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Implementing Combination Prevention Technologies:
The New York City Experience
M. Monica Sweeney, MD, MPHAssistant CommissionerBureau of HIV/AIDS Prevention & ControlSYNChronicityThe State of the Science: Combination Prevention TechnologiesApril 20, 2012
New Prevention Strategies for a New Era
IBM, 1980s iPad 3, 2012
We must use, deliver and bring to scale the full range of tools available for addressing HIV prevention
Note: PMTCT, Screening transfusions, Harm reduction, Universal precautions, etc. have not been included – this is focused on reducing sexual transmission
LargestImpact
SmallestImpact
Structural Interventions that Impact Health OutcomesExamples
Socioeconomic Factors
Changing the Contextto make individuals’ default
decisions healthy
Long-lasting Protective Interventions
ClinicalInterventions
Counseling &
Education
Condoms, eat healthy, be physically active
Rx for high blood pressure, high cholesterol, depression
Poverty, education, housing
Immunizations, brief intervention, cessation treatment, colonoscopy
Fluoridation, 0g trans fat, iodization, smoke-free laws, tobacco tax
Health Belief Model
Perceived Susceptibility to Disease “X”
Perceived Severity of Disease “X”
Perceived Susceptibility to Disease “X”
Perceived Severity of Disease “X”
Demographic variable(age, sex, race, ethnicity, etc.)Socio-psychological variables
Demographic variable(age, sex, race, ethnicity, etc.)Socio-psychological variables
Perceived benefits of preventative action
minus Perceived barriers to preventative action
Perceived benefits of preventative action
minus Perceived barriers to preventative action
Perceived Threat of Disease “X”
Perceived Threat of Disease “X” Likelihood of Taking
Recommended Preventative Health Action
Likelihood of Taking Recommended Preventative
Health Action
Cues to Action•Mass Media Campaign•Advice from others•Illness of family member or friend•Newspaper/magazine article
Cues to Action•Mass Media Campaign•Advice from others•Illness of family member or friend•Newspaper/magazine article
Individual Perceptions
Modifying Factors Likelihood of Action
General Media Campaigns National
General Media Campaigns Local
Targeted Media Campaigns for sub-populations
*Community Level Interventions (CLI’s)
(e.g., DEBI’s: Community Promise, Popular Opinion Leader,)
General Audience *Group Level Interventions (GLIs)
(e.g., General Awareness workshops)
Targeted GLIs for sub-populations (e.g., Health Relationships, SISTA, Street Smart, Safety Counts)
Brief *Individual Level Intervention (ILIs) –trained providers
Ongoing ILIs- trained provider(e.g., Counseling with a trusted expert)
Number of people reached
Extent of Tailoring for Personal Impact
A Model: The Perceived Potential Reach and Impact of Various Prevention Strategies
(Adapted from model by Robert Zielony, Ph.D. 2010)
Social Media & HIV Prevention at the New York City Department of Health and Mental Hygiene
NYC Condom Finder Application
• Available on Apple iPhone, Android Phone, Microsoft Phone, and BlackBerry
Youth Risk Behavior Survey,Condom Use at Last Sex, 1999-2009
U.S. data adapted from: Centers for Disease Control and Prevention (CDC). 1991-2009 High School Youth Risk Behavior Survey Data. Available at http://apps.nccd.cdc.gov/youthonline. Accessed on April 16, 2012; *sample limited to public school students attending school the day survey was administered
Remember to Visit & Download…
The NYC Condom Finder Application→Search “find condoms”
facebook.com/NYCcondom
HIV Testing Technologies
HIV Tests That Produces Results in 60 Minutes or Less
• Rapid point-of-care test
• Enzyme Immunoassays (EIAs)
Testing for HIV VirusNucleic acid amplification tests (NAAT)
• Aptima HIV-1 RNA Qualitative Assay– Only FDA-approved test to diagnose Acute HIV Infection
• Other HIV NAAT/PCR tests can detect HIV virus– Quantitative tests (HIV viral load tests)– FDA-approved for monitoring status of HIV disease and for
guiding therapeutic recommendations
Treatment Recommendations
NYT article: http://www.nytimes.com/2011/12/01/nyregion/to-stop-aids-nyc-wants-drugs-given-sooner-for-hiv.html?_r=1
Offer Treatment, Regardless of CD4 Count
nPEPnon- occupational Post Exposure Prophylaxis
Acknowledgments
THANK YOU!
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