1. State Office of AIDS Update
May 3, 2017
Juliana Grant, MD MPH
Chief, Surveillance, Research, and Evaluation Branch
Office of AIDS
California Department of Public Health 1

2. Office of AIDS (OA) California Dept of Public Health (CDPH)
Lead responsibility for coordinating state programs, services, and activities relating to HIV/AIDS
HIV prevention
HIV care
HIV treatment: ADAP and OA-HIPP
HIV/AIDS surveillance, research, and program evaluation 2

3. Source: HIV/AIDS Surveillance, eHARS data as of Mar 16, 2017
The Big Picture
Source: HIV/AIDS Surveillance, eHARS data as of Mar 16, 2017

4. Source: HIV/AIDS Surveillance, eHARS data as of Mar 16, 2017
Demographic Characteristics of Persons Living with HIV/AIDS: California, 2015
Risk Category
Gender
Race/Ethnicity
Source: HIV/AIDS Surveillance, eHARS data as of Mar 16, 2017

5. Source: HIV/AIDS Surveillance, eHARS data as of Mar 16, 2017
Demographic Characteristics of Persons Newly Diagnosed with HIV/AIDS, California, 2015
Risk Category
Gender
Race/Ethnicity
Source: HIV/AIDS Surveillance, eHARS data as of Mar 16, 2017

6. Source: HIV/AIDS Surveillance, eHARS data as of Dec 31, 2015
Age Distribution of Newly Diagnosed HIV Infection and Living HIV/AIDS Cases: California, 2014
Source: HIV/AIDS Surveillance, eHARS data as of Dec 31, 2015

7. California’s Continuum of HIV Care – 2015
Unaware
Data were obtained from the HIV surveillance system, for persons diagnosed and meeting CDC case definition for HIV, and living in California as of 12/31/2015. In HIV care includes persons with at least one care visit during Retained in HIV care includes persons with at least 2 or more care visits 3 months apart during Achieved viral suppression includes persons with most recent viral load test results <=200 copies /mL during.
Source: HIV/AIDS Continuum, eHARS data as of Mar 16, 2017

8. Office of AIDS Guiding Documents
National HIV/AIDS Strategy (NHAS)
President’s HIV Care Continuum Initiative
Laying the Foundation for Getting to Zero: California’s Integrated HIV Surveillance, Prevention, and Care Plan

9. Getting to Zero June 2014: New York State’s Plan to End AIDS
December 2014: San Francisco’s “Getting to Zero” Initiative
July 2015: National HIV/AIDS Strategy updated
August 2015: California Assembly Select Subcommittee on Infectious Diseases in High Risk Disadvantaged Communities’ hearings on “A California Plan to End AIDS”
October 2016: Laying a Foundation for Getting to Zero: California’s Integrated HIV Surveillance, Prevention, and Care Plan

10. Getting to Zero: Why now?
Affordable Care Act
Availability of preventive services
Access to comprehensive health coverage for PLWH through Medi-Cal Expansion and Covered California
HPTN 052 and START trials
Early treatment reduces risk of transmission by 96%
New HIV test technologies can detect acute HIV infection
Broaden window for intervention during time when HIV most likely to be transmitted to others
FDA approval of HIV Pre-Exposure Prophylaxis (PrEP)
Reduce risk of HIV acquisition by over 90%

11. Getting to Zero: Why Now?
Scientific tools now exist
Modeling shows that can end transmission by rapid diagnosis, treatment, and viral suppression
Modeling shows that increasing the proportion of at-risk negative persons on PrEP further improves the rate of prevention of new infections
Actual data from California and elsewhere suggest that already seeing declines in new infections due to increased viral suppression

12. Getting to Zero in California
Zero new HIV infections
Zero AIDS-related deaths
Zero stigma and discrimination against people living with HIV (PLWH)

13. Laying a Foundation for Getting to Zero: Overall Approach
Vision and possibility
Challenging but potentially achievable objectives
Broad support throughout Governor Brown’s administration—all state partners, including Medi-Cal, Covered California, California Department of Corrections and Rehabilitation, California Department of Education
Broad support from local public health partners
Broad support from community
Add prior slide – What do we mean by “get to zero”?

14. Laying a Foundation for Getting to Zero: Goals
Goal 1: Prevent new HIV infections
Goal 2: Increase access to care and improve health outcomes for PLWHA
Goal 3: Reduce HIV/AIDS-related health disparities
Goal 4: Achieve a coordinated response to the HIV epidemic in California

15. Laying a Foundation for Getting to Zero: Objectives to be achieved by 2021

16. Laying a Foundation for Getting to Zero: Objectives to be achieved by 2021
Add slide after this of the objectives focused on health disparities.

17. Laying a Foundation for Getting to Zero: Fifteen Strategies
Improve PrEP Utilization
Increase and Improve HIV Testing
Expand Partner Services
Improve
Linkage to Care
Retention in Care
Overall Quality of HIV-Related Care
Availability of HIV Care
Integration of HIV Services with STD, TB, Dental, and Other Health Services
Case Management for PLWH with High Need

18. Laying a Foundation for Getting to Zero: Fifteen Strategies
Increase
Rates of Insurance/Benefits Coverage for PLWH or on PrEP
HIV Prevention and Support Services for People Who Use Drugs
General HIV Education & Awareness and Reduce Stigma around HIV, Sexual Orientation, and Gender Identity
Improve Usability of Collected Data
Enhance Collaborations and Community Involvement
Further Leverage Existing Resources to Better Meet the Needs of People at Risk for and Living with HIV in California

19. Laying a Foundation for Getting to Zero: Activities to date
Executive summary
Designated leads within Office of AIDS for each strategy
Monitoring plan
Set annual and local targets for each objective
Will publish statewide progress annually

20. Laying a Foundation for Getting to Zero: Highlights of activities to date
PrEP
PrEP assistance program - January 2018
Funding multiple PrEP-related projects
Linkage to care
Local jurisdictions receiving ‘out of care’ lists to identify newly diagnosed PLWH not in care
Acute HIV infection reportable to local health department within 1 business day

21. Laying a Foundation for Getting to Zero: Highlights of activities to date
Quality of HIV care
Collaborating with Medi-Cal to monitor viral suppression among Medi-Cal enrollees by plan
Integration of HIV services with STD, TB, dental, and other health services
Quality improvement project on extragenital STI screening among PLWH
Case management
ADAP case management program – under development

22. Laying a Foundation for Getting to Zero: Highlights of activities to date
Prevention and support for people who inject drugs
Naloxone distribution from CDPH OA to California syringe exchange programs
Approval to use federal funds for syringe exchange

23. Laying a Foundation for Getting to Zero: California’s Integrated Surveillance, Prevention, and Care Plan 23

24. Acknowledgments
Office of AIDS Surveillance, Prevention, Care, ADAP, and Support staff
Local AIDS Directors and local surveillance, prevention, care, and ADAP staff
HIV providers, advocates, and stakeholders
State and local HIV planning groups
Persons living with and at risk for HIV/AIDS 24

25. Juliana Grant
Thank you