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Maintaining HIV and STI Services During COVID-19

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Maintaining HIV and STI Services During COVID-19 COVID-19: Maintaining HIV and STI Services During the COVID-19 public health emergency, sexual health care providers can reduce in-person encounters for nonurgent care and continue to provide access to key HIV and sexually transmitted infection (STI) services. General Guidance • Consult updated guidance on providing in-person care. • Provide clinical services via telehealth if in-person care is not necessary. • Encourage patients to use mail-order pharmacies or delivery services. • Share tips for enjoying safer sex during the COVID-19 public health emergency. Guidance on Specific Clinical Services HIV Testing • Immediately test patients with rash or flu-like symptoms for acute HIV infection, particularly if they may have recently been exposed to HIV. • Encourage patients to resume regular screening for HIV. • Patients can test themselves at home. Clinics can provide free HIV self-test kits to eligible patients through the NYC Community Home Test Giveaway, or have patients order a free kit from agencies listed on the NYC Health Map (under Sexual Health Services and HIV Testing). HIV Treatment • See the U.S. Department of Health and Human Services’ interim guidance on COVID-19 and people with HIV. • Offer in-person visits or visits via telehealth to ensure continuity of HIV primary care, case management, mental health and substance use services. • Encourage all New Yorkers with HIV to get vaccinated against COVID-19. • Inform patients with HIV that there is no conclusive evidence they are at greater risk of severe COVID-19 unless they are immunocompromised. • Support patients with HIV to achieve and maintain an undetectable viral load to prevent illness related to both HIV and COVID-19. o New York State (NYS) has approved 90-day prescriptions for patients enrolled in Medicaid, Medicare and Uninsured Care Programs including the AIDS Drug Assistance Program. • Ensure that patients are screened for viral load and CD4 count at least every six months. • Provide regular opportunities to discuss any barriers to care, including past negative experiences while seeking care. • Offer immediate treatment to patients with newly reactive HIV test results or who are previously diagnosed and treatment-naïve, following NYC and NYS guidance. • Share any contractual barriers to providing services with insurers or government funders. Many funders are relaxing certain obligations during the COVID-19 public health emergency. 1 HIV PrEP • Ask patients how they protect themselves against HIV, including those who may have paused taking PrEP medicines. • Use an in-person visit, or telephone or video conference to discuss initiating or pausing PrEP, or, for cisgender men who have sex with men, switching to PrEP on demand. o Cisgender men who have sex with men and are taking tenofovir disoproxil fumarate- emtricitabine (TDF/FTC) as PrEP can conserve their medicines by taking PrEP on demand before and after sex, following NYC and NYS guidance. • Consider offering a free HIV self-test kit through the NYC Community Home Test Giveaway to patients who are starting PrEP. Patients can also order a free kit from agencies listed on the NYC Health Map (under Sexual Health Services and HIV Testing). • If regular follow-up testing is delayed, ask patients about symptoms of incident HIV and STIs. • For more information, see COVID-19: HIV PrEP and PEP Best Practices. HIV Emergency PEP • Inform patients that people with a high-risk exposure to HIV can receive emergency post- exposure prophylaxis (emergency PEP) without a visit to an emergency room or clinic by calling the 24/7 NYC PEP hotline at 844-3-PEPNYC (844- 373-7692). o Qualified patients will receive an electronic prescription for a full 28 days of emergency PEP medicines and free at-home test kits to test themselves for HIV at baseline and after completing the PEP regimen. • For more information, see COVID-19: HIV PrEP and Emergency PEP Best Practices. STI Screening • Providers offering in-person care should consider offering routine screening for STIs. • Prioritize routine STI screening for patients at highest risk and from populations with the highest disease burden, including young women and men who have sex with men. • If your facility has a shortage of chlamydia and gonorrhea test kits, use Centers for Disease Control and Prevention (CDC) guidance to prioritize select groups for STI testing and screening. STI Diagnosis and Treatment • Providers with limited capacity for in-person care can use telehealth or video conference to manage patients reporting symptoms or exposure. • Refer to the NYC Department of Health and Mental Hygiene guidance on syndromic management of STIs. • Treat STIs presumptively, prescribing oral medicines whenever possible and using recommended oral regimens for gonorrhea treatment. • Refer to newly updated CDC guidelines on treating gonococcal infection. • Consider providing expedited partner therapy for gonorrhea, chlamydia and trichomonas, as NYS law now allows, using a shared clinical decision-making process with patients. • To prevent congenital syphilis, use injectable benzathine penicillin G to treat people who are pregnant or may become pregnant if they have syphilis or may have been sexually exposed (other treatments for syphilis are not acceptable during pregnancy). 2 NYC Sexual Health Clinics • Select Sexual Health Clinics are offering certain HIV and STI services on a walk-in basis to a limited number of patients each day. See updated information on clinic locations, hours of operations and available services. • Patients can also call the NYC Sexual Health Clinic Hotline at 347-396-7959, Monday through Friday, from 9 a.m. to 3:30 p.m., for certain HIV and STI telemedicine services. HIV and STI Resources • NYC Health Map: Find HIV and STI testing and treatment, and HIV PrEP and PEP (under Sexual Health Services). • NYS Department of Health AIDS Institute Provider Directory: To find HIV services, including PrEP and PEP, STI services, hepatitis C services, and drug use services (including Opioid Overdose Prevention programs), visit providerdirectory.aidsinstituteny.org. • NYS Uninsured Care Programs: For more information on the NYS Uninsured Care Programs, including the AIDS Drug Assistance Program, call 800-542-2437 or visit health.ny.gov/diseases/aids/general/resources/adap/. • COVID-19 Guidance for Medicaid Providers and NYS Department of Health Medicaid Updates For more information on COVID-19, visit nyc.gov/health/coronavirus. Select “Information for Providers” for Dear Colleague updates, health alerts and advisories, webinars and other resources for health care providers. The NYC Health Department may change recommendations as the situation evolves. 5.20.21 3 .
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