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!

austin.padilla@gmail.comoliver.bacon@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