Coleman Terrell (AACO)'s presentation on Philadelphia's HIV prevention plan, as presented to the HIV Prevention Planning Group (HPG) on July 24, 2013

1. June 2013
Outline of the Philadelphia
Prevention Plan

2. Philadelphia
HIV Prevention
Plan

3. Philadelphia’s prevention plan is
based on NHAS goals
Reduce the number of people who are infected with HIV in
Philadelphia
Increase the number of people who are infected with HIV
who have medical care so that they are in the best health
possible
Reduce HIV-related health disparities

4. High Impact HIV Prevention
“Using combinations of scientifically proven, cost-
effective, and scalable interventions targeted to
the right populations in the right geographic
areas”

5. CDC Resource Allocation Model
Intervention Cost Per New Infection Averted
Targeted Testing MSM $17,965
Testing in Healthcare Settings $51,293
Targeted Testing IDU $53,935
Prevention with Positives (PS, Linkage,
Retention, Adherence)
$55,524 - $114,644
Behavioral Interventions MSM+ $97,724
Behavioral Interventions All Other
Populations
$327,210 - $15,642,124
Targeted Testing HRH $866,272

6. Estimated Incidence Rates - 2010
Population Population in
2010 (13 +)
ESTIMATED
Incidence
Estimate,
2010
Estimated
Case Rate
per
100,000
95% CI
lower
bound
95% CI
upper
bound
MSM 29,737 306 1,029 578 1,483
IDU 37,378 44 118 0 254
HET 294,682* 226 77 36 118
*Includes persons >13 living in poverty
Data Source: PDPH/AACO HIV Incidence Surveillance Program
**Includes persons >13 living in poverty

7. Scalability of HE/RR

8. Geographic
analysis
Targeting sites to high
prevalence areas
Subpopulation analysis
Tracking distance to care
Identifying areas with
significant co-morbidities
Monitoring the epidemic at
the census tract level

9. Funding constraints
75% for testing, policy, condoms, and prevention with
positives, as well as planning, TA and M & E
25% for evidence-based intervention for HR; social
marketing, media, and mobilization, PrEP and nPEP
Only local funding for syringe exchange
No clinical labs or drugs for nPEP or PrEp
Emphasis on reimbursement for testing in healthcare settings
Overall decrease in both care and prevention resources

10. Prevention plan strategies to
decrease HIV transmission
Syringe Exchange
Condom distribution
Test and link to Care/Prevention with Positives
Reducing individual and community viral load
Preventing maternal to child transmission
Partner Services
Community mobilization; changing community norms
Highly focused behavioral interventions and/or low
threshold messaging

11. Syringe exchange
• 1993: 38% of AIDS
diagnoses were IDU
(N=655)
• 2012: 14% of AIDS
diagnoses were IDU
(N=88)
• Only 42 new HIV
diagnoses among IDU in
2012

12. Condom distribution
Youth, especially in high
schools – changing norms
about use
Prison: in-jail availability
and upon release
Widespread availability to
HIV+ populations through
care programs
Coordinated with STD
Control Program

13. Philadelphia Engagement in Care by
Mode of Transmission, 2009

14. HIV screening in healthcare
Implement CDC and USPTF guidelines for routine screening
in a variety of healthcare settings
City Jails
Emergency departments
Other outpatient settings
Community health care settings
Policy projects
Monitor and ensure linkage to HIV medical care

15. Targeted HIV testing
Hard to reach populations:
MSM and IDU
Mobile testing
Identification of venues for
testing
Neighborhood saturation
strategies – Do One Thing
Social network strategies

16. Test and Link to Care
Ensure HIV+ persons are linked to medical care
Support and retain HIV+ persons in medical care
Provide ART, support adherence, decrease viral load
Provide risk reduction support to HIV+ persons
Leverage the HIV medical care system to support HIV prevention
goals (e.g. Ryan White case management)
Improve voluntary partner services
Decrease over time the HE/RR targeting only HIV-negative
persons

17. Emerging initiatives
 Social Marketing, Media and Mobilization
PrEP and nPEP
Structural changes, policy initiatives
Using surveillance data for public health purposes
surveillance-assisted retention activities

18. Collaboration, coordination, and
integration
Other systems
Ryan White Program Continuum of Care
Prison Health
Behavioral health
Schools
Private partnerships
Do One Thing
Patient navigation
HPG and stakeholder engagement