Overview of Ryan White-Funded Rapid Testing Services

1. Overview of Ryan White-Funded Rapid Testing Services • Benjamin Tsoi, MD, MPH • Director, HIV Testing Unit • Mara Pillinger, MPH • Technical Assistance Coordinator, HIV Testing Unit 1

2. Ryan White-Funded Testing • Ryan White (Ryan White) provides testing under: • BASE-funded EIS contracts • MAI-funded ESC contracts • Harm reduction (HRR) contracts • Core services: • Rapid HIV Testing (RHT) • Confirmatory Testing* • Linkage to Care (LtC)** *As of Mar ‘10 for HRR & Aug ‘10 for EIS/ESC **As of Mar ’10 for HRR

3. Ryan White Testing Contracts • 35 contracts funding 31 agencies across 5 boroughs • Diverse settings • Community-based organizations (CBOs) • Hospitals • Community health centers (CHCs)

4. Ryan White Testing ContractsDiverse Settings • CBOs target • MSM (& MSM of color), African Americans, Latinos, immigrants, the homeless, formerly incarcerated, current/former substance users, etc. • Hospitals offer testing in ERs, inpatient units (e.g. internal medicine, psych, detox) & outpatient clinics (e.g. STDs, OB/GYN)

5. Testing Program Goals • Identify PLWHA through testing and link them to medical care • Provide RHT in communities with high prevalence of HIV • Targeted outreach to at-risk populations and those with a high proportions of delayed/concurrent diagnosis • Routinized testing in medical settings in high prevalence neighborhoods • Provide LtC for newly-diagnosed persons or those who have been out-of-care for >9 months or have never before been in care in NYC • Serve as payer of last resort

6. Ryan White TestingContract Distribution NB: This chart reflects the number of funded agencies with headquarters in each borough. Many agencies test across multiple boroughs.

7. Ryan White Testing Models • Targeted Testing • Outreach-based—identifying those at high-risk • CBOs & Hospitals/CHCs • Routinized testing • Screening—routine offer of an HIV test to every patient who sees presents to a clinical setting • Hospitals/CHCs • Mandated by new NYS HIV Testing Law

8. Ryan White Testing Funding • Total funding= ~$ 6.5 million/year • BASE=~$3.8 million/year • MAI=~$1 million/year • HRR= ~ $1.7million/year

9. Ryan White Testing Data (Jan 2008-Oct 2010) • Over 167,000 tests conducted • 30% increase in volume of tests between 2008 and 2009; on track to meet/exceed 2009 performance in 2010 • ~ 2,400 preliminary positives identified • ~350 clients linked to care • 63% of self-reported “new positives” were linked • Over 1,000 out-of-care previously diagnosed positives were linked to care

10. Ryan White Testing Data(July 2009-June 2010)

11. HIV Testing In NYC • A Complicated Picture 11

12. HIV Testing in NYCA Complicated Picture Testing Providers

13. HIV Testing in NYCA Complicated Picture Testing Providers • Clinical Settings • Hospitals • CHCs • STD Clinics • TB Clinics • Dental Clinics

14. HIV Testing in NYCA Complicated Picture Testing Providers • Clinical Settings • CBOs • Agency- based • Mobile Testing • Testing Events (fairs, etc.)

15. HIV Testing in NYCA Complicated Picture Testing Providers • Clinical Settings • CBOs • Correctional Settings

16. HIV Testing in NYCA Complicated Picture Testing Providers • Clinical Settings • CBOs • Correctional Settings • Private Practices

17. HIV Testing in NYCA Complicated Picture Testing Providers Testing Payers • Clinical Settings • CBOs • Correctional Settings • Private Practices

18. HIV Testing in NYCA Complicated Picture Testing Providers Testing Payers • Clinical Settings • CBOs • Correctional Settings • Private Practices • Direct Funders • CDC • SAMHSA • NYS DOH • HRSA (RW Part C)

19. HIV Testing in NYCA Complicated Picture Testing Providers Testing Payers • Clinical Settings • CBOs • Correctional Settings • Private Practices • Direct Funders • Third Party Payers

20. HIV Testing in NYCA Complicated Picture Testing Providers Testing Payers • Clinical Settings • CBOs • Correctional Settings • Private Practices • Direct Funders • Third Party Payers • NYC DOHMH

21. HIV Testing Funded by NYC DOHMH • STD Clinics • TB Clinics • NYC Jails • Bureau of HIV/AIDS • Ryan White funds • CDC funds • City Tax Levy Funds

22. HIV Testing Funded byNYC DOHMH • STD Clinics • TB Clinics • NYC Jails • Bureau of HIV/AIDS • Ryan White portfolio • Prevention portfolio

23. Prevention Testing Portfolio • Prevention is the other major portfolio of DOHMH testing contracts • Funded by CDC & City Tax Levy dollars • 39 contracts in 32 agencies • Testing models: • Screening • Targeted Testing • Social Network Strategy • Bath houses, homeless shelters, etc.

24. Comparing Contract Distribution

25. Comparing Funding Distribution *Post Aug 2010

26. A Unified Testing Effort? • 9 separate contract families result in significant overlap • Overlap in targeted populations (risk groups) • Agencies targeting same populations in same neighborhoods creates “competition” • Overlap in funded agencies • Roughly 1/3 of funded agencies have >1 contract • Agencies use different contracts to fund the same activities at different times • Creates greater administrative and reporting burden for agencies

27. A Unified Testing Effort? • Different contract structures with different payment points and different reimbursement rates fuels differences in performance • Before mid-2010 • Prevention paid for testing, confirmation & linkage • EIS/ESC paid for testing & linkage • HRR paid for testing • Only EIS/ESC paid for linkage of “known positives”

28. One City, One Plan • Propose a joint RFP for Ryan White- & Prevention-funded contracts • Advantages: • Enables Planning Council to support one unified testing plan for the entire city • Allows agencies to submit only one application • Enables agencies to plan, propose & manage a single comprehensive testing program • Reduces administrative burden and reporting burden for agencies • Provides consistent reimbursement structure

29. One City, One Plan • Advantages, con’t: • Enables DOHMH to better coordinate funding, ensuring that all target groups and all areas of the city are covered by both CBOs & hospitals/CHCs • Reduces administrative burden for DOHMH