Catalina Sol, MPH John Nelson, PhD, CPNP Tisha Wheeler, MSc DEFINING & WORKING WITH HARD-TO-REACH POPULATIONS: INNOVATION & GAME CHANGING IDEAS Facilitators: Catalina Sol, MPH John Nelson, PhD, CPNP Tisha Wheeler, MSc Required slide. Please complete

Identifying “Hard-to-Reach” Populations Who are the “key populations” or HIV most-at-risk populations? Who is not fully accessing HIV-related healthcare? What social determinants make accessing HIV-related healthcare easier or harder? What attributes make some within key populations harder-to- reach than others? What policies promote access to healthcare for hard-to-reach individuals/populations?

Evaluating “Reach”

U.S. NHAS 2020 Goals Increase the % of PLWH who KNOW their status to at least 90% Increase the % of newly diagnosed persons LINKED to HIV medical care within 1 month of diagnosis to at least 85% Increase the % of persons with diagnosed HIV infection who are RETAINED in HIV medical care to at least 90% Increase the % of persons with diagnosed HIV infection who are VIRALLY SUPPRESSED to at least 80%

UNAIDS Global Targets

Current Global Stats1 46% (treated) 38% (virally suppressed) 57% (diagnosed) 46% (treated) 38% (virally suppressed) Global Disparities: % in eastern Europe, central Asia and western and central Africa < all other regions 1UNAIDS. Progress Report. July 2016. http://www.aidsmap.com/Progress-towards-90-90-90- targets-is-promising-but-funding-is-the-critical-step-says-UNAIDS-leader/page/3071870/. Accessed July 20, 2016.

First Steps in Connecting to Care Services Identify Key Populations Reach Key Populations Test Key Populations Link to appropriate services based on test results * Based on recommendations by UNAID 2014 Report: http://www.fhi360.org/sites/default/files/media/documents/CascadeGuide-USAID-SMARTTA.pdf

Source: LINKAGES/USAID Global Project. https://www. fhi360

Social Determinants of Health

Social Determinates of Health Components World Health Organization (2016): The person’s social and economic environment (laws, policy, culture, social capital, education, social status, income) The person’s physical environment (water, sanitation, pollution, safety, health care service availability) The person’s individual characteristics and behaviors (age, race, gender, gender identity and expression, sexual orientation , genetics. . . )

Operational Definition of HIV-Infected Hard-to-Reach Populations

Operational Definition Why? To assist in making sure HIV services are inclusion of HIV at- risk and HIV-infected subpopulations whom traditionally have been marginalized to some degree in receiving services How will this help? Will allow for broader inclusion of those at greatest risk of being neglected at the front line of outreach, engagement, and direct services to the public health level of policy and legal rights Examples of subpopulations whom may fit this definition: MSM, sexual minority persons, gender minority persons, sex workers, substance users, domestically victimized persons, minor adolescents, immigrants, incarcerated persons , rural residents. . .

Next Steps What interventions work to increase testing and diagnosis in hard-to- reach subpopulations? Which hard-to-reach subpopulations are missed with these interventions? What interventions work to increase engagement of hard-to-reach HIV- infected populations in linkage, retention, and ongoing HIV care? What interventions work in increase the prescription of antiretroviral therapy (ART), accession of ART, and administration of ART to increase viral suppression?

BREAKOUT GROUPS Testing, Diagnosis, and Linkage Linkage, Engagement, Retention, and Treatment Viral Suppression attainment and maintenance

Group Considerations Based on “what works” for identified hard-to-reach key populations, what are recommendations for the following : LAW POLICY RESOURCES STIGMA REDUCTION PUBLIC HEALTH MESSAGING HEALTHCARE PROVIDER EDUCATION COMMUNITY-BASED INTERVENTIONS/SUPPORTS EFFECTIVE, INNOVATIVE INTERVENTION DISSEMINATION & UPTAKE Focus also on: Continuation, Sustainability, and Replicability

Recommendations for HRSA HAB