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SUNY Downstate’s STAR Program Awarded nearly $4.6 Million in Additional Funding
SUNY Downstate Medical Center’s Special Treatment and Research (STAR) Program has received three funding awards totaling nearly $4.6 million to provide HIV care and ancillary services, supportive counseling and family stabilization services, and care for individuals co-infected with HIV and hepatitis C virus (HCV).
HRSA’s HIV/AIDS Bureau, Ryan White Part C Award
The federal Health Resources and Services Administration’s HIV/AIDS Bureau, Ryan White Part C, awarded $2,840,346 in continuation funding to the STAR Program. This two-year Early Intervention Services (EIS) award will allow the STAR Health Center, directed by Jack DeHovitz, MD, MPH, distinguished service professor of medicine at SUNY Downstate, to address the three goals of the National HIV/AIDS Strategy (NHAS): 1) reduce the number of people who become infected with HIV; 2) increase access to care and optimize health outcomes for people living with HIV and AIDS; and 3) reduce HIV-related health disparities.
Central Brooklyn, the primary catchment area of SUNY Downstate, contains some of the highest HIV seroprevalence rates in New York City, especially among persons of color, women, children, and men who have sex with men. As a result of delayed testing, a sizeable portion of people living with HIV or AIDS in Brooklyn enter the care and treatment system late in the course of their disease. Nearly one-third of Brooklyn individuals with newly reported HIV infection have a concurrent diagnosis of AIDS, highlighting the challenges of late diagnosis. Brooklyn leads NYC in new HIV diagnoses (27.4%), AIDS diagnoses (29%), concurrent HIV and AIDS diagnoses (30.2%), and deaths (31.6%).
The STAR Program conducts specific initiatives to target sub-populations of people living with HIV or AIDS including women, men who have sex with men, and transgender young adults of color. Ryan White Part C provides core funding for a large proportion of the STAR Program’s primary care services.
Ryan White Part A Award
The STAR Program also was awarded $1,050,000 over three years in continuation funding for its Supportive Counseling and Family Stabilization (SCF) Project. The SCF Project, a component of the STAR Program's Behavioral Health Services, was one of the first projects to offer care to people with HIV/AIDS at SUNY Downstate and the first of its kind in Brooklyn, providing comprehensive support group services and supportive counseling to adults with HIV/AIDS and their family members since 1989. Initially funded by the New York City Department of Health, in 1992 it received continued support provided by HRSA/Ryan White Title I (now Part A) funding. STAR Behavioral Health Services offers psychiatric care, full psychosocial assessment, diagnostic evaluation and treatment planning, crisis intervention, ongoing psychotherapy, substance abuse counseling, support groups, patient navigators, buprenorphine treatment (for opiate addiction) and acupuncture. The SCF Project, funded through the Ryan White HIV/AIDS Treatment Extension Act of 2009, Part A, will build on our previous model by adding multi-level staff, including case managers and community healthcare workers; providing appointment accompaniment; and providing home visits to reach those most in need.
“Our SCF team is greatly looking forward to implementing this enhanced service model, which increases our ability to address treatment barriers, and will facilitate improved retention in care, consistent implementation of antiretroviral therapy, and sustained suppression of patients’ viral loads, all of which are key components of the National HIV/AIDS Strategy,” said Program Manager Lori Hurley, LMSW, MPH.
Care for Individuals with HIV/HCV Co-Infection
In addition, the STAR Program was awarded $675,000 over five years from the New York State Department of Health AIDS Institute for improving linkage and access to Hepatitis C care and treatment. This program will link individuals who are dually infected with HIV and hepatitis C (HCV) to comprehensive care and treatment at the STAR Health Center. The program will address primarily Black and/or Hispanic adults in Brooklyn who are co-infected with HIV and HCV, including uninsured persons. On-site services will include linkage to care, HCV care/treatment, nutritional services, mental health care, substance abuse treatment, adherence support, peer support and other supportive services. Anticipated outcomes include: 1) increasing the number of people with HCV who are linked to care; and 2) improving HCV treatment initiation and completion rates.
Collaborating partners include SUNY Downstate University Hospital of Brooklyn’s Center for Liver Disease, a component of the Division of Gastroenterology and Hepatology, and CAMBA, a Brooklyn-based community organization serving persons with or at risk for HCV.
Brooklyn reported almost 2,000 cases of chronic HCV in 2012 and Central Brooklyn neighborhoods have disproportionately high rates of chronic HCV. Major barriers to HCV screening and treatment include addiction, homelessness, and poor social support. The STAR Health Center has provided integrated HCV/primary care and other services on site since 2000.
Chronic hepatitis C has traditionally been difficult to treat. Until recently the standard of care was dual therapy with pegylated interferon and ribavirin, which lasts up to a year – perhaps even longer for HIV/HCV coinfected people – but has serious side effects, and offers only a modest cure rate. Recently, the field has been revolutionized by the development of direct acting antivirals (DAAs). These next-generation HCV drugs now in the pipeline are better tolerated, more convenient, and raise cure rates even further – often into the 90% to 100% range even in patients with HIV coinfection. However, these drugs are expensive, and require close adherence in order to be effective. Thus, a program such as STAR’s will facilitate both engagement and completion of care.
Elliot DeHaan, MD, clinical assistant professor of medicine and a STAR Health Center infectious disease specialist, will manage the program. Dr. DeHaan, who has extensive experience treating HIV/HCV co-infected patients, noted, “We are excited and grateful for the opportunity to collaborate with the New York State Department of Health AIDS Institute on this Linkage-To-Care project for persons co-infected with HIV/HCV. Our experience to date with the new all-oral direct antiviral agents has been very encouraging, with high adherence rates and rapid virologic responses. We expect that this funding will further improve patient access to care, increase our capacity to treat HCV, and result in high retention and cure rates in this exciting era of interferon-free therapy."
About SUNY Downstate Medical Center
SUNY Downstate Medical Center, founded in 1860, was the first medical school in the United States to bring teaching out of the lecture hall and to the patient’s bedside. A center of innovation and excellence in research and clinical service delivery, SUNY Downstate Medical Center comprises a College of Medicine, College of Nursing, School of Health Professions, a School of Graduate Studies, School of Public Health, University Hospital of Brooklyn, and a multifaceted biotechnology initiative including the Downstate Biotechnology Incubator and BioBAT for early-stage and more mature companies, respectively.
SUNY Downstate ranks twelfth nationally in the number of alumni who are on the faculty of American medical schools. More physicians practicing in New York City have graduated from SUNY Downstate than from any other medical school.