Health Care Services

HIV Uninsured Care Programs (ADAP - ADAP PLUS - HIV Home Care - ADAP Plus Insurance Continuation)

Program Description

The New York State Department of Health AIDS Institute has established four programs for HIV Uninsured Care (ADAP, ADAP Plus, ADAP Plus Insurance Continuation and the HIV Home Care Program). The mission of these programs is to provide access to medical services and medications for all New York State residents with HIV/AIDS. The programs' dual goals are: to empower individuals to seek, access, and receive medical care and prescription drugs without cost and to supply a stable and timely funding stream to health care providers, enabling them to use the revenues to develop program capacity to meet the needs of the uninsured HIV population.

The AIDS Drug Assistance Program (ADAP) began in 1987 as part of a national program to provide free HIV/AIDS drugs to low-income individuals not covered by Medicaid or without adequate third-party insurance. In November 1991, the HIV Home Care Program, modeled after ADAP, was implemented through a federal demonstration grant. The ADAP Plus primary care initiative was developed with cooperative funding through a unique partnership between New York City and New York State and was implemented statewide in October 1992. The ADAP Plus Insurance Continuation Program (APIC) began July 1, 2000. All four programs are integrated, centrally administered, use a unified application form, and coordinate outreach activities. The programs serve HIV-infected New York State residents who are uninsured or under-insured and meet established residency, financial, and medical criteria. The programs serve as a transition to Medicaid by providing interim assistance to individuals eligible for, but not yet enrolled in Medicaid, or assistance in meeting spend-down requirements. Individuals with third-party insurance who cannot meet the deductibles or co-payments, or whose policies have waiting periods, are eligible to enroll in the Programs. Adolescents who do not have access to the financial or insurance resources of their parents/guardians are also eligible.

The programs' service benefit package has been restructured several times based on available funding. As of August 5, 2005, the ADAP formulary consists of more than 470 drugs, including: antiretrovirals, antineoplastics, prophylaxis and treatments for opportunistic infections, and medications for related conditions. ADAP Plus covers a full range of HIV primary care services, provided on an outpatient ambulatory basis, including: annual comprehensive medical evaluation, clinical HIV disease monitoring, drug and immunotherapy administration, treatment of both HIV-related and non-HIV related illness, mental health and dental services, ambulatory surgery, laboratory services, and nutritional counseling and supplements. Services covered through the Home Care Program include: skilled nursing, personal care, homemaker and home health aid services, adult day health care, intravenous administration and supplies, and durable medical equipment. ADAP Plus Insurance Continuation (APIC) will pay the premiums of individuals who lose their employment and are eligible to continue their insurance, or working individuals who cannot afford their insurance premiums. Coverage of drugs and services is revised based on available funding and the changing clinical profile of the epidemic.

The HIV Uninsured Care Programs use the AIDS Institute's network of programs and providers and those of other New York State agencies as a comprehensive referral system and distributor for applications and promotional materials. The Programs provide Federal Minority AIDS Initiative funding to nine community based organizations throughout New York State to support outreach and educational activities to increase minority participation in care and ADAP. In cooperation with state, federal, and local corrections authorities, program applications and information are provided to HIV-positive inmates nearing release from correctional facilities. The programs are coordinated with Medicaid to assure non-duplication of coverage, continuity of care and an easy transition to Medicaid when participants meet Medicaid eligibility criteria. An advisory workgroup provides input, guidance, and recommendations to the programs from a wide variety of perspectives to recommend coverage elements and to ensure integration with other HIV services. The workgroup is comprised of persons living with HIV/AIDS, representatives of Title I Planning Councils, local and state government officials, health care providers, agencies, associations, and clinicians.

Cumulative and annual program enrollment for the period ending December, 2004 are as follows:

Enrollment: Cumulative
10/87-12/04		 Year
1/04-12/04
ADAP
70,483
22,203
ADAP Plus
58,988
19,505
Home Care
4,815
184
APIC
2,083
1,526

The programs serve all populations affected by AIDS in New York State, with participant demographics changing over the years to reflect changes in the epidemic.

The programs have a broad statewide network of over 3,800 providers, including: 2,711 local pharmacies; 188 hospitals and clinics (348 service sites); 579 private physicians; 82 clinical laboratories; and 259 home health agencies, long term home health care programs, hospices, and licensed home care service agencies. New York State's ADAP/ADAP Plus has the most comprehensive drug and service coverage of any state in the country. Utilization of combination antiretroviral therapy, drugs to treat side effects and toxicity, and ambulatory care services has consistently increased over time.

Funding

The HIV Uninsured Care Programs are funded through a partnership among New York State and the HIV Planning Councils of New York City, Long Island, the Lower Hudson and Dutchess County Regions, using funds from Titles I and II of the federal Ryan White CARE Act. The Department of Health also uses funds from the New York State Health Care Reform Act for drugs and services and State funds to pay for a portion of the administration of the programs. The Health Care Reform Act of 2004 authorizes up to $60 million in funding for the Uninsured Care Programs for fiscal year 2004 - 2005. The programs have expended more than $1 billion for drugs and services for participants since 1987. Funding for fiscal year 2004-2005 exceeded $255 million from all sources, including insurance recoveries and pharmaceutical rebates.

Contact:

HIV Uninsured Care Programs
Bureau of Community Support Services
Division of HIV Health Care and Community Services
(518) 459-1641 or 1-800-542-2437 (NYS only)

Back to top of page

AIDS Nursing Facilities

Program Description

The AIDS Nursing Facilities Initiative began in 1988 to provide appropriate nursing home care for people with HIV/AIDS. The Department of Health issued regulations for the development of AIDS nursing facilities and an enhanced Medicaid reimbursement structure that allows for increases in nursing time, substance abuse counseling, AIDS medications, and medical care. Nursing facilities providing services to residents with AIDS must ensure special services are provided including: medical services by a physician who has experience in the care and clinical management of persons with AIDS; sub-specialty physician services; nursing services supervised by a registered professional nurse with experience in the care and management of persons with AIDS; substance abuse services; HIV risk/harm reduction education; comprehensive case management; and pastoral care.

The AIDS Institute has completed the development of new, discrete AIDS nursing facilities in the greater New York City metropolitan area. As a result of this initiative, there are 15 facilities with a total of 1,171 beds. The majority of these facilities (14) were new construction projects, publicly financed through the sale of State bonds. New alternatives in long term care, including AIDS Day Health Care Programs, increased access to home care and supportive housing programs, as well as improved health as a result of the use of combination therapies, have reduced the need for AIDS nursing home beds.

An additional 23 facilities across New York State are approved for AIDS scatter beds. These facilities have the ability to admit up to ten AIDS residents at any point in time. The AIDS Institute encourages the development of AIDS scatter beds in nursing facilities in upstate New York to meet the need in regions that do not currently have sufficient capacity to care for persons with AIDS. The AIDS Institute will continue to identify facilities that have the capacity to provide these services and provide them with technical assistance and training to increase access to care.

Funding

All AIDS nursing facilities are primarily funded through Medicaid reimbursement.

Contact:

Chronic Care Section
Bureau of HIV Program Review and Systems Development
Division of HIV Health Care
(518) 474-8162

Back to top of page

AIDS Home Care Programs

Program Description

AIDS Home Care Programs (AHCPs) are required to meet the federal conditions of participation for Certified Home Health Agencies (CHHAs) and Long Term Home Health Care Programs (LTHHCPs). Providers are also responsible for case management/coordination services consistent with the comprehensive interdisciplinary assessment, which at a minimum, addresses the medical, social, mental health, and environmental needs of the client. An AIDS Home Care program may be provided by a long term home health care program or a Designated AIDS Center specifically authorized to provide an AHCP.

In general, home health services agencies are responsible for arranging and/or providing, either directly or through contract arrangements, one or more of the following: nursing services, home health aide services, medical supplies, equipment and appliances, and other therapeutic and related services. These services may include but are not limited to, physical and occupational therapy, speech pathology, nutritional services, medical social services, personal care services, home maker services, and housekeeping services. These services may be of a preventive, therapeutic, rehabilitative, health guidance and/or supportive nature to persons at home. LTHHCPs may also apply for eight optional waived services: personal emergency response, respite, meals on wheels, housing improvement, home maintenance, moving assistance, social day care, and social transportation services. AHCPs and Special Needs CHHAs ensure patients' access to enhanced physician services (primary care physician and subspecialty physicians); dental care; HIV prevention and education services; substance abuse and treatment services; pastoral care; mental health services; peer support; HIV clinical trials; and HIV therapies.

Because of the special needs of persons with HIV/AIDS, AHCPs must establish and implement procedures to coordinate care with other facilities or agencies conducting clinical trials of HIV therapies; arrange for substance abuse treatment services; and assure patient access to such services as pastoral care, mental health, dental, and enhanced physician services.

To date, there are 33 AHCPs and special needs CHHAs providing care in New York State.

Funding

AHCPs receive enhanced Medicaid reimbursement for nursing services and are not held to the 75% cap which is imposed on non-AIDS LTHHCPs. All home care programs serving AIDS patients can receive enhanced rates for nursing services.

Contact:

Chronic Care Section
Bureau of HIV Program Review and Systems Development
Division of HIV Health Care
(518) 474-8162

Back to top of page

AIDS Adult Day Health Care Programs

Program Description

AIDS Adult Day Health Care Programs (ADHCPs) have evolved over the past eight years to meet the emerging needs of individuals with HIV/AIDS. ADHPs were originally designed for a frail population that required a greater range of comprehensive health care services than can be provided in any single ambulatory setting, but that do not require the level of services provided in a hospital or a skilled nursing facility. These programs now serve clients with medication adherence issues; those who are in need of medical monitoring for chronic medical conditions; and those who are dually or triply diagnosed with HIV/AIDS, substance abuse, and mental illness.

The intent of ADHCPs is to complement or enhance the existing continuum of medical services through careful coordination with primary care providers. ADHCPs are designed to provide a comprehensive and integrated model of service delivery in a cost-effective manner by avoiding duplication of services and minimizing the need for patients to attend additional off-site services.

ADHCPs provide a comprehensive range of services in a community-based, non-institutional setting. General medical care, including treatment adherence support, nursing care, rehabilitative services, nutritional services, case management, HIV risk reduction, substance abuse, and mental health services are among the services provided.

ADHCPs receive a fixed price for services delivered, which includes transportation and capital costs. Clients are required to attend the program for at least 3 hours for each billable visit and must, over the course of a week, receive 3 hours of health-related services.

ADHCPs serve individuals living with HIV/AIDS who are poor, homeless, psychiatrically/mentally impaired, chemically dependent, formerly incarcerated and otherwise disenfranchised from the health care system. The three primary geographic areas targeted for ADHCP services are the Greater New York Metropolitan area, Westchester County and Long Island. To date, there are 13 licensed programs with a capacity to serve 714 clients per day. An additional 4 programs have received Certificate of Need (CON) approval and are in the pipeline to be developed. It is anticipated that these programs will be open in 2006.

Funding

Services provided in ADHCPs are funded through Medicaid reimbursement.

Contact:

Chronic Care Section
Bureau of HIV Program Review and Systems Development
Division of HIV Health Care
(518) 474-8162

Back to top of page

Community-Based HIV Primary Care and Prevention Services

Program Description

The Community HIV Prevention and Primary Care Initiative was established in 1989 to meet the growing need for community-based HIV services. AIDS Institute grants were offered to local health departments and community health centers willing to develop or expand on-site HIV prevention and primary care services and to hire and train additional staff. Initially, seventeen facilities received grants. With the addition of federal funding and a State appropriation targeted to rural counties, the Initiative was expanded. Community health centers, hospitals, and county health departments are currently funded through this Initiative.

In 2001, the Initiative issued a competitive resolicitation, involving the majority of its State and federal funding. The purpose of the resolicitation was to increase the availability of comprehensive and quality HIV prevention and primary care services in community-based health care settings by incorporating the advances of the past decade into program models and standards. These advances include: behavioral-based prevention interventions, harm reduction, new testing technologies, and best practices in the treatment of HIV/AIDS. As a result of the resolicitation process, the Primary Care Initiative currently funds thirty-nine providers throughout New York State.

The goals of the Initiative are to educate those at risk of HIV infection, promote the availability of HIV counseling and testing, facilitate access to coordinated and comprehensive care, and develop the capacity to deliver on-site quality HIV primary care services. Facilities are funded to provide a wide range of prevention, supportive, and care services including: targeted street outreach, community outreach and education, on-site patient education, HIV counseling and testing, partner notification, peer support, HIV primary care, staff education, case management, prevention with positives, and referral to services unavailable on-site. Many agencies also offer mental health, substance abuse, dental, nutrition, and specialty services. Quality improvement principals are woven into all aspects of services delivery for providers funded by this Initiative.

Key features of the Initiative model are: the care coordination and referrals follow up; access to patients at multiple points in service delivery; and on-site multidisciplinary services teams that offer a unique opportunity for care coordination. Early access and maintenance that in continuous care are important aspects of the Initiative program model. Special emphasis has recently been placed on the development of strategies to strengthen treatment adherence, the integration of health behavior counseling, and partner/spousal notification as critical components of all Initiative programs.

In a rapidly changing environment, the Initiative has responded by shifting the focus of grant funded services to reflect current knowledge, best practices, new testing technologies, and policy directives. Increased emphasis has been placed on the expanding availability and integration of HIV counseling and testing as a routine part of care, implementation of evidence-based prevention interventions, prevention with positives, and increased evaluation of all program components. In addition, all programs funded through this initiative are required to develop regular mechanisms to integrate consumer feedback into the implementation and evaluation of program activities.

To support the introduction and expansion of rapid HIV testing technology, the initiative has made training and kits available to providers. Currently, twenty-three providers in the Initiative offer rapid testing as part of their comprehensive HIV services protocol. Additional support, training, and technical assistance has been provided to contractors to strengthen and expand their ability to deliver prevention with positives services.

Linkages with other service providers offering services not provided on-site are important to ensuring access to the full continuum of HIV related care services. Grant-funded programs are required to develop referral agreements with other HIV service providers, including: Designated AIDS Centers and other hospitals; community-based service organizations; drug treatment programs; county tuberculosis control programs; women's service agencies; parole offices; anonymous counseling and testing programs; and agencies providing services to adolescents.

From 1991 to June 2005, Initiative programs provided 299,341 HIV antibody tests, identifying 7,395 infected persons. During the same period, 25,499 HIV-positive persons were brought into care.

In 2004, more than 18,000 persons were tested, with an overall seropositivity rate of 1.4 percent (2.8 percent in New York City). From January to June 2005, approximately 10,800 persons were tested, with an overall seropositivity rate of 2.1 percent (3.4 percent in New York City).

From January 1 to June 30, 2005, a total of 6,855 HIV positive persons had received primary care services through the Initiative's health care providers. The Initiative continues to succeed in reaching target populations. In 2004, African Americans and Hispanics accounted for 74 percent of those receiving counseling and testing and 75 percent of primary care patients. Of new primary care patients, 31 percent were women and 12 percent were injection drug users.

Funding

The Community HIV Prevention and Primary Care Initiative is supported by approximately $10.2 million in combined State and federal funds. In addition, programs receive third party reimbursement for clinical and counseling and testing services from Medicaid, AIDS Drug Assistance Program (ADAP), managed care, and private insurances..

Contact:

Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 486-6806

or

Primary Care Section
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 474-7802

Back to top of page

Designated AIDS Centers

Program Description

Designated AIDS Centers (DACs) are State-certified, hospital-based programs that serve as the hubs for a continuum of hospital and community-based care for persons with HIV infection and AIDS. The Centers provide state-of-the-art, multi-disciplinary inpatient and outpatient care coordinated through hospital-based case management. DACs with pediatric and obstetrical departments also provide specialized HIV care to infants, children, and pregnant women.

HIV-specific care standards developed for DACs are intended to ensure uniformly high quality care for HIV patients. DACs usually have a dedicated team and are required to provide or arrange for specialized inpatient units and/or scattered beds; coordinated outpatient services including a broad array of subspecialty services; 24-hour emergency room coverage; long-term care, as necessary; counseling, testing, and education in the community; and comprehensive inpatient and outpatient case management services. DACs must establish infection control policies, make arrangements for patients' personal or home care as required, and arrange for patients to participate in clinical trials. The quality of care is monitored and evaluated by the AIDS Intervention Management System (AIMS), described in a separate section of this document. Each DAC is required to have an active quality program including a broadly inclusive quality improvement committee to implement targeted strategies to improve patient care.

With the implementation of Special Needs Plans (capitated managed care plans for persons with HIV/AIDS and their uninfected children) over the past two years, DACs continue to maintain state-of-the-art HIV treatment, serve geographic areas with the highest HIV/AIDS prevalence, and have been sought after by the SNPs to serve their members under contract.

Currently, there are forty-four (44) DACs statewide treating approximately 48,000 unique persons with HIV/AIDS as outpatients and inpatients.

Funding

Designated AIDS Center services are Medicaid reimbursable. Inpatient care is usually reimbursable through Diagnostic Related Groups (DRGs) though a few hospitals with longer than average inpatient stays have chosen to continue to utilize per diem payments. Outpatient care is reimbursed by Medicaid through an HIV specialized tiered rate structure which pays a predetermined amount for each specific visit type.

Contact:

DAC Program
Bureau of Program Review and Systems Development
Division of HIV Health Care
(518) 486-1383

Back to top of page

HIV Special Needs Plans (SNPs)/Managed Care

Program Description

HIV Special Needs Plans (SNPs), as defined in the New York State Medicaid Managed Care Act of 1996, are intended to provide an alternate source of capitated managed care to Medicaid-eligible persons with HIV infection.

Specialized managed care plans to address the health and medical needs of persons with HIV/AIDS first began to be explored by New York State in 1994 with the award of a Special Projects of National Significance (SPNS) grant from the federal Health Resources and Services Administration. Using this grant as a cornerstone, the AIDS Institute initiated formal HIV SNP development. Activities included awarding $2 million in grant funds for planning purposes; initiating a research study designed to evaluate the health care experiences of persons with HIV infection as they transition from a Medicaid fee-for-service program to a capitated managed care environment (the "Client Cohort"); and passage of legislative language authorizing the creation and licensure of HIV SNPs. These activities culminated in federal approval of the Department of Health's application to implement SNPs.

HIV SNPs, fully operational since 2003, provide an alternative source of care to Medicaid-eligible persons in New York City with HIV/AIDS. Medicaid eligible individuals have the option of enrolling in an HIV SNP, a mainstream managed care plan, or receiving services through the traditional fee-for-service system. HIV SNP networks are broadly composed, encompassing the full continuum of HIV services currently available in New York State. Inclusion of health and human service providers with experience in the provision of HIV services enables SNPs to meet the complex medical and psychosocial needs of enrollees, either through direct service provision or by referral. Clinical care provided by SNPs is in accordance with AIDS Institute established standards for HIV care and assessed through continuous quality improvement techniques. Three SNPs, selected through a competitive process to proceed toward SNP certification, are currently licensed and enrolling eligible individuals throughout New York City.

The AIDS Institute is working to assure that all Medicaid-eligible persons with HIV infection have appropriate access to health care services delivered in a managed care setting. To assure that services offered by mainstream managed care plans are appropriate and assure access and are of high quality, the AIDS Institute participates in the development of programmatic standards for mainstream managed care plans, conducts quality of care reviews, and participates in Article 44 surveys. The AIDS Institute also provides technical assistance to managed care plans regarding prevention activities and establishing coordinated systems of care that are appropriate to the specific health care needs of enrollees with HIV/AIDS.

Contact:

AIMS/SNP Operations
Bureau of HIV Program Review and Systems Development
Division of HIV Health Care
(518) 486-1383

Back to top of page

Enhanced Fees for Physicians Program

Program Description

The HIV Enhanced Fees for Physicians (HIVEFP) Program was established in 1991 by the New York State Department of Health to provide enhanced Medicaid rates to physicians for HIV primary care visits. These visits include:

  • pre-test counseling (with and without testing);
  • post-test counseling (negative and positive);
  • annual comprehensive exam;
  • drug and immunotherapy services; and
  • CD4 monitoring.

Physicians who participate in the HIV Enhanced Fees for Physicians Program must:

  • be in private practice and enrolled in the New York State Medicaid Program;
  • have active hospital admitting privileges;
  • be Board certified (preferably in internal medicine, family practice, pediatrics or obstetrics/gynecology);
  • provide 24 hour coverage; and
  • coordinate medical services, including hospital admissions and referrals for specialty care and social services.

There are currently over 1,900 physicians enrolled in the HIVEFP program statewide.

Funding

The enhanced Medicaid rates range from $30 - $42 depending on the visit type and the geographic area.

Contact:

HIV Ambulatory Care Administrator
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-3786
HIVEFP@health.state.ny.us

Back to top of page

HIV Primary Care Medicaid Program

Program Description

The Primary Care Medicaid Program was established in 1989 by the New York State Department of Health to provide enhanced Medicaid rates to Article 28 facilities for HIV primary care visits.

In order to be enrolled in the Primary Care Medicaid Program, a facility must: 1) be an Article 28 facility (hospital OR diagnostic and treatment center); and 2) sign an agreement with the Department of Health to provide comprehensive services and coordination of care for persons with HIV. The application processing time for this program is approximately six months.

To date, there are 310 facilities enrolled in the HIV Primary Care Medicaid Program. Ninety-six (96) facilities are enrolled to provide HIV counseling and testing services only.

Funding

Medicaid rates are established for the following visits:

  • pre-test counseling (with and without testing);
  • post-test counseling (positive);
  • annual comprehensive exam;
  • HIV monitoring.

The Medicaid rates for this program range from $66 to $512 depending on the visit type and geographic area. These rates are all-inclusive and cover labor, ancillary, capital, and administrative costs.

Department of Health Memorandum: Changes to the HIV Primary Care Medicaid Program

Contact:

HIV Ambulatory Care Administrator
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-3786
HIVPCMP@health.state.ny.us

Back to top of page

HIV Primary Care and Prevention Services for Substance Users

Program Description

The Substance Abuse Initiative (SAI) is designed to develop a co-located continuum of comprehensive HIV prevention and primary care services in substance abuse treatment settings throughout New York State. Outreach, HIV education, risk/harm reduction services, capacity building for smaller drug treatment programs, and transitional case management for active substance users not in treatment, are also featured in this model. To date, twenty-four drug treatment agencies of varied modalities, including methadone maintenance, methadone-to-abstinence, drug-free residential, outpatient, and detoxification, have participated in this Initiative. In addition, nine community-based programs that serve substance users are funded, including two that focus on co-occurring mental health issues and two syringe exchange programs. This Initiative has been instrumental in broadening the mission of the substance abuse treatment community from a singular focus on rehabilitation to the provision of public health service.

The SAI was originally conceived and developed in 1989 through a collaboration between the New York State Department of Health AIDS Institute and the New York State Office of Alcohol and Substance Abuse Services (OASAS) to respond to the twin epidemics of HIV and addiction. Implemented in phases, the first phase of the Initiative was a comprehensive prevention program in drug treatment facilities to provide outreach; HIV education; counseling and testing; referral; partner notification; and individual and group supportive counseling. In 1990, HIV primary care was introduced to expand the continuum. Primary care services include some or all of the following: HIV primary care, staff education, case management, coordination of tuberculosis services, and specialty HIV medical care.

The SAI works with drug treatment providers to ensure the most recent developments, technologies, and models for best practices are incorporated in the HIV service protocols. Along with the AIDS Institute's Office of the Medical Director, the SAI convenes a learning network committee of providers to address quality of care issues. HIV counseling and testing availability is being increased and integrated within the drug treatment environment. Training on rapid testing technologies has been provided and rapid test kits purchased for providers so that eighteen substance abuse contractors now offer rapid testing as a routine component of HIV services. Training and support for evidenced-based prevention interventions including behavior change and prevention with positives is ongoing.

Hepatitis Services

The SAI has taken the lead coordinating role with OASAS and the Association of Substance Abuse Providers (ASAP) to identify needs and resources for hepatitis C diagnostic and treatment activities in drug treatment programs. The SAI has also conducted surveys to assess reimbursement issues for hepatitis C services and the current level of services available on-site at eighteen SAI-funded drug treatment programs.

Committed to bringing hepatitis services to active substance users, the SAI sought and was awarded a five-year CDC grant in August 2004, in response to a competitive solicitation for the development of hepatitis prevention services for persons at greatest risk. The project is designed to develop and enhance hepatitis screening, vaccination, and access to care for active injection drug users (IDUs) and IDUs in methadone treatment. The project participants are a large Methadone Maintenance Treatment Program (MMTP) in the Bronx with 3,400 clients and two harm reduction programs that operate syringe exchanges: New York Harm Reduction Educators (Manhattan and the Bronx) and St. Ann's Corner of Harm Reduction (Bronx). Services at the methadone clinics will focus on enhancement of hepatitis C evaluations and access to treatment. Services at the harm reduction clinics include screening for hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HVC); vaccination for HAV and HBV; and case management to assist clients in accessing hepatitis and drug treatment services.

Resolicitation

In 2001, following more than ten years of promoting co-located HIV and addiction services, the Initiative issued a competitive resolicitation, involving the majority of its State and federal funding. The purpose of the resolicitation was to increase the availability and quality of HIV prevention and primary care services for substance users both in and out of treatment by incorporating the advances of the past decade into programming. These advances include: behavioral-based prevention interventions, harm reduction, new testing technologies, transitional case management, and new standards and best practices in the treatment of HIV/AIDS. As a result of the resolicitation process, the SAI currently funds fifty-three (53)contracts for HIV prevention and primary care services, targeting more than 34,000 substance users throughout New York City (NYC), Long Island, the Mid-Hudson region, Rochester, Buffalo, and Central New York.

Transitional Case Management

Recognizing the need to serve substance users not engaged in either the drug treatment or health care systems, the SAI fostered the development of service coalitions among grant-funded drug treatment agencies, harm reduction/syringe exchange programs (SEPs), and community-based residences. These coalitions resulted in HIV prevention services at two SEPs in NYC and one in Buffalo. In the Bronx and Harlem, a mobile outreach team provides HIV medical screening, assessment, care, and referral, to residents of single room occupancy (SRO) and transitional housing.

Since substance abuse treatment has long been established as an effective HIV prevention intervention, the SAI has devoted a portion of its resources toward establishing a transitional case management component to its services delivery model. The goal of transitional case management is to connect active substance users with the continuum of addiction treatment services. Two syringe exchange/harm reduction programs that serve active injection drug users are funded to establish referral relationships with the various components of the treatment continuum (detox, rehab, drug free and opioid treatment services) and to provide cross-training of staff, in order to shepherd active users from addiction into recovery, understanding that relapse is intrinsic to the process. Data on transitional case management activities for January through June 2005 reflects: 184 of 201 referrals for in-patient detoxification were kept for an entrance into service rate of 91.5 percent; 28 of 31 referrals for methadone maintenance treatment (opioid treatment) were kept for an entrance into service rate of 90.3 percent; 67 of 76 referrals for drug-free residential treatment were kept for an entrance to service rate of 88.2 percent. Referrals for methadone-to-abstinence (MTA), (2 of 2) and referrals for drug-free ambulatory treatment (19 of 25) are modest and reflect clients' limited preference for these modalities.

HIV Testing and Primary Care Activity

From the inception of the Initiative through June 2005, a total of 211,951 people were tested for HIV and 16,337 infected people were identified. For the most recent twelve month period, July 2004 through June 2005, 21,710 clients were tested, of whom 666, or 3.1 percent, were HIV positive. The post-test counseling rate of those testing HIV positive was 90 percent. As a result of the development of on-site medical services, over 3,638 infected substance users are receiving co-located substance abuse and HIV primary care services through the SAI. In addition, the Initiative is effectively targeting clients at highest risk for HIV. From July 1, 2004 through June 30, 2005, 18 percent of those tested and 32 percent of new clients report a history of injection drug use. The Initiative has also reached traditionally underserved populations that bear an increasingly disproportionate burden of the AIDS epidemic including persons of color and women. July 1, 2004 through June 30, 2005 data shows 77 percent of clients tested were African American or Hispanic and 37 percent were female. Similarly, 84 percent of new clients enrolled in HIV primary care were African American or Hispanic and 36 percent were female.

Funding

The Substance Abuse Initiative is supported by approximately $9.7 million in combined State and federal funds and an additional $1.3 million from the federal Substance Abuse and Mental Health Services Agency through OASAS. In addition, programs receive Medicaid reimbursement for HIV counseling, testing, and primary care activities.

Contact:

Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 486-6806

or

Substance Abuse Section
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(212) 417-4530

Back to top of page

Treatment Adherence Initiative

Program Description

Scientific advances in the clinical therapeutics of HIV have changed the nature of managing HIV disease. There is now a greater understanding of HIV virology and pathogenesis, the development and use of quantitative HIV RNA testing, and highly active antiretroviral therapy (HAART). These advances have given clinicians and patients better knowledge, drugs, and tools to manage HIV infection more effectively.

These therapeutic advances provide new opportunities to delay disease progression and improve the quality of life. Yet achieving this potential in the practice setting remains challenging. It requires the patient and health care provider, in collaboration with the patient's support network, to address the multidimensional issues surrounding adherence to the treatment plan. These issues involve patient characteristics and circumstances, the treatment regimen, the health care delivery system, and the patient-provider relationship.

The consequences of non-adherence to HAART can seriously affect an individual's personal health and that of the community. Less than perfect adherence allows viral replication and mutation to continue, leading to the development of drug-resistant strains of virus which can, in turn, compromise an individual's health and future treatment. Adherence to antiretroviral therapy may be the single most critical determinant of the success of clinical therapeutics for HIV infection today.

The AIDS Institute's Office of the Medical Director coordinates a number of activities designed to support and enhance treatment adherence:

  • develops and disseminates information, strategies and tools for clinical providers;
  • provides fora for providers and consumers to share adherence best practices;
  • reviews emerging adherence research and program designs and shares successful strategies and community-level practice experiences with health care and social service providers;
  • provides technical assistance to integrate treatment adherence methodologies and training throughout community-level clinical education and service programs;
  • develops educational materials and training opportunities for consumers; and
  • monitors public health concerns related to treatment access and treatment adherence.

Seventeen treatment adherence programs are funded in collaboration with Title I of the Ryan White CARE Act to integrate treatment adherence services into the continuum of HIV primary care. Each program implements strategies to promote adherence to HAART through a client-centered approach. Members of the health care team work in concert with consumers to develop, implement, and evaluate tools and skills-building activities to increase and sustain adherence to therapy. One of the fundamental objectives of the Treatment Adherence Initiative is to foster a comprehensive approach to assess and assist consumers at risk for non-adherence, focusing on consumer and provider collaboration to develop consumer-specific strategies that lead to sustained treatment adherence.

Treatment Adherence Programs

  • AIDS Community Resources - Syracuse
  • Albany Medical College - Albany
  • Albert Einstein College of Medicine - New York City
  • Bellevue Hospital Center - New York City
  • Beth Israel Medical Center - New York City
  • Community Health Network - Rochester
  • Erie County Medical Center - Buffalo
  • Harlem Hospital Center - New York City
  • Kings County Hospital Center - New York City
  • Joseph L. Mailman School of Public Health of Columbia University - New York City
  • Long Island Jewish Medical Center - Long Island
  • Montefiore Medical Center - New York City
  • Nassau University Medical Center - Long Island
  • New York Presbyterian Hospital - New York City
  • SUNY Health Science Center of Brooklyn - New York City
  • Village Center for Care - New York City
  • Westchester Medical Center - Westchester

Funding

The Treatment Adherence Demonstration Project is supported by $2,265,040 in combined State and federal funds.

Contact:

Office of the Medical Director
(518) 473-8815

Back to top of page