HIV PREVENTION EFFORTS
Mecklenburg County's PrEP program received a 2019 LGFCU Achievement Award from the National Association of Counties (NACO) out of over 600 entries from 32 states.
The PrEP program also received a 2019 Excellence in Innovation Awards at the NC Association of County Commissioners (NCACC) Annual Conference for its outstanding and innovative solutions to county issues.
The PrEP Pilot program was presented at the American Public Health Association (APHA) Annual Meeting by six members of the APHI HIV prevention team .
In response to the HIV epidemic in Mecklenburg County, and following key activities by both Mecklenburg County Public Health (MCPH) and community members, APHI partners from MCPH and the University of North Carolina at Charlotte (UNC-C) made the prevention and treatment of HIV infection a priority in the focus area of preventive health. Among all of the states in the U.S., North Carolina had the 6th highest number of new HIV diagnoses in 2017, and the Charlotte Metropolitan area ranks among the worst 25% of metropolitan areas in the nation for new HIV infections. In 2017, 6,792 people were living with HIV in Mecklenburg County, and 270 new cases were diagnosed, accounting for almost 20% of all new cases in North Carolina.
The most recent Community Health Assessment identified HIV and STDs as one of the nine health priorities in Mecklenburg County, and the 2020-2022 Mecklenburg County Public Health Strategic Business Plan includes the objective of reducing new cases of HIV and STIs. In the fall of 2017, in response to growing concern over the rate of new HIV infections and the availability of newly emerging treatment and prevention tools, a collaborative planning association began a series of planning meetings to create an aggressive, comprehensive and effective community-wide approach to lower new HIV infection rates and to improve care for people living with HIV in Mecklenburg County. This HIV Getting to Zero Mecklenburg County (G2Z-Meck) Planning Group was made up of MCPH, community-based organizations, healthcare agencies and medical providers, educators, members of the faith community, and members of the HIV-affected community. By early 2018, the G2Z-Meck Plan to reduce new cases of HIV in Mecklenburg County had been put in place and was endorsed and accepted by county government. In 2019, the plan received additional support when the Board of County Commissioners included funding for the plan in the 2019-2020 fiscal year and indicated future support in succeeding budgets.
Members of the APHI Preventive Health Focus Area are involved in a number of research and evaluation projects related to HIV prevention in Mecklenburg County that support the goals of the Community Health Assessment, the MCPH Strategic Business Plan, and the G2Z Meck Plan, including the following:
PrEP Pilot Project
In early 2018, Mecklenburg County began implementation of a 24-month PrEP Pilot Project, aimed at providing Pre-Exposure Prophylaxis (PrEP) to uninsured individuals at high risk for developing HIV. Through a network of participating clinics, uninsured participants and patients at high risk for HIV were administered Truvada™ and clinics were monitored to determine patient enrollment rates, adherence, and new HIV infections. The cost of screening, office visits, and laboratory testing was covered by MCPH funds and the medication was provided at no cost by the pharmaceutical manufacturer. With the effectiveness of this Pilot being demonstrated by APHI-lead evaluations, it has now been expanded and converted into a longer-term County initiative. Analyses of this project are being used to evaluate patient experiences, best clinical practices for optimization of PrEP therapy, adherence and retention rates, incidence of new HIV infection and STIs, adverse medication reactions, barriers to patient treatment and retention rates, and how well PrEP-treated subjects match the demography and geography of the identified population of highest need. Since the implementation of the program, medical clinics have provided PrEP to nearly two hundred CharMeck clients. None of the clients who started the program has developed a new HIV infection on PrEP.
PrEP Provider Cohort Study
Recognizing the absence of information on PrEP usage in Mecklenburg County, a PrEP Provider Cohort was established to collect and evaluate data from PrEP providers in Mecklenburg County. The resulting PrEP Provider Cohort Study is an APHI project funded by MCPH to determine the extent of PrEP usage, the number and characteristics of PrEP providers and patients, potential barriers to healthcare access, and needs for establishing and maintaining PrEP-providing practices. The goal of this study is to develop a better understanding of who is providing PrEP and to whom; and to identify any gaps in the system re: getting PrEP to those who need it.
Pre-Exposure Prophylaxis, or PrEP, is a
way for people who do not have HIV
(but are at substantial risk of getting it) to prevent HIV infection by taking a pill every day. When someone is exposed to HIV through sex or injection drug use, this medicine can work to keep the virus from replicating in the body and prevent the establishment of a permanent infection. When taken consistently and correctly,
PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92%. Truvada™ and Descovy™, prescription medications manufactured by Gilead Sciences, Inc., are currently the only drugs approved for use as PrEP to reduce the number of new HIV infections.
Pharmacy Claims Data Analysis
In 2019, APHI members undertook a broader-reaching evaluation of PrEP usage in Mecklenburg County through the use of area pharmacy data. Researchers were provided access to anonymous commercial pharmacy claims data, which show the number of prescriptions filled for PrEP in Mecklenburg County. This data will help to explain how widely used PrEP therapy is in the County, whether or not PrEP therapy seems to be adequate to meet the needs of area patients, and can also serve as a source to compare changes over time and to other areas in the United States.
HIV Surveillance Data Analysis
Public health surveillance involves the systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice. The North Carolina Department of Health and Human Services is providing APHI members annual HIV surveillance data for Mecklenburg County and three surrounding counties. Analyses of this data will include identifying screening providers who account for the majority of new diagnoses, evaluating time periods between diagnosis and entry into medical care and reaching the goal of viral suppression, and assessing demographic factors related to steps along the HIV care continuum.
Knowledge & Attitudes Surveys
Surveys have been developed to assess HIV and PrEP knowledge and attitudes among high-risk populations and college undergraduates, and data has been collected from patients in the MCPH STD clinics and college undergraduates from four local educational institutions. Data from this project has provided analyses of PrEP and HIV knowledge, attitudes toward the use of PrEP, and associations between various demographic factors and HIV/PrEP knowledge and attitudes.
These APHI activities fall under the Preventive Health Focus Area, Co-Directed by Brian Witt, MPH, PhD (MCPH) and Patrick Robinson, MD (UNCC), who work in close collaboration with MCPH leadership, including Renate Nnoko, MBA, MPH (Senior Health Manager - Ending the HIV Epidemic) and Angela Lee, MPH (Assistant Health Director, MCPH Office of Preventive Health). Other members of the Focus Area team include MCPH personnel and UNC Charlotte faculty and students: Shi Chen, PhD; Sweta Harihar, MS; Jenny Hutchison, MBA, PhD; Chiamaka Okonkwo, Yakubu Owolabi, MS, DVM; Monika Sawhney, MSW, PhD; Sagar Satyanarayana, MS; Meagan Zarwell, PhD; and Gabriel Zenarosa, PhD.