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Continuum of HIV Prevention, Care, and Treatment

You Are Here. November 2010Overview of ECHPP to HPPC. February 2011Presentation of ECHPP 14 Required Activities to HPPC. March 2011Presentation of Draft ECHPP Plan to HPPC. Nov. 2010

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Continuum of HIV Prevention, Care, and Treatment

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    1. Enhanced Comprehensive HIV Prevention Plan (ECHPP) March 10, 2011

    2. You Are Here

    3. What is the ECHPP Plan? The ECHPP Plan is a description and justification of the SF HIV/AIDS Strategy It has four parts: Situational Analysis (a review of the past) Goals, Strategies, and Objectives (vision for the future) Rationale for Goals An “At-A-Glance” summary (shows the scale of and resources devoted to each of the interventions) #2, 3, and 4 were sent via email #1 is available upon request (documentation of activities already completed)

    4. Brief Summary of the ECHPP Plan The ECHPP Plan reflects: The services described in the HPS and Centers of Excellence RFPs as well as DPH-delivered services A scale up of HIV testing and interventions for HIV-positive people A scale down and re-focusing of interventions to reduce sexual risk behavior

    5. Continuum of HIV Prevention, Care, and Treatment

    6. Community-Level Harm Reduction

    7. Some Evidence to Support the ECHPP Plan Why focus on status awareness (HIV testing, partner services)? MSM and IDU are not testing frequently enough (NHBS 2005 and 2008) A new diagnosis reduces risk behavior (Ex: Colfax et al., 2002) If people know their HIV+ status, they can be linked to care (in SF, 24% not linked to care) Some are testing late in the course of their infection (mean CD4 at diagnosis has been in the 400’s since 2004)

    8. Some Evidence to Support the ECHPP Plan Why focus on prevention with positives, care, and treatment? In SF, 28% who are diagnosed with HIV have unsuppressed viral load Suppressing viral load reduces HIV transmission (Engsig et al 2010) Ensuring HIV+ people are engaged in care and promoting voluntary treatment are necessary to achieve individual and community viral load suppression

    9. Some Evidence to Support the ECHPP Plan If all PLWHA were aware of their status, and all were on voluntary treatment, mathematical modeling shows we could reduce new HIV infections by 76% by 2014 (Charlebois, Das, Porco, Havlir et. al. CROI, 2010) We will not achieve 100% status awareness or 100% treatment but we can improve If we add these new approaches to the best of HIV prevention in SF - “the love” (HERR, holistic health, interventions to reduce high-risk sexual behavior, etc.) - we can end new HIV infections in SF

    10. Scaled Up Interventions The main focus is on: HIV testing (medical and community-based) Partner services Linkage to HIV primary care Retention/re-engagement in care Treatment adherence

    11. Scaled Up Interventions (cont.) We will also scale up: Implementation of SFDPH treatment guidelines Condom distribution Health communication/public information re: HIV testing Service integration (hepatitis, TB, STD, HIV) Linkage to ancillary services for HIV-negative people Alcohol screening and intervention (?) PrEP (pre-exposure prophylaxis)

    12. Scaled Down Interventions Behavioral interventions to reduce sexual risk

    13. Change in Resources

    14. Interventions with No Change in Scale PEP (post-exposure prophylaxis) Structural change (different goals, but no change in level of effort) STD screening for HIV-positive persons Perinatal prevention Linkage to ancillary services for HIV-positive people Community mobilization Syringe access (to be included in final plan)

    15. Implementation Funds $887,968 through September 30, 2011 Funds to be spent on: HPS staffing for ECHPP Plan development Start-up for DPH re-engagement in care services (Engagement and Support Efforts Program, or EASE Program) Police education video re: syringe program Exploration of names-based service utilization data system options Other possible projects: Social marketing to promote testing? Condom dispensers?

    16. Next Steps Incorporate HPPC, HIV Health Services Planning Council, and CDC feedback as appropriate Submit final plan to CDC by March 15

    17. Discussion Questions? Feedback?

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