0. Public Health Models to Address HIV at the Local and National Levels Presentation to the African-American HIV University August 25, Mario J. Perez, Director Division of HIV and STD Programs Los Angeles County Department of Public Health

1. Quick Overview
Role of a Local Public Health Department
Los Angeles County Overview
Epidemiology Overview
Overview of Goals, Strategies, and Activities
A Few Take Home Messages
Overview of NHAS: Updated to 2020

2. The Role of a Public Health Department
Assurance, Assessment and Policy Development or
Map disease burden, assess capacity, target resources, monitor performance, evaluate use of funds, consider multiple funding streams, support local planning, use surveillance for improved service delivery, inform State and national priorities, support community planning, etc….

3. Los Angeles County Most populous county in U.S.
Greater population than 42 individual states
88 incorporated cities and many unincorporated areas
Among the most racially/ ethnically diverse jurisdictions in U.S.
Urban, suburban, and rural areas
Divided by the San Gabriel and Santa Monica mountain ranges

4. DHSP Program Revenue 2014-2015 CDC $23.5 million HRSA $40 million
CDPH/
State OA
$14.3 million
NCC
$25.8 million
Other
$2.1 million
STD AAPPS
Flagship Agreement/
A, B, C
HIV Case and Incidence Surveillance
Medical Monitoring Project (MMP)
National HIV Behavioral Surveillance (NHBS)
MyLife MyStyle
Ryan White
Part A
Part A Minority AIDS Initiative
HIV Surveillance
HIV Care Base Program
Ryan White
Part B
Minority AIDS Initiative
AIDS Drugs Assistance Program Enrollment
NCC STDP
NCC HIV
California HIV/AIDS Research Program (CHRP) Patient Centered Medical Homes
CHRP PATH
NIH Jails Initiatives
SAMHSA (IBHPC)
SAMHSA HIV Set-Aside
Grant amounts are based on FY funding

5. HIV+ Aware, But Not in Care
Los Angeles County Conceptual Model for the
Continuum of HIV Services
No HIV,
Low Risk
High Risk for HIV
HIV+,
Unaware
HIV+ Aware, But Not in Care
PLWHA Linked to Care
PLWHA Retained in Care
Social marketing
Capacity building
Routine HIV testing
Targeted & Routine HIV Testing
Risk Reduction Activities
Social Marketing
Syringe Exchange Programs
Biomedical Prevention (PEP/PrEP)
Partner Services
STI Screening and Treatment
Targeted & Routine HIV Testing
Social Marketing
Partner Services
Outreach
Linkage to Care Programs (Project Engage, Navigation Program)
Mental health and substance use programs
Ancillary support services
Social Marketing
Medical Care Coordination
STI screening and treatment
HIV medical care and ART
Treatment adherence
Ancillary services
Mental health and substance use programs
Partner Services
Risk Reduction Activities
Social marketing

6. DHSP Testing, Linkage, Care and Treatment Framework and Programs
HIV Testing
DHSP Programs:
Project Engage
Navigation Programs
LRP Program
CBO Programs
Linkage to Care Programs
Medical Care Coordination (MCC) Program
High Risk Persons
HIV Positive
Linked to Care
Re-Engaged Care
Retained in Care
Adherent to ART Medication
Suppressed VL and Reduced Transmission
Los Angeles County received funding from the California HIV/AIDS Research Program (CHRP) to fund several demonstration projects focused on TLC+ activities intended to work along the continuum of care. These two presentation will focus on two of these programs, the Navigation Program and Project Engage, which are focused on using different methods to re-engaging HIV infected persons who have fallen out of care.
This presentation involves one of these re-engagement efforts, The Navigation Program, which is focused on identifying HIV infected persons who have fallen out of care through investigation of clinic records and local HIV surveillance. This presentation will actually detail two separate projects, a pilot program done with one of our community partners APLA which was used to inform our current Navigation Project.
Customized Prevention Programs (PEP/PrEP)
HIV Negative

7. Reported STD and HIV/AIDS Cases Los Angeles County, 2013
A total of 66,290 STD and HIV/AIDS cases were reported in LAC in 2013:
72.6% Chlamydia
18.8% Gonorrhea
5.6% Syphilis
2.7% HIV/AIDS
This pie chart shows the breakdown of total STD and HIV/AIDS cases in Los Angeles County in Note: HIV/AIDS cases pertain to new diagnoses only. If all people living with HIV/AIDS were included, then HIV/AIDS would account for a much larger proportion of cases.
*Pelvic Inflammatory Disease. Includes Chlamydia, Non-Chlamydia, Gonococcal, and Non-Gonococcal.
Note: Data are reported as of September and exclude cases of Chlamydia, Gonorrhea, Syphilis, and PID in
Long Beach and Pasadena.
Source: Division of HIV and STD Programs

8. Chlamydia, Gonorrhea, P&S Syphilis and HIV Cases Diagnosed and Rates for Selected US Urban Areas, 2012
Geographic Area
Chlamydia
Rate (n)1
Gonorrhea Rate (n)1
P&S Syphilis Rate (n)1
HIV
Rate (n)1,2
Los Angeles County, CA3
521 (48,461)
123 (11,425)
9 (878)
19 (1,911)
Chicago, IL4
1,039 (28,006)
360 (9,715)
21 (577)
37 (1,008)
Houston, TX5
836 (17,561)
263 (5,519)
21 (442)
53 (1,114)
King County, WA5
357 ( 6,896)
81 (1,560)
12 (223)
15 (292)
Miami-Dade
County, FL
387 ( 9,650)
97 (2,412)
14 (348)
50 (1,262)
New York, NY
764 (62,460)
180 (14,747)
12 (996)
38 (3,141)
San Francisco, CA5
605 (4,871)
309 (2,486)
61 (489)
51 (413)
Washington, D.C.4,5
1,094 (6,584)
427 (2,572)
27 (165)
119 (718)
United States
457 (1,422,976)
108 (334,820)
5 (15,667)
*16 (42,181)
-This slide shows the numbers and rates (per 100,000) for CT, GC, P&S SY and HIV in 9 large urban cities or counties in the US in 2011, the latest year that data are available for many of these areas. Los Angeles County is shown at the top (in red) and the overall U.S. rates are shown at the bottom (in red).
- Of the areas shown, LAC and New York have the highest numbers of cases for all three STDs. The number of HIV cases are more evenly distributed with several cities reporting numbers similar to LAC, but well below New York.
- However, if we look at rates of disease, which take into account population size, then we see that LAC has lower rates of STDs and HIV than most other large urban areas.
-Overall, although LAC has a large HIV/STD epidemic, we seem to be faring better than other big cities/counties in the US.
Rate per 100,000 population.
New HIV diagnoses, regardless of stage of infection.
Excludes cases of Chlamydia, Gonorrhea and P&S Syphilis in Long Beach and Pasadena.
2012 data not available, rates are from Chicago data is from 2012 with the exception of the HIV rate which is from 2011.
Rates not provided in source document, estimated rates were calculated using the 2010 U.S. census population.
Source: LAC Division of HIV and STD Programs

9. Rates of Chlamydia, Gonorrhea, P&S Syphilis and HIV/AIDS by Race/Ethnicity and Gender, LAC 20131
Rate per 100,000 population
P&S Syphilis2
This slide shows the LAC HIV and STD rates by race/ethnicity and highlights the racial/ethnic disparities that we have in LAC, particularly for African Americans. In 2013, African American females had the highest rates of chlamydia, gonorrhea, P&S syphilis and HIV among females. In addition, among males, African Americans had the highest rates of chlamydia, gonorrhea and P & S syphilis. If we exclude unstable estimates, among males, African Americans also had the highest rate of HIV/AIDS.
1 Rates with a pattern fill are unstable due to small numbers (<12); rates for groups with fewer than 5 cases are not shown. Rates for APIs and NA may be unstable due to small numbers; 2013 data are provisional due to reporting delay
2 Data are from STD Casewatch system; excludes cases with unknown race/ethnicity and cases in Long Beach and Pasadena
3 Data are from I-HARS system; includes cases in Long Beach and Pasadena
Source: Division of HIV and STD Programs

10. Rates of Chlamydia, Gonorrhea, P&S Syphilis and HIV/AIDS by Age and Gender, LAC 20131
Rate per 100,000 population
P&S Syphilis2
-This slide shows the LAC HIV and STD rates by age group and highlights differences between females and males in terms of which ages are most impacted by the four diseases.
-Among females, the highest rates of Chlamydia and Gonorrhea occurred among those aged years. Females had very low rates for P&S SY and had the highest rates of HIV among those aged
-Among males, elevated HIV/STD rates occurred over a much wider age range than was observed for females. This is especially true for P&S Syphilis and HIV where the 20-24, 25-34, and age groups all had a much higher rate than the age group.
1 Rates with a pattern fill are unstable due to small numbers (<12); rates for groups with fewer than 5 cases are not shown. Rates for APIs and NA may be unstable due to small numbers; 2013 data are provisional due to reporting delay
2 Data are from STD Casewatch system; excludes cases with unknown race/ethnicity and cases in Long Beach and Pasadena
3 Data are from I-HARS system; includes cases in Long Beach and Pasadena
Source: Division of HIV and STD Programs

11. This slide shows the 2011-2013 HIV rates in LAC by census tract and service planning area (SPA).
In 2013, the highest HIV rate was in the Metro SPA followed by the South and South Bay SPAs. Although not shown here, in 2013, the largest number of HIV cases were diagnosed among residents of the Metro SPA with the next largest number of cases diagnosed among residents of the South Bay SPA followed by the San Fernando SPA and followed by the South SPA

12. This slide shows the 2013 Chlamydia rates by census tract and SPA
This slide shows the 2013 Chlamydia rates by census tract and SPA. Chlamydia is the most common STD as evidenced by geographic hot spots throughout the county.
In 2013, the South SPA (SPA 6) had the highest rate of Chlamydia followed by the Metro SPA (SPA 4) and the Antelope Valley SPA (SPA 1). Although not shown here, the number of Chlamydia cases was highest in the South SPA followed by the Metro and the San Fernando SPAs.

13. This slide shows the 2013 gonorrhea rates by census tract and SPA and the highest rates of gonorrhea are shown in the Metro(SPA 4) and South(SPA 6) SPAs.
Although not shown here, the highest numbers of gonorrhea cases in 2013 were also in the Metro SPA followed by the South SPA.

14. This slide shows the 2013 Syphilis rates and the highest rates of Syphilis are in the Metro SPA or SPA 4.
Although not shown here, the highest number of Syphilis cases were also in the Metro SPA.

15. Chlamydia, Gonorrhea, P&S Syphilis, and HIV Rates and Cases by Service Planning Area (SPA), LAC 20131
Service Planning Area (SPA)
Chlamydia
Rate2 (n)
Gonorrhea
P&S Syphilis
HIV
Antelope Valley (1)
533 (2,086)
100 (389)
5 (18)
8 (32)
San Fernando (2)
352 (7,653)
85 (1,851)
8 (168)
11 (241)
San Gabriel (3)
359 (5,872)
63 (1,029)
4 (71)
9 (152)
Metro (4)
677 (7,719)
301 (3,434)
34 (389)
53 (600)
West (5)
313 (2,024)
84 (545)
8 (49)
13 (81)
South (6)
955 (9,837)
246 (2,539)
11 (115)
23 (235)
East (7)
480 (6,288)
80 (1,050)
7 (98)
11 (143)
South Bay (8)
470 (5,061)
120 (1,288)
8 (86)
18 (272)
Unknown
---- (1,542)
---- (360)
---- (16)
---- (23)
LAC Total
511 (48,099)
133 (12,486)
11 (1,014)
18 (1,779)
-This slide shows the rates and case counts for CT, GC, P&S SY and HIV for LAC for 2013 by Service Planning Area (SPA).
The South SPA (SPA 6) had the highest rate of CT followed by the Metro SPA (SPA 4). The number of CT cases were also highest in the South SPA followed by the Metro SPA.
-The highest rate of GC was in the Metro SPA followed by the South SPA. The highest numbers of GC were also in the Metro SPA followed by South SPA.
-The highest rates and numbers for Primary and Secondary SY were in the Metro SPA.
-The highest HIV rate was in the Metro SPA followed by the South and South Bay SPAs. The highest number of HIV cases was also in the Metro SPA followed by the South Bay SPA.
1 STD data are from STD Casewatch and exclude cases in Long Beach and Pasadena; HIV data are from the I-HARS system and include cases in Long Beach and Pasadena; data are provisional due to reporting delay
2 Per 100,000 population
Source: Division of HIV and STD Programs

16. Proportion of MSM, MSW and Women Testing Positive for Chlamydia, Gonorrhea and P&S Syphilis, LAC STD Clinics 20131
Percent(%)
This slide shows the proportion of MSM, MSW and women from all LA County STD clinics who tested positive for chlamydia, gonorrhea and P&S syphilis in While the proportion of patients who tested positive for chlamydia is similar among these groups, a much higher proportion of MSM tested positive for gonorrhea and P&S Syphilis.
1 Includes 20,856 persons who were tested for CT; 20,911 for GC and 18,830 for P&S SY in 2013; Rates with a pattern fill are unstable due to small numbers (<12); rates for groups with fewer than 5 cases are not shown.
Source: Division of HIV and STD Programs

17. with HIV (including AIDS) in LAC
Estimated Number of Persons Living with HIV and AIDS in Los Angeles County at End of 2013
Estimate
~ 60,050 persons living
with HIV (including AIDS) in LAC
13,250
9,500
1,500
3,200
3,200
16,155
50,550
Estimate
~ 61,700 living
with HIV & AIDS in LAC
25,895
We estimate that over 60,000 persons were living with HIV in Los Angeles County at the end of 2013.
Nearly 10,000 of whom are unaware of their infection.
Footnotes:
1. The CDC estimates 15.8% of PLWH are unaware of their infection.
2. The number reported here includes (1) half of our pending lab notifications and (2) half of our coded cases, that we believe represent real cases of HIV, but have not yet reported as a case in our registry by name.
(1) CDC estimates 15.8% of persons with HIV are unaware of their infection.
(2) Reported cases includes half of 3,500 lab reports pending investigation and half of 3,300 cases reported to us only by code likely to result in unduplicated named cases.
Source: LAC Division of HIV and STD Programs, reported as of 12/31/13. 17

18. Rates of HIV Diagnoses Among Adult/Adolescent Men by Race/Ethnicity
Rates of HIV Diagnoses Among Adult/Adolescent Men by Race/Ethnicity*, Los Angeles County,
This slide shows the HIV rates for adult and adolescent males by race/ethnicity for LAC from 2006 to 2013 although the later years are provisional.
Although the HIV rates for African American men were as much as two times higher than for Latino and white men from , the HIV rate for African American men has steadily decreased since The disparity that we have observed for African American men for years in LAC appears to be improving, however a disparity still remains.
* American Indian and Alaskan Native are not presented due to small numbers that may cause unstable estimates.
** Data are provisional due to reporting delay.

19. Rates of HIV Diagnoses Among Adult/Adolescent Women
by Race/Ethnicity*, Los Angeles County,
This slide shows the HIV rates for adult and adolescent females by race/ethnicity for LAC from 2006 to Note that the HIV rates overall for females is much lower in LAC than that for males.
Although the HIV rates for African American females were more than three times higher than for Latina and white females in 2006 and 2007, the HIV rate for African American females has steadily decreased since The disparity that we have observed for African American females for years in LAC appears to be improving, however a disparity still remains.
* American Indian and Alaskan Native are not presented due to small numbers that may cause unstable estimates.
** Data are provisional due to reporting delay.

20. Estimated Rate of New HIV Infection in Young MSM by Race/Ethnicity and Age, , LAC HIV Incidence Surveillance
Rate per 1,000
These data are from our CDC-funded HIV Incidence Surveillance projects which uses data from detuned assay analysis of blood samples of new HIV cases to distinguish a new or long-standing HIV infection to calculate estimates of new HIV infections. In Los Angeles County, MSM, the group that comprises the majority of our new (incident) and existing (prevalent) HIV cases, young African American MSM ages had the highest estimated HIV incidence rate at 25 per 1000 in and also the highest HIV incidence rate among year olds at 23 per The rate of 25 per 1000 for African American year olds was significantly higher than the rate for year old Latino and white MSM.
As seen in other parts of the US and highlighted in HPTN 061, African American MSM continue to be disproportionately impacted by HIV. As highlighted in the Brothers Study, HPTN 061, black MSM with HIV are more likely to have a history of STDs, be non-adherent to HIV testing, have undiagnosed HIV infection, late HIV diagnosis, experience healthcare specific racial discrimination and a high prevalence of incarceration. In addition, the high HIV rates in black MSM in HTN 061were associated with stigma, discrimination, joblessness, and homelessness. These and other data provide support to continue our efforts to find scalable and effective prevention interventions along with treatment as prevention programs to reduce the disproportionately high rates of HIV in young African American MSM in LAC.
Age Group (years)
*Rate for black MSM significantly different from other MSM.
Source: LAC Division of HIV and STD Programs, reported as of 12/31/2012.

21. NHBS HIV Prevalence in MSM by Race/Ethnicity, Los Angeles County, 2004-14
This slide shows the HIV prevalence for men who have sex with men (MSM) who participated in the CDC-funded National HIV Behavioral Surveillance (NHBS) project in which MSM are sampled every three years.
The sample of MSM is selected using time-space sampling methods at various community, social and public venues throughout Los Angeles County.
African American MSM had the highest HIV prevalence which was 36% in 2004, 35% in 2008 and 27% in 2011, with an increase to 34% in 2014.
The HIV prevalence for white MSM was 24% in 2004, 16% in 2008 and 16% in 2011 and a decrease to 9% in The prevalence for Latino MSM was 16% in 2004, 19% in 2008 and 19% in 2011 and 15% in 2014.
In 2004, the HIV prevalence for black MSM was statistically higher than that for Latinos and Asian Pacific Islanders. In addition, the HIV prevalence for white MSM was statistically higher than that for Asian Pacific Islanders.
In 2008, the HIV prevalence for black MSM was statistically higher than that for white and API MSM.
In 2011, there were no statistical differences in HIV prevalence by race/ethnicity among MSM in NHBS.
In 2014, there were statistical differences in HIV prevalence between blacks and Latinos, blacks and whites and blacks and APIs.
All of these prevalence percentages are much higher than the general population which is generally estimated at less than 1%. MSM in LAC remain a sub-group disproportionately impacted by HIV.
1.Significant differences between blacks and Latinos, blacks and APIs, and whites and APIs
2.Significant differences between blacks and whites, and blacks and APIs
3.Significant differences between blacks and Latinos, blacks and whites, and blacks and APIs.

22. HIV Care Continuum: Los Angeles County using
HIV Surveillance and MMP Data – 2011
By the end of 2011, we estimate there were approximately 59,500 people living with HIV, including AIDS in LAC.
82% of the 59,500 were diagnosed with HIV, while 18% were unaware of their HIV infection (per CDC estimate).
Of those diagnosed or would have been diagnosed if they were aware of their infection in 2011 (n=2,263), 66% were linked into care within 3 months, 69% were linked by 6 months and 71% were linked within 12 months of diagnosis.
Among all estimated PLWH in LAC, 47% were retained in care, as defined by having had 2 or more VL at least 90 days apart during 2011; while 56% had at least 1 VL done in the last 12 months.
ART coverage was estimated at 41% using data from the Medical Monitoring Project.
Overall, 45% of the estimated 59,500 PLWH in LAC had an undetectable viral load 2011.
Among those who had 1 VL in 2011, indicating that they had seen a provider at least once in the last year, 81% were virally suppressed (data not shown).
Among only cases reported to DHSP as having been diagnosed in 2011, 80% had evidence of being linked to care within 3 months, 84% within 6 months and 86% within 12 months.
(1) Estimate of PLWH in LAC for 2011 includes 18.1% PLWH that CDC estimates are unaware of status.
(2) Linked to care within (a) 3 months, (b) 6 months and (c) 12 months of HIV diagnosis. Denominator is estimated number HIV diagnosed in 2011, plus 18.1% unaware (n=2,263).
(3) Retained in Care: (a) PLWH with ≥2 Viral Load reported at least 3 months
apart and (b) PLWH with at least one Viral Load reported in last 12 months.
(4) Information on ART from Medical Monitoring Project (MMP). (5) Viral suppression defined as VL <200.

23. Comparison of HIV Care Continuum using HIV Surveillance and MMP: US vs LAC, 2009/2010
Los Angeles County**
Comparison of spectrum of engagement in care between LAC and USA. (updated)
LAC spectrum is defined using the same criteria as the 2012 CDC Fact Sheet and the 2013 Irene Hall paper in JAMA.
* Hall et al JAMA 2013 and CDC Fact Sheet, July 2013.
** DHSP HIV Surveillance and Medical Monitoring Project (MMP).
*** Retained in Care based on MMP for U.S. and based on HIV Surveillance data for LAC.

24. HIV Care Continuum by Race/Ethnicity, LAC 20134
Data for 2013 are provisional. Denominators include 324 African Americans, 658 Latinos, 378 whites, 61 Asians/PIs, 7 American Indian/Alaskan Native, and 25 multi-racial persons who were reported with a new HIV diagnosis in 2013 and were living in LAC as of 12/31/2013
Includes persons diagnosed through 2012 and living in LAC as of 12/31/2013 based on most recent residence and an additional 14% that CDC estimates are unaware of HIV status; 4,511 persons who no longer live in LAC were not included and 5,667 persons who moved to LAC were included
Engaged in care: ≥ 1 CD4/VL/Geno test in 2013; Retained in Care: ≥2 CD4/VL/Geno tests at least 3 months apart
Viral suppression defined as VL ≤ 200 copies/ml

25. HIV Linkage, Retention & Viral Suppression in LAC 2009-2013
This slide shows the trend in HIV linkage, retention and viral suppression from 2009 to 2013 using LAC HIV surveillance data.
The percent of total persons 18 years of age and older living with HIV who were linked to care within three months of their HIV diagnosis has been hovering around 79% which is below the 85% National HIV AIDS Strategy (NHAS) target.
The percent retained in care has been slowly improving with almost 60% of persons 18 and older living with HIV with at least 2 care visits at least three months apart.
Finally, the percent virally suppressed (<=200 copies/ml) has steadily increased from 51% in 2009 to 56% in Clearly, there is still the need for improvement in all of the NHAS measures for LAC.
Linkage to Care: Percentage of persons 18+ linked to care within 3 months of their HIV diagnosis among persons 18+ diagnosed with HIV in each calendar year and residing in Los Angeles County.
2.Retained in Care: Percentage of persons 18+ with >=2 care visits at least 3 months apart among all 18+ persons living with HIV in each calendar year.
3. Viral Suppression: Percentage of persons with HIV viral suppression (most recent viral load <=200 copies/ml) in each calendar year.
Reported through 12/23/2013.
* 2013 Data are provisional due to reporting delay.

26. Although LAC had higher numbers of STDs compared to most other jurisdictions in 2013, LAC rates are generally lower than other US urban areas
There are large disparities for HIV/STDs including a disproportional impact on African Americans, MSM and youth

27. HIV and syphilis disproportionally impact MSM while gonorrhea and chlamydia impact a broader segment of LAC’s population
Geographic disparities include a high HIV, GC and CT burden in the Metro and South SPAs and a high SY burden in the Metro SPA

28. Approximately 1,850 new HIV infections annually and ~ 60,050 persons living with HIV in LAC
An estimated 9,500 persons in LAC were unaware of their HIV infection in 2013
It is estimated that 66% of newly-diagnosed HIV+ persons link to care in 3 months, 69% within 6 months and 71% within 12 months

29. 47% of HIV+ persons are retained in care with 2 VL at least 3 mos apart and 56% had at least 1 VL in the previous 12 months in 2011
It is estimated that only 45% of total PLWH, including those unaware of their HIV infection, had suppressed VL in 2011
Among patients in the Ryan White HIV care system in LAC, 87% were retained in care and 75% had suppressed viral loads in 2010

30. HIV surveillance data show increases in overall viral suppression in LAC, however improvements are still needed
Continuing high HIV prevalence among MSM and MSM of color
Decreasing HIV rates for African American men and women

31. NHAS: UPDATED TO 2020
Released July 2015
Anchored by goals tied to Incidence, Access to Care, and Disparities
Calls for continued Coordinated National Response
Includes 11 Steps and 37 Actions
Right People, Right Places, Right Practices
10 Outcomes by 2020

32. NHAS: UPDATED TO 2020
FIVE MAJOR CHANGES
Expanded Prevention Toolkit
PrEP and TasP
ACA Transforms Health Care Access
Affordable, quality health coverage
No denial of coverage for pre-existing conditions
Preventive services, covered w/o copays
Protections against discrimination

33. NHAS: UPDATED TO 2020
FIVE MAJOR CHANGES
Recommended HIV Testing and Treatment
Routine Screening for 15 to 65 year olds
Updated recs for labs to detect infections earlier
Recommended treatment for all PLWH
Improving HIV Care Continuun
Diagnosis, Linkage, Retention, Prescription, Viral Suppression

34. NHAS: UPDATED TO 2020
FIVE MAJOR CHANGES
Research unlocking new knowledge and tools
Starting HIV treatment earlier
New HIV testing technologies
New meds with fewer side effects, less frequent dosing, lower risk of drug resistance
Investigation of long-acting drugs for treatment and prevention, HIV vaccine, ultimately, a cure

35. Thank You
Gracias