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HIV Prevention and Treatment Efforts Go High-Tech in New York

Primary care physicians are using an innovative heatmap, customized web-based software, and an extensive survey to reduce the number of new HIV diagnoses and increase viral suppression rates in patients with HIV.

An HIV primary care program in Queens and Long Island, New York, is using data gleaned from an innovative heatmap, web-based software, and a survey, to identify hotspots of HIV activity in an attempt to help facilitate prevention and treatment efforts in these areas.

The initiative was created by a team from Northwell Health’s Center for AIDS Research and Treatment (CART) at North Shore University Hospital. The multidisciplinary team, made up of not only physicians, but also social workers, nurse case managers, health educators, and dieticians, has been able to boast a 93.6% viral suppression rate among their patients. “But, we wanted to look forward and say, ‘Is everyone doing well?’ We wanted to see if there were some people not benefitting equally," explained Joseph McGowan, MD, medical director, CART, in an interview with Contagion®’s sister journal, The American Journal of Managed Care® (AJMC).

To this end, the team created a 2-part program. First, they collected information on the incidence of sexually transmitted infections from the state health department and results of viral loads being sent to the health system. After laying out the data, the team was able to create a heatmap that identified where new diagnoses and high-risk behavior was occurring as well as where individuals with unsuppressed viral loads were residing.

“Lo and behold, there were certain areas where all of these elements were overlapping,” said Dr. McGowan. “We called these ‘hot zones’. If you looked within these communities, the [individuals] were at risk for all these components.”

From there, the team reached out to and worked with these communities. In addition to identifying individuals within the community to alert them of their high risk, a community liaison identified where these individuals were getting their medical information and where they go to meet people—venues they go to or apps they use—and used these venues to educate others.

“Most people know about HIV. They’ve heard about it, they know how it’s transmitted, but for whatever reason, people don’t necessarily apply that message to themselves, or they may not realize that they’re living in a community of high risk,” said Dr. McGowan.

The second part of the initiative was an extensive survey and customized web-based software, RED Cap, through which the team collected and analyzed patient data. Through years of surveying patients on mental health status, housing status, and other psychosocial characteristics, the social workers were able to come up with a vast survey that is completed with patients twice a year.

The meta-driven survey creates branching logic for the questions, and so patient questions are based on their previous answers. Through these answers and logged data, the team is able to identify various disparities, explained Richard Varghese, who is part of the CART team, in an interview with AJMC. The survey is able to recognize the relationship between variables, such as housing status, depression, insurance type, and food access, and viral suppression load.

According to Dr. Varghese this information is yielded in real-time, so that when the patient is meeting with their social worker, they are able to provide the patient with informa

“This information is given to the social worker in real-time so as the patient is having a discussion with the social worker, the social worker is immediately able to identify barriers facing the patient and make referrals for any needs,” said Varghese.

An earlier version of this article was published on AJMC.com.