Community Engagement to End the HIV Epidemic · Community Engagement to End the HIV Epidemic...
Transcript of Community Engagement to End the HIV Epidemic · Community Engagement to End the HIV Epidemic...
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: [email protected] me on Twitter: @drmt