The purpose of the District of Columbia Department of Health (DOH) HIV, AIDS, Hepatitis, STD and TB Administration (HAHSTA) integrated HIV surveillance and prevention program is to prevent new HIV infections and improve health outcomes among individuals living with HIV through the implementation of individual and population-based comprehensive testing, behavioral, biomedical, care linkage, treatment adherence, and support services informed by timely surveillance and programmatic data.
Under Component A (Core Project), DOH intends to reduce transmission and prevent new infections of HIV and STDs and enhance interventional surveillance to increase response capacity and access to behavioral, structural and/or biomedical interventions for persons living with HIV and persons at risk of HIV, including testing in health care and community settings, Data-to-Care activities, biomedical risk reduction interventions, harm reduction, condom distribution and social marketing. The main process outcomes will be: 1) improved data completeness, timeliness, and quality; 2) increased utilization of data to inform program and policy development activities; 3) enhanced utilization of data for public health action; and 4) expanded accessibility to behavioral, biomedical, treatment, and support services designed to meet the needs of those at-risk or living with HIV.
The overall impact of achieving these capacity and process related outcomes will be a more robust public health system for monitoring service utilization patterns and clinical outcomes among individuals at-risk or living with HIV in the District, as well as a more responsive system for addressing identified needs. Long-term clinical and health outcomes associated with the proposed effort include the following: 1) increased number of individuals aware of their HIV status; 2) increased viral load suppression among individuals living with HIV; 3) reduced HIV transmission; and 4) reduced HIV-related health disparities.
For Component B (Demonstration Project), DOH will develop and implement a model using real-time pharmacy data to identify persons living with HIV who fail to pick up ART or pick up incomplete regimens and persons at risk for HIV who fail to pick up PrEP with the dual goals of improving treatment adherence to achieve viral suppression and optimizing HIV prevention. There are two specific aims: (1) collect and analyze identified, individual-level pharmacy data on ART and PrEP to inform and implement individual adherence interventions and (2) collect and analyze de-identified, population-level pharmacy data on ART and PrEP to inform strategic public health program development and monitoring. The main sources of identified, individual-level pharmacy claims data will be the Medicaid PBMs and DC ADAP. Pharmacy claims data will be used to identify persons who have not picked up prescribed ART or PrEP medication by 30 and 60 days. For persons who fail to pick up medication by these time points, targeted interventions will be deployed, with the goals of increased engagement in care, adherence, and treatment success. A sub-study using a tenofovir adherence assessment will be conducted among young adults.