CommunityEngagementtoEndtheHIVEpidemic

#EndAIDSFulton@HIVTaskForceFC

Melanie Thompson, MDExecutive Editor, Strategy to End AIDSFulton County Task Force on HIV/AIDS

Atlanta, GA

Objectives

• DiscusstheimportanceofcreatingstrategicplanstoimpactthetrajectoryoftheHIVepidemic.

• Identifystrategiesforinvolvingkeystakeholderswhoshouldparticipateinbuildingyourlocalplan.

• Identifystrategiesforsettingkeyobjectivesforyourplan.

ThereisGoodNews

AbouttheStateofHIVMedicine

in2017!

OUR Time is NOW!

HIVIsNotaDeathSentence!

PeoplewithHIVcanliveahealthy,near-normallifespanwithHIVwhentheyare• Diagnosedearly• Startedonantiretroviraltherapy(ART)rightaway

• Abletoaccesscareandmedscontinuously tosuppressthevirustoundetectablelevels

• NooneshouldprogresstoAIDSin2017!

HIVInfectionIsPreventable!

• PLWHIVwhosevirusiscontinuouslysuppressedoneffectiveARTdonottransmit– TreatmentIsPrevention!– Undetectable=Untransmittable(U=U)

HIVInfectionIsPreventable!

• Preexposureprophlaxis(PrEP)withTruvadaTM

decreasesHIVacquisitionbyover95%inthosewhotakeitdaily,asprescribed.

• ARTforpregnantwomenandnewbornsreducesthechanceofHIVtransmissionto<1%

• SafeinjectingequipmenteliminatestransmissionofHIV,hepatitisBandCandotherinfectionsinthosewhoinjectdrugs

NowWeHaveGoals!“AIDS-FreeGeneration”“ZeroNewInfections”

“EndAIDS”

WhyDoWeNeedAStrategy?

Unfortunately,manyarenotbenefittingoptimallyfromthese

advances

We know what works. Why isn’t it working?

“Agoalwithoutaplanisjustawish.”―AntoinedeSaint-Exupéry

“Ifyoudon'tknowwhereyouaregoing,you'llendupsomeplaceelse.”

―YogiBerra

WhyDoWeNeedAStrategy?

• Astrategyforcesustonameandcommitto– Goals– Concreteobjectivesrequiredtoreachthem– Actionsneededtoachievetheobjectives– Accountabilityforthework

• Requiresustomeasureourprogresstowardgoalsandobjectives– Identifydatasources– Definemetrics– Assigntargetsandtimelines– Evaluateandreviseperiodically

Wheretobegin?

1. ReducenewHIVinfections2. Increaseaccesstocareand

improvehealthoutcomesforpeoplelivingwithHIV

3. ReduceHIV-relateddisparitiesandhealthinequities

4. Achieveamorecoordinatedresponsetotheepidemic

WhyDoWeNeedLocalStrategies?

• Localplansadaptthecarecontinuumandlocalgoalstolocalepidemiology,whichdiffersfromregiontoregion,andamongpopulations.

• Localstrategiesgiveeachjurisdictionameanstoassessitsowndata,setbenchmarks,andidentifyhighestimpactinterventions

KeyStepsinPlanningaStrategy

• Stealasmuchasyoucanfromothers!• Identifykeystakeholders– PLWHIVshouldbeapriority

• Convenestakeholdersinoneroom(+/-electronictechnology)tofindcommonground

• Findpoliticalwillwhereyoucan– Healthdepartments– Electedofficials:city/county/state

KeyStepsinPlanningaStrategy

• Defineyourbaseline– Knowyourlocalepidemiology– Knowyourlocalcarecontinuum– Listentostakeholders,especiallyPLHIV

• Identifygoals• Identifyobjectives,metrics• Identifyactionsrequiredtoattainobjectives• Identifyaccountability,timelines,priorities

HowtoInvolveKeyStakeholders

• Identifykeydecisionmakerswhocontrolandreceivefunds– Localhealthdepartmentleaders– RyanWhiterecipientandgrantees– CDCpreventionfundrecipientsandgrantees– SAMHSAgrantees– HOPWArecipientandgrantees– Substanceuseandmentalhealthprograms– PrivatehealthsystemsandVA– Non-HIVcommunityleaders(education,faith,etc.)

• Establish“warm”oneononecontactinitially;powerbreakfastswork!

HowtoInvolveKeyStakeholders

• IdentifyandreachouttoPLWHIVandpopulationsathighestriskforHIV– PersonsreceivingservicesfromRyanWhiteclinics,privatehealthsystems,VA,communityhealthcentersandFQHCs

– Personsreceivingservicesthroughcommunityorganizationsfundedfortestingandprevention

– Personsreceivinghousingservices– Personsreceivingsubstanceuseandmentalhealthservices

• InvolvekeyleadersinTaskForce&committees• Organizelisteningsessionsforbroaderinput

HowtoInvolveKeyStakeholders

• Identifyandreachouttocareandserviceproviders– Physiciansandadvancedpracticeproviders– Pharmacists–Mentalhealthprofessionals– Clinicmanagers– Casemanagersandcounselors– Navigators,includingpeers– Housingproviders

HowtoSetKeyObjectives

• Lookatyourdataandqualitativeinput–Whereareyourbiggestproblems?

• Engagestakeholders–Wheredoyouwanttobe?Bywhen?

• MakeobjectivesasSpecific,Measurable,Attainable,Realistic,andTimely(SMART)aspossible

• Setobjectivesthathavebroadsupportbytheteam

Remember…

• Astrategyshouldbealivingdocument– Implementit– Monitorit– Evaluateit– Don’tbeafraidtoreviseit

• “InpreparingforbattleIhavealwaysfoundthatplansareuseless,butplanningisindispensable.”―DwightD.Eisenhower

• Rememberthatyourgoalisnottowritedocuments– itistoEndtheEpidemic!

CaseStudy:TheFultonCountyStrategytoEndAIDS

Fulton County Task Force On HIV / AIDS

OUR Time Is NOW

PhaseIIIProgressReportBuildingtheStrategytoEndAIDS

inFultonCountyProgressandPriorities

#EndAIDSFulton@HIVTaskForceFC

FultonCountyTaskForceonHIV/AIDS

• Created December,2014byFultonCountyBoardofCommissioners

• Mission:EndAIDSinFultonCounty– CreateandimplementaStrategytoEndAIDSinFultonCo.

• Leadership:PLWHIV.LocalandnationalHIVexperts• Participation:– 14commissionerappointedmembers– 25non-appointedcontributors– Unlimitedcommitteemembers– ExofficiomembersfromFultonCountyandGADPH

Structure

SocialDeterminants

Prevention&Care

Data Policy

ExecutiveCommittee

InterculturalAwareness

Methodology

• Principles– Seekbroadinputwithrobustcommunityengagement

– PrioritizeinvolvementofPLWHIV–Makedecisionsbyconsensus–Makeevidence-baseddecisions

• Consultothersalreadydoingthework– NewYork“EndtheEpidemic”TaskForce– SanFrancisco“GettingtoZero”

CommunityEngagement

• CommunityListeningSessions(1.5-2hrs)– Broadgeographicinput– Inputfromkeypopulations– Foodifpossible;convenienthoursandvenue

• Makesuretolisten!• Agenda– Verybriefintroandepidemiology(10min)– Twoquestions:

• HowcanwepreventHIV?• HowcanwehelpPLWHIVgetincareandstayincare?

StakeholderEngagement

• Intensivetopic-drivenFace-to-Facemeetings– Generally3hours– Briefpresentations:frametheissue– Discussionofbarriers:extensivenotesusinglargeflipchartpagestapedtowalls

– Actions– Priorities

CommitteeWork

• Frequenttopicdrivenphonecalls– Focusonaspecificobjective– Identifyspecificquestionstoanswer(ie.g.WhatarethebestdatasourcesandmetricsformeasuringPrEP uptake?)

– Engagecontentexpertswhocanaddressquestions

3PhasesoftheStrategytoEndAIDS

• PhaseI:BroadObjectives,12/1/15• PhaseII:Actionplantoachieveobjectives,6/27/16

• PhaseIII:Prioritizationandtransitiontopermanentadvisorycommittee,July312017

InvolvedOver120TaskForceParticipants!

OurVision

• FultonCountywillbeacommunitywithoutnewHIVinfectionsorAIDS-relateddeaths,whereallPLWHIVwillbevirologicallysuppressedwhile– Receivinguninterruptedcareandtreatment,– Freefromstigmaanddiscrimination,and– Groundedintherecognitionthataccesstohealthcareisahumanright.

• PersonswithoutHIVwillbeeducated,empowered,andabletoaccesstoolstopreventHIVtransmission.

10KeyPriorities

• StigmaKills.Don’tTolerateIt.• MakeCareandServicesClient-Centered• MakeitEasytoGetintoCareFastandStayinCaretoRemainHealthy.

• EveryoneShouldBeTestedforHIV.• HIVIsPreventable.SoPreventIt.• NoMoreBabiesBornwithHIV.• EducationisHIVPrevention.• HousingisHIVPreventionandTreatment.• MentalHealth&SubstanceUseServicesareCare,Too.• CreatePoliciesthatPromoteHealth.

StigmaKills.Don’tTolerateIt.

EliminatestigmaassociatedwithHIV,sexualorientation,genderidentityandexpression,race/ethnicity,gender,class,andmentalhealthandsubstanceusedisorders

• healthcaresettings• faithcommunities• educationalinstitutions• governmentinstitutions• mediacoverage• allpoliciesandlaws

ZEROStigmaAndDiscriminationPriorities2017-8

• POLICY:ReformHIVcriminalizationlawstoalignwithcurrentHIVscienceandadvancebestpublichealthpracticesforHIVpreventionandcare.

• IncludeInterculturalAwarenessplansinallFultonCountycontracts

• InstituteInterculturalAwarenessprogramsinclinicsandservicesforpeoplewithandatriskforHIV

• AdoptpoliciesandproceduressupportingtheMeaningfulInvolvementofPLWHIVacrossallHIVservices

TestingAndPrevention

Testing

• Objective:↑%ofPLWHIVwhoknowstatusto90%• Objective:↓%ofpersonswithAIDSatdiagnosisto<10%

• Opt-outtesting:implementandscale-up– POLICY:BOCtorequireopt-outtestinginallcountycontracts

– NeeddatasystemsforM&E/accountabilityincontracts

• Maketargetedtestingtrulytargeted– <4%oftestingwastargetedtokeypopulations

RoutineOpt-OutTestingProgress

• OperativeinGradyEDwithscale-upacrossGradyHealthSystem(funding:HIPP,GileadFOCUS,Grady)

• FultonBoardofHealthidentifiedopt-outtestingasa2017priority

• GeorgiaAETCistrainingSouthsideandMercyCare(bothFQHCs)personnelonHIVtestingandcounseling

• OptouttestinglanguageinFultonjailmedicalservicescontract– Noevaluationsofaronimplementation– NoHIPPcontractyetfor2017testingatFultonjails(6,640conductedin2016)

Prevention

• Objective:↓numberofnewHIVdiagnosesby25%(toabout525by2020)– Reducedisparitiesbyatleast15%

• Actions– AccesstotreatmentforPLWHIV(seecareandtreatment)

– EnsureaccesstoPrEP (andPEP)forthoseathighrisk– ComprehensivecareforpregnantwomenlivingwithHIV– POLICY:ClarifylegitimacyofSSPandexpandaccess

EnsureAccesstoPrEP/PEPPriorities2017-8

• EnsureaccesstoPrEPforeligiblepersonsathighriskofHIVinfection.– EnsurefundingofFultonPrEPClinic&mobileunit– CreatemultipleaccesspointsforPrEP

• Increasecommunityandproviderawareness,knowledge,trainingaboutPrEP/PEP

• Createandimplementdatamonitoringsystems

EarlySuccessesinPrevention

PrEP Clinic DateOpened NumberServed

FultonBOH 2/2016 2016-3402017-55

AbsoluteCare Began2012;Clinicguidelines2014

450(6/2017), 250-300active

AIDAtlanta May2015 125 receivedRx

Empowerment Resource 2015 1859“accessto”PEP/PrEP services

Positive Impact 2016 100+

SomeoneCares 10/2016 137MSM; 2women

POLICYNov2016,SyringeServiceBill

SSPsarelegitimatemedicalinterventiontopreventHIV,HCVandHBV

CareandTreatment

CareandTreatment:KeyObjectives

*Aspartofretentionwealsostrivetore-engagethoseoutofcarewithin3days

Objective 2015 Challenge↑NewlydiagnosedLTCto 85%in3days

73%in30days

- Lackcentral referralcenter

- LessonsfromREpilots↑Retentionto90%*

49% - SocialDeterminants- ComplexSystems

↑Viral suppressionto80%ofdiagnosed

48% - ADAP lapses- Transportation

ActionsAlongTheCareContinuum

• BetterdatasystemstoallowevaluationofRapidEntry• Intensivelinkageservicesforvulnerablepopulations• RetentionandReengagementTaskForce• AllocateadditionalRyanWhitePartAfunding– RapidEntry$$;expandedclinichoursinnewRFP

• Makeclinicsmorewelcoming– Implement&evaluateinterculturalawarenessplans

• CreateanADAP/HICPWorkingGroup

Diagnosis LinkgagetoCare Retention ART Viral

Suppression

Progress:RapidEntryinFultonCountyClinics

Clinic DateOpened NumberServedFultonBOH* 4/2016 102(newlydiagnosed)Fulton/HEALingCtr,NeighborhoodUnion*

3/2017 10

AIDSHealthcareFoundation– Midtown*

12/2016 19by6/2017

AIDSHealthcareFoundation– Lithonia*

10/2016 49by6/2017

GradyIDP 5/2016 230by9/2016PositiveImpactHealthCenters*

11/2016 121by5/2017

*ReceivedsupplementaryRyanWhitePartAfundingforRapidEntry

CrossCutting:SocialDeterminants

• HousingObjective:<5%ofPLWHIVwillbeunstablyhoused– Action:All2017housingcontractsnowhave“HousingFirst”requirements,nowworkingonenforcementplans

• EducationObjective: EvidencebasedsexualhealthcurriculuminFultonCountyandCityofAtlantaPublicSchools– SeatonAtlantaPublicSchoolscurriculumadvisorycomm.– Performedintensiveevaluationofproposedcurriculum– NewcurriculumapprovedinAtlantaPublicSchools!

PolicyObjectives

FewerUninsuredPeoplewithHIV

WeMUSTExpandMedicaidto

ExpandAccesstoCare

SyringeServicesProgramsSaveLives!

POLICY:ClarifythelegalityofsyringeexchangeforthelegitimatemedicalpurposeofpreventingHIV,HBVandHCV,andotherblood-borneinfections

ReformHIVCriminalizationLaws

POLICY:ReformHIVcriminalizationlawstoalignwithcurrentHIV

scienceandadvancebestpublichealthpracticesforHIVprevention

andcare.

CrossCuttingIssues:HealthDepartmentKeyPriorities2017-8

• AddressissuesthatimpedeoptimalfunctioningofFulton’shealthdepartment– Improvehiringandcontractingpracticesthatimpedetimely&effectiveuseoffunds• HIPPDirectorposition“interim”for10months• ContinuedHIPPcontractdelays

– Ensureongoingtransparencyinuseoffederal,state,countyfunds

– Strengthenongoingcommunicationswithcommunity,CBOs,andHIVcareproviders

PassingtheTorch

From the Fulton County Task Force on HIV/AIDS to The Fulton County HIV Prevention, Care and Policy

Advisory Committee

YOURTimeIsNOW!

• ContinuetoputthecommunityandPLWHIVfirstbyregularlisteningsessionsandinvolvingthemateverylevelofthework.

• ContinuetomonitorimplementationoftheStrategyandupdateitasneeded.

• GivetheBOCadvice.TheywanttoEndAIDS.Helpthemknowhowtodoit.

• BevocaladvocatesforFultonBOHandDPHandalsoensuretransparencyandaccountability

• Thisisaworkinprogress.Don’tjointhecommitteeifyoudon’twanttowork.ItwilltakealotmoreworktoEndAIDS!Butwecanandwemust.

Acknowledgements

All120TaskForcecontributors,especially…– PLWHIV– ChairmanJohnEavesandVice-ChairJoanGarner– TheWorkersBees:WendyArmstrong,LeishaMcKinleyBeach,EmilyBrown,JeffCheek,JonathanColasanti,WilliamConnor,CarlosdelRio,DanielDriffin,JeffGraham,DavidHolland,SeanMcIntosh,PascaleWortley

– EmoryCFAR:PublicationCosts• Peoplewhohelpedusfromaroundthecountry,especiallyNYandSF

Questions?

Contact Info: drmt@mindspring.comFollow me on Twitter: @drmt