Staten Island NYLinks Evaluation Dissemination Slide Set August

Staten Island NYLinks Evaluation Dissemination Slide Set August 2015 1

Contents 1. NYS, NYC and Staten Island maps 2. Facility-level measures 3. Surveillance-based measures 2

Updates to NYLinks Maps • Glossary of key terms • Data suppression rules utilized for cells (geographic units) with low numbers (marked by grey shading and diagonal lines) • Actual case count numbers (e. g. plwhdi, new diagnoses, etc. ) included at the county and UHF level for NYLinks regional maps • Site names listed on all NYLinks regional maps • Numbers of sites by type of services added to map legends • Site locations added to Mid and Lower Hudson regional group map • ‘Inactive’ sites removed from NYC maps • Areas exceeding 2015 NHAS target 85% of linkage to care highlighted on linkage to care map • Definitions of linkage, retention and viral load suppression added as footnotes where applicable • NYC region added to NYS Ryan White Region HIV care outcome maps • Map showing HIV viral suppression among all PLWDHI added for NYC and NYS (pending) • State and city-wide rates added to NYS/NYC HIV care outcome maps(pending) 3

Glossary of Key Map Terms Linkage to Care: Percentage of newly diagnosed PLWH during the time period of interest (e. g. , 2013) that had evidence of HIV care (≥ 1 CD 4 or viral load test) reported within 90 days of the date of diagnosis. *Note for NYC linkage maps only: CD 4 and viral load tests within 7 days of a patient’s diagnosis do not count towards linkage. NYS Prison Inmates: Prison inmates refer to persons incarcerated in state correctional facilities at the time of diagnosis (even if they are no longer in prison). The county of residence at diagnosis reflects the county of incarceration at the time of diagnosis or first report, which may be different from the individual’s home county and later county of incarceration. PLWHA: Persons Living with HIV/AIDS PLWDHI: Persons Living with Diagnosed HIV Infection Prevalence: The number or proportion of people with a particular disease or condition in a given population and at a specific time. For this set of maps, living HIV/AIDS cases per 100, 000 population. Retention in Care (among newly diagnosed PLWH): Percentage of newly diagnosed PLWH during the time period of interest (e. g. , 2013) who had evidence of care (≥ 1 CD 4 or viral load test) at least three times during the 12 months following diagnosis, with at least one event occurring in each 4 -month period. 4

Glossary of Key Map Terms (2) UHF: United Hospital Fund neighborhood corresponds to a geographic area within New York City that is an aggregate of between 1 and 9 zip codes but that is smaller than a borough. UHF neighborhoods reflect catchment areas for certain healthcare facilities. Viral Suppression (among newly diagnosed PLWH): Percentage of newly diagnosed with HIV during the time period of interest (e. g. , 2013) whose last viral load test in the 12 months after diagnosis was <200 copies/m. L (NYS) or ≤ 200 copies/m. L (NYC). Viral Suppression (among all PLWDHI): Percentage of all PLWDHI at a specific point in time (e. g. 2013), whose most recent viral load test was <200 copies/m. L (NYS) or ≤ 200 copies/m. L (NYC). Viral Suppression (among PLWDHI in care): Percentage of PLWDHI with evidence of care (CD 4/VL test) during the year (e. g. 2013) whose most recent viral load test was <200 copies/m. L (NYS) or ≤ 200 copies/m. L (NYC). 5

NYLinks Regional Groups 6

NYLinks Regions and HIV/AIDS Prevalence by County of Residence at Diagnosis: New York State, 2013 7

HIV Diagnosis Rates by UHF Neighborhood New York City, 2013 8

Prevalence of HIV/AIDS by UHF Neighborhood of Residence: New York City, 2013 9

NYLinks Staten Island New HIV Diagnoses and HIV/AIDS Prevalence 2013 10

Staten Island, 2013 HIV/AIDS Prevalence and New HIV Diagnoses Staten Island Sites: Community Health Center of Richmond, Project Hospitality, Richmond University Medical Center, 11 Community Health Action of Staten Island, Staten Island University Hospital

NYLinks HIV Care Outcomes New York City, 2013 12

Linkage to Care among Newly Diagnosed Persons by UHF Neighborhood at Diagnosis New York City, 2013 74% linked out of 2, 521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 13

Retention in Care among Newly Diagnosed Persons by UHF Neighborhood at Diagnosis New York City, 2013 54% retained out of 2, 521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 14

Viral Suppression among Newly Diagnosed Persons by UHF Neighborhood at Diagnosis New York City, 2013 65% virally suppressed within 12 months out of 2, 521 new diagnoses in NYC Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 15

Viral Suppression among PLWDHI with Evidence of Recent Care by UHF Neighborhood New York City, 2013 80% virally suppressed among 65, 555 PLWDHI in care in NYC, 2013 Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 16

Viral Suppression among All PLWDHI by UHF Neighborhood: New York City, 2013 52% virally suppressed among 101, 848 PLWDHI in NYC, 2013 Excludes cases without a definitive UHF residence at diagnosis. Citywide percentage shown may differ from other NYC publications. 17

Staten Island Facility-level measures 18

Major Changes to Facility-Level Measure Slides • Added list of NYLinks agencies • Added data summary for facility-level measures • Both retention measures show measurement period on the x-axis 19

Facility-level Measure Definitions Linkage to care among newly diagnosed persons Percentage of newly diagnosed persons in the reporting period who had their first HIV clinical care visit within 30 days of the date of their confirmatory HIV test result Retention Percentage of patients with at least one HIV clinical care visit during the first six months of the 24 -month measurement period, who had at least one HIV clinical care visit in each 6 month period of the remaining 18 months of the measurement period with a minimum of 60 days between HIV clinical care visits New patient retention Percentage of new patients who have their initial HIV clinical care visit during their first four months of the 12 -month measurement period who had an HIV clinical care visit in each of the subsequent 4 -month periods in the measurement period 20

Staten Island—Linkage to care (1): proportion of newly diagnosed persons linked to care within 30 days 100% Start of Q/SI collaborative Feb 2013 100% % of persons linked 90% 80% 70% 60% 50% 40% 30% All sites 20% 10% 0% Dec'12 Jan'13 Eligible clients 3 clients Sites reporting 2 sites Aug. Calendar time of diagnosis. Apr. Sep'13 May'14 1 client 3 clients 2 sites Feb. March 0 2015 clients -Linked to care: defined as having had an HIV clinical care visit within 30 days of the date of confirmatory HIV test result. -Each data point represents the aggregate bi-monthly data submission from Apr 2013 - Jun 2015. Data Source: NYLinks facility-level measures, updated: June 23, 2015 21

Staten Island Facility-level Data Summary • Data submissions by Staten Island (SI) sites have been variable across time. • Difficult to interpret outcome trends for Staten Island without consistent data submissions from most sites. • Linkage, retention and new patient retention rates often have only 1 site submitting data (Data not shown). 22

NYC Surveillance-Based Measures: Staten Island May 2015 23

Staten Island NYLinks Providers Included in Surveillance Slides • North Shore LIJ/Staten • Richmond University Island University Hospital Medical Center • Community Health Action of • Community Health Center Staten Island of Richmond • Project Hospitality 24

Newly Diagnosed Indicators 25

Total Number of Newly Diagnosed Persons: Staten Island rest of NYC Diagnosed by Provider in SI NYLinks the Rest of Provider NYC 2011 TOTAL Jan-Mar 5 (0. 6%) 860 865 Apr-Jun 6 (0. 6%) 925 931 Jul-Sep 8 (1. 0%) 817 825 Oct-Dec 6 (0. 8%) 769 775 Jan-Mar 6 (0. 7%) 802 808 Apr-Jun 7 (0. 8%) 831 838 Jul-Sep 11 (1. 4%) 765 776 Oct-Dec 5 (0. 8%) 652 657 Jan-Mar 8 (1. 1%) 709 717 Apr-Jun 8 (1. 1%) 738 746 Jul-Sep 3 (0. 4%) 754 757 Oct-Dec 5 (0. 8%) 607 612 2013 SI collaborative begins 26 Data Source: NYC HIV/AIDS Surveillance data, updated July 2015 with data reported by March 31, 2015

CONCURRENT DIAGNOSIS and MEDIAN CD 4 AT DIAGNOSIS Data Source Measure HIV/AIDS Surveillance Registry Concurrent HIV/AIDS diagnosis: Proportion of new HIV diagnoses during the reporting period of interest (e. g. , 1 st quarter 2009) with an AIDS diagnosis that occurred within 31 days of the HIV diagnosis. Median CD 4 cell count at diagnosis: median CD 4 cell count of patients newly diagnosed during the reporting period (e. g. , 1 st quarter 2009). The first CD 4 cell count within 3 months of diagnosis is used to calculate the median. Example: Proportion of newly diagnosed PLWH during the first quarter of 2009 who also have an AIDS diagnosis within 31 days of their initial HIV diagnosis. Median CD 4 count of those diagnosed in the first quarter of 2009 among those with a CD 4 count available within 3 months of diagnosis. Numerator Number of PLWH diagnosed with HIV during the time period with a concurrent AIDS diagnosis. Denominator Total number of newly diagnosed PLWH in the time period. Patient Numerator and Denominator Exclusions PLWH who have no CD 4 cell count within 3 months of diagnosis will not contribute to the median calculation. 27

Concurrent AIDS diagnosis* and median CD 4 cell count at HIV diagnosis Diagnosed by Staten Island NYLinks provider and Rest of NYC providers 100% 500 450 80% 400 350 60% 300 250 40% 200 150 20% 100 50 0% 0 Jan - Jun 2011 Jul - Dec 2011 Jan - Jun 2012 Jul - Dec 2012 Jan - Jun 2013 Time Period Diagnosed Jul - Dec 2013 Diagnosed by an Staten Island NY Links provider Diagnosed by a provider in rest of NYC Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 *Concurrent diagnosis: AIDS diagnosis within 31 days of HIV diagnosis Jan - Jun 2014 28 Median CD 4 cell count (cells/mm 3) at diagnosis % New diagnoses in time period with concurrent AIDS dx* SI collaborative begins February 2013

Concurrent AIDS Diagnoses* from Staten Island NYLinks providers and Rest of NYC providers % New diagnoses in time period with concurrent AIDS dx* 100% 80% 60% SI collaborative begins February 2013 40% 20% 0% Jan - Jun 2011 Jul - Dec 2011 Jan - Jun 2012 Jul - Dec 2012 Quarter Diagnosed by an Staten Island NY Links provider Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 *Concurrent diagnosis: AIDS diagnosis within 31 days of HIV diagnosis Jan - Jun 2013 Jul - Dec 2013 Jan - Jun 2014 Diagnosed by a provider in rest of NYC 29

Median CD 4 cell count at HIV Diagnosis by Staten Island NYLinks providers and Rest of NYC providers 500 SI collaborative begins February 2013 Median CD 4 cell count (cells/mm 3) at diagnosis 450 400 350 300 250 200 150 100 50 0 Jan - Jun 2011 Jul - Dec 2011 Jan - Jun 2012 Jul - Dec 2012 Quarter Diagnosed by an Staten Island NY Links provider Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 Jan - Jun 2013 Jul - Dec 2013 Jan - Jun 2014 Diagnosed by a provider in rest of NYC 30

LINKAGE TO CARE Data Source HIV/AIDS Surveillance Registry Linkage: Percentage of newly diagnosed PLWH during the time period of interest (e. g. , 1 st quarter 2009) that had evidence of HIV care reported within 30 days, 60 days, 3 months, and 12 months of the date of diagnosis. Measure Example: Percentage of newly diagnosed PLWH during the first quarter of 2009 that had evidence of HIV care within 30 days, 60 days, 3 months, and 12 months of the date of diagnosis. Numerator Number of newly diagnosed PLWH during the time period who had evidence of care reported within 8 -30 days, 8 -60 days, 8 days - 3 months, and 8 days - 12 months of the date of diagnosis. Denominator Total number of newly diagnosed PLWH during the time period. Patient Numerator and Denominator Exclusions CD 4 and viral load tests within 7 days of a patient’s diagnosis do not count towards linkage as these may be associated with a diagnostic event only, and not a specific HIV care visit. Important definitions and conventions Evidence of care is defined as ≥ 1 CD 4 or viral load test. 31

Linkage to care within 30 days, 60 days, 3 months, and 12 months post diagnosis* Diagnosed by SI NYLinks provider or Rest of NYC provider 100% 93. 75 Linked 12 months 90% 80% Linked 90 days 74. 3 % Linked to Care 70% Linked 60 days 63. 5 60% 56. 65 Linked 30 days 50% 40% 30% 20% 10% 0% Jan - Jun 2011 Jul - Dec 2011 Jan - Jun 2012 Jul - Dec 2012 Jan - Jun 2013 Jul - Dec 2013 Jan - Jun 2014 Diagnosis Period Diagnosed by Staten Island NY Links provider - 30 days Diagnosed by any other NYC provider - 30 days Diagnosed by Staten Island NY Links provider - 60 days Diagnosed by any other NYC provider - 60 days Diagnosed by Staten Island NY Links provider - 3 months Diagnosed by any other NYC provider - 3 months Diagnosed by Staten Island NY Links provider -12 months Diagnosed by any other NYC provider - 12 months Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 *Labs (CD 4/VL) within 7 days of diagnosis removed. 32

Staten Island Linkage to Care within 30 Days Post HIV Diagnosis* by year of diagnosis 100% 90% 85% NHAS Linkage Goal by 2020 80% 75% % Linked to Care 70% 60% 56% 50% 46% 42% 40% 30% 26% 20% 10% 0% 11/26 5/10 2011 Diagnosed by Staten Island NYLinks provider 7/27 6/8 12/26 2012 5/9 2013 Year of Diagnosis Diagnosed by Staten Island non-NYLinks provider* *Labs (CD 4/VL) within 7 days of diagnosis removed. Bottom numbers=(# linked by providers / total # diagnosed by providers) Data Source: NYC HIV/AIDS Surveillance data, updated March 2015 with data reported through June 30, 2014. 33

Staten Island Linkage to Care within 60 Days Post HIV Diagnosis* by year of diagnosis 100% 88% 90% 81% 80% 78% % Linked to Care 70% 60% 58% 50% 44% 40% 30% 20% 10% 0% 15/26 8/10 2011 Diagnosed by Staten Island NYLinks provider 12/27 7/8 21/26 2012 7/9 2013 Year of Diagnosis Diagnosed by Staten Island non-NYLinks provider* *Labs (CD 4/VL) within 7 days of diagnosis removed. Bottom numbers=(# linked by providers / total # diagnosed by providers) Data Source: NYC HIV/AIDS Surveillance data, updated March 2015 with data reported through June 30, 2014. 34

Staten Island Linkage to Care within 3 Months Post HIV Diagnosis* by year of diagnosis 100% 90% 85% NHAS Linkage Goal by 2015 % Linked to Care 70% 81% 80% 100% 65% 59% 60% 50% 40% 30% 20% 10% 0% 17/26 8/10 2011 Diagnosed by Staten Island NYLinks provider 16/27 8/8 21/26 2012 9/9 2013 Year of Diagnosis Diagnosed by Staten Island non-NYLinks provider* *Labs (CD 4/VL) within 7 days of diagnosis removed. Bottom numbers=(# linked by providers / total # diagnosed by providers) Data Source: NYC HIV/AIDS Surveillance data, updated March 2015 with data reported through June 30, 2014. 35

Staten Island Linkage to Care within 12 Months Post HIV Diagnosis* by year of diagnosis 100% 90% 88% 78% 80% % Linked to Care 70% 60% 50% 40% 30% Full 2013 data to be available fall of 2015 20% 10% 0% 23/26 9/10 2011 Diagnosed by Staten Island NYLinks provider 21/27 2012 8/8 2013 Year of Diagnosis Diagnosed by Staten Island non-NYLinks provider* *Labs (CD 4/VL) within 7 days of diagnosis removed. Bottom numbers=(# linked by providers / total # diagnosed by providers) Data Source: NYC HIV/AIDS Surveillance data, updated March 2015 with data reported through June 30, 2014. 36

RETENTION IN CARE AMONG NEWLY DIAGNOSED PLWH Data Source HIV/AIDS Surveillance Registry Measure Retention among newly diagnosed PLWH: Percentage of newly diagnosed PLWH during the time period of interest (e. g. , Q 1 2009) who had evidence of care at least three times during the 12 months following diagnosis, with at least one event occurring in each 4 month period. Example: Percentage of newly diagnosed PLWH during the first quarter of 2010 who had evidence of care during each 4 month period during the 12 months following diagnosis. Numerator Denominator Number of newly diagnosed PLWH during the time period that had evidence of care in each 4 month period during the 12 months following diagnosis. Total number of newly diagnosed PLWH during the time period. Patient Numerator and Denominator Exclusions Important definitions and conventions Evidence of care is defined as ≥ 1 CD 4 or viral load test. 37

Retention in Care among Newly Diagnosed PLWH in Staten Island Rest of NYC ≥ 1 lab in each 4 -month period % of new diagnoses retained in care 12 months post dx 100% SI collaborative begins February 2013 80% 60% 40% 20% 0% Jan - Jun 2011 Jul - Dec 2011 Jan - Jun 2012 Diagnosis Period Patients diagnosed by Staten Island NY Links provider Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 Jul - Dec 2012 Jan - Jun 2013 Patients diagnosed by any other NYC provider 38

VIRAL SUPPRESSION AMONG NEWLY DIAGNOSED PLWH Data Source Measure HIV/AIDS Surveillance Registry Viral suppression among newly diagnosed PLWH: Percentage of newly diagnosed PLWH during the time period of interest (e. g. , 1 st quarter 2009) whose most recently reported VL in the first 6 months post diagnosis was ≤ 200 copies/m. L. Example: Percentage of patients newly diagnosed during the first quarter of 2009 whose most recent VL during the 6 month period following diagnosis was ≤ 200 copies/m. L. Numerator Number of patients newly diagnosed during the time period whose most recent VL in the 6 months period following diagnosis was ≤ 200 copies/m. L. Denominator Total number of patients newly diagnosed during the time period. Patient Numerator and Denominator Exclusions Patients who are documented to be deceased at any time during the time period. Important definitions and conventions Patients with no VL reported are considered not suppressed. 39

Evidence of VLS within 6 and 12 months of diagnosis: Diagnosed by Staten Island NYLinks provider vs. Diagnosed by any other NYC provider 100% % of new diagnoses with a VL ≤ 200 copies/m. L SI collaborative begins February 2013 80% 60% 12 months 40% 6 months 20% 0% Jan - Jun 2011 Jul - Dec 2011 Jan - Jun 2012 Jul - Dec 2012 Quarter Diagnosed Jan - Jun 2013 Jul - Dec 2013 12 months: Patients diagnosed by Staten Island NY Links provider 12 months: Patients diagnosed by any other NYC provider 6 months: Patients diagnosed by Staten Island NY Links provider 6 months: Patients diagnosed by any other NYC provider 40 Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015

PLWDHI Indicators 41

Persons Living with Diagnosed HIV as of December 31, 2013 that received any care in NYC in 2013 Total Sex Male Age (median, quartile range) Race/Ethnicity Black White Hispanic Asian/Pacific Islander Native American Multiracial Transmission Risk Men who have sex with men Injection drug use history Heterosexual Perinatal Other Unknown CD 4 count (median, quartiles) Viral Load Quantity (median, quartiles) Upper Manhattan Queens Staten Island Received care by non-NYLinks provider in NYC 10, 610 68% 34 (27 -42) 48% 14% 36% 1% <1% 34% 17% 22% 4% <1% 23% 527 (334 -743) 22 (0 -621) 3, 621 64% 35 (28 -43) 47% 8% 40% 5% <1% 31% 13% 34% 2% <1% 20% 534 (327 -782) 60 (0 -5246) 740 58% 34 (27 -41) 43% 22% 33% 1% <1% 14% 29% 30% 4% 23% 549 (221 -719) 351 (54 -4496) 56, 089 71% 35 (28 -42) 45% 21% 32% 2% <1% 39% 16% 21% 2% <1% 22% 547 (352 -764) not available Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 42

EVIDENCE OF RECENT HIV CARE AMONG ALL PLWDHI Data Source HIV/AIDS Surveillance Registry Evidence of recent care among PLWDHI: Percentage of PLWDHI with any evidence of care during the reporting period of interest (e. g. , 1 st quarter 2009). Measure Example: Percentage of PLWDHI who had any evidence of care during the 1 st quarter of 2009. Numerator Number of PLWDHI with any evidence of care during the time period. Denominator Total number of PLWDHI during the time period. Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the time period. Important definitions and conventions Evidence of care is defined as ≥ 1 CD 4 or viral load test. 43

Evidence of Recent Care Among all PLWDHI in NYC 100% % of PLWDHI in care in the time period 80% UMRG collaborative begins January 2012 Q/SI collaborative begins February 2013 60% 40% All NYC 20% 0% Jan - Mar Apr - Jun Jul - Sep Oct - Dec Jan - Mar Apr - Jun Jul - Sep 2011 2012 2013 2014 Time period Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 44

RETENTION AMONG ALL PLWDHI IN CARE Data Source HIV/AIDS Surveillance Registry Retention among all PLWDHI: Percentage of PLWDHI with evidence of care during the time period of interest (e. g. , 1 st quarter 2009) who had subsequent evidence of care 45183 days after the most recent care event in the time period of interest. Measure Example: Percentage of PLWDHI in care during the 1 st quarter of 2010 who had evidence of care 45 -183 days after the most recent care event in the 1 st quarter of 2010. Numerator Number of PLWDHI with evidence of care during the time period of interest who had subsequent evidence of care 45 -183 days after the most recent care event in the time period of interest. Denominator Total number of PLWDHI, with evidence of care during the time period of interest. Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the time period. Important definitions and conventions Evidence of care is defined as ≥ 1 CD 4 or viral load test. 45

Retention Among all PLWDHI in Care by a Staten Island NYLinks provider or another provider in Rest of NYC SI collaborative begins February 2013 % of PLWDHI in care in the time period who were retained in care 100% 80% 60% * 40% PLWH in care at Staten Island NY Links provider PLWH in care with any other NYC provider 20% 0% Jan - Mar Apr - Jun 2011 Jul - Sep 2011 Oct - Dec Jan - Mar Apr - Jun 2011 2012 Jul - Sep 2012 Oct - Dec Jan - Mar Apr - Jun 2012 2013 Jul - Sep 2013 Oct - Dec Jan - Mar 2013 2014 Time period Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 *Data reporting issue due to Hurricane Sandy 46

VIRAL SUPPRESSION AMONG PLWDHI IN CARE Data Source Measure HIV/AIDS Surveillance Registry Viral Suppression among PLWDHI in care: Percentage of PLWDHI with evidence of care during the time period of interest (e. g. , 1 st quarter 2009) whose most recent viral load test result during the time period was ≤ 200 copies/m. L. Example: Percentage of PLWDHI with evidence of care during the 1 st quarter of 2009 for whom the whose most recent viral load result in the time period was ≤ 200 copies/m. L. Numerator Number of PLWDHI whose most recent viral load results in the time period was ≤ 200 copies/m. L. Denominator Total number of PLWDHI with evidence of care during the time period. Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the time period. Important definitions and conventions Patients with no VL reported are considered not suppressed. 47

Viral Suppression among all PLWDHI in Care by a Staten Island NYLinks provider or another NYC provider % of PLWDHI in care in the time period who were virally suppressed 100% SI collaborative begins February 2013 80% 60% 40% PLWH in care at Staten Island NY Links provider 20% PLWH in care with any other NYC provider 0% Jan - Mar Apr - Jun Jul - Sep Oct - Dec Jan - Mar Apr - Jun Jul - Sep 2011 2012 2013 2014 Time period Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 48

SUSTAINED VIRAL SUPPRESSION AMONG ALL PLWDHI IN CARE Data Source HIV/AIDS Surveillance Registry Measure Sustained viral suppression among all PLWDHI: Percentage of diagnosed PLWDHI living and in care during the time period of interest (e. g. Q 1 2009) whose VL quantities reported during the 12 months following evidence of care in the time period were all ≤ 200 copies/m. L. Example: Percentage of diagnosed PLWH alive and in care Q 1 2009 whose VL quantities drawn through Q 1 2010 were all ≤ 200 copies/m. L. Numerator Number of diagnosed PLWH alive as of a specific point in time (e. g. , March 31, 2009), test whose VL quantities reported during the 12 months following the point in time were all ≤ 200 copies/m. L. Denominator Total number of diagnosed PLWH alive as of a specific point in time (e. g. , March 31, 2009) with ≥ 1 VL test over 12 months following the time point. Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the time period. Important definitions and conventions Patients with no VL reported are considered not suppressed. 49

% of PLWDHI in care in the time period who had sustained viral suppression Sustained Viral Suppression among PLWDHI in Care by a Staten Island NYLinks provider or another NYC provider 100% SI collaborative begins February 2013 80% 60% 40% PLWH in care at Staten Island NY Links provider 20% PLWH in care with any other NYC provider 0% Jan - Mar 2011 Apr - Jun 2011 Jul - Sep 2011 Oct - Dec 2011 Jan - Mar 2012 Apr - Jun 2012 Jul - Sep 2012 Oct - Dec 2012 Jan - Mar 2013 Apr - Jun 2013 Jul - Sep 2013 Oct - Dec 2013 Time period Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 50

VIRAL SUPPRESSION AMONG ALL PLWDHI Data Source Measure HIV/AIDS Surveillance Registry Viral suppression among all PLWDHI: Percentage of diagnosed PLWDHI alive as of a specific point in time (e. g. , June 30, 2010), whose most recent VL during the prior 6 months (January 1 -June 29, 2010) was ≤ 200 copies/m. L. Example: Percentage of diagnosed PLWH alive as of June 30, 2010 whose most recent viral load during the prior 6 months (January 1 -June 29, 2010) was ≤ 200 copies/m. L. Numerator Number of diagnosed PLWH alive as of a specific point in time (e. g. , June 30, 2010), whose most recent VL during the prior 6 months (January 1 -June 29, 2010) was ≤ 200 copies/m. L. Denominator Total number of diagnosed PLWH alive as of a specific point in time (e. g. , June 30, 2010). Patient Numerator and Denominator Exclusions Patients that were newly diagnosed or died during the 6 month window period leading up to the specific point in time 51

Viral Suppression among all PLWDHI in NYC 100% Q/SI collaborative begins February 2013 % of PLWDHI who were virally suppressed 80% UMRG collaborative begins January 2012 60% 40% All NYC 20% 0% June 2011 Dec 2011 June 2012 Dec 2012 Time period Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 June 2013 Dec 2013 Jun-14 52

Staten Island HIV care cascades 53

HIV care cascade for newly diagnosed PLWH in NYC and Staten Island, 20121 Total newly diagnosed¹ n=28 n=3, 214 57% Linked timely to care² 43% unlinked 66% 57% Retained in care³ 46% 18% Viral suppression within 6 months of diagnosis⁴ 82% not suppressed by 6 months 37% 39% Viral suppression within 12 months of diagnosis⁴ 61% not suppressed by 12 months 53% 0% 20% 43% not retained 60% 80% 100% Diagnosed by a NY Links provider in Staten Island Diagnosed by a rest of NYC provider As reported to the New York City HIV Surveillance Registry (NYC HSR) by April 30, 2014. 2 Timely linkage to care is defined as ≥ 1 CD 4/VL reported to the NYC HSR 8 - 91 days post diagnosis. 3 Retention in care is defined as ≥ 1 CD 4/VL test reported to the NYC HSR during each 4 month period in the 12 months immediately following diagnosis. 4 Suppressed viral load is defined as a patient's most recent viral load quantity reported to the NYC HSR within 6 or 12 months of diagnosis that was ≤ 200 copies/m. L. 1 Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 54

HIV Care Cascade: Newly Diagnosed by NYLinks Staten Island Provider, 2011 -2012 n=25 Total newly diagnosed¹ n=28 68% Linked timely to care² 57% 44% Retained in care³ 57% Diagnosed by NYLinks provider in 2011 Diagnosed by NYLinks provider in 2012 36% VLS w/in 6 months of diagnosis⁴ 18% 52% VLS w/in 12 months of diagnosis⁴ 39% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1 As reported to the New York City HIV Surveillance Registry (NYC HSR) by June 30, 2014. 2 Timely linkage to care is defined as ≥ 1 CD 4/VL reported to the NYC HSR 8 - 91 days post diagnosis. 3 Retention in care is defined as ≥ 1 CD 4/VL test reported to the NYC HSR during each 4 month period in the 12 months immediately following diagnosis. 4 Suppressed viral load is defined as a patient's most recent viral load quantity reported to the NYC HSR within 6 or 12 months of diagnosis was ≤ 200 copies/m. L. 55

NY Links HIV care cascade: all PLWH in NYC and Staten Island, 2013 1 Total PLWH³ N=131, 919 Diagnosed PLWH 86% Evidence of care in 2013⁴ 58% 70% among diagnosed PLWH Retention in care among PLWH with evidence of recent care⁵ 80% 77% Viral suppression among PLWH with evidence of recent care⁶ 52% Sustained viral suppression among PLWH with evidence of recent care⁷ 78% 29% 64% Viral suppression among all diagnosed PLWH⁶ 50% Viral suppression among all PLWH⁶ 43% 0% N=113, 450 20% 40% All NYC PLWH receiving care in Staten Island² NYC PLWH receiving care outside by rest of NYC provider² 60% 80% 100% 1 Persons diagnosed with HIV on or before June 30, 2012 and living as of December 31, 2013. As reported to the New York City HIV Surveillance Registry (NYC HSR) as of March 31, 2015. 2 Receviving care at a Staten Island provider or elsewhere is determined by the ordering provider of the first CD 4/VL reported to the NYC HSR January 1, 2013 - December 31, 2013 3 NYC has a 14% undiagnosed HIV rate; for reference, see : Eavey JJ, Torian LV, Jablonsky A, Nickerson JE, Fettig JF, Leider J, Calderon Y. Undiagnosed HIV Infection in a New York City Emergency Room: Results of a Blinded Serosurvey, December 2009 -January 2010. 19 th International AIDS Conference, 2012, Washington, DC. Abstract# TUPE 282 4 Evidence of recent care is define as ≥ 1 CD 4/VL reported to the NYC HSR January 1, 2013 - December 31, 2013 5 Retained in care is defined as the percentage of PLWH with recent care who had ≥ 2 CD 4/VL tests reported to the NYC HSR January 1, 2013 - December 31, 2013 that were at least 45 days but nor more than 183 days apart 6 Viral load suppression is defined as the % of PLWH with evidence of recent care whose most recent VL reported to the NYC HSR January 1, 2013 - December 31, 2013 was ≤ 200 copies/m. L 7 Sustained viral load suppression is defined as the % of PLWH with evidence of recent care whose VL tests reported to the NYC HSR January 1, 2013 - December 31, 2013 were ALL ≤ 200 copies/m. L Data Source: NYC HIV/AIDS Registry, updated July 2015 with data reported by March 31, 2015 56

Other related data sources • • NYLinks website: http: //newyorklinks. org NYLinks database: http: //newyorklinks. org/ny_database NYLinks blog: linkandretain. wordpress. com ETE dashboard: etedashboardny. org 57