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December 2015
New York State Recognizes World AIDS Day 2015 
On November 30, 2015, in recognition of World AIDS Day, Governor Cuomo announced new financial and programmatic commitments as part of the next phase of the State's End the Epidemic Initiative:
  • $200 million in new funding, in addition to the $2.5 billion that the State has already committed to address HIV/AIDS 
  • Increased commitment to helping people living with HIV obtain affordable housing and/or housing assistance
  • Approval of a life insurance product for people aged 30 to 60 who are living with HIV
  • Medicaid Managed Care program to promote patient linkage and retention in care
  • Additional funding to NYC "One Stop" STD clinics to enhance services
  • Intensified efforts to ensure compliance with the HIV testing law
The Governor also announced that the State has already achieved key accomplishments in its efforts to End AIDS by 2020, including the following:
  • No new cases of mother-to-child transmission reported since August 2014
  • 300% increase in PrEP use among Medicaid enrollees since June 2014
  • Updated surveillance and methodology for identifying people living with HIV

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2015 Laubenstein Awards Announced
On December 1, the Office of the Medical Director, NYSDOH AIDS Institute, announced the recipients of the 2015 Linda Laubenstein HIV Clinical Excellence Award: Robert Murayama, MD, MPH, Chief Medical Officer of APICHA, and Rona M. Vail, MD, HIV Specialist, Callen-Lorde Community Health Center. Both of these distinguished clinical leaders have excelled in providing HIV care to the LGBT community and in championing sensitive care for vulnerable, often marginalized populations. 

The AIDS Institute established this award in 1992 in memory of Dr. Linda Laubenstein (1947-1992), a Manhattan physician, to honor her pioneering work and outstanding contribution to the quality of AIDS care in the early years of the epidemic.

Congratulations, Drs. Murayama and Vail!
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What We're Reading
Modeling the Effects of Strategies to End the HIV Epidemic 
Christopher J. Hoffmann, MD, MPH, Johns Hopkins University School of Medicine
New York State's plan for Ending the AIDS Epidemic as well as the National HIV/AIDS Strategy call for significant increases in the number of individuals who know their HIV status, linking individuals to care at the time of HIV diagnosis, and providing care that enables HIV-infected patients to achieve undetectable viral loads. These important and ambitious goals require three distinct steps: (1) increased HIV testing among individuals at highest risk for acquiring HIV; (2) improved linkage to care soon after a person's diagnosis of HIV; and (3) long-term engagement with care.

To identify improvements that could provide the best value along this care continuum, Shah and colleagues [CID 2015] developed a predictive 20-year model of HIV infection in the United States. The research team's compartmental model allows for transitions between HIV status, care status, and CD4 count by HIV transmission risk category (men who have sex with men, injection drug users, and heterosexual individuals). The authors used data from the US epidemic, costs from HIV care, and results of studies of strategies to increase testing, linkage, or retention in care. Uncertainty ranges were estimated using probabilistic modeling.

At 2015 levels of testing, linkage, and retention in care, 1.39 million new HIV infections (uncertainty range: 0.91-2.2 million) are predicted over the next 20 years, at an estimated cost to the US healthcare system of approximately $256 billion. A substantial increase in HIV testing could reduce this projected HIV incidence by approximately 16%. If enhanced HIV testing is coupled with a 90% increase in linkage to care within 90 days of diagnosis, it is estimated that HIV incidence could be reduced by 21%. Each strategy would have substantial costs.
However, a 50% increase in long-term retention in care may offer the greatest benefit at the lowest cost: 36% fewer infections (prevention of 494,000 new infections) over 20 years. The estimated added healthcare cost for increased retention in care is $47.7 billion. That cost is slightly less than either the $49 billion cost of enhanced HIV testing or the $52.9 billion cost of enhanced testing plus linkage to care after diagnosis. 

This study highlights the importance of active strategies to retain people living with HIV in care and suggests that retention in care may provide the best monetary value when considering strategies along the care continuum of testing, linkage, and retention. 

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