Acknowledgments G2Z Consortium Shannon Weber Diane Havlir Susan Buchbinder Dana Van Gorder Jeff Sheehy
Getting to Zero San Francisco: The Power of Collective Impact Zero new HIV infections Zero HIV deaths Zero stigma and discrimination (or at least 90% reduction by 2020) North American HIV and Housing Research Summit Washington, DC, 14-16 September 2015
We have been heading toward zero New HIV diagnoses and deaths in SF Number 1000 900 800 700 600 500 400 300 200 100 0 2010: 2006: ART at HIV test w/o diagnosis; written HIV test consent scale-up 2011: LINCS 519 527 522 327 324 467 2012: PrEP 439 413 429 264 254 247 234 236 2013: RAPID Pilot 371 209 HIV diagnoses Deaths 2014 306 HIV diagnoses 177 HIV-related deaths Year
How it began. This is all interesting, but are you working together? --Community member
Getting to Zero is a multi-sector independent consortium, operating under principles of collective impact: Long-term commitment of groups from different sectors to a common agenda to solve a specific social problem. Improve HIV for persons living with disease and at risk in San Francisco Maintain funding for existing efforts Achieve success in signature initiatives Secure funding and broad city/private sector support Create innovative programs Exchange best practices with other cities
What s Working? Robust HIV Surveillance System Access to testing, syringes Comprehensive, accessible patient care Strong linkages CBOs Public Health Private Providers Scientists/Academia Where We Need to Go Increase knowledge In most-impacted groups Prevention Treatment Peer support Improve access Mental health Housing Substance use services Immediate, sustained ART Reduce Stigma PrEP RAPID Retention End Stigma
RAPID* Goals: reach 80% of new diagnoses by December 2016 Patients On day of diagnosis Disclosure Counseling Medical evaluation Baseline testing Offer immediate ART Benefits navigation and enrollment Linkage to HIV 1 o care Providers (RAPID nodes + HIV clinics) Outreach Academic Detailing Rapid Referral Pathways Single POC Team-based Protocol/SOP Case Reviews Ongoing Support *Rapid ART Program Initiative for HIV Diagnoses Evaluation Mapping the Landscape Interviews w Patients, Care Teams Collection of performance data Uptake Time to ART start Regimens used % linked Sites of care Retention Time to viral suppression Durable suppression
Testing sites AHP/Magnet /Glide/DPH (CHN+ Consortium) (37%) Private/UC SF/StM/CP MC (22%) SF City Clinic (14%) SFGH (13%) Kaiser (9%) Other (5%) RAPID PROCESS: within 48 hours of Diagnosis Disclosure Counseling Partner Services Medical Evaluation Benefits/Insurance Navigation and Rapid Enrollment Linkage to HIV Primary Care within 5 Days Immediate ART (Starter Pack or Prescription) HIV Primary Care Sites Private/UC SF/StM (32%) SFGH (26%) Kaiser (14%) SFCC/DPH (12%) Other/AHP/VA/ OOJ/Jail (9%) Unknown (7%)
PrEP Committee Metrics Report Back Getting to Zero Metrics Where are we now? Goal 2020 # and % at risk individuals who report current PrEP use # Clinical providers who report any pts on PrEP # Clinical providers reached through academic detailing 10.1-15.5% of MSM surveyed report current PrEP use; approximately 5000 users Currently 31 clinics, representing at least 41 individual clinicians Zero 150 10,000 users # HIV test counselors trained Zero 400 PrEP speakers bureau None Set up and used at least 4x/year PrEP navigators One 5 in the field PrEP hotline for users None Launched Direct PrEP measurement, impact NHBS, Stop AIDS surveys, asking recent dx if on PrEP Social harms and use registry
PrEP: What is Needed? PrEP Providers: Metrics & Milestones User Centralized website Hotline for users Navigators Education campaign (PrEP users speakers bureau, others) Increase provider capacity (SFDPH, others) Provider Training (include Ob/Gyn, Peds, Psych) Academic detailing Warmline for consultations (SFGH) Online tools PrEP Programs (e.g., Kaiser, Magnet, City Clinic, Ward 86, BPAC, 360 clinic) Measurement Uptake HIV infections in current/recent users ARV resistance Social harms HIV incidence STI incidence Cost
Milestones by 2020 Retention Greater than 90% of people with HIV linked to care Greater than 90% of people with HIV retained in care Greater than 90% of people with HIV virally suppressed Newly Diagnosed Persons Living with HIV
Retention Focus Populations Persons w/ co-occurring Homelessness Mental illness Substance use Young MSM African American and Latino MSM and women Transgender Uninsured Persons w pattern of missed appointments or who begin to miss Virally non-suppressed Low CD4
Ending Stigma Priorities Focus Neighborhoods for Needs, Intervention Bayview/Hunter s Point (young MSM of color) Tenderloin (IDU, Trans, Precariouslyhoused, sex work) Mission (undocumented, MSM-Latino) Castro (Aging and aging w HIV) Metrics (in progress) Endorsement of stigmatizing beliefs (HIV-) Perception of respect in interactions (HIV+) Self-reported/observed events Coping/resilience (HIV+) Disparities Testing ART Prevention
Thanks! austin.padilla@gmail.com oliver.bacon@sfdph.org
Extra Slides
Retention Committee Metrics Report Back Getting to Zero Metrics to evaluation success of retention efforts in San Francisco Metrics Persons with New HIV Diagnosis All Persons living with HIV Linked to HIV Care Lab result within 3 months of diagnosis. At least one clinic visit with lab result in year of interest. Retained in Care Viral Suppression 2 nd clinic visit with lab result 3-6 months after initial linkage visit. VL <=200 copies/ml within 12 months of diagnosis. At least 2 clinic visits with lab results in year of interest. Last VL <=200 copies/ml in year of interest. Sustained viral suppression 1 st suppressed VL within 12 months of diagnosis; 2 nd 3-6 months later. Last 2 VL suppressed in year of interest.
Univer sal ART PrEP Demo Incr. Testin g HIV Semi-Annual Surveillance Report, SFDPH, June 2015
We have been heading toward zero New HIV diagnoses and deaths in SF 2006: HIV test w/o written consent 2010: ART at diagnos is; HIV test scaleup 20 11: LIN CS 201 2: PrE P
How many newly diagnosed patients get and stay in treatment? SFDPH HIV Annual Report, 2013