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Outline of the Philadelphia Prevention Plan


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

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Outline of the Philadelphia Prevention Plan

  1. 1. June 2013 Outline of the Philadelphia Prevention Plan
  2. 2. Philadelphia HIV Prevention Plan
  3. 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. 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. 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. 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. 7. Scalability of HE/RR
  8. 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. 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. 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. 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. 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. 13. Philadelphia Engagement in Care by Mode of Transmission, 2009
  14. 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. 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. 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. 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. 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