As a part of work to ensure that all Rhode Islanders with HIV have the opportunity to live long, full, productive lives, the Rhode Island Department of Health (RIDOH) and the Executive Office of Health and Human Services (EOHHS) continue to coordinate closely with community partners throughout the state to meet aggressive HIV targets by 2020.
Director of Health Nicole Alexander-Scott, MD, MPH, provided an update on this work, which is known as the 90-90-90 Campaign, at a state house event today, World AIDS Day.
"Despite the progress that we have made over the last three decades, stigma and discrimination are still realities for people living with HIV. To combat this, we are putting HIV front and center, not just on World AIDS Day, but 365 days a year through a strategic campaign that is getting resources to the places where they are needed most," said Governor Gina M. Raimondo. "The 90-90-90 Campaign is an innovative, data-driven approach that is building healthier communities and a healthier Rhode Island."
The three targets of the 90-90-90 Campaign are that by 2020, 90% of all HIV-infected Rhode Islanders will know their HIV status, 90% of all HIV-infected Rhode Islanders will be in care and receiving treatment, and 90% of all HIV-infected Rhode Islanders will have suppressed viral loads. Early diagnosis and treatment of people living with HIV promotes healthy living and prevents transmission to others.
"The goals of the 90-90-90 Campaign are ambitious and aggressive," said Director of Health Nicole Alexander-Scott, MD, MPH. "It truly takes a village to achieve success. In Rhode Island, we are fortunate to have so many amazing clinical and community partners on our team who work every day to help Rhode Island achieve 90-90-90."
With the signatures of Governor Raimondo, Providence Mayor Jorge Elorza, and Dr. Alexander-Scott, Rhode Island and Providence became the first state-city partnership to join the International 90-90-90 Campaign in December 2015.
90-90-90 Goal 1: Know HIV status Estimates indicate that there are 280 Rhode Islanders who do not know they are HIV-infected. RIDOH funds several community agencies to provide free and anonymous rapid HIV testing. As of November 15th, RIDOH partners at AIDS Care Ocean State, AIDS Project Rhode Island, and Project Weber have conducted 1,750 rapid HIV tests in 2016.
When an individual is newly diagnosed with HIV, RIDOH's Partner Services Program talks to patients to identify other individuals who may have been exposed to HIV (through sexual contact or needle sharing) and to help get their partners tested.
RIDOH also actively works with community partners to prevent HIV. RIDOH continues to fund ENCORE, the state's needle exchange program run by AIDS Care Ocean State. ENCORE has distributed 74,539 clean needles in 2016 so far. More than 100 community condom distribution sites provide at-risk individuals with a safe and effective way to protect themselves during sex. RIDOH also provides mini grants to five schools (Central Falls High School, Lincoln Middle School, North Kingstown High School, Segue Institute, and Woonsocket Middle School) to improve the environment and opportunities for young people to be healthy. The grants also provide health teachers with a curriculum and resources to help them address sensitive topics.
90-90-90 Goals 2 and 3: Stay in care and suppress HIV viral loads Individuals with HIV who are connected to care can receive medications that control their virus levels. This not only improves their own health, but means they are also less likely to spread HIV to other people. Through the Ryan White Program, EOHHS works with AIDS Care Ocean State, AIDS Project Rhode Island, Community Care Alliance/AGAPE, Thundermist Health Center, The Miriam Hospital, and University Medical Group/Roger Williams Medical Center to offer case management services to people living with HIV and AIDS to help them stay in care.
"EOHHS is charged with providing high-quality HIV care and treatment for Medicaid beneficiaries and Rhode Islanders in the Ryan White Program who are living with HIV," said Paul G. Loberti, MPH, Administrator for Medical Services at EOHHS. "Consistently throughout the last two years, Ryan White patients and clients have surpassed national averages for viral suppression, a key marker in determining HIV treatment success. In addition, the HIV Provision of Care and Special Populations Unit at EOHHS implements a variety of HIV services, such as case management, ambulatory care, premium assurance, financial assistance, and dental care for people living with HIV in the state."
If someone with HIV stops taking medications to suppress viral loads, RIDOH's Return to Care Program reaches out and helps those people address the barriers that prevent them from staying in care.
Next Steps in the 90-90-90 Campaign Rhode Island requires a coordinated effort among all partners who are committed to reaching the 2020 targets. The 90-90-90 Campaign Steering Committee and the HIV Care and Prevention Planning Group are focused on leading the way together, with each partner doing their part. The Miriam Hospital's Immunology Center, which cares for more than two-thirds of the people in Rhode Island who are living with HIV or AIDS, recently reviewed their patient records and provided an important insight that will guide Rhode Island's efforts to reach 90-90-90 by 2020.
"Unstable housing, mental health, and substance abuse are the three biggest challenges that impact our patients' engagement with care," said Dr. Aadia Rana, Director of The Miriam Hospital Immunology Center Adherence and Retention Program and Assistant Professor of Medicine at Alpert Medical School of Brown University. "Even though these conditions often co-exist, addressing a basic need, such as housing, is a critical step on our path to the 90-90-90 targets."
As Dr. Rana's recent analysis at The Immunology Center found that unstable housing is a significant predictor for people falling out of care and not taking their medications that suppress their viral load, RIDOH has made this a priority for 2017. Director Alexander-Scott added, "We are committed to working with our partners in the housing field to identify opportunities to reduce the barriers that people who are HIV-infected may face."