1. “Getting to Zero” in San Francisco Consortium
Zero new HIV infections
Zero HIV deaths
Zero stigma and discrimination
Photo by Jim Herd

2. Agenda Welcome & Overview Update on Funding SF HIV Epidemiology Data
Committee updates
PrEP
RAPID
Ending Stigma
Retention & Re-engagement
Panel Discussion: HIV Navigation
Thank you Will Hagerty

3. Getting to Zero SF: What are we?
Multi-sector independent consortium– operates under principles of collective impact:
“Commitment of groups from different sectors to a common agenda to solve a specific problem.”
Vision
Become the first municipal jurisdiction in the United States to achieve the UNAIDS vision of “Getting to Zero”

4. GTZ reach since last meeting
Government
SF part of FTCI launch and website
Updates with DPH Director Barbara Garcia and Senator Feinstein
Health Commission presentation 9/22
Update to National Institutes of Health and DC City efforts
Conferences- Community and Scientific
Adherence 2016, May 9-11
AIDS 2016, July 18-22
USCA, Sept 15-18
Media
PBS NewsHour
HIV plus
Takepart
Bay Area Reporter
Star Observer (AU)
San Francisco Chronicle
KGO-TV San Francisco/abc7news
Collaborations
Meeting with representatives from South African representative, England
Modeling
Paris/London/Amsterdam Collaboration

5. Getting to Zero SF: Global Movement: Fast Track Cities Initiative

6. Update on Funding

7. Increasing PrEP uptake among MSM of color, young MSM, and Trans women
Community-based
Increase PrEP services for African American MSM, Latino MSM, young MSM, and Transwomen.
Emergency Truvada for youth unable to use patient assistance programs.
Pharmacy Demo Project.
SFDPH
PrEP Coordinator and PrEP Navigator to support a Tele-PrEP program in SFDPH Primary Care.
>300 PrEP starts among these priority populations
**Award GTZ PrEP RFPs in 2017**

8. Project Pride (funded by CDC)
Increase user knowledge and interest in PrEP
Social marketing campaign, Popular Opinion Leader
Increase linkage of focus populations to PrEP
City-wide PrEP coordinator and navigator using innovative social media strategies
“Data-to-PrEP”– use of STI surveillance to link patients diagnosed with rectal STIs and syphilis to PrEP
PrEP navigators Group: share best practices
Increase primary care provider engagement in PrEP
Public Health Detailing

9. Expand City-wide RAPID Program
Focus on providers serving MSM of color and youth.
Evaluation of process and outcome measures, stratified by age, race/ethnicity, and gender.
Academic Detailing
Provider training and technical assistance for RAPID hubs across SF.
LINCS RAPID Specialist
Support RAPID implementation for all newly diagnosed patients in SF.
Decrease time from diagnosis to viral suppression.

10. Increasing Retention and Re-engagement in Care
Increasing support services for Persons living with HIV
Community-based Intensive Case Management (via RFP)
Addressing Food Insecurity (via RFP)
Increasing Employment Training (via RFP)
In-home Support for those over 50 (via RFP)
ZSFGH PHAST Team at Ward 86
Expanded Navigation services
LINCS Team (MAC AIDS Yr. 2)
Data to Care
Increase viral suppression among those most likely to be out of care.

11. Increase capacity to address HIV-related stigma in SF.
Addressing Stigma
Develop an anti-stigma initiative (via RFP)
Stigma is an important barrier for HIV prevention, care, and treatment.
Create an initiative with sustainable impact on the community and providers.
Representation from disproportionally impacted communities: young MSM and MSM >50; MSM of color; and women at risk.
Increase capacity to address HIV-related stigma in SF.

12. Requests for Proposals (RFPs)
: Support Services and Program Coordination for HIV-positive Adults Age 50 and Older (here)
: Communications Support and Capacity‐Building for HIV Frontline Workers Group (here)

13. Requests for Proposals (RFPs)
: Getting to Zero: Community‐Based Intensive Case Management Services for HIV‐positive Clients with Complex Needs (here)
: G2Z: Community‐Based Intensive Pre‐Exposure Prophylaxis (PrEP) Services (here)

14. HIV Epidemiology Annual Report 2015

15. HIV Epidemiology Section
Annual Report
2015
Susan Scheer, PhD, MPH
Director
HIV Epidemiology Section

16. Outline
Key highlights from the recently released HIV Epidemiology Section 2015 Annual Report including trends in key indicators
Encouraging trends on the population level
Overall declines in new HIV diagnoses
Declines in deaths and late diagnoses
Care and treatment items along the HIV care continuum
Not all San Franciscans have experienced the same improvements; significant health disparities identified
By race/ethnicity, particularly African-Americans, in treatment and care outcomes, survival and new diagnoses
Gender disparities in survival and viral suppression
People experiencing homelessness have very low engagement care and viral suppression

17. New HIV diagnoses, deaths, and prevalence, 2006-2015, San Francisco
Last year saw a 19% decrease in new diagnoses from 382 to 309
This year new diagnoses decreased 17% from 309 to 255
Number of deaths is becoming leveling or stable
Now nearly 16,000 people living with HIV

18. Among women, # stable, %↑
In all races, # ↓ except AA, # stable, %↑
Most new dx in
ages 30-39
60% PLWH
>50; ⅟₄ >60
years
MSM dis-proportionately affected

19. Number of persons newly diagnosed with HIV infection by race/ethnicity
, San Francisco

20. Annual Rates of men newly diagnosed with HIV Infection
per 100,000 population by Race/ethnicity, , SF
Rates 2015
140 AA
83 Latino
52 White
24 Other

21. Annual Rates of women newly diagnosed with HIV Infection per 100,000 population by Race/ethnicity, , SF
Rates 2015
31 AA
8 Latina
5 White
2 Other

22. Disparities and Health Inequities: Late HIV Diagnosis by Race/Ethnicity

23. Number and percent of homeless persons newly diagnosed with HIV infection by year of diagnosis , San Francisco

25. Continuum of HIV care among persons newly diagnosed with HIV infection
, San Francisco

26. Continuum of HIV Care among persons living with HIV San Francisco, 2014

27. Time Between the Steps in the HIV Care Continuum Improving
, San Francisco

28. Estimate of ART use among living HIV cases with chart review by nadir CD4 level December 2015, San Francisco

29. Disparities and Health Inequities: Viral Suppression

30. Disparities and Health Inequities: Survival after AIDS

31. Number of STD diagnoses among persons living with HIV by year of STD diagnosis , San Francisco

32. Summary
Positive trends: new diagnoses, late diagnoses and care & treatment outcomes
Significant health disparities. Not all San Franciscans experiencing the same improvements
African-Americans, in particular, experiencing health inequities:
disproportionately diagnosed; poorer treatment and care outcomes,
poorer survival
Other population groups also experiencing disparities:
Latinos most likely to uninsured at diagnosis and less likely to be engaged in care and virally suppressed
Women and transwomen are less likely to achieve viral suppression
Persons experiencing homelessness are less engaged in care and virally suppressed
Asians are most likely to be diagnosed late
Women and PWID have poorer survival
Younger people less engaged in care and virally suppressed
Disparities in our most vulnerable populations will need to be addressed to achieve the goal of Zero New Infections for all San Franciscans

33. Questions

34. GTZ Committee Updates

35. GTZ PrEP Committee Co-Chairs: Al Liu & Robert Grant
PrEP User Subcommittee Co-chairs: Pierre Crouch & Stephanie Goss
PrEP Provider Subcommittee Co-chairs: Tracey Packer & Stephanie Cohen
PrEP Metrics Subcommittee Chair: Susan Scheer
Members: Oliver Bacon, Halvard Bagoien, Jackson Bowman, Susan Buchbinder, Jim Dilley, Edvard Engesaeth, Jonathan Fuchs, Jesus Gaeta, Jayne Gagliano, Ruben Gamundi, Hans Gangeskar, Ron Goldschmidt, Robert Grant, Brad Hare, Geoff Hart-Cooper, Jen Hecht, Mike Hickey, Anne Hirozawa, Alison Hughes, Cait Koss, Skot Land, Montica Levy, Paul Marcelin, Julia Marcus, Erick Martinez, John Melichar, Gavin Morrow-Hall, Austin Nation, Trang Nguyen, Miranda Nordell, Sergio Paz, Susan Philip, Greg Rebchook, Michael Reyes, Hyman Scott, Matt Sharp, Miriam Sheinbein, Lisa Stern, Eric Tang, Adam Taylor, EB Troast, Paul Urban, Dana van Gorder, Jonathan Volk, Shannon Weber, Sophy Wong

36. Updates & Recent Activities (since March 2016)
2 transgender PrEP demonstration projects funded by CHRP [UCSF, SFDPH] (April)
Presented on GTZ PrEP activities at Adherence 2016 meeting (May)
Updated SFHN PrEP guidelines published (May)
Hired PrEP navigators through Campos RFP
Scale up of PrEP services at Mission Neighborhood Health Center and CHPY (Cole/Larkin)
Coordinated monthly city-wide PrEP navigator meetings (ongoing)
Provided PrEP trainings to >50 clinical providers and >150 front-line staff since March 2016
Launch of E-referral system for PrEP consultation (Sept)
Awarded 2 NIH supplements to evaluate PrEP cascade and PrEP retention in SF (Sept)

37. Our new citywide PrEP team
Montica Levy
Citywide PrEP Coordinator
Miranda Nordell
SFHN Lead PrEP Navigator
Michael Barajas
Citywide PrEP Navigator
Alyson Decker, NP
PrEP Academic Detailing

38. PrEP social marketing and digital stories launched in June 2016

39. PrEP Committee Plans – next 6 months
User
Expand PrEP ambassador program, specific outreach to African-American MSM, youth
Looking for volunteers for Folsom/Castro Fairs
Investigate strategies to increase PrEP access for homeless
Launch PrEP Demo project in transgender women and men
Provider
Launch academic detailing program, with focus on clinics serving prioritized populations
Work to establish Truvada medication access program for youth and pharmacy delivered PrEP program in Mission
Establish quarterly mtgs of community of practice of PrEP providers: Next mtg November 9
Measurement
Update metrics, from community-based surveys and medical providers, every 3 months (posted to GTZ website)
Establish PrEP cascade measures and begin measurement in transgender cohort in SF
Launch study to evaluate reasons for poor retention in PrEP programs
GTZ PrEP RFP for

40. G2Z RAPID Committee

41. Progress since Last Meeting
New RAPID protocol with updated linkage algorithm
Additional RAPID clinics enrolled
Larkin
Private Offices
FHC
2 Detailing/outreach specialists hired
$$ for RAPID navigation specialist
Inclusion of RAPID indicators in Surveillance Data

42. Lesson Learned: 2016 Provider acceptance high
Greatest challenge: linkage/insurance navigation
Uninsured but non-MediCal/HSF eligible are most challenging
Disparities a challenge
Race/ethnicity
Homelessness

43. RAPID Goals for
Systematic RAPID detailing of all HIV providers
G2Z funding for 1 year of detailing assistance
RAPID linkage
Navigation “bootcamp” for navigators/test sites
Bridging RAPID ART site to care for difficult-to-link patients ??using Ryan White (A) funds while they are being navigated??
G2Z funding a RAPID navigator to work with LINCS
Shorten time from diagnosis to care, care to ART, diagnosis to viral suppression: goal is 56 days +5 from diagnosis to suppression
A plan to address disparities in ART

44. Austin Padilla, Wayne Steward
Co-Chairs
Austin Padilla, Wayne Steward
Members
Tez Anderson, Samuel Berston, Jonathan Gomez, Stephanie Goss, Robert Grant, Alison Hughes, Brandon Ivory, Shaddai Martinez-Cuestas, Mark Molnar, Thomas Muyunga, Jenna Rapues, Armando Rodriguez, Ashley Rojas, Will Vincent, Lance Toma

45. Upcoming Committee Meeting
Tuesday, October 4, 6p
San Francisco City Hall, Room 270
*Security requires people with backpacks to enter through the loading dock entrance on Grove Street

46. Retention & Re-engagement
Amanda Newstetter/bay area aetc
Andy Scheer/sfdph sf city clinic (co-chair)
Austin Padilla (Stigma Committee rep.)
Beth Mazie/prc
Bill Hirsh/alrp + hapn
Chip Supanich/hiv planning council
Chuan Teng/prc
Dana Van Gorder/project inform
Darpun Sachdev/sfdph lincs navigation
Dave Jordan/shanti + hhspn
Dean Goodwin/sfdph hhs
Edwin Charlebois/ucsf caps (co-chair)
Erin Antunez/sfdph lincs navigation
Eva Mureithi/ucsf w86
Gale Sandoval/ifr
Hyman Scott/dph
Joanna Eveland/tom waddell
Joe Ramirez-Forcier/prc
Julie Lifshay/sfaf
Kat Christopoulos/ucsf w86
Kate Darling/ucsf
Kate Franza/api wellness
Kristi Dizon/ahf
Linda Walubengo/catholic charities
Lori Thoemmes/ucsf ahp
Marc Vincent/ucsf
Monica Gandhi/ucsf w86
Susan Scheer/sfdph
Tracey Packer/sdfph

47. Updates & Recent Activities
MAC AIDS Fund, LINCS Lessons Learned
Clinic-based and Surveillance-derived data effective in locating and re-engaging Pts in care; in 9-month period, 120 clinic-based referrals enrolled in LINCS
Navigation increases viral suppression, supporting TasP biomedical intervention
Approx 1/3 of Pts are homeless and 1/2 substance-using; more support needed to address these issues
MAC AIDS Fund, Current Practices Survey
DPH/Public/Private providers surveyed: majority use pre-appointment reminders (phone/voic /SMS) & do missed visit follow-up
Few clinics pass on out-of-care patient info to the DPH for re-engagement in care
Clinics willing to develop links to programs for PrEP and RAPID ART start
Clinics interested in support with linkage to MH & SU tx resources
Metrics Development: Work group formed, met, goal-setting commenced
Retention & Re-Engagement Toolkit: Content developed; funding secured; moving on to design & distribution phase
RFP Development: Intensive Case Mgmt, Communications, Frontline Workers, Aging Services RFP’s released

48. Committee Plans – next 6 months
MAC AIDS Fund Renewal, LINCS Y2:
Develop novel approaches for clients who use substances
Continue data-to-care efforts in collaboration w/ DPH Surveillance & clinics
MAC AIDS Fund Renewal, Best Practices Y2:
Optimize and evaluate R&R package
Finalize & disseminate findings
Metrics:
Establish and obtain preliminary measures, review
ID measures currently not being evaluated
R&R Toolkit: Finalize design; academic detailing to practices; group trainings
RFP Initiatives: Support implementation
Pharmacy Workgroup: Convene workgroup for leveraging pharmacies for retention & re-engagement collaboration
GTZ Cross-Committee Collaboration: on MH, SU, housing, benefits navigation, and other issues that impact retention in treatment and prevention interventions

49. HIV Navigation Panel

50. GTZ Navigation Panel LINCS Navigator, Nora Anderson
LINCS Navigation patient, Robert
SF AIDS Foundation Navigator, Naomi Prochovnick
LINCS Program Coordinator, Erin Antunez

51. HIV Navigation Community Discussion