1. Beachin’: High Impact Prevention and Scalability in Broward County, Florida Alyssa Bosold Ashley Hill Public Health Associates, Class of 2014 Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention Summer Meeting June 1, 2015 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. SIGNIFICANCE AND BACKGROUND

3. Why High Impact Prevention & Scalability?  High Impacted Prevention  Recommended by CDC to reduce new HIV cases  Scalability  Monitoring and evaluation should focus on encouraging scalable interventions  Few examples of scalability in literature Even fewer examples at local health department level *http://www.cdc.gov/hiv/policies/hip.html

4. HIV/STIs in Broward County, Florida  Florida  Highest rate of new HIV cases in the nation in 2013 (N= 5,377) N=6, 132 newly reported infections in 2014 MSA (2014) Miami, Fort Lauderdale, West Palm Beach (N=2,582)  Broward  N=993 new HIV cases in 2014 – second highest in the state  N=660 Gonorrhea cases in 2015 (1)  N=2,342 Chlamydia cases in 2015 (2)  N=75 Syphilis cases in 2015 (2) http://broward.floridahealth.gov/programs-and-services/infectious-disease-services/hiv-aids/hiv-aids-surveillance/index.html http://floridahealth.gov/diseases-and-conditions/aids/surveillance/fact-sheet1.html http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/_documents/msr/2015-msr/index.html

5. Palm Beach Broward Miami-Dade Diagnosed AIDS Cases Florida, through 2013 Each dot = 3 cases Map excludes Department of Corrections (N=4,619) Note: 72,849 (56%) are known dead Data as of 6/30/2014 N= 130,038 http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/epi-slide-sets.html

6. Fort Lauderdale Beach Photo by Florida Department of Health in Broward County Broward County in March  Influx of Tourists  “Spring Break”  Winter Party  Increased social activity can lead to increased transmission of HIV/STDs

7. Response: The Broward Beach Blitz (February 14,2015- March 6, 2015) Photo by Florida Department of Health in Broward County

8. METHODS

9. Methods  The Broward Beach Blitz goals:  Distribute condoms  Engage businesses through the Business Response to AIDS (BRTA) initiative  Conduct HIV/STI screenings  Promote interagency collaboration  Administer condom knowledge surveys (condom polls)  Engage stakeholders (i.e. community partners, populations at risk) Interagency Collaboration

11. Distribution of Beaches

12. Google.com/maps Beach Assignments

13. High Impact Prevention  Advances the prevention goals of the National HIV/AIDS Strategy  Uses combinations of scientifically proven, cost-effective, and scalable interventions  Targets populations in geographic areas with the most need  Promises great impact to HIV prevention efforts http://www.cdc.gov/hiv/policies/hip.html

14. High Impact Prevention Components Descriptions adapted from http://www.cdc.gov/hiv/policies/hip.html ComponentDescription Effectiveness and Cost Utilizes funds to most efficiently reduce overall rates of HIV Infection Feasibility of full-scale implementation Interventions are practical to implement on a large scale, at reasonable cost Coverage in the target populations Select interventions based on number of individuals potentially reached Interaction and targeting Considers how interventions interact, and how they can most effectively be combined to reach the most affected populations in a given area. PrioritizationAssesses impact of activities on HIV infection rates. Uses interventions with the greatest potential to reduce infections.

15. Analysis For Evaluation  Qualitative Data  Calendars, outreach activity report, evaluation forms, debriefing  Coded based on categories Location, Time, Attitudes, and Community Engagement  Quantitative Data  Condom polls (knowledge surveys)  Number of condoms distributed, businesses engaged, tests conducted, etc. http://www.cdc.gov/hiv/policies/hip.html

16. RESULTS: QUALITATIVE

17. Analysis of Staff Notes: Location & Target Population Description of Broward Beach Blitz Sites; google.com/maps Las Olas Blvd: “Spring Breakers” Sebastian Street: MSM, young adults Hollywood Beach: elderly, white, “family oriented”, “snowbirds” (tourists from Canada and Northern areas)

18. Analysis of Staff Notes: Timing

19. RESULTS: QUANTITATIVE

20. Results  Data collected during outreach activities conducted March 2- 6, 2015  20 BRTA partners recruited as condom distribution sites  8 agency collaborations (community organizations/advocacy groups)  36 staff volunteers, 119 total volunteer hours  50 combined HIV/STI screenings  607 risk reduction session were conducted  307 condom polls completed *Responses were excluded if person was < 18 years

21. Results: Condom Polls Question: Resident or Visitor Question: Condom use

22. Results: Condom Polls Question: Condoms are effective against transmission of HIV/STIs Question: Best type of condom for protection against HIV/STIs

23. Results: Condom Polls Question: Condoms are enjoyable

24. DISCUSSION AND SUGGESTIONS

25. Evaluation: High Impact Prevention ComponentProgressSuggestions Effectiveness and Cost Success with volunteer recruitment, BRTA Designing cost effectiveness algorithm for comparison Compare cost effectiveness after each event to assess progress Determine potentially averted cases and cost of treatment vs. prevention Coverage in the target populations Qualitative analysis suggests that Fort Lauderdale Beach during the afternoon reaches “Spring Breakers” Other locations target different demographics Collect uniform quantitative data on demographics reached at specific hour intervals, by location

26. Evaluation: High Impact Prevention Cont. ComponentProgressSuggestions Interaction and targeting 50 Combined HIV/STI Screenings Use location/time/demographic data to determine target populations for testing PrioritizationPrioritization based on high numbers of PLWA and lack of business partners Condom polls suggest we reached a group in need of education Chart new infection rates, especially by zip code

27. Scalability Planning: Suggestions  Increase Cost-Effectiveness  With tool for comparison, can test strategies for maximizing resources and reaching large groups  Potential Strategies from qualitative data: recruiting more partners, utilizing police and city resources, increase staff at target hours  Expanded Data Collection  Collect quantitative data to confirm ideal locations for interaction/targeting and reaching large numbers of high-risk demographics  Quality assurance measures

28. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thank you Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support