With the CDC’s PS18-1802 funding opportunity the Rhode Island Department of Health (RIDOH) aims to respond to the ongoing HIV epidemic through expanded surveillance and prevention activities. During the last ten years, Rhode Island has seen a decline in the number of newly diagnosed cases of HIV by virtually eliminating mother to child transmission, as well as a significant decrease in IDU transmission, but there is a disproportionate disease burden among gay, bisexual, and other men who have sex with men (MSM).
The most recent care continuum, which was calculated using 2014 data, shows just over 2,500 persons living with HIV (PLWH) in Rhode Island. Of these 2,500 people, 67% of individuals were engaged in care, but only 48% of all diagnoses were retained in care and only 57% of all diagnoses had achieved viral suppression. RIDOH plans to enhance the Return-to-Care program and offer reengagement services to individuals who appear to be out of care to ensure viral suppression.
There are many different components to the HIV Surveillance and Prevention Programs at RIDOH. This comprehensive approach includes condom distribution, syringe services, community-based rapid HIV testing, partner services, Return-to-Care activities, provider education and training, and social marketing activities. The highest risk populations served by this funding opportunity include people who inject drugs, PLWH including pregnant HIV-positive women and their babies, MSM, and male, female, and transgender sex workers. By contracting with multiple community based organizations for rapid HIV testing and condom distribution, many of the highest risk populations are offered services in an environment where they feel most comfortable.
RIDOH’s HIV Partner Services (PS) program is one of the most successful components of the HIV Prevention Program. Nearly 100% of index clients over the last five years have accepted a partner services interview and RIDOH PS staff are successful at obtaining partner information leading to testing. HIV PS staff are trained to perform HIV rapid testing in the field and test 40-50 clients annually, with a positivity rate between 5-10%.
RIDOH is committed to responding to the HIV epidemic, and a large part of this commitment is implementing data-driven approaches. These data have informed prevention efforts such as where to target resources and what populations to reach out to. Further, RIDOH is committed to staying informed on the newest ways of responding to the epidemic. RIDOH continues to encourage PrEP use and support its roll-out state-wide. Through the proposed demonstration project RIDOH will contract with The Miriam Hospital STD Clinic to conduct physician assisted partner services, identify additional exposed partners, and provide PrEP referrals for eligible individuals. Finally, RIDOH has built greater collaborations with partners to respond holistically to the HIV epidemic.
Overall, the RIDOH is well positioned to strengthen its integrated surveillance and prevention programs to ensure that the trends in HIV continue to decline. The RIDOH has adopted the International Association of Providers of AIDS Care’s 90 90 90 targets and is committed to working with various partners to meet the needs of people at risk for HIV and those living with HIV. These partners include a unique blend of health care providers, other state agencies, community groups, AIDS service organizations, and consumer groups. The RIDOH staffing team represents a group of seasoned and committed professionals who have strong backgrounds in HIV epidemiology, surveillance, program evaluation, health promotion, and prevention services. Given Rhode Island’s geographic small size and the RIDOH’s dual role as a state and local public health department, as well as our strong infrastructure, our goal is to be the first state in the nation to reduce the HIV incidence to zero.