HIV: NEW PUBLIC HEALTH INTERVENTIONS Patrick Loose & Heidi Aiem April 15, 2016 UCSD HIV & Global Health Rounds

2. HIV: NEW PUBLIC HEALTH
INTERVENTIONS
Patrick Loose & Heidi Aiem
HIV, STD & Hepatitis Branch
Public Health Services
County of San Diego Health & Human Services Agency

3. GETTING TO ZERO

4. NATIONAL HIV/AIDS STRATEGY
The United States will become a
place where new HIV infections are
rare and when they do occur, every
person regardless of age, gender,
race/ethnicity, sexual orientation,
gender identity or socio-economic
circumstance, will have unfettered
access to high quality, life-
extending care, free from stigma
and discrimination.

5. HIV IN SAN DIEGO COUNTY
Demographic Group
2014- PREVALENCE
AS OF 12/31/14
Race/Ethnicity HIV AIDS
# % # %
White, not Hispanic 6,623 52.1 3,727 49.6
Black, not Hispanic 1,793 14.1 1,142 15.2
Hispanic 3,674 28.9 2,330 31.0
Asian/Pacific Islander 420 3.3 218 2.9
American Indian/Alaska Native 89 0.7 38 0.5
Multi-Race 114 0.9 60 0.8
Total 12,713 100 7,515 100

6. CASCADE COMPARISON

7. CASCADE COMPARISON

8. CASCADE OF CARE
100%
43%
51%
100%
57%
67%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Total living with HIVa Retention in careb Viral suppressionc
Percent
Persons living with HIV, diagnosed as a resident or known to have
moved to San Diego (N=16,898)
Persons living with HIV, recently diagnosed or recently in care in San
Diego (N=12,863)
Total living with HIVa Virally suppressedcHad > 2 lab testsb
aPersons living with HIV, diagnosed as a resident of San Diego or known to have moved to San Diego defined as persons diagnosed with HIV through
12/31/2013 and living through 12/31/2014, regardless of stage of disease. Recently diagnosed or recently in care in San Diego defined as persons
diagnosed with HIV 2009-2013 or diagnosed prior to 2009 and having at least one CD4 or viral load between 2010 and 2014, living through 12/31/2014,
regardless of stage of disease.
bOf the total, persons who had >2 CD4 or viral load tests at least 3 months apart during 2014.
cOf the total, persons wih virologic supression (<200 copies/mL) at most recent test during 2014.
HIV Care Continuum, San Diego County, 2014

9. 36%
43%43%
49%
45% 46%
38%
44%
34%
28%27%* 28%*
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 2
Percent
MSM Continuum of HIV Care by Race/ethnicity
San Diego County, FY 2012/2013
Overall Asian/PI Hispanic White American Indian Black
*Statistically lower than the overall percent; p<.05.
aSan Diego data source: FY 12/13 unmet need file. Of those diagnosed with HIV disease, persons who had >=2 CD4 or viral load tests at least 3 months apart during FY
12/13.
bSan Diego data source: Of those diagnosed with HIV disease, persons with virologic suppression (<=200 copies/mL) at most recent test during FY 12/13.
Viral suppressionbRetention in carea
CONTINUUM OF CARE BY
RACE/ETHNICITY

10. WHY THE OPTIMISM?

12. LOCAL LIMITATIONS
Program
Focus
Partner
Services
Scope
Surveillance
Data
Restrictions
Staff
Capacity

13. THREE FUNDAMENTAL
STRATEGIES
Prevent new
infections
Identify & link
everyone with
HIV to
Treatment
Retain
everyone living
with HIV in care

14. LEG AUTHORITY
LHO AUTHORITY TO USE HIV SURVEILLANCE DATA
FOR PARTNER SERVICES
 California Health and Safety Code (HSC) Section 120175 provides LHOs with broad
authority to proactively investigate cases of disease, to ascertain the infection source, and
take measures as may be necessary to prevent the spread of the disease or occurrence of
additional cases. Thus, LHOs or their designees, who may be STD Control Branch staff or
DIS/partner services staff working on the LHO’s behalf, may use HIV surveillance data to
identify HIV-infected individuals and initiate partner services with them. HIV surveillance
data consists of LHD-acquired/developed data or data shared with the LHO by the state or
another jurisdictional LHO. LHOs and their DIS/partner services staff should ensure that
their activities adhere to CDC security and confidentiality requirements and California HSC
confidentiality protections within both the surveillance and partner services areas before
proceeding with utilizing HIV surveillance data to identify potential clients for partner
services.

15. LOCAL HEALTH OFFICERS OR THEIR DESIGNEES,
INCLUDING PARTNER SERVICES STAFF, MAY:
 Tell anyone reasonably believed to be a spouse, or sex, or needle-sharing partner of
a person who has tested positive for HIV about their exposure to HIV. The LHO or
their designees may not disclose any identifying information about the person with
HIV or the physician making the report to the LHD. Any person to whom the
disclosure is made must be referred for appropriate care and follow-up. Health and
Safety Code (HSC) Section 121015[d)])

16. STATE/LOCAL HEALTH DEPARTMENT HIV
SURVEILLANCE STAFF MAY:
 Disclose personally identifying information about HIV-positive reported individuals to
other local and state health department staff without written authorization. HSC
Section 121025(b) specifically authorizes state and local public health agencies to
disclose personally identifying information to CDPH and to other local public health
agencies when the information is necessary for the investigation, control, or
surveillance of disease. This includes partner services. (HSC Section 121015[d)])

17. PHYSICIANS OR SURGEONS MAY:
 With the written consent of the patient with HIV, provide LHO or the LHD partner
services staff the patient’s contact information for partner services. (HSC Section
121015[a)])
 Without the written consent of the patient with HIV, notify the spouse, or sex, or
needle-sharing partners of the patient if the physician or surgeon: 1) discusses the
test results with the patient; 2) offers the patient appropriate educational and
psychological counseling, including information on the risks of transmitting HIV to
other people and methods of avoiding those risks; 3) attempts to obtain the patient’s
voluntary consent for notification of their contacts; and 4) notifies the patient of their
intent to notify the patient’s contacts prior to any notification. (HSC Section
121015[b)])

18. HIV & STD REPORTING
STD REPORTING
 STD Surveillance Unit
 619-692-8501
HIV REPORTING
 HIV/AIDS Epidemiology Unit
 619-692-8545

19. LINKAGE TO PrEP

20. GC/HIV PARTNER SERVICES

21. SURVEILLANCE-BASED HIV
PARTNER SERVICES

22. DATA 2 CARE

24.  Patrick Loose, Chief, Patrick.Loose@sdcounty.ca.gov
 Heidi Aiem, Clinic Services Coordination, Heidi.Aiem@sdcounty.ca.gov
 www.stdsandiego.org
 HIV, STD & Hepatitis Branch:
http://www.sandiegocounty.gov/hhsa/programs/phs/hiv_std_hepatitis_branch/inde
x.html
 HIV/AIDS Epidemiology Unit:
http://www.sandiegocounty.gov/hhsa/programs/phs/hiv_aids_epidemiology_unit/re
ports_and_statistics.html