300 200 169 Latino/Hispanic 153 147 105 158 111 73 31 98 White 87 100 81 Asian/Pacific Islander 27 22 12 11 2013 2014 2015 Year of HIV diagnosis 2016 2017 Between 2013 and 2017, the number of HIV diagnoses decreased only among Blacks while they increased among other race/ethnicities in Brooklyn. Native American and multiracial groups not shown due to small numbers. There were 3 Native American and 7 multiracial people newly diagnosed with HIV in Brooklyn in As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 8

NUMBER OF NEW HIV DIAGNOSES BY AGE IN BROOKLYN, 2013-2017
300 251 245 239 231 20-29 years 216 New HIV diagnoses (N) 200 189 171 30-39 years 150 145 150 146 129 94 40-49 years 50-59 years 60+ years 13-19 years 100 88 78 93 78 77 55 74 31 68 48 28 44 44 37 37 27 27 2013 2014 2015 Year of HIV diagnosis 2016 2017 Between 2013 and 2017, people ages 20 to 29 had the highest numbers of new HIV diagnoses in Brooklyn. New diagnoses increased among people ages 30 to 39 between 2013 and 2017. New diagnoses in the 0 to 12 age group not displayed because of small numbers. There was 1 child ages 0 to 12 years old newly diagnosed with HIV in Brooklyn in 2017. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 9

NUMBER OF NEW HIV DIAGNOSES BY RACE/ETHNICITY AND AGE IN BROOKLYN, 2017
140 13-19 years 20-29 years 30-39 years 40-49 years 50-59 years 60+ years 120 New HIV diagnoses (N) 100 80 60 40 20 Black N=352 Latino/Hispanic N=158 Race/Ethnicity White N=98 Asian/Pacific Islander N=22 Blacks ages 20 to 29 and 30 to 39 accounted for the largest proportion of new HIV diagnoses in Brooklyn in 2017. Native American, multiracial groups, and people ages 0 to 12 not shown due to small numbers. There were 3 Native American, and 7 multiracial people newly diagnosed with HIV in Brooklyn in 2017. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 10

NUMBER OF NEW HIV DIAGNOSES BY TRANSMISSION RISK IN BROOKLYN, 2013-2017
400 342 347 MSM 297 300 New HIV diagnoses (N) 200 167 158 Heterosexual contact 119 125 118 100 22 14 9 18 11 9 12 13 8 10 12 4 12 10 8 IDU TG-SC MSM-IDU 2015 Year of Diagnosis 2013 2014 2016 2017 Between 2013 and 2017, the number of new HIV diagnoses decreased among all transmission risk groups except TG-SC in Brooklyn. TG-SC = transgender people with sexual contact. People with perinatal and unknown risks are not shown. There were 144 people with unknown risk and 0 persons with perinatal risk newly diagnosed with HIV in Brooklyn in 2017. 12 As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

NUMBER OF NEW HIV DIAGNOSES BY AREA-BASED POVERTY LEVEL IN BROOKLYN, 2013-2017
400 329 300 303 20%-<30% below FPL (High poverty) 300 270 266 New HIV diagnoses (N) 240 241 10%-<20% below FPL (Medium poverty) 171 191 192 200 171 30%-100% below FPL (Very high poverty) 126 117 129 100 122 41 0%-<10% below FPL (Low poverty) 25 18 26 13 2015 Year of Diagnosis 2013 2014 2016 2017 Between 2013 and 2017, the number of new HIV diagnoses decreased in neighborhoods with very high levels of poverty in Brooklyn. FPL=Federal Poverty Level. Unknown poverty category is not shown and includes those newly diagnosed with HIV and missing ZIP code at diagnosis. 13 As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

Mexico and Central America 12%
PERCENTAGE OF NEW HIV DIAGNOSES AMONG PEOPLE BORN OUTSIDE OF THE US BY REGION OF BIRTH, BROOKLYN, 2017 Africa 4% Other/Unknown <1% Middle East 2% South America 13% Asia 15% Europe 9% Most Frequent Countries: Haiti Mexico Jamaica Dominican Republic Mexico and Central America 12% Caribbean1 45% People born outside of the US accounted for 30% of new HIV diagnoses in Brooklyn in The Caribbean1, Mexico and Central America, and South America accounted for 70% of these new HIV diagnoses. 1 Excludes Puerto Rico and the US Virgin Islands. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 13

(33%) of its new HIV diagnoses born in the Caribbean.
NEW HIV DIAGNOSES AMONG PEOPLE BORN IN THE CARIBBEAN BY UHF NEIGHBORHOOD, NYC 2017 The Brooklyn neighborhood of East Flatbush-Flatbush had the largest number (33) and percent (33%) of its new HIV diagnoses born in the Caribbean. There were 237 new HIV diagnoses among people born in the Caribbean; due to missing address and people living outside NYC, data for 217 people are displayed on map. Riker’s Island is classified with the UHF neighborhood of West Queens. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 10

TIMELY LINKAGE TO CARE 16

with HIV increased in Brooklyn and in NYC.
TIMELY INITIATION OF CARE AMONG PEOPLE NEWLY DIAGNOSED WITH HIV IN NYC AND BROOKLYN, 100% Brooklyn NYC 82% 80% 75% 76% 76% 69% Timely initiation of care (%) 80% 72% 73% 69% 60% 65% 40% 20% 0% 2013 2014 2015 Year of Diagnosis 2016 2017 Between 2013 and 2017, timely initiation of care among people newly diagnosed with HIV increased in Brooklyn and in NYC. Timely initiation of care is defined as first CD4, VL, or genotype drawn within 30 days of HIV diagnosis. People diagnosed at death have been excluded. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 58

of women were linked timely to care than men or transgender people.
TIMELY INITIATION OF CARE AMONG PEOPLE NEWLY DIAGNOSED WITH HIV BY GENDER IN BROOKLYN, 2017 100% 91% 83% 80% 75% Timely initiation of care (%) 60% 40% 20% 0% Men N=485 Women N=137 Transgender N=11 Among people newly diagnosed with HIV in Brooklyn in 2017, a smaller proportion of women were linked timely to care than men or transgender people. Timely initiation of care is defined as first CD4, VL, or genotype drawn within 30 days of HIV diagnosis. People diagnosed at death have been excluded. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 59

TIMELY INITIATION OF CARE AMONG PEOPLE NEWLY DIAGNOSED WITH HIV BY RACE/ETHNICITY IN BROOKLYN, 2017
100% 88% 83% 80% 81% 80% 60% 40% 20% 0% Timely initiation of care (%) Black N=348 Latino/Hispanic N=157 White N=97 Asian/Pacific Islander N=21 Among people newly diagnosed with HIV in Brooklyn in 2017, a smaller proportion of Blacks were linked timely to care than Latino/Hispanics, Whites, and API . Timely initiation of care is defined as first CD4, VL, or genotype drawn within 30 days of HIV diagnosis. People diagnosed at death have been excluded. Native American and multiracial groups not displayed. There were 3 Native American and 7 multiracial people newly diagnosed with HIV in 2017. 19 As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

TIMELY INITIATION OF CARE AMONG PEOPLE NEWLY DIAGNOSED WITH HIV BY AGE IN BROOKLYN, 2017
100% 93% 87% 85% 82% 80% 72% 71% Timely initiation of care (%) 60% 40% 20% 0% 13-19 N=28 20-29 N=230 30-39 N=170 40-49 N=90 50-59 N=68 60+ N=46 Among people newly diagnosed with HIV in Brooklyn in 2017, people ages 40 to 49 and 60 and older had the smallest proportions of timely initiation of care. Timely initiation of care is defined as first CD4, VL, or genotype drawn within 30 days of HIV diagnosis. People diagnosed at death have been excluded. New diagnoses in the 0 to 12 age group not displayed. There was 1 child ages 0 to 12 years newly diagnosed with HIV in Brooklyn in 2017. 20 As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

Heterosexual contact N=119
TIMELY INITIATION OF CARE AMONG PEOPLE NEWLY DIAGNOSED WITH HIV BY TRANSMISSION RISK IN BROOKLYN, 100% 100% 90% 86% 83% 77% 80% Timely initiation of care (%) 60% 40% 20% 0% MSM N=346 IDU N=12 MSM-IDU N=8 Heterosexual contact N=119 TG-SC N=10 Among people newly diagnosed with HIV in Brooklyn in 2017, people with heterosexual contact had the smallest proportion with timely initiation of care. Timely initiation of care is defined as first CD4, VL, or genotype drawn within 30 days of HIV diagnosis. People diagnosed at death have been excluded. TG-SC = Transgender people with sexual contact. New diagnoses with other/unknown transmission risk not displayed. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 21

TIMELY INITIATION OF CARE AMONG PEOPLE NEWLY DIAGNOSED WITH HIV BY AREA-BASED POVERTY IN BROOKLYN, 2017 100% 96% 86% 79% 80% 74% Timely initiation of care (%) 60% 40% 20% 0% 0%-<10% below FPL (Low poverty) N=26 10%-<20% below FPL (Medium poverty) N=192 20%-<30% below FPL (High poverty) N= 297 30%-100% below FPL (Very high poverty) N= 116 Among people newly diagnosed with HIV in Brooklyn in 2017, those living in medium poverty areas had the smallest proportion timely linked to care. FPL=Federal Poverty Level. Timely initiation of care is defined as first CD4, VL, or genotype drawn within 30 days of HIV diagnosis. People diagnosed at death have been excluded. New diagnoses without area-based poverty information not displayed. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 22

TIMELY INITIATION OF CARE AMONG PEOPLE NEWLY DIAGNOSED WITH HIV BY COUNTRY OF BIRTH IN BROOKLYN, 100% 84% 86% 86% 80% 72% Timely initiation of care (%) 60% 40% 20% 0% US N= 277 US Dependency N= 7 Outside US N= 191 Unknown N=158 Among people newly diagnosed with HIV in Brooklyn in 2017, similar proportions of people born outside the US and those born in the US or in US dependencies were timely linked to care. Timely initiation of care is defined as first CD4, VL, or genotype drawn within 30 days of HIV diagnosis. People diagnosed at death have been excluded. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 23

Staten Island had the smallest proportions timely linked to care.
TIMELY INITIATION OF CARE AMONG PEOPLE NEWLY DIAGNOSED WITH HIV BY BOROUGH IN NYC, 2017 100% 84% 85% 82% 80% 79% 80% Timely initiation of care (%) 60% 40% 20% 0% Bronx Brooklyn Manhattan Queens Staten Island Among people newly diagnosed with HIV in NYC in 2017, residents of Queens and Staten Island had the smallest proportions timely linked to care. Timely initiation of care is defined as HIV viral load, CD4, or genotype test drawn within 1 month (30 days) of HIV diagnosis. People diagnosed at death have been excluded. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 24

Bedford Stuyvesant-Crown Heights
TIMELY INITIATION OF CARE AMONG PEOPLE NEWLY DIAGNOSED WITH HIV BY UHF NEIGHBORHOOD IN NYC, 2017 Proportion linked to care within 30 days by UHF neighborhood Bedford Stuyvesant-Crown Heights East Flatbush-Flatbush Coney Island-Sheepshead Bay Brooklyn neighborhoods with the smallest proportion of people timely linked to care in 2017 were East Flatbush-Flatbush (68.7%), Bedford Stuyvesant-Crown Heights (76.1%), and Coney Island-Sheepshead Bay (81.8%). Timely initiation of care is defined as first CD4, VL, or genotype drawn within 30 days of HIV diagnosis. People diagnosed at death have been excluded. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 25

VIRAL SUPPRESSION 26

VIRAL SUPPRESSION AMONG DIAGNOSED PLWHA BY BOROUGH IN NYC, 2017
100% 84% 84% 80% 83% 80% 74% 60% 40% 20% 0% Bronx Brooklyn Manhattan Queens Staten Island Among diagnosed PLWHA in NYC, Bronx residents had the smallest proportion virally suppressed. Viral suppression (%) 27 Viral suppression is defined as viral load <200 copies/mL. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

VIRAL SUPPRESSION BY UHF NEIGHBORHOOD IN NYC, 2017
Proportion virally suppressed by UHF neighborhood East New York Bedford Stuyvesant-Crown Heights Canarsie-Flatlands Brooklyn neighborhoods with the smallest proportion of virally suppressed PLWH in were Bedford Stuyvesant-Crown Heights (76.6%) East New York (78.0%), and Canarsie-Flatlands (79.6%). Viral suppression is defined as most recent viral load in 2017 was <200 copies/mL. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 69

VIRAL SUPPRESSION AMONG DIAGNOSED PLWHA BY GENDER IN BROOKLYN, 2017
100% 81% 79% 80% 76% Viral suppression (%) 60% 40% 20% 0% Men Women Transgender Among diagnosed PLWHA in Brooklyn, women and transgender people had smaller proportions of people virally suppressed than men. Viral suppression is defined as most recent viral load in 2017 was <200 copies/mL. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018. 70

largest proportions virally suppressed among all racial/ethnic groups.
VIRAL SUPPRESSION AMONG DIAGNOSED PLWHA BY RACE/ETHNICITY IN BROOKLYN, 2017 100% 89% 88% 82% 78% 80% 75% 65% Viral suppression (%) 60% 40% 20% 0% Black Latino/Hispanic White Asian/Pacific Islander Native American Multiracial Among diagnosed PLWHA in Brooklyn, Whites and Asian/Pacific Islanders had the largest proportions virally suppressed among all racial/ethnic groups. Viral suppression is defined as most recent viral load in 2017 was <200 copies/mL. Unknown race not shown. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

VIRAL SUPPRESSION AMONG DIAGNOSED PLWHA BY AGE IN BROOKLYN, 2017
100% 87% 83% 80% 79% 75% 71% 69% Viral suppression (%) 60% 40% 20% 0% Among diagnosed PLWHA in Brooklyn, those ages 20 to 29 had the smallest proportion virally suppressed, and those ages 60 and older had the largest. Viral suppression is defined as most recent viral load in 2017 was <200 copies/mL. PLWHA in the 0 to 12 age group not displayed. There were 23 children living with HIV/AIDS ages 0 to 12 in Brooklyn in As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

VIRAL SUPPRESSION AMONG DIAGNOSED PLWHA BY TRANSMISSION RISK IN BROOKLYN, 2017
100% 82% 82% 80% 80% 77% 80% 77% Viral suppression (%) 58% 60% 40% 20% 0% MSM IDU MSM-IDU Heterosexual TG-SC Perinatal Other/Unknown contact Among diagnosed PLWHA in Brooklyn, MSM and IDU had the highest proportions virally suppressed, and people with perinatal transmission risk had the smallest. TG-SC = Transgender people with sexual contact. Viral suppression is defined as most recent viral load in 2017 was <200 copies/mL. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

poverty neighborhoods were virally suppressed.
VIRAL SUPPRESSION AMONG DIAGNOSED PLWHA BY AREA- BASED POVERTY IN BROOKLYN, 2017 100% 84% 81% 79% 79% 80% Viral suppression (%) 60% 40% 20% 0% 0-<10% below FPL (Low poverty) 10-<20% below FPL (Medium poverty) 20-<30% below FPL (High poverty) 30-100% below FPL (Very high poverty) Among diagnosed PLWHA in Brooklyn, smaller proportions of people living in higher poverty neighborhoods were virally suppressed. FPL=Federal Poverty Level; Viral suppression is defined as most recent viral load in 2017 was <200 copies/mL. PLWHA without area-based poverty information not displayed. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

were virally suppressed compared to people born outside of the US.
VIRAL SUPPRESSION AMONG DIAGNOSED PLWHA BY COUNTRY OF BIRTH IN BROOKLYN, 2017 100% 84% 84% 82% 80% 77% Viral suppression (%) 60% 40% 20% 0% US US Dependency Outside US Unknown Among diagnosed PLWHA in Brooklyn, a smaller proportion of people born in the US were virally suppressed compared to people born outside of the US. Viral suppression is defined as most recent viral load in 2017 was <200 copies/mL. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

PROPORTION OF PLWH IN BROOKLYN ENGAGED IN SELECTED STAGES OF THE HIV CARE CONTINUUM, 2017
100% 100% 26% are not suppressed 93% 80% 85% 79% 74% 60% 40% 20% 0% People living with HIV-diagnosed Retained in care Prescribed ART Virally suppressed HIV/AIDS Of approximately 23,300 PLWHA in Brooklyn in 2017, 74% had a suppressed viral load. For definitions of the stages of the continuum of care, see Technical Notes. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2018.

diagnosed with HIV increased in Brooklyn and in NYC.
VIRAL SUPPRESSION WITHIN 3 MONTHS AMONG PEOPLE NEWLY DIAGNOSED WITH HIV IN NYC AND BROOKLYN, 100% 80% 60% Viral suppression (%) 47% Brooklyn NYC 36% 40% 31% 45% 27% 21% 33% 30% 20% 25% 19% 0% 2013 2014 2015 Year of Diagnosis 2016 2017 Between 2013 and 2017, viral suppression within 3 months among people newly diagnosed with HIV increased in Brooklyn and in NYC. Viral suppression is defined as most recent viral load in 2018 was <200 copies/mL. People diagnosed at death have been excluded. As reported to the New York City Department of Health and Mental Hygiene by March 31, 2019. 36

HIV/AIDS IN BROOKLYN: SUMMARY
The rate of new HIV diagnoses continues to decline Brooklyn has highest number of diagnoses but third highest rate Men, MSM, young adults ages 20-29, Blacks, and those born in the Caribbean continue to account for the largest number of HIV diagnoses After several years of not increasing, timely linkage to care increased in 2017 to be higher than citywide Within Brooklyn, levels were lower for women, Blacks, adults ages 40 to 49 and 60+, people with heterosexual contact, and in higher-poverty areas Viral suppression was same as NYC overall (74%). Timely viral suppression in 3 months in Brooklyn increased 124% in past 5 years Within Brooklyn, viral suppression was lower for transgender persons, people of color, younger people, those who acquired HIV through mother-to-child transmission, and in higher-poverty areas 37

HOW TO FIND OUR DATA Our program publishes annual surveillance reports and slide sets, as well as special supplemental reports during the year. Annual reports: surveillance-and-epidemiology-reports.page Slide sets: sets.page Statistics tables: surveillance-statistics.page HIV Care status reports (CSR) system: reports-system.page HIV Care Continuum Dashboards (CCDs): dashboard.page data requests to: – 2 weeks minimum needed for requests to be completed 38

APPENDIX: DEFINITIONS AND STATISTICAL NOTES Definitions:
“HIV diagnoses” include diagnoses of HIV (non-AIDS) and HIV concurrent with AIDS (AIDS diagnosed within 31 days of HIV), unless otherwise specified. “New HIV diagnoses” include individuals diagnosed in NYC during the reporting period and reported in NYC. “Death rates” refer to deaths from all causes, unless otherwise specified. Data presented by “Transmission risk” categories include only individuals with known or identified transmission risk, except when an “unknown” category is presented. “PWHA” refers to people with HIV or AIDS during the reporting period (note: includes people with HIV/AIDS who remained alive or died during the reporting period); “PLWHA” refers to people living with HIV or AIDS during the reporting period. “Women” includes transgender women and “Men” includes transgender men. For more information on transgender surveillance in NYC, please see the “HIV among People identified as Transgender” slide set. Risk information is collected from people’s self-report, their diagnosing provider, or medical chart review. “Heterosexual contact” includes people who had heterosexual sex with a person they know to be HIV-positive, an injection drug user, or a person who has received blood products. For women only, also includes history of sex work, multiple sex partners, sexually transmitted disease, crack/cocaine use, sex with a bisexual man, probable heterosexual transmission as noted in medical chart, or sex with a man and negative history of injection drug use. “Transgender people with sexual contact” includes people identified as transgender by self-report, diagnosing provider, or medical chart review with sexual contact reported and negative history of injection drug use. “Other” includes people who received treatment for hemophilia, people who received a transfusion or transplant, and children with a non-perinatal transmission risk. The MSM risk category does not include people known to surveillance to be transgender. Statistical notes: UHF boundaries in maps were updated for data released in 2010 and onward. Non-residential zones are indicated, and Rikers Island is classified with West Queens. 33

TECHNICAL NOTES: HIV CARE CONTINUUM
“People living with HIV/AIDS”: calculated as “HIV-diagnosed” divided by the estimated proportion of people living with HIV/AIDS (PLWHA) who had been diagnosed (92.6%), based on a CD4 depletion model. Source: NYC HIV Surveillance Registry. Method: Song R, et al. Using CD4 Data to Estimate HIV Incidence, Prevalence, and Percent of Undiagnosed Infections in the United States. J Acquir Immune Defic Syndr Jan 1;74(1):3-9. “HIV-diagnosed”: calculated as PLWHA “retained in care” plus the estimated number of PLWHA who were out of care, based on a statistical weighting method. This estimated number aims to account for out-migration from NYC, and therefore is different from the number of PLWHA published elsewhere. Source: NYC HIV Surveillance Registry. Method: Xia Q, et al. Proportions of Patients With HIV Retained in Care and Virally Suppressed in New York City and the United States. JAIDS 2015;68(3): “Retained in care”: PLWHA with ≥1 VL or CD4 count or CD4 percent drawn in 2017, and reported to NYC HIV surveillance. Source: NYC HIV Surveillance Registry. “Prescribed ART”: calculated as PLWHA “retained in care” multiplied by the estimated proportion of PLWHA prescribed ART in the previous 12 months (93.2%), based on the proportion of NYC Medical Monitoring Project participants whose medical record included documentation of ART prescription. Source: NYC HIV Surveillance Registry and NYC Medical Monitoring Project, 2016. “Virally suppressed”: calculated as PLWHA in care with a most recent viral load measurement in 2017 of <200 copies/mL, plus the estimated number of out-of-care 2017 PLWHA with a viral load <200 copies/mL, based on a statistical weighting method. 40

Public Charge-Immigration and HIV
82

Group Brainstorming 83

Brainstorming Exercise
Please form a small group of 8 to 10. Determine one facilitator in the group. Each small group will travel with a marker and with limited time to the flip charts on the wall. You can brainstorm ideas together and write them down on the flip-chart for couple of minutes. Every couple of minutes you will rotate to the next topic (flip chart) on the right, and see what you can add to the ideas already on the page from the previous small group entries. Then review everything together once the groups are at their starting page. Brainstorm together and write more if any new idea comes add to the flip-chart

Brainstorming Topics How we can work together to end the HIV epidemic in Brooklyn? Consumers: Stigma action plan HIV Testing: Social media awareness/education Peer outreach (Non-Clinical) Linkage to Care: Follow up call checking in on first visiting including trouble shooting issues as well as access to referral forms on NY knows directory (or something like EPIC) Keeping staff happy and prepared to work with clients, trauma informed care Prevention toolbox: More education that targets youth including condom demonstrations for both males and females to shift thinking (CBOs) PrEP Strategies: Enhancing trust in the medical system by addressing language/cultural barriers, increasing cultural competency among providers, and implementing peer-to-peer services Viral Load Suppression: Target activities toward high prevalence/low VL suppression and communities and agencies within these communities (3 in Brooklyn, Bedstuy/Crown heights) iART Enhancement of interagency collaboration and coordination (particularly between health care providers and CBOs) Other Topics: : Immigration, Mental health, Housing, Should we use these topics to the flip charts and put on the wall?? Consumer HIV Testing Linkage to Care PrEP Viral Load Suppression

TCQ + 86

Training of Consumers on Quality (TCQ) Plus Orientation Webinar
New York State Training of Consumers on Quality (TCQ) Plus Orientation Webinar

Pre-TCQ Participant Expectations
Identify and select NYLINKS regional group members to form up to two training team(s) Up to 2 teams per regional group Each training team will include one staff member from a provider organization and up to two consumers. Complete pre-work assignments by participating in 3 webinars on topics that include: Provide overviews of TCQPlus Program and Ryan White Program quality expectations Familiarize participants with basic principles of adult learning and discuss how these principles relate to designing learning experiences Read two essays on different methods of involvement including agitation, activism, and advocacy

Participant Expectations During TCQPlus
Attend and actively participate in TCQPlus in-person session Approximately 2 ½ full days of training (Proposing to deliver March Dates TBD) Training Location Location TBD

Post-TCQ Plus Participant Expectations
Participate in follow-up webinar for networking and staying connected to members of TCQPlus training team Design and deliver two (2) ½ day local TCQ Programs within 2-4 months after attending TCQPlus Identify and recruit consumers and providers to participate in local TCQ programs Work with AIDS Institute staff to plan TCQ program logistics (i.e., space, food, training materials, etc.) Report back to AIDS Institute staff on TCQ program(s) delivered and outcomes using Survey Monkey tool Participate in future clinical quality management capacity building webinars

Propose TCQPlus Participant Selection Process
Each NYLINKS regional group should determine who has the time, energy, and commitment to participate in the TCQPlus program Up to two PLWHA and one staff member can make up a training team All members of each training team should be or plan to be actively engaged in clinical quality management program activities Up to two training teams can be selected for each NYLINKS regional group Provider staff must review and sign “Recipient Agreement” to participate in the TCQPlus on behalf of the training team Agree to assist with logistical planning of regional TCQ program(s) Serve as regional content experts and present on facility or regional level cascade data during regional TCQ programs. The deadline to select NYLINKS regional training teams is January 31, 2020

Contact Information Steven Sawicki, NYLINKS Lead (518) (voice) or Daniel Tietz, Director Consumer Affairs (518) (voice)

Working Lunch 93

Presentations From The Field
94

Data for Quality Improvement: Improving Linkage to Care
October 1, 2019 Third Annual ETE / Brooklyn Knows / NY Links Meeting Finn David Schubert, MPH Network HIV Site Director Dana Evans Data Analyst

Family Health Centers at NYU Langone
FQHC network; established in 1967 Affiliated with NYU Langone Health Primarily serves Sunset Park, Park Slope, and Flatbush neighborhoods of Brooklyn 9 primary care centers 11 community medicine sites 46 school health sites 28 community based programs 130,000 patients served annually

HIV Program Overview Comprehensive program includes:
Counseling, testing, and referral Community outreach PEP and PrEP counseling and provision Medical services Medical and non-medical case management Mental health screening and treatment Substance abuse screening and treatment Medical nutrition and therapy

HIV Program Overview 469 patients were enrolled in the Ryan White Program in 2018 60% were born in 1970 or before; only 5% born in 60% Hispanic or Latino 67% White, 44% Black/African-American, 16% American Indian/Alaska Native 58% cisgender male, 39% cisgender female, 3% transgender female 66% below 100% federal poverty level 13% temporary or unstable housing

2018 Care Cascade Methodology
Azara registry reviewed daily by HIV data analyst Patient charts manually reviewed and updated in CAREWare Patients considered to be Open if they touch our system in any way—including the emergency department or NYU Langone Hospital – Brooklyn Care status of patients confirmed as they touch our system throughout the year Limitations: Some data (date and location of external dx, HIV care provider outside the network) only available in Epic notes, requiring careful manual review

2018 Cascade: Key Findings

Additional QI Findings

QI Priorities Reduce disparities in viral load suppression among transgender individuals and women ages 40-59 Actions taken: Focus group held at Brooklyn Community Pride Center to gain input from transgender community regarding creating a welcoming clinic environment Transgender cultural competency training for clinic staff Implementation of wellness/chronic disease educational workshops targeted at patients ages 40 and up Implementation of activity/social support group targeted at female patients ages 40 and up Improve 3-day and 7-day linkage to care (from 33% and 58%, respectively, to 50% and 75%) See next slides

Improving 3-day and 7-day linkage to care: Identifying the problem
Despite low rates of 3-day and 7-day linkage to care, we had achieved 92% 30-day linkage to care, suggesting that the linkage to care workflow needed to be streamlined to be completed more rapidly. Actions Taken: Creation of a daily report of network-wide HIV results Initiation of a rapid-rapid testing protocol to confirm a preliminary positive result and immediately link patient to care Provider education at all FHC sites regarding protocol for timely linkage (in process)

Daily network-wide report of HIV results
Report auto-generates daily from Epic Business Objects Lists all HIV tests in the network that resulted the previous day Patient information Provider/clinic location Type of HIV test Result Report is manually reviewed by HIV Data Quality Manager daily, HIV Navigation staff are alerted if there are any positive results for patients not already known to be in HIV care with us A separate daily report is generated for HIV tests conducted for patients hospitalized at NYU Langone Hospital – Brooklyn, this report is also reviewed daily by program staff

Rapid-Rapid Testing Protocol (Main HIV clinic sites only)

Provider Education (All FHC sites)

Data visualization to support ongoing monitoring

Questions?

Family Health Centers at NYU Langone
Lauren Jones, Nephtalie Dorceus, Panama Chavis

Park Slope Family Health Center: Teen Health Clinic
Thursdays 3:30pm-7:00pm Services: STI testing and counseling HIV testing and counseling PrEP counseling and linkage Birth control counseling Family planning Options counseling Family Planning Benefit Program (FPBP) Additional location: Sunset Park Clinic, Tuesdays 3:30-7:00pm

Family Health Centers at NYU Langone School Based Health Centers- Erasmus Campus
Monday –Friday 8:30-3:30 Making Proud Choices curriculum HIV 101 workshops Drug and Alcohol Risk Assessment Counseling and linkage STI testing and counseling HIV testing and counseling PrEP /PEP counseling and linkage Birth control counseling Family planning Options counseling Family Planning Benefit Program (FPBP) Yearly Physicals Eye exams

Ambassadors Youth led-peer education group that are educated and encouraged to provide workshops in the community Provide sexual health workshops HIV 101 Female male anatomy Contraception STI prevention Community engagement Tabling Workshops in non traditional settings

Success Increased access to STI testing for male patients leading to increase in treatment for those that test positive. Promoting the clinics in the workshops have lead to higher clinic visits across both sites. Our program evaluations have shown that, as a result of the workshops, most participants know more about how to protect themselves from pregnancy or STI’s and are more likely to practice safer sex or abstain from sex (97% and 89% respectively).

Challenges Follow through with students making appointments at the clinic when the clinic isn't directly connected to their school. Underrepresentation of male identifying patients among those that are tested. Making sure that information is shared in a way that is sensitive to different cultural groups among students and family members of students.

Contacts NYU Lutheran Family Health Centers
199 14th Street , 3rd floor Brooklyn, NY 11215 Lauren Jones- Nephtalie “Neph” Dorceus - Panama Chavis-

Lived Experiences 119

Team Action Planning and Report Back
Everyone works with their team 120

What one thing will you do, over the next 12 months, to improve HIV services in Brooklyn
Identify yourself or your organization Be specific Use Numbers Use dates Everyone works with their team 121

Next Steps and Evaluation
122

Thank You!! 123

Joint EtE/Brooklyn Knows/NYLinks Meeting

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