Susan J. Klein

Progress in prevention of mother-to-child transmission of HIV in New York State: 1988-2008.

OBJECTIVES To assess the outcomes of efforts to prevent mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) made over the last 2 decades in New York State (NYS), through review of data from multiple sources. METHODS Using available surveillance, laboratory, and program monitoring data, the following were examined for NYS: (1) the rate of prenatal HIV testing, (2) HIV prevalence among childbearing women, (3) maternal prenatal and delivery care, (4) care of HIV-exposed infants, and (5) the rate of MTCT. Trends over time and comparisons among groups were assessed. RESULTS In NYS, HIV prevalence in childbearing women has declined 70% since its peak in 1989. Rates of prenatal HIV testing have been more than 95% in recent years. Rates of MTCT have decreased significantly; since 2003, transmission in HIV-exposed births has ranged from 1.2% to 2.6% annually. On bivariate analysis, MTCT is more likely to occur with breastfeeding or absence of antiretroviral administration in the prenatal, labor/delivery, and newborn periods. CONCLUSIONS Mother-to-child HIV transmission has declined dramatically in all groups in NYS. Universal newborn screening data have provided the foundation for identifying HIV-exposed births and for initiating follow-up to track all aspects of MTCT in NYS. Remaining challenges include universal prenatal care, prevention of acquisition of HIV infection during pregnancy, and adherence to antiretroviral therapy.

Promoting HCV Treatment Completion for Prison Inmates: New York State's Hepatitis C Continuity Program

This article describes the development of a statewide program providing continuity of hepatitis C virus (HCV) treatment to prisoners upon release to the community. We discussed length of stay as a barrier to treatment with key collaborators; developed protocols, a referral process, and forms; mobilized staff; recruited heath-care facilities to accept referrals; and provided short-term access to HCV medications for inmates upon release. The Hepatitis C Continuity Program, including 70 prisons and 21 health-care facilities, is a resource for as many as 130 inmates eligible to start treatment annually. Health-care facilities provide fairly convenient access to 87.1% of releasees, and 100% offer integrated HCV-human immunodeficiency virus/acquired immunodeficiency syndrome care. As of March 2006, 24 inmates had been enrolled. The program was replicated in the New York City Rikers Island jail. The program is operational statewide, referrals sometimes require priority attention, and data collection and other details are still being addressed.

Expanding access to sterile syringes through pharmacies: Assessment of New York's Expanded Syringe Access Program

OBJECTIVES To investigate the evolution of pharmacist practices, attitudes, and experiences with the Expanded Syringe Access Program (ESAP), which permits over-the-counter sale of syringes by registered pharmacies in New York State. DESIGN Longitudinal study. SETTING New York State in 2002 and 2006. PARTICIPANTS 506 (2002) and 682 (2006) managing pharmacists (response rates approximately 70%) at ESAP-registered pharmacies (n = 346 in both years). INTERVENTION Mailed surveys (2002 and 2006). MAIN OUTCOME MEASURES Pharmacist practices, attitudes, and experiences with ESAP over time. RESULTS Approximately 75% of pharmacists reported that ESAP had facilitated timely/emergency access to syringes, and more than 90% in each year reported no problems or very few problems administering ESAP. The practice of placing additional requirements on the sale of syringes decreased from 2002 (51.4%) to 2006 (45.1%), while a 55% increase in syringe sales was reported between 2002 (43.3/month) and 2006 (67.1/month). The sale of sharps containers also increased between 2002 (85.2%) and 2006 (92.8%). Community independent pharmacies and those located outside New York City generally expressed more favorable attitudes and experiences with ESAP, although these differences decreased over time. CONCLUSION Pharmacy-based syringe access is a viable harm-reduction alternative in the fight against blood-borne diseases, with ESAP now equaling the number of syringes being distributed by syringe exchange programs in New York State. Continued education/training is necessary to increase participation in ESAP and to further reduce barriers to ESAP use.

Youth Development Is a Public Health Approach

The health and well-being of adolescents have a major impact on the overall health of society: today’s adolescents are tomorrow’s workforce, parents, and leaders. In the past, approaches to working with youth to improve health often focused solely on problem behaviors in an effort to change them. As detailed in the series of articles that make up this supplement, “youth development” emphasizes the many positive attributes of young people and focuses on working to develop inherent strengths and assets in youth to promote healthy behavioral development. The youth development model mirrors a public health approach; many of the principles that comprise youth development strategies— prevention, specific population focus, mobilization of affected communities—also guide public health activities. This supplement to the Journal of Public Health Management andPractice presents and discusses youth development approaches in the context of public health programs. The overarching purpose of the supplement is to acquaint public health practitioners with the basic concepts of youth development and to provide guidance about how to put them into practice. Articles in this supplement address related topics, including how to mount a successful public health program based on youth development principles, what partnerships are important for successful outcomes, and how to evaluate the impact of such programs. Supplement articles highlight the underlying theory of youth development, provide case studies from actual practice, and suggest ways that public health practitioners can incorporate youth development concepts into practice. The supplement is presented in three parts. First, there is a general section giving background information on youth development as an approach for public health practitioners in what might be termed “youth development 101.” The second section details specific experiences of the New York ACT (Assets Coming Together) for Youth program and its funded projects. The final section covers evaluation of youth development projects, including those in New York State.

What do pharmacists think about New York State's new nonprescription syringe sale program? Results of a survey

Access to sterile syringes can prevent transmission of blood-borne diseases such as human immunodeficiency virus (HIV) and hepatitis B and C. We conducted a survey of attitudes of pharmacists to aid, in development of the Expanded. Syringe Access Demonstration Program (ESAP) in New York State. ESAP is an HIV prevention initiative that authorizes nonprescription sale of hypodermic needles and syringes by registered pharmacies in New York State beginning January 1, 2001. As part of planning for program implementation, the New York State Department of Health (NYSDOH), in collaboration with the New York State Education Department, conducted a mailed survey of all 4,392 licensed pharmacies in New York State during the summer of 2000. Some surveys (171) were returned as undeliverable. Of the 4,221 eligible respondents, 874 (20.7%) completed surveys were received, of which 574 (65.7%) indicated that their pharmacy would likely participate in ESAP. An additional 11.0% were not sure. Only 139 (15.9%) indicated that they would definitely not participate; 7.4% left this question blank. There were 608 responses to questions on safe disposal practices. Of these, 315 (51.8%) respondents indicated that their pharmacy sold sharps containers, and an additional 29 made them available at no cost. Only 133 (21.9%) respondents to this question did not offer sharps containers and were not interested in doing so. In all, 54 responses indicated that they accepted used hypodernmic needles and syringesfor disposal. Some (170, 28%) that did not accept shaprs for disposal were interested in doing so. More than half (382, 63.0%) did not wish to do so. NYSDOH considered respondent suggestions and minimized ESAP requirements. By March 31, 2001, only 3 months after ESAP became effective, more than half of all licensed pharmacies in New York State were registered for ESAP. Survey results provided useful information to NYSDOH and a good indication of likelihood of registration. The high level of pharmacy participation in ESAP may be reflective of NYSDOH attention to issues raised by pharmacists, as well as the direct effects of outreach to pharmacy chains regarding ESAP.

Program and policy interventions for preventing mother-to-child transmission of HIV in New York State.

Mother-to-child transmission (MTCT) of human immunodeficiency virus has been virtually eliminated in New York State (NYS) in a relatively short time. The dramatic reduction in MTCT was achieved through a comprehensive public health program that maximized the benefits of advances in both diagnosis and treatment of HIV infection. The multifaceted program encompassed interventions at multiple levels. It mobilized and engaged medical providers, and it changed clinical practice and the health care delivery system in NYS. Specific approaches were developed and modified over time by using data from multiple sources and in response to medical and scientific advances. This article describes factors associated with MTCT in NYS, the framework for program development, the evolution of NYSs public health program to prevent MTCT, remaining issues, and recommendations.

Who Purchases Nonprescription Syringes? Characterizing Customers of the Expanded Syringe Access Program (ESAP)

This study represents the first attempt in the USA to survey pharmacy nonprescription syringe customers at their point of purchase. We surveyed 62 individuals purchasing nonprescription syringes in seven pharmacies located in NYC and Albany, NY, USA. Three quarters of respondents purchased for illicit use, and 36% purchased for medical use, with differences found by race and gender. Half got their syringes from pharmacies “most of the time.” Half had ever been refused a syringe purchase in a NYS pharmacy, with men, Blacks, and Hispanics reporting higher levels of refusals than women or whites. Two thirds reported syringe reuse but very few reported sharing. While approximately one quarter safely obtained and disposed of syringes “most of the time,” two thirds used both safe and unsafe methods. Pharmacy-based syringe access programs are essential in areas not served by syringe exchanges.

Availability of HIV Prevention Services Within New York State Correctional Facilities During 1999-2000: Results of a Survey

This survey examined the extent of HIV prevention interventions available to approximately 70,000 inmates housed in the 69 correctional facilities that comprise New York States prison system and explored barriers to offering prevention services. Specific HIV prevention interventions were selected. A written survey was used to ascertain their availability within the previous 12-month period at each correctional facility. Correctional facilities reported a high level of availability of HIV prevention interventions and services. All 69 (100%) reported prevention education, and 59 (86%) said they met or exceeded inmate demand. More than 90% reported individual and group counseling and more than three-quarters offered both English and Spanish. Support groups were reported as being offered at 50 (73%) prisons. Significant progress in meeting HIV prevention needs of New York State inmates has been achieved. The Criminal Justice Initiative is a highly effective service delivery model. Efforts to better meet needs of Spanish-speaking inmates should continue.

Creation of a tuberculosis directly observed therapy provider network in New York City: a new model of public health.

A 1990-1991 New York State Department of Health (NYSDOH) assessment of the ongoing tuberculosis (TB) epidemic in New York City (NYC) led to legislative enactment of policy recommendations to help stem the epidemic. The principal strategy entailed mobilization of community resources for TB directly observed therapy (DOT) to supplement the DOT available from the NYC Department of Health (NYCDOH). For implementation, the NYSDOH engaged a coalition of public and private health care providers in a TB DOT Provider Network. Network participants include freestanding facilities, many of which already have preexisting affiliative relationships through which DOT can be extended. The number of individuals receiving DOT in NYC has increased more than 10-fold in two years. Over 1,000 individuals have completed their anti-TB treatment while enrolled in the network.

Screening persons newly diagnosed with HIV/AIDS for risk of intimate partner violence: early progress in changing practice.

Interventions to prevent intimate partner violence (IPV), including among those at risk for or living with HIV/AIDS, are needed. In 2001, screening persons who test positive for HIV for risk of IPV was required in New York State, launching the first large-scale program to screen for IPV risk in conjunction with HIV counseling and testing (HCT). Written surveys of counselors, physicians, and agency supervisors explored attitudes, practices, knowledge, and training needs surrounding screening for risk of IPV during HCT. Most HCT providers were aware of screening requirements, but practice varied. Counselors were more likely to screen than were physicians and asked more screening questions. Despite guidelines, screening was generally not standardized and sporadic. IPV screening in conjunction with HCT is possible. Building capacity and commitment of local HCT providers through provision of training and by fostering partnerships with public health partner services staff can help overcome identified barriers to preventing IPV in a high-risk population.