The National Institute of Mental Health (NIMH) has awarded the CUNY Graduate School of Public Health and Health Policy (CUNY SPH) and the New York City Department of Health and Mental Hygiene (NYC Health Department) a five-year, $3.3 million grant to test a new strategy to help people living with HIV achieve viral suppression.
The project, led by CUNY SPH Distinguished Professor Denis Nash and Dr. Mary Irvine, Director of the NYC Health Department's HIV Care and Treatment Research and Evaluation Unit, will implement, refine, and evaluate a "data-to-suppression" (D2S) intervention designed to improve viral suppression among Ryan White HIV/AIDS Program Part A (RWPA) clients in New York City.
Some existing HIV care continuum strategies, such as "data-to-care," target linkage to care and limit data sharing to medical providers. However, while people with HIV enrolled in NYC's RWPA program in 2018-2019 were more likely to be retained in care than people with HIV not enrolled in RWPA, they were less likely to be virally suppressed or to have achieved durable viral suppression while retained in care. Furthermore, since 2017, New York State regulations now permit person-level HIV surveillance data sharing with entities engaged in care coordination with primary care providers.
Therefore, the focus of the D2S strategy is to bolster antiretroviral medication adherence by delivering actionable client-level viral suppression status reports and targeted capacity-building to RWPA support-service providers. The intervention was successfully piloted among RWPA medical case management programs in NYC in 2018, and the study team aims to refine, scale up and implement the intervention starting in 26 agencies funded for RWPA behavioral-health and housing services delivery.
We cannot think about ending HIV as a public health threat until we achieve much-needed, long overdue gains and outcome improvements among the most vulnerable people with HIV, such as those who receive services in the federally funded Ryan White Program."
Denis Nash, Executive Director, CUNY Institute for Implementation Science in Population Health (CUNY ISPH)
The D2S study is a randomized "stepped-wedge" trial that will leverage HIV surveillance data, programmatic reporting on clients and services, and focus groups with RWPA clients and service providers, to understand the effectiveness of the strategy at improving client HIV care outcomes. It will also use discrete choice experiments (DCEs) with service providers to assess their preferences for intervention delivery and specific intervention features. This work and other CUNY ISPH-NYC Health Department collaborations are evaluating and advancing interventions capable of strengthening the care continuum among RWPA clients who have been unable to achieve desired antiretroviral outcomes using existing interventions, due to structural or psychosocial barriers.
"If we find the D2S strategy to be effective at improving HIV viral suppression," said Nash, "then there is potential to greatly influence practice changes all over New York State and around the United States that could improve HIV care outcomes for people who have struggled to maintain HIV viral suppression."