1 Overview of Overview of Ryan White-Funded Ryan White-Funded Rapid Testing Rapid Testing Services Services Benjamin Tsoi, MD, MPH Benjamin Tsoi, MD, MPH Director, HIV Testing Unit Director, HIV Testing Unit Mara Pillinger, MPH Mara Pillinger, MPH Technical Assistance Coordinator, HIV Technical Assistance Coordinator, HIV Testing Unit Testing Unit
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Overview of Ryan White-Funded Rapid Testing Services
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. Ryan White-Funded Testing. Ryan White (Ryan White) provides testing under: BASE-funded EIS contracts - PowerPoint PPT Presentation
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Overview of Overview of Ryan White-Funded Ryan White-Funded
Rapid Testing ServicesRapid Testing ServicesBenjamin Tsoi, MD, MPHBenjamin Tsoi, MD, MPHDirector, HIV Testing UnitDirector, HIV Testing Unit
Mara Pillinger, MPHMara Pillinger, MPHTechnical Assistance Coordinator, HIV Testing Technical Assistance Coordinator, HIV Testing
UnitUnit
Ryan White-Funded TestingRyan White-Funded Testing
Ryan White (Ryan White) provides Ryan White (Ryan White) provides testing under:testing under: BASE-funded EIS contractsBASE-funded EIS contracts MAI-funded ESC contractsMAI-funded ESC contracts Harm reduction (HRR) contractsHarm reduction (HRR) contracts
Core services: Core services: Rapid HIV Testing (RHT)Rapid HIV Testing (RHT) Confirmatory TestingConfirmatory Testing**
Linkage to Care (LtC)Linkage to Care (LtC)****
*As of Mar ‘10 for HRR & Aug ‘10 for EIS/ESC **As of Mar ’10 for HRR
Ryan White Testing Ryan White Testing ContractsContracts
35 contracts funding 31 agencies across 35 contracts funding 31 agencies across 5 boroughs5 boroughs
Diverse settingsDiverse settings Community-based organizations (CBOs)Community-based organizations (CBOs) HospitalsHospitals Community health centers (CHCs)Community health centers (CHCs)
Ryan White Testing Ryan White Testing ContractsContracts
Diverse SettingsDiverse Settings CBOs targetCBOs target
MSM (& MSM of color), African Americans, MSM (& MSM of color), African Americans, Latinos, immigrants, the homeless, Latinos, immigrants, the homeless, formerly incarcerated, current/former formerly incarcerated, current/former substance users, etc.substance users, etc.
Hospitals offer testing in ERs, inpatient Hospitals offer testing in ERs, inpatient units (e.g. internal medicine, units (e.g. internal medicine, psych, detox) & outpatient clinics (e.g. psych, detox) & outpatient clinics (e.g. STDs, OB/GYN) STDs, OB/GYN)
Testing Program GoalsTesting Program Goals Identify PLWHA through testing and link them to Identify PLWHA through testing and link them to
medical caremedical care
Provide RHT in communities with high Provide RHT in communities with high prevalence of HIVprevalence of HIV Targeted outreach to at-risk populations and those Targeted outreach to at-risk populations and those
with a high proportions of delayed/concurrent with a high proportions of delayed/concurrent diagnosisdiagnosis
Routinized testing in medical settings in high Routinized testing in medical settings in high prevalence neighborhoodsprevalence neighborhoods
Provide LtC for newly-diagnosed persons or Provide LtC for newly-diagnosed persons or those who have been out-of-care for >9 months those who have been out-of-care for >9 months or have never before been in care in NYCor have never before been in care in NYC
Serve as payer of last resortServe as payer of last resort
Ryan White TestingRyan White TestingContract DistributionContract Distribution
CBOsCBOs HospitalHospitals/s/
CHCsCHCs
TotalsTotals
BronxBronx 55 22 77
BrooklynBrooklyn 44 33 77
ManhattManhattanan
1111 77 1818
QueensQueens 22 00 22
Staten Staten IslandIsland
11 00 11
TotalsTotals 2323 1212 3535
NB: This chart reflects the number of funded agencies with headquarters in each borough. Many agencies test across multiple boroughs.
Ryan White Testing Ryan White Testing ModelsModels
Targeted TestingTargeted Testing Outreach-based—identifying those at Outreach-based—identifying those at
~350 clients linked to care~350 clients linked to care 63% of self-reported “new positives” were linked63% of self-reported “new positives” were linked
Over 1,000 out-of-care previously diagnosed Over 1,000 out-of-care previously diagnosed positives were linked to carepositives were linked to care
Ryan White Testing DataRyan White Testing Data(July 2009-June 2010)(July 2009-June 2010)
Prevention is the other major portfolio Prevention is the other major portfolio of DOHMH testing contractsof DOHMH testing contracts Funded by CDC & City Tax Levy dollarsFunded by CDC & City Tax Levy dollars
39 contracts in 32 agencies39 contracts in 32 agencies Testing models:Testing models:
A Unified Testing Effort?A Unified Testing Effort? 9 separate contract families result in 9 separate contract families result in
significant overlapsignificant overlap
Overlap in targeted populations (risk groups)Overlap in targeted populations (risk groups) Agencies targeting same populations in same Agencies targeting same populations in same
Overlap in funded agenciesOverlap in funded agencies Roughly 1/3 of funded agencies have >1 contractRoughly 1/3 of funded agencies have >1 contract Agencies use different contracts to fund the same Agencies use different contracts to fund the same
activities at different timesactivities at different times Creates greater administrative and reporting Creates greater administrative and reporting
burden for agenciesburden for agencies
A Unified Testing Effort?A Unified Testing Effort? Different contract structures with Different contract structures with
different payment points and different different payment points and different reimbursement rates fuels differences in reimbursement rates fuels differences in performanceperformance
Before mid-2010Before mid-2010 Prevention paid for testing, confirmation & Prevention paid for testing, confirmation &
linkagelinkage EIS/ESC paid for testing & linkageEIS/ESC paid for testing & linkage HRR paid for testingHRR paid for testing Only EIS/ESC paid for linkage of “known Only EIS/ESC paid for linkage of “known
positives”positives”
One City, One PlanOne City, One Plan Propose a joint RFP for Ryan White- & Propose a joint RFP for Ryan White- &
Advantages:Advantages: Enables Planning Council to support one Enables Planning Council to support one
unified testing plan for the entire cityunified testing plan for the entire city Allows agencies to submit only one applicationAllows agencies to submit only one application Enables agencies to plan, propose & manage a Enables agencies to plan, propose & manage a
single comprehensive testing programsingle comprehensive testing program Reduces administrative burden and reporting Reduces administrative burden and reporting
burden for agenciesburden for agencies Provides consistent reimbursement structure Provides consistent reimbursement structure
One City, One PlanOne City, One Plan
Advantages, con’t: Advantages, con’t: Enables DOHMH to better coordinate Enables DOHMH to better coordinate
funding, ensuring that all target groups funding, ensuring that all target groups and all areas of the city are covered by and all areas of the city are covered by both CBOs & hospitals/CHCsboth CBOs & hospitals/CHCs
Reduces administrative burden for Reduces administrative burden for DOHMHDOHMH