getting to zero in san francisco · getting to zero is a multi -sector independent consortium,...
TRANSCRIPT
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 infectionsZero HIV deathsZero stigma and discrimination(or at least 90% reduction by 2020)
North American HIV and Housing Research SummitWashington, DC, 14-16 September 2015
We have been heading toward zeroNew HIV diagnoses and deaths in SF
519 527 522467 439 413 429
371
327 324264 254 247 234 236 209
0100200300400500600700800900
1000
Num
ber
Year
HIV diagnosesDeaths
2013:RAPID Pilot
2010:ART at
diagnosis;HIV test scale-up
2012:PrEP
2006: HIV test w/o
written consent 2011:
LINCS
2014306 HIV diagnoses177 HIV-related deaths
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
RAPIDPrEP Retention End Stigma
RAPID* Goals: reach 80% of new diagnoses by December 2016
PatientsOn day of diagnosis• Disclosure• Counseling• Medical evaluation• Baseline testing• Offer immediate
ART• Benefits navigation
and enrollment• Linkage to HIV 1o
care
Providers(RAPID nodes +
HIV clinics)• Outreach• Academic Detailing• Rapid Referral
Pathways• Single POC• Team-based
• Protocol/SOP• Case Reviews• Ongoing Support
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*Rapid ART Program Initiative for HIV Diagnoses
SFGH (13%)
SF City Clinic (14%)
AHP/Magnet/Glide/DPH
(CHN+ Consortium)
(37%)
Private/UCSF/StM/CPMC (22%)
Kaiser (9%)
Other (5%)
RAPID PROCESS: within 48 hours of DiagnosisDisclosureCounseling
Partner ServicesMedical Evaluation
Benefits/Insurance Navigation and Rapid EnrollmentLinkage to HIV Primary Care within 5 Days
Immediate ART (Starter Pack or Prescription)
Private/UCSF/StM(32%)
SFGH (26%)
SFCC/DPH (12%)
Kaiser (14%)
Other/AHP/VA/OOJ/Jail
(9%)
Testing sites
HIV Primary Care Sites
Unknown(7%)
PrEP CommitteeMetrics Report Back
Getting to Zero
Metrics Where are we now? Goal 2020
# and % at risk individuals who report “current” PrEP use
• 10.1-15.5% of MSM surveyed report current PrEP use; approximately 5000 users
• 10,000 users
# Clinical providers who report any pts on PrEP
• Currently 31 clinics, representing at least 41 individual clinicians
# Clinical providers reached through academic detailing
• Zero • 150
# HIV test counselors trained • Zero • 400
PrEP speakers bureau • None• Set up and used
at least 4x/yearPrEP 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 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
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 StigmaPriorities• Focus Neighborhoods for Needs, Intervention
• Bayview/Hunter’s Point (young MSM of color)
• Tenderloin (IDU, Trans, Precariously-housed, 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!
[email protected]@sfdph.org
Extra Slides
Retention CommitteeMetrics 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 2nd clinic visit with lab result3-6 months after initiallinkage visit.
At least 2 clinic visits with lab results in year of interest.
Viral Suppression VL <=200 copies/ml within 12 months of diagnosis.
Last VL <=200 copies/ml in year of interest .
Sustained viral suppression 1st suppressed VL within 12 months of diagnosis; 2nd 3-6 months later.
Last 2 VL suppressed in year of interest.
HIV Semi-Annual Surveillance Report, SFDPH, June 2015
Universal
ART
PrEP Demo
Incr. Testin
g
We have been heading toward zeroNew HIV diagnoses and deaths in SF
2010:ART at
diagnosis;HIV test
scale-up
2012:
PrEP
2006: HIV test
w/o written consent
2011: LINCS
How many newly diagnosed patients get and stay in treatment?
SFDPH HIV Annual Report, 2013