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HIV/STD Prevention & Care
1
HIV/STD Prevention and Care(Special Projects of National Significance
Program)
Victoria Mobley, MD MPHCommunicable Disease BranchNC Division of Public Health
July 27, 2012
HIV/STD Prevention & Care
2
Diagnosis of HIV Infection and Population, by Race/Ethnicity, 2010 ‐ NC
26%
66%
6%
2%
Diagnosis of HIV infection, N=25,074
White Black Hispanic Other
69%
22%
8%
1%
North Carolina population, N=9,535,483
White Black Hispanic Other
Diagnosis of HIV Infection among Adults and Adolescents, by Sex and Transmission Category, 2010‐NC
75%
3%1%
21%
Mode of Transmission ‐ AdultMSM IDU MSM/IDU Heterosexual
5%
95%
Mode of Transmission ‐Adolescent
IDU Heterosexual
AIDS Cases among Adults and Adolescents by Race/Ethnicity, NC
2006‐2010
0
100
200
300
400
500
600
700
2006 2007 2008 2009 2010
AIDS CA
SES
YEAR
HISPANICWHITEBLACK
HIV Prevention Trial Network (HPTN) 052
• Phase III, randomized controlled trial• Primary Objective: Does ART prevent HIV transmission in serodiscordant couples?
• Multi‐center study including African, Asian, North and South American sites
• Enrollment between April 2005 and May 2010• April 2011, the DSMB suggested the study be halted and findings released ASAP
HIV/STD Prevention & Care
3
Early initiation of ART decreased HIV transmission by 96%CARE=Prevention
THE CASCADE
10MMWR / December 2, 2011 / Vol. 60 / No. 47 1621
Special Projects of National Significance (SPNS)
• Develop innovative models of HIV treatment
• Advance knowledge and skills in the delivery of health care
• Provide support services to underserved HIV‐infected populations
• Design, implement, evaluate and disseminate information
NC CDB response: NC‐LINK Goal: To address the 4 gaps along the HIV care continuum spectrum Use internet‐based prevention to reduce the number who don’t know their HIV status
Reduce number who do not enter care for more than 3 months
Reduce the number who do not receive a minimal level of continuous care
Use CD4/VLs to provide surveillance for HIV care, not just cases
Improve delivery of quality care using shared data systems
HIV/STD Prevention & Care
4
State Bridge Counselors Rapid entry into care for newly diagnosed
Regional Bridge Counselors Locate and re‐engage lost to care patients
Internet Bridge Counselors Work with the internet partner notification program
Bridge Counselors Bridge CounselorsTypes of activities:
Work with specialty populations: newly released inmates and their partners
Follow up on reports from providers of lost‐to‐care patients
Receive reports from ADAP when patient doesn’t refill prescriptions
Work with the Regional Networks of Care case managers to locate lost patients
Ultimate goal of NC‐LINK
Through linkage and retention of patients in care:
Decrease HIV transmission
Decrease HIV‐associated morbidity
Decrease HIV‐associated mortality