STDS IN SAN FRANCISCO IN THE ERA OF GETTING TO ZERO Susan Philip MD MPH Disease Prevention and Control Branch Population Health Division San Francisco Health Commission May 16, 217
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SFDPH STD Prevention Efforts are Fundamental to Getting to Zero City-wide coordinated PrEP program Rapid ART start with treatment hubs Linkageengagementretention in care Reducing HIV stigma Drug user health Mental health/ Substance use/housing as HIV prevention Linkage to care and partner services (LINCS) Treatment as prevention Primary care HIV screening Syringe access Health ed/risk reduction STD testing & treatment Prevention with positives HIV testing 3
STD Increases are Occurring Even as HIV Diagnoses Decline 1,2 5 1, 8 HIV HIV Diagnoses Chlamydia Rate 45 4 35 STD Rate per 1, 6 4 Gonorrhea Rate 3 25 2 15 Number of HIV Diagnoses 2 1 P&S Syphilis Rate 5 27 28 29 21 211 212 213 214 215
Priority Populations are Those at Highest risk for STDs or Severe Complications of STDs Slide 5 Gay and Bisexual Men and other Men who have sex with Men (MSM) Adolescents and Young Adults of Color Transgender persons Pregnant women (Preventing Congenital Syphilis Cases)
STD Increases are Occurring in other Cities and States 5 4 Men Rate per 1, 3 2 1 Total Women 211 212 213 214 215 216 Rate per 1, Primary and Secondary Syphilis Rates in NYC Chlamydia, Gonorrhea, and Syphilis Rates in CA
CDC National HIV Behavioral Surveillance Survey results in San Francisco Offer Some Insight into these Trends 4 36.8 35 3 3.5 3.5 1% Condom use Proportion 25 2 17.3 15 1 Gonorrhea (self report) 9.9 11.9 9.6 5 4.5 4.7 Using PrEP Chen Y-H AIDS Care 216 24 28 211 214
8 HIV and STD Decision Making is Complex KQED Forum on 1/26/16; guests Drs. Susan Philip, Heidi Bauer, Cherrie Boyer I just wanted to say, you know, I m a gay man, I ve been taking PrEP for two years now, and as I ve learned more about the efficacy of PrEP, I take it every day at the same time, I ve stopped using condoms.. after spending 3 some odd years of being safe, and being terrified, I finally feel like I have a enjoyable sex life and the possibility of getting an STI, is, is very much less significant and important to me https://ww2.kqed.org/forum/216/1/26/std-rates-in-california-u-s-soar/
MSM have Disproportionately High Rates of Gonorrhea and Chlamydia 7 Gonorrhea Rates 7 Chlamydia Rates 6 MSM 6 MSM Rates per 1, 5 4 3 5 4 3 2 2 1 Other Men Female 27 28 29 21 211 212 213 214 215 216 1 Female Other Men 27 28 29 21 211 212 213 214 215 216
As Early Syphilis Cases have Increased, the Largest Proportion Continues to be among MSM 1% Percent of Total Early Syphilis Cases 9% 8% 7% 6% 5% 4% 3% 2% 1% Gay/Bi Men Other Men Unknown Men Women % 27 n=355 28 n=548 29 n=52 21 n=659 211 n=679 212 n=89 213 n=5 214 n=1117 215 n=125 216 n=1145
White MSM have the Most Cases of Early Syphilis; Rates are Highest for Black/African American MSM 6 25 5 2 Cases 4 3 2 15 1 Rate per 1, 1 5 27 28 29 21 211 212 213 214 215 216 White MSM Cases Black/African American MSM Cases White MSM Rates Black/African American MSM Rates
City Clinic is Our Essential Hub for Sexual Health Services, Training and Research Slide 12 High Volume 17,662 visits in 216; 53% people of color Diagnosed 34/255 (13.3%) of the new HIV infections in San Francisco in 215 Diagnosed and treated 2,536 cases of chlamydia, gonorrhea or syphilis in 215 496 PrEP initiation visits in 216 16 patients in HIV Early Care in 216 Trained ~1 medical and nursing students, residents, fellows and practicing clinicians in 216 Locally relevant research: e.g. critical site for NIH-CDC gonorrhea study leading to new alternative treatments in the CDC STD Treatment Guidelines Hub for Integrated STD clinical and surveillance database (ISCHTR) which also contains HIV partner services and linkage and navigation data.
SF City Clinic s PrEP Program Serves Key Populations 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % New infxns Kaiser SF SFDPH PC Clinics STD clinic 99% 96% 93% 86% 69% 27% 28% 18% 11% 11% 13% 8% 1% 9% 3% 45% 17% 1% Male Black Latino API White 43% 42% Slide courtesy Al Liu
Quality Improvements to Benefit Sexual Health: Chlamydia and Gonorrhea Testing at the Public Health Lab and City Clinic 9, 8, 22% more tests 7 6 Specimen Count 7, 6, 5, 4, 3, 2, Total Specimen Count Turn Around Time (Days) 6% faster results 5 4 3 2 Time to Results (days) 1, 1 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Month - Year
Slide 15 New Program Approaches for MSM Francisco Buchting, PhD consultant behaviorist Continued enhancement of integrated STDs and Sexual Health into HIV-related interventions
16 Conclusions STD rates continue to increase in MSM in San Francisco and many other areas of the U.S. Declining condom use is contributing to the increases, as MSM utilize HIV treatment to prevent HIV. The expertise of SFDPH STD staff and our disease intervention infrastructure and clinical services at City Clinic allow us to address STD increases and reduce disparities in STDs and HIV. Enhanced initiatives continue, with ongoing innovation and also continuous quality improvement of the work we currently do.
THANK YOU! Susan.Philip@sfdph.org Design by Mehroz Baig v. 217-4-14