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 initiative 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 2008, the ADAP formulary consists of more than 480 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, 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. APIC pays 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 distribution network 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 Part A Planning Councils, local and state government officials, health care providers, agencies, associations, and clinicians.

Cumulative and annual program enrollment for the period ending December, 2007 are as follows:

Enrollment: Cumulative
10/87-12/07		 Year
1/07-12/07
ADAP 79,375 21,780
ADAP Plus 67,463 18,749
Home Care 5,139 287
APIC 3,472 2,036

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 4,255 providers, including: 3,430 local pharmacies; 163 hospitals and clinics (265 service sites); 396 private physicians; 61 clinical laboratories; and 205 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.

Contact:

Christine A. Rivera
Director
Bureau of HIV Uninsured Care Programs
518-459-1641 or 1-800-542-2437 (In New York State Only)
car05@health.state.ny.us

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 14 facilities with a total of 1125 beds. The majority of these facilities 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 13 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.

Contact:

Joe Losowski
Director, Chronic Care Section
Bureau of HIV Program Review and Systems Development
Division of Medicaid Policy and Programs
(518) 474-8162
jml03@health.state.ny.us

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 a comprehensive interdisciplinary assessment, which at a minimum, addresses the medical, social, mental health, and environmental needs of the client. An AHCP may be provided by a LTHHCP or a Designated AIDS Center specifically authorized to provide an AHCP.

In general, AIDS home care programs 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 therapeutic 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. AHCPs that are LTHHCPs may also apply for eight optional services: personal emergency response; respite; meals on wheels; housing improvement; home maintenance; moving assistance; social day care; and social transportation services. These programs seek to ensure that patients' access 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.

Contact:

Joe Losowski
Director, Chronic Care Section
Bureau of HIV Program Review and Systems Development
Division of Medicaid Policy and Programs
(518) 474-8162
jml03@health.state.ny.us

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 did 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.

AIDS Adult Day Health Care Programs 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.

AIDS Adult Day Health Care Programs 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.

AIDS Adult Day Health Care Programs 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. ADHCP services are primarily located in the Greater New York Metropolitan area. Services are also located in Westchester County, and a program is currently in development in the Western New York region that is anticipated to open in 2008.

To date, there are 15 licensed programs with a capacity to serve 997 clients per day.

Contact:

Joe Losowski
Director, Chronic Care Section
Bureau of HIV Program Review and Systems Development
Division of Medicaid Policy and Programs
(518) 474-8162
jml03@health.state.ny.us

Back to top of page

Community-Based HIV Prevention and Primary Care 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, 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 39 providers throughout New York State.

The goals of the initiative are to educate those at risk of HIV infection, promote the availability of routine HIV testing, facilitate early access to coordinated, comprehensive and continuous care, and develop provider 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: enhanced street outreach; routine HIV testing as part of primary care; counseling for high risk individuals; partner counseling and referral services; 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 principles are woven into all aspects of service delivery for providers funded by this Initiative.

Key features of the initiative are: early access to care, access at multiple points of care, maintenance in care, referral follow-up, and on-site care coordination by multidisciplinary service teams. Special emphasis has recently been placed on the development of strategies to strengthen treatment adherence, the integration of health behavior counseling, and partner counseling and referral services.

In a rapidly changing environment, the Initiative has responded by shifting the focus of grant funded services to reflect current knowledge, best practices, advances in 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 HIV test kits available to providers. Currently, 37 providers in the Initiative offer rapid testing as part of their comprehensive HIV services protocol. Additional support, training, and technical assistance have been provided to contractors to strengthen and expand their ability to deliver prevention services to positive persons.

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 December 2007, Initiative programs provided 369,472 HIV antibody tests, identifying 8,534 infected persons. In calendar year 2007, more than 21,000 individuals were tested, with an overall seropositivity rate of 1.4% (2.0% in New York City).

In calendar year 2007, a total of 7,770 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 2007, African Americans and Hispanics accounted for 72% of primary care patients (73% of all new patients). Of new primary care patients, 31% were women, 9% were injection drug users, and 36% were men who have sex with men.

Contact:

Lisa Roland-Labiosa
Director, Primary Care Section
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 474-7802
lar15@health.state.ny.us

or

Felicia Schady
Director
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-8427
ffs01@health.state.ny.us

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. AIDS 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.

The AIDS Center program was developed and remains a patient-centered program model that can evolve with the needs of the patient in the changing health care environment. AIDS Centers provide a primary care home for the person with HIV. Patient outcomes improve when care is seamless, coordinated by a care manager utilizing multi-agency, multi-disciplinary health care teams.

HIV-specific care standards developed for DACs are intended to ensure uniformly high quality care for HIV patients. AIDS Centers usually have a dedicated team and are required to provide or arrange for inpatient care; coordinated outpatient services including a broad array of subspecialty services; long-term care, as necessary; and counseling and testing services. AIDS Centers must make arrangements for patients' personal or home care as required, and arrange for patients to participate in clinical trials. AIDS Centers must enhance coordination with their community-based partners to identify patients at risk, help patients access and remain in care, and understand and adhere to their complicated regimens.

The quality of care is monitored and evaluated by the AIDS Intervention Management System (AIMS), described in a separate section of this document. Each AIDS Center is required to have an active quality program including a broadly inclusive quality improvement committee as well as a consumer advisory group and other mechanisms to involve consumers in improving services for PLWHA.

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

Currently, there are forty-two (42) DACs statewide treating approximately 48,000 unique persons with HIV/AIDS as outpatients and inpatients.

Contact:

Deborah Dewey, MUP
Statewide Coordinator, AIDS Center Program
Bureau of HIV Program Review and Systems Development
Division of HIV Health Care
(518) 486-1383
dmd16@health.state.ny.us

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. In New York City approximately 25,000 HIV+ Medicaid individuals must choose either an HIV SNP or a mainstream managed care plan to receive their Medicaid benefits. 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 are currently licensed and enrolling eligible individuals throughout New York City.

The AIDS Institute works to assure that all Medicaid-eligible persons with HIV infection have access to appropriate health care services whether services are delivered through a special needs plan or in a mainstream managed care setting. To assure that services offered by mainstream managed care plans are appropriate, 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 mainstream managed care surveys. The AIDS Institute also provides technical assistance to managed care plans regarding prevention activities and establishment of coordinated systems of care that are appropriate to the specific health care needs of enrollees with HIV/AIDS.

Contact:

Carol DeLaMarter
Director, AIMS/SNP Operations
Bureau of HIV Program Review and Systems Development
Division of HIV Health Care
(518) 486-1383
cmd13@health.state.ny.us

Back to top of page

HIV Enhanced Fees for Physicians Program

Program Description

The Enhanced Fees for Physicians Program (EFP) was established in 1991 by the New York State Department of Health to give private practice physicians enhanced Medicaid rates for HIV Primary Care Visits. These visits include:

  • HIV Testing
  • HIV Post-test positive counseling
  • HIV monitoring

Physicians who participate in the 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 infectious disease, 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.

Currently there are over 2,066 physicians enrolled in the HIV EFP program.

Contact:

John J. Schnurr
HIV Reimbursement and Program Administrator
Bureau of Program Review and System Development
(518) 486-1383
HIVEFP@health.state.ny.us

Back to top of page

HIV Primary Care Medicaid Program

Program Description

The HIV 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 HIV 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.

There are 287 facilities enrolled in the HIV Primary Care Medicaid Program; 84 facilities enrolled to provide only HIV counseling and testing services and 203 enrolled to provide HIV counseling/testing and HIV primary care services.

Contact:

John J. Schnurr
HIV Reimbursement and Program Administrator
Bureau of Program Review and Systems Development
(518) 486-1383
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 is designed to develop a co-located continuum of comprehensive HIV prevention and primary care services within substance abuse treatment settings throughout New York State. At its core, the co-located model operates on the principles of integration of HIV services within the drug treatment environment and the seamless transition from testing to care. Reaching active users not in treatment and responding to their complex needs is also integral work of the Initiative. For those actively using and willing, the program facilitates the transition and entry into addiction services, treatment and toward recovery.

The Initiative was originally conceived and developed in 1989 through 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 companion epidemics of HIV and addiction. Implemented in phases, the first phase 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: HIV primary care, disease monitoring, staff education, case management, coordination of tuberculosis services, and specialty HIV medical care. In 2001, the Initiative issued a competitive resolicitation, to increase the availability and quality of HIV prevention and primary care services 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. In 2006, the Initiative began promoting and adopting The Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Health Care Settings issued by the CDC in their Morbidity and Mortality Weekly (MMWR). Moreover, the Initiative has been instrumental in the substance abuse treatment community broadening its mission from a singular focus on rehabilitation to that of public health service provision.

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, ten community-based programs that serve substance users are funded, including three syringe exchange programs and a mobile medical van that provides HIV primary care and care coordination to residents of transitional housing for the HIV infected. Currently, 53 contracts for HIV prevention and primary care services, targeting more than 34,000 substance users throughout New York City, Long Island, the Mid-Hudson region, Rochester, Buffalo, and Central New York, are funded through this Initiative.

New Model of Integrated HIV testing & Shifting Resources to Retention in Care and Prevention with Positives:

The Substance Abuse Initiative (Initiative) continues to evolve its service delivery model and is developing a new tri-pronged model to increase the number of newly identified infected, to reduce the transmission of HIV and to engage and improve retention in continuous HIV care among substance users. The model features:

  • Integrated HIV testing in drug treatment settings;
  • Engagement and retention in continuous HIV care, both on a co-located and off-site basis, and prevention with positives; and;
  • Transitional case management, enhanced outreach and rapid HIV testing for active users not in treatment.

For those already in drug treatment, consented HIV testing is being uncoupled from risk-based assessments and will be routinely provided by medical staff of substance abuse treatment programs as part of admission and annual physical exams. For active users not in care, a model of enhanced outreach, that utilizes evidenced based outreach interventions, has been incorporated along with rapid HIV testing technologies and referral for drug treatment and/or HIV health care.

Substance Use Learning Network (SULN)

The Initiative features a peer-based learning collaborative for grant funded drug treatment agencies that provide co-located HIV primary care. The Network goal is to improve and sustain the quality of HIV services provided to substance users in treatment. The SULN framework includes identifying performance measures and indicators, activities, data collection and peer learning opportunities to allow sharing of successful strategies and best practices. Priorities identified in 2007 include: client retention in care, partner notification and disclosure, and prevention with positives. Emphasis on diminishing sexual transmission risks, particularly heterosexual transmission among substance users, was identified as a top priority.

Hepatitis Services

The Initiative 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 Initiative was awarded a five-year CDC grant in August 2004 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.

Serving Pregnant Substance Using Women

The Substance Abuse Section and the Community Action for Prenatal Care (CAPC) Initiative collaborate to enable CAPC funded agencies to work jointly with substance use treatment programs for the placement and treatment of pregnant addicted women. The goal of this collaboration is to develop partnerships to facilitate intake and respond to the unique needs of pregnant addicted women. This collaboration is effective in reducing the institutional barriers in the substance use treatment system. Building coalitions among providers who serve this shared and complex population is paramount to enhanced access to care.

Transitional Case Management Activity

Data on transitional case management activities for January through December 2007 reflects the following successful entrance to service rates: 702 of 812 (86.5%) referrals for in-patient detoxification; 71 of 79 (89.9%) referrals for methadone maintenance treatment (opioid treatment); 221 of 298 (74.2%) referrals for drug-free residential treatment. Nine of 11 (81.2%) referrals for methadone-to-abstinence and 72 of 106 (68%) referrals for drug-free ambulatory treatment are modest and reflect clients' limited interest in these modalities. Notably, 83 of 118 (70.3%) referrals for Buprenorphine, a relatively "new" treatment option, were successful.

HIV Testing and Primary Care Activity

From the inception of the Initiative through December 2007, a total of 263,956 people were tested for HIV and 17,592 infected people were identified. For the most recent twelve month period, January through December 2007, 20,273 clients were tested, of whom 379, or 2 % were HIV positive. The post-test counseling rate of those testing HIV positive was 98%. As a result of the development of on-site medical services, 3,677 infected substance users received co-located substance abuse and HIV primary care services. The Initiative has reached traditionally underserved populations that bear an increasingly disproportionate burden of the AIDS epidemic, including persons of color and women. January through December 2007 data shows 83% of clients tested was African American or Hispanic and 34 % were female. Similarly, 80% of clients who received HIV primary care services were African American or Hispanic and 38 % were female.

Contact:

Diane Rudnick
Director, Substance Abuse Section
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(212) 417-4530
dmr06@health.state.ny.us

or

Felicia Schady
Director
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-8427
ffs01@health.state.ny.us

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. Achieving this potential in the practice setting remains challenging. It requires that the patient and health care provider, in collaboration with the patient's support network, 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:

  • development and dissemination of information, strategies and tools for clinical providers;
  • providing for providers and consumers to share adherence best practices;
  • review of sharing emerging adherence research/program designs and successful strategies and community-level practice experiences with health care providers;
  • providing technical assistance to integrate treatment adherence methodologies and training throughout community-level clinical education and service programs; and
  • development of educational materials and training opportunities for consumers.

Seventeen treatment adherence programs are funded 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 assessing and assisting consumers at risk for non-adherence, and focusing on consumer and provider collaboration to develop consumer-specific strategies that lead to sustained treatment adherence.

Contact:

Beth Woolston, LMSW
Office of the Medical Director
(518) 473-8815
bew01@health.state.ny.us

Back to top of page

Family-Centered Health Care Services

Program Description

In New York State, many families affected by HIV experience poverty, substance use, domestic violence, mental illness and family disruptions. HIV often affects several generations in one family. In addition to addressing their immediate health care concerns and the emotional needs of their children and adolescents, infected parents or caregivers often face compounding issues such as custody arrangements, daily child care, disclosure, elder care and discrimination.

The number of women newly infected with HIV, especially women of color, continues to grow, and the role of HIV-infected men and their involvement in the care of families has been largely overlooked. Family responsibilities, lower socioeconomic status, disability, and access issues continue to present barriers to health services. Engaging and retaining HIV-positive pregnant women and parents with dependent children in the health care system requires holistic, family-centered services that recognize their roles as primary caregivers and address the multiple needs of all family members.

The Family-Centered HIV Health Care Services Initiative provides a framework for the treatment and care of adults living with HIV in the context of family. Its goal is to reduce access barriers within the health care system, improve the health status of HIV-affected families, reduce the risk of perinatal transmission, support adherence to treatment and understand the role of families in HIV prevention.

Family-Centered HIV Health Care is an integrated model of service that coordinates HIV, primary care and gynecologic services. Multicultural, multidisciplinary teams integrate medical care, including HIV specialty care, with mental health, substance use, prevention with positives, case management and other HIV-related services to address the complex medical and social issues faced by HIV-affected families. Programs foster strong working relationships among adult medicine, obstetric, and pediatric programs for the care of children and adolescents who are exposed to, infected, or affected by HIV. For women with HIV, gynecologic and reproductive health services, including family planning, are crucial components of care that have not been adequately addressed in many specialized HIV programs. Family-Centered HIV Health Care programs play a key role in reducing the risk of HIV perinatal transmission and provide comprehensive care for pregnant women with HIV.

Established in 2003, a statewide network of eleven health care agencies provide funded services. Women and men living with HIV and their dependent children/adolescents are eligible for program services.

Contact:

Jo Ann Beasley
Program Coordinator
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-3435
jcb04@health.state.ny.us

or

Felicia Schady
Director
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-8427
ffs01@health.state.ny.us

Back to top of page

Centers of Excellence in Pediatric HIV Care

Program Description

Since the mid-1990's, pediatric HIV infection has changed dramatically. The number of seropositive women giving birth in New York State declined from 1,898 in 1990 to 567* in 2007, a 70% reduction. Between 1990 and 2007, the seroprevalance rate among childbearing women also declined from 0.66% to 0.23%. With the advent of antiretroviral prophylaxis, the statewide perinatal HIV transmission rate declined from an estimated 25% in the early 1990's to 1.7% in 2006. The annual number of reported pediatric AIDS cases and the number of pediatric deaths attributable to AIDS have also declined significantly due to the factors mentioned above and to advances in medical management of the disease. While there are few infected children currently entering care, perinatally acquired HIV infection is, for most infected children, a chronic disease that requires complex medical and psychosocial management.

The Centers of Excellence in Pediatric HIV Care were designed to meet the complex medical management and unique psychosocial and educational support needs of these children as they grow and develop while living with HIV. In addition, Centers of Excellence in Pediatric HIV Care are key players in community/regional systems to prevent perinatal HIV transmission and to care for pregnant women with HIV and their children. To fulfill this role, Centers promote access to care; provide consultation to community providers and birth facilities; and accept referrals for the direct provision of comprehensive care and services for HIV-exposed newborns and children with HIV.

Centers of Excellence in Pediatric HIV Care:

  • offer multicultural, multidisciplinary teams of experienced providers that include one or more pediatric HIV specialists;
  • provide pediatric primary care on-site or by a close consultative relationship with the primary care provider that includes regular communication, case conferencing, and education activities as appropriate;
  • provide a continuum of care that includes prompt access to pediatric subspecialists, an adolescent HIV specialist/adolescent medicine clinician and tertiary care centers with experience in treating children/youth with HIV; and
  • provide continuous support to family members in their caregiver roles.

Children/youth with HIV infection may have significant mental health, neurological, or developmental problems due to the impact of the disease on their maturation, often compounded by psychosocial issues such as poverty and parental substance use. Therefore, mental health, nutritional, neurological, and developmental assessments by qualified staff are integrated into the services provided on-site at Centers of Excellence. A Center's network of grant-funded services also includes family-centered case management, treatment and prevention education, adherence support, and strong linkages with a variety of community-based organizations to support the child and his/her family with psychosocial services.

Ten Centers of Excellence in Pediatric HIV Care were established statewide in 2003 to serve perinatally HIV-infected children/youth, including HIV-exposed infants. Centers of Excellence in Pediatric HIV Care also serve behaviorally infected adolescents in geographic areas where access to youth-oriented specialized HIV health care programs is limited.

* Data are preliminary

Contact:

Jo Ann Beasley
Program Coordinator
Family and Youth Services Section
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-3435
jcb04@health.state.ny.us

or

Beth Bonacci Yurchak
Program Coordinator
Family and Youth Services Section
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-3435
bby01@health.state.ny.us

or

Felicia Schady
Director
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-8427
ffs01@health.state.ny.us

Back to top of page

Youth-Oriented Health Care Programs

Program Description

As of December 2007, the total number of young people ages 13 to 24 years living with HIV/AIDS was 4,601. In 2007, 697 adolescents aged 13 – 24 were newly diagnosed with HIV. Because of the average 10 to 12 year incubation period between HIV infection and AIDS diagnosis, many adults were likely infected with HIV in their teens. There is also a significant population of adolescents and young adults who were infected perinatally. Due to advanced treatments, including antiretroviral medications, children have aged into adolescence and young adulthood.

This Initiative includes two programs: Specialized Care Centers and Youth Access Program. These programs seek to serve adolescents and young adults, ages 13-24, who have HIV or are at high risk for HIV infection. This population includes, but is not limited to: young men who have sex with men; lesbian, gay, bisexual, questioning or transgender youth; youth who use substances; mentally ill youth; runaway/throwaway youth and other young people at high risk for HIV.

The goals of Youth-Oriented Health Care Programs are: prevention of HIV infection in at-risk youth; early identification of HIV-infected youth; support for adherence to HIV care and treatment for HIV-infected youth; improved access to quality health care and social services; and promotion of positive youth development, including increased self-esteem and self management. Grant funding supports the development of youth models that promote collaborations among providers; integrate prevention and care services; and provide services in safe, confidential environments.

Specialized Care Centers

Specialized Care Centers provide integrated, comprehensive health care and support services to address the needs of adolescents and young adults who have, or are at high risk for, HIV. In addition to providing comprehensive services on-site, the centers are responsible for developing linkage agreements to create a continuum of services needed by youth. Centers are funded to provide client recruitment; HIV prevention education; individualized risk assessment and health promotion; HIV counseling and testing; comprehensive medical services including HIV care and primary medical care; social work; case management and advocacy; supportive counseling; concrete supportive services (e.g., transportation, child-care, language interpretation); and peer support. In addition, programs provide mental health and substance use assessments with referral to or provision of treatment services, if indicated. All services are designed to promote youth self-esteem and build skills related to risk reduction and health promotion.

Youth Access Programs

Youth Access Programs provide low-threshold clinical services in accessible community-based settings to meet the immediate health care and social service needs of at-risk youth. In many cases, these needs are met before or concurrent with addressing issues related to HIV testing and treatment. Methods for implementing low-threshold clinical services include mobile multidisciplinary teams, part-time clinics in community-based settings, and medically equipped vans. Youth Access Programs have community partners who can assist with reaching the highest risk youth. Programs are funded to provide client recruitment; targeted HIV prevention and risk reduction services; HIV counseling and testing; immediate primary and preventive health care for acute illnesses; access to pharmaceuticals; pregnancy testing and family planning services; screening and treatment for sexually transmitted diseases (STDs), TB, and hepatitis; partner notification services; psychosocial assessments; referrals for needed services and transitional case management.

Target Areas

Eleven Youth-Oriented Health Care Programs were established statewide in 2003. Target areas include communities in New York State with a high number of HIV/AIDS cases among adolescents and young adults, high rates of teen pregnancy, and high rates of STDs among persons ages 13 to 24.

Contact:

Beth Bonacci Yurchak
Program Coordinator, Youth-Oriented Health Care Programs
Family and Youth Services Section
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-5467
bby01@health.state.ny.us

or

Felicia Schady
Director
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-8427
ffs01@health.state.ny.us

Back to top of page

Supportive and Legal Services for Families in Transition

Program Description

The Families in Transition Initiative provides supportive and legal services to stabilize and maintain families affected by HIV/AIDS, as well as to assist families in planning for the future care and custody of their children during parental illness and after the death of a parent. Future care and custody options include legal adoption, foster care, guardianship, and standby guardianship. The latter enables HIV-infected parents to designate a guardian who, at the discretion of the parent, assumes caregiving responsibilities for children during parental illness and after the parent's death.

Experience has shown that supportive and legal service programs for children, families and young people should be based on comprehensive, integrated models that promote a continuum of services and facilitate access to services via multiple pathways. This initiative promotes a comprehensive and integrated model of service delivery that links families with health care and other services and creates a comprehensive continuum of service providers.

Eighteen organizations are funded statewide, seven of which are for Family Supportive Services, ten for Family Legal Services, and one for both Family Supportive and Legal Services. Of the organizations funded, eight are located in New York City and ten are located throughout the rest of New York (Albany, Buffalo, Rochester, Syracuse, Long Island and the Hudson Valley Region). Funded programs are located within community-based organizations, child welfare agencies, legal services providers, and a hospital.

Legal assistance tailored to the family’s need is provided by not-for-profit legal service agencies to establish and maintain family stability. HIV-affected families face an array of problems and issues that can threaten the family stability and create barriers to accessing services and planning for the future care and custody of minor children. Legal assistance is tailored to the individual family’s needs.

Social support programs are funded to provide assistance to parents, their children, and other family members to help them cope with the emotional and physical needs of living with HIV/AIDS. Services are intended to promote optimal physical and emotional development of children and adolescents. Caregivers are supported in their efforts toward assisting children dealing with the loss of a parent. Services include, but are not limited to, assisting parents in disclosing their HIV infection to their children; counseling family members to improve coping skills; education about placement and custody plan options available to families; assistance in identifying an appropriate new caregiver; and activities to promote stabilization and build relationships between children and new caregivers.

Contact:

Deborah Hanna
Program Coordinator, Families in Transition
Family and Youth Services Section
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(212) 417-4764
dlh02@health.state.ny.us

or

Felicia Schady
Director
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473 – 8427
ffs01@health.state.ny.us

Back to top of page

Viral Hepatitis Program

Program Description

The Viral Hepatitis Program is responsible for the coordination of all viral hepatitis (A, B, and C) activities associated with treatment and with primary and secondary prevention, including but not limited to the identification, counseling and referral for medical management of persons living with chronic HBV and HCV and integration of viral hepatitis services into existing health care programs across the state. The Program is also responsible for the development and maintenance of a Comprehensive Hepatitis C Program. The overall Program goals are to:

  • Assure access to hepatitis services including screening, testing, counseling, education, substance abuse treatment, and harm reduction;
  • Assure access to appropriate medical management and treatment for those chronically infected with HBV and HCV;
  • Assure access to affordable hepatitis A and B vaccine for adults at high-risk; and
  • Provide education to patients, health and human service providers and the public about viral hepatitis.

The Viral Hepatitis Program collaborates with the New York State Department of Health (NYSDOH) Bureau of Communicable Disease Control’s Regional Epidemiology Program, which is responsible for hepatitis surveillance and outbreak activities, and the Immunization Program, which is responsible for the coordination of the Adult Hepatitis Vaccination Initiatives. Department-wide Hepatitis Integration.

The Viral Hepatitis Program is responsible for the following activities:

Viral Hepatitis Strategic Plan

The purpose/mission of the 2004 New York State Viral Hepatitis Strategic Plan is to outline a coordinated, comprehensive and systematic approach that will decrease the incidence of acute viral hepatitis and limit the disease burden from chronic hepatitis among those living in New York State. The vision is to eliminate new hepatitis A, B and C infections and to improve the quality of life of those chronically infected with hepatitis B and C.

Hepatitis C Advisory Council

The Hepatitis C Advisory Council was established in March 2008. This 14-member Council, chaired by NYSDOH Commissioner, is charged with advising the Department in the development and implementation of a comprehensive hepatitis C program including: prevention and education; surveillance; management and treatment; screening, testing, counseling; and substance use treatment. Members of the Council include the Commissioner of the Office of Alcohol and Substance Abuse Services, clinicians, patient advocates and others experienced in the growing epidemic of hepatitis C.

Viral Hepatitis Integration Project

In 2004, the AIDS Institute was awarded a five-year CDC grant to develop and enhance hepatitis screening, vaccination, and access to care for active injection drug users (IDUs) and IDUs in methadone treatment. Viral Hepatitis Integration Program participants include Albert Einstein Methadone Maintenance Treatment Program (MMTP) and two syringe exchange programs, NY Harm Reduction Educators and St. Ann’s Corner of Harm Reduction. Services at the methadone clinics focus on enhancement of hepatitis C evaluations and access to treatment. Services at the harm reduction clinics include screening for HAV, HBV and HVC; vaccination for HAV and HBV; and case management to assist clients in accessing hepatitis and drug treatment services.

Hepatitis C Continuity Program

The Hepatitis C Continuity Program makes it possible for treatment for Hepatitis C to be initiated within New York State Department of Correctional Services without regard to the expected incarceration time remaining, since arrangements for continuity of treatment after release are possible. It enables inmates who initiate treatment prior to release to receive timely referral to appropriate clinics for continuation of treatment.

Statewide Hepatitis Conference

The New York State Statewide Hepatitis C Conference provides the most up-to-date information on Hepatitis C epidemiology, diagnosis, management, treatment and prevention, which will assist health and human service providers to offer the most effective care to persons infected with HCV. Since 2002, the conference has attracted over 1000 participants, including health and human service providers and consumers.

Contact:

Colleen Flanigan, RN, MS
Viral Hepatitis Coordinator
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
518-486-6806
caf03@health.state.ny.us

or

Felicia Schady
Director
Bureau of HIV Ambulatory Care Services
Division of HIV Health Care
(518) 473-8427
ffs01@health.state.ny.us

Back to top of page

Oral Health Care

Program Description

The New York State Department of Health AIDS Institute recognizes the importance of oral health care delivery as an integral component of quality HIV primary care. In addition, the AIDS Institute is under contract with the New York/New Jersey AIDS Education and Training Center (AETC) as the Oral Health Regional Resource Center (RRC). To address the varied needs and services associated with dental care, the AIDS Institute offers the following:

  • Clinical Practice Guidelines: Oral Health Care for People With HIV Infection. This state-of-the-art booklet is intended to provide dentists and other primary care team members with important clinical information to address the oral health needs of HIV patients in a multidisciplinary manner.
  • Educational presentations: The New York/New Jersey AETC RRC and the Clinical Education Initiative (CEI) offer specialized trainings in HIV oral health care to meet specific agency and individual needs of dentists, dental hygienists and dental assistants while providing educational credits. Training is available in a variety of formats ranging from didactic presentations to case presentations, clinical consultations and customized preceptorships. Available educational modules include but are not limited to the following:
    • diagnosis and management of oral lesions;
    • post-exposure prophylaxis and accident prevention;
    • legal and ethical dental issues;
    • dental treatment modifications for HIV infected patients; and
    • dental management of HIV infected pediatric patients.
  • HIV Oral Health Resource Directory: This resource, organized by region and borough, is intended as a referral tool for providers and individuals seeking oral health services.
  • Promoting Oral Health Care for People with HIV Infection - Best Practices: This booklet and/or DVD provides health care practitioners and administrators with information to initiate and maintain a high standard of oral health care. Examples from model programs are included.
  • Technical assistance: Technical assistance is available to oral health providers and administrators to assist in the development of new or expanded dental services responsive to the needs of HIV-infected persons.
  • Clinical performance quality indicators: The Oral Health Guidelines Committee has developed quality of care performance indicators for HIV health care facilities that provide dental services.
  • Good Oral Health is Important: This consumer brochure illustrates the importance of oral care and what the patient can do to promote oral health.
  • Oral Health Care is Important - A Guide for Caregivers of Children with HIV: This consumer brochure highlights the importance of oral care for HIV infected children and the role of the caregiver in promoting oral health care.

Contact:

Howard Lavigne, Deputy Director
HIV Clinical Education
Office of the Medical Director
(315) 477-8479
hel01@health.state.ny.us

or

David Nassry, D.M.D.
Oral Health Policy and
Technical Assistance
Office of the Medical Director
(212) 417-4553
daviddnassry@nyu.edu