This document summarizes Israel Nieves-Rivera's presentation on San Francisco's approach to HIV prevention and care. It discusses:
1) San Francisco's comprehensive continuum of HIV prevention, care, and treatment services.
2) Key data on the HIV epidemiology in San Francisco, including populations most at risk and underlying risk factors.
3) San Francisco's efforts to optimize various aspects of the HIV care continuum, including testing rates, linkage to care, viral suppression, and expanding access to antiretroviral treatment.
This document discusses the challenges of improving population health outcomes for children through children's healthcare services. It argues that the focus needs to shift from caring for individual children with health problems to implementing proactive strategies that improve outcomes across entire populations of children. Programs aimed at populations are more effective when they address key social determinants of health through high-coverage interventions early in life. The document examines differences between individual care and population care, and emphasizes the importance of understanding determinants like poverty, parenting programs, and early childhood development to achieve meaningful improvements in outcomes for all children.
A presentation given by Gabrielle Murphy at The Journey, CHA Conference 2012, in the 'Innovations in Mental Health Care for Children and Young People' stream.
The Intersection of Medical Research and Public Healthkmbrown08
The purpose of this project is to show the necessity of collaboration between medical research and public health to improve the outlook of our nation’s future. Case studies focusing on influenza, childhood obesity and HIV/AIDS show how the fields have intersected to address health problems in the past, and how they can continue to intersect in the present and the future. Finally, this study identifies key public health advocacy messages that need to be heard on a national level in order to bolster the intersection of medical research and public health.
Policy brief impact-of-covid-19-on-womenAparna K S
1) The COVID-19 pandemic is having disproportionate impacts on women and girls including increased risk of violence, greater mental health impacts due to increased caregiving responsibilities, and reduced access to sexual and reproductive health services.
2) Evidence from past epidemics and initial reports on COVID-19 suggest increases in domestic violence against women. Women also bear a greater burden of unpaid care work, negatively impacting their mental health.
3) During past outbreaks, resources were diverted from routine healthcare including services for women like maternal care and contraceptives. Projections estimate COVID-19 could lead to millions of unintended pregnancies and unsafe abortions due to reduced access to family planning services.
This document provides an overview of the rights of women during childbirth. It discusses key international treaties that protect human rights, such as the Universal Declaration of Human Rights. Several definitions are provided related to quality of care, experience of care, disrespect and abuse during childbirth. Epidemiological data shows mistreatment of women during childbirth is common in many settings worldwide. The document outlines potential contributors to and consequences of disrespect and abuse. It discusses the WHO standards for quality maternal and newborn care, which include promoting respectful care. The document emphasizes the importance of recognizing women's rights, understanding causes of mistreatment, and taking actions at multiple levels to prevent disrespect and abuse during childbirth.
The prayer requests guidance and help from Jesus for an upcoming examination. It asks Jesus to help the person feel at ease, think clearly without panicking or guessing, and give their best effort. It prays for enlightenment, divine assistance, and the best results from working to their full ability with Jesus' help.
Ebola primary health care system survey in focus countriesFolahan Johnson
The document reviews primary healthcare (PHC) systems in countries affected by Ebola in order to investigate the capacity of PHC to support disease control strategies. It discusses seven key principles that PHCs should uphold: serving as first contact, providing continuous care, coordinated care, comprehensive care, family-centered care, community-oriented care, and culturally competent care. Adhering to these principles can help PHCs strengthen disease prevention, detection, and response efforts in their communities.
The document provides guidance on patient education for those with HIV/AIDS. It outlines discussing transmission prevention, testing of partners and children, family planning, establishing medical care, symptom monitoring, modifying high risk behaviors, and referrals to additional resources. It also cautions on potential drug interactions between contraceptives and antiretrovirals, as well as between protease inhibitors and St. John's wort.
This document discusses the challenges of improving population health outcomes for children through children's healthcare services. It argues that the focus needs to shift from caring for individual children with health problems to implementing proactive strategies that improve outcomes across entire populations of children. Programs aimed at populations are more effective when they address key social determinants of health through high-coverage interventions early in life. The document examines differences between individual care and population care, and emphasizes the importance of understanding determinants like poverty, parenting programs, and early childhood development to achieve meaningful improvements in outcomes for all children.
A presentation given by Gabrielle Murphy at The Journey, CHA Conference 2012, in the 'Innovations in Mental Health Care for Children and Young People' stream.
The Intersection of Medical Research and Public Healthkmbrown08
The purpose of this project is to show the necessity of collaboration between medical research and public health to improve the outlook of our nation’s future. Case studies focusing on influenza, childhood obesity and HIV/AIDS show how the fields have intersected to address health problems in the past, and how they can continue to intersect in the present and the future. Finally, this study identifies key public health advocacy messages that need to be heard on a national level in order to bolster the intersection of medical research and public health.
Policy brief impact-of-covid-19-on-womenAparna K S
1) The COVID-19 pandemic is having disproportionate impacts on women and girls including increased risk of violence, greater mental health impacts due to increased caregiving responsibilities, and reduced access to sexual and reproductive health services.
2) Evidence from past epidemics and initial reports on COVID-19 suggest increases in domestic violence against women. Women also bear a greater burden of unpaid care work, negatively impacting their mental health.
3) During past outbreaks, resources were diverted from routine healthcare including services for women like maternal care and contraceptives. Projections estimate COVID-19 could lead to millions of unintended pregnancies and unsafe abortions due to reduced access to family planning services.
This document provides an overview of the rights of women during childbirth. It discusses key international treaties that protect human rights, such as the Universal Declaration of Human Rights. Several definitions are provided related to quality of care, experience of care, disrespect and abuse during childbirth. Epidemiological data shows mistreatment of women during childbirth is common in many settings worldwide. The document outlines potential contributors to and consequences of disrespect and abuse. It discusses the WHO standards for quality maternal and newborn care, which include promoting respectful care. The document emphasizes the importance of recognizing women's rights, understanding causes of mistreatment, and taking actions at multiple levels to prevent disrespect and abuse during childbirth.
The prayer requests guidance and help from Jesus for an upcoming examination. It asks Jesus to help the person feel at ease, think clearly without panicking or guessing, and give their best effort. It prays for enlightenment, divine assistance, and the best results from working to their full ability with Jesus' help.
Ebola primary health care system survey in focus countriesFolahan Johnson
The document reviews primary healthcare (PHC) systems in countries affected by Ebola in order to investigate the capacity of PHC to support disease control strategies. It discusses seven key principles that PHCs should uphold: serving as first contact, providing continuous care, coordinated care, comprehensive care, family-centered care, community-oriented care, and culturally competent care. Adhering to these principles can help PHCs strengthen disease prevention, detection, and response efforts in their communities.
The document provides guidance on patient education for those with HIV/AIDS. It outlines discussing transmission prevention, testing of partners and children, family planning, establishing medical care, symptom monitoring, modifying high risk behaviors, and referrals to additional resources. It also cautions on potential drug interactions between contraceptives and antiretrovirals, as well as between protease inhibitors and St. John's wort.
Community diagnosis involves analyzing the health status, resources, and services of a community to identify priorities and goals for improving community health. It examines mortality and morbidity rates, nutritional status, healthcare access, and other social and environmental health indicators. The process involves listening to community members, observing health problems, reviewing available data, conducting surveys, and holding monthly meetings. The results are used to plan and evaluate community health programs and services.
Vision health an integral part of public health in nigeriaChibuzor Emereole
A article on why vision care should be inclusive in the Nigerian concept of public health. The article provides the avenues through which advocacy, and public-private partnerships can be employed to achieve this feat, in view of the VISION 2020 - Right to Sight by all by the year 2020.
Pre natal diagnosis and abortion bioethicsLyca Mae
The document discusses several cases involving complex medical ethics issues:
1) The case of a man with Down syndrome whose health is declining. His parents disagree on whether to remove his feeding tube.
2) A family is divided on whether to place a feeding tube for their father who is minimally conscious with no chance of improvement.
3) The document provides advice for communicating with families in these difficult situations, considering the patient's values and preferences to make the most ethical decision. Outcomes for the patient's well-being and avoiding prolonged suffering are important factors discussed.
This document provides an overview of community health programs in the Philippines. It discusses key concepts in community health including primary health care, determinants of health, and the levels of the health care system. It also outlines several specific health programs implemented by the Department of Health in the Philippines, including programs focused on adolescents, breastfeeding promotion, cancer control, and diabetes control. The overall goal of the health programs is to improve health outcomes by reducing mortality and morbidity rates through prevention and early treatment initiatives.
This document discusses three key areas that warrant attention regarding the consequences of the COVID-19 pandemic on care for high-risk newborns and their families: 1) Inpatient care policies around visitation, developmental care, and communication have changed, which may impact parent participation and outcomes; 2) Outpatient care including follow-up clinics and early intervention have shifted to telehealth, raising access issues; 3) Parent psychosocial distress from mental health impacts, lack of social support, and financial toxicity are concerns as the pandemic exacerbates existing stressors for families in the NICU.
This presentation was part of Embody's Safe Healthy Strong 2014 conference on sexuality education (www.ppwi.org/safehealthystrong). Embody is Planned Parenthood of Wisconsin's education and training programs. Learn more: www.ppwi.org/embody
DESCRIPTION
Improve clinical assessment of and increase referrals for IPV- including reproductive coercion – through increased understanding of the prevalence and impact of IPV, acknowledging the role that reproductive coercion plays in IPV, utilizing clinical best practices for IPV assessment and referral, and considering use of a brief, evidence-based, brochure-based intervention to enhance IPV and reproductive coercion assessment and referral in clinical settings.
ABOUT THE PRESENTER
Meghan Benson, MPH, CHES has worked in the field of sexuality education since she was a teen peer HIV educator in high school. She completed her MPH in Community Health Sciences with a focus on adolescent health and development at the University of Illinois at Chicago, and is a Certified Health Education Specialist (CHES). As the Planned Parenthood of Wisconsin Director of Community Education, Meghan develops programming and coordinates educational opportunities throughout the state. Meghan is a board member for the Association of Planned Parenthood Leaders in Education (APPLE), a co-chair of the Policy and Action Subcommittee of the Wisconsin Maternal and Child Health Advisory Committee, and a member of the Dane County Youth Commission.
The Fund for a Healthy Maine (FHM) allocates funds from Maine's annual tobacco settlement payments to support health programs aimed at disease prevention. It accounts for only 0.7% of Maine's total healthcare spending but funds critical programs in areas like smoking prevention and cessation, childcare, oral health, substance abuse treatment, and school-based health centers. Greater investment in prevention through the FHM has the potential to dramatically reduce chronic disease and healthcare costs over the long term.
The document provides information about a Certificate Course in Community Health (CCCH) being offered by the DINSHA PATEL College of Nursing, NADIAD. The 6-month course will train mid-level providers to operationalize Health and Wellness Centers under the Ayushman Bharat program. It describes the 5 modules that will be covered including basics of community health, primary health care for common conditions, clinical skills, national health programs, and public health management. The course aims to equip community health workers with the skills needed to provide comprehensive primary healthcare in rural areas.
Health Promotion and Education program in prevention and control of H...Arjun Hamal
This document outlines a health promotion program to prevent HIV/AIDS using the PRECEDE-PROCEED framework. It begins with an introduction and objectives. Baseline data is presented on the target population which shows some risky behaviors. A needs assessment is then conducted using the PRECEDE components which examine social, epidemiological, behavioral, educational, and policy factors. Objectives are set and a program is designed which includes awareness activities, condom demonstrations, and monitoring. The program aims to increase knowledge of HIV prevention and promote safe sexual practices to reduce new HIV cases in the target area by 50% by 2022.
This document discusses community health needs assessment and the nursing process. It provides an overview of the steps in assessing a community's health needs which include collecting demographic data, identifying major health issues, planning programs, implementing activities, and evaluating outcomes. The nursing process is also summarized as a systematic method used in nursing practice with the main components being assessment, nursing diagnosis, planning, implementation, and evaluation. Methods of collecting and analyzing health data from communities are also outlined.
This document provides an overview of Parkinson's disease (PD), including its history, diagnosis, management, treatment, and impact on both patients and society. Some key points:
- PD is a chronic, progressive neurological disorder first described in 1817 that affects movement and other brain functions. It has no known cure.
- Symptoms include tremors, rigidity, slowed movement, and impaired balance and coordination. Diagnosis is based on clinical examination and can be difficult, with around 25% of cases initially misdiagnosed.
- Management involves medication, exercise, potential deep brain stimulation surgery, and palliative care in advanced stages. Coordinated support from a multidisciplinary team is important.
Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up
This document discusses different levels of disease prevention including primordial, primary, secondary, tertiary, and quaternary prevention. It defines each level and provides examples of interventions used. Primordial prevention aims to establish conditions that minimize health hazards through measures to inhibit risk factors. Primary prevention removes the possibility of disease through health promotion, immunizations, and reducing environmental risks. Secondary prevention uses early diagnosis and treatment to halt disease progression and complications. Tertiary prevention aims to reduce impairments and disabilities through rehabilitation when disease has advanced.
This document discusses sepsis, post-sepsis syndrome, and the benefits of early hospice referral. Key points include:
- Sepsis affects millions worldwide each year and is a leading cause of death in hospitals. Survivors often experience post-sepsis syndrome with new physical and cognitive impairments.
- Early identification of sepsis and standardized hospital treatment can improve outcomes, but there is no consensus on best post-acute care. Hospice may be appropriate for some patients.
- Over 40% of sepsis patients who die in the hospital meet hospice eligibility guidelines upon admission due to underlying terminal conditions exacerbated by sepsis. Hospice referral rates for sepsis patients remain low compared to non-
Integrating Community-Based Strategies into Existing Health Systems_Judy Lewi...CORE Group
This document discusses information sharing to change policy for child pneumonia treatment in Haiti. It summarizes:
1) In 2000, 40,000 Haitian children under 5 were diagnosed with pneumonia and almost 3,000 died, showing pneumonia was a leading cause of child death.
2) Beginning in the 1980s, the Haitian Health Foundation implemented a community-based primary health care program that treated over 17,000 pneumonia cases in its first 3 years, reducing child pneumonia mortality.
3) Based on the Foundation's data and advocacy, the Haitian government adopted community-based treatment of pneumonia as national policy in 2005.
The study evaluated the success of an intervention in Eastern Visayas, Philippines to strengthen mental health services following Typhoon Haiyan. [1] Between 2014-2015, 1038 community workers were trained in psychosocial support and 290 healthcare providers received mental health training and supervision. [2] By March 2015, 97.5% of primary care units and 87.5% of district hospitals had trained providers, benefiting 50-200 patients each. [3] Regional hospitals added psychiatric beds and provincial hospitals established acute care capacity, improving availability across all levels of care.
Palliative care aims to improve quality of life for patients facing serious illness through comprehensive pain and symptom management and coordination of care across settings. While some view it as a form of rationing, studies show palliative care can help patients live longer while feeling better. It works to resolve conflicts among clinicians and between clinicians and patients/families around goals of care. Implementing a palliative care program at Cape Cod Hospital could help address frequent ER visits and readmissions at end of life through improved symptom control and advance care planning.
This document discusses key concepts in public health including definitions of health, the spectrum of health, concepts of causation, changing concepts in public health, millennium development goals, primary health care, public health in India, and concepts of prevention. It provides definitions and explanations of different models and approaches in public health such as the levels of health, determinants of health, epidemiological triad, risk factors, natural history of disease, and concepts of prevention including primordial, primary, secondary, and tertiary prevention.
Un hombre observaba a una anciana que todos los días tiraba semillas por la ventana del autobús en el que viajaban. La anciana le explicó que quería ver flores a lo largo del camino. Aunque el hombre pensó que la idea era absurda, meses después se sorprendió al ver que todo el camino estaba lleno de flores. Se enteró de que la anciana había fallecido, pero su trabajo había dejado una herencia a todos los que podían disfrutar de la belleza de las flores.
Este documento discute la narcoestética y narco cultura en Colombia. Argumenta que la cultura narco no solo se refiere al tráfico de drogas, sino que también se manifiesta en la música, televisión, lenguaje y arquitectura del país. Describe la estética narco como ostentosa y exagerada, que celebra los autos caros, mujeres hermosas y fincas lujosas. También analiza cómo el presidente Álvaro Uribe ha llegado a encarnar los valores de esta cultura narco en Colombia.
Community diagnosis involves analyzing the health status, resources, and services of a community to identify priorities and goals for improving community health. It examines mortality and morbidity rates, nutritional status, healthcare access, and other social and environmental health indicators. The process involves listening to community members, observing health problems, reviewing available data, conducting surveys, and holding monthly meetings. The results are used to plan and evaluate community health programs and services.
Vision health an integral part of public health in nigeriaChibuzor Emereole
A article on why vision care should be inclusive in the Nigerian concept of public health. The article provides the avenues through which advocacy, and public-private partnerships can be employed to achieve this feat, in view of the VISION 2020 - Right to Sight by all by the year 2020.
Pre natal diagnosis and abortion bioethicsLyca Mae
The document discusses several cases involving complex medical ethics issues:
1) The case of a man with Down syndrome whose health is declining. His parents disagree on whether to remove his feeding tube.
2) A family is divided on whether to place a feeding tube for their father who is minimally conscious with no chance of improvement.
3) The document provides advice for communicating with families in these difficult situations, considering the patient's values and preferences to make the most ethical decision. Outcomes for the patient's well-being and avoiding prolonged suffering are important factors discussed.
This document provides an overview of community health programs in the Philippines. It discusses key concepts in community health including primary health care, determinants of health, and the levels of the health care system. It also outlines several specific health programs implemented by the Department of Health in the Philippines, including programs focused on adolescents, breastfeeding promotion, cancer control, and diabetes control. The overall goal of the health programs is to improve health outcomes by reducing mortality and morbidity rates through prevention and early treatment initiatives.
This document discusses three key areas that warrant attention regarding the consequences of the COVID-19 pandemic on care for high-risk newborns and their families: 1) Inpatient care policies around visitation, developmental care, and communication have changed, which may impact parent participation and outcomes; 2) Outpatient care including follow-up clinics and early intervention have shifted to telehealth, raising access issues; 3) Parent psychosocial distress from mental health impacts, lack of social support, and financial toxicity are concerns as the pandemic exacerbates existing stressors for families in the NICU.
This presentation was part of Embody's Safe Healthy Strong 2014 conference on sexuality education (www.ppwi.org/safehealthystrong). Embody is Planned Parenthood of Wisconsin's education and training programs. Learn more: www.ppwi.org/embody
DESCRIPTION
Improve clinical assessment of and increase referrals for IPV- including reproductive coercion – through increased understanding of the prevalence and impact of IPV, acknowledging the role that reproductive coercion plays in IPV, utilizing clinical best practices for IPV assessment and referral, and considering use of a brief, evidence-based, brochure-based intervention to enhance IPV and reproductive coercion assessment and referral in clinical settings.
ABOUT THE PRESENTER
Meghan Benson, MPH, CHES has worked in the field of sexuality education since she was a teen peer HIV educator in high school. She completed her MPH in Community Health Sciences with a focus on adolescent health and development at the University of Illinois at Chicago, and is a Certified Health Education Specialist (CHES). As the Planned Parenthood of Wisconsin Director of Community Education, Meghan develops programming and coordinates educational opportunities throughout the state. Meghan is a board member for the Association of Planned Parenthood Leaders in Education (APPLE), a co-chair of the Policy and Action Subcommittee of the Wisconsin Maternal and Child Health Advisory Committee, and a member of the Dane County Youth Commission.
The Fund for a Healthy Maine (FHM) allocates funds from Maine's annual tobacco settlement payments to support health programs aimed at disease prevention. It accounts for only 0.7% of Maine's total healthcare spending but funds critical programs in areas like smoking prevention and cessation, childcare, oral health, substance abuse treatment, and school-based health centers. Greater investment in prevention through the FHM has the potential to dramatically reduce chronic disease and healthcare costs over the long term.
The document provides information about a Certificate Course in Community Health (CCCH) being offered by the DINSHA PATEL College of Nursing, NADIAD. The 6-month course will train mid-level providers to operationalize Health and Wellness Centers under the Ayushman Bharat program. It describes the 5 modules that will be covered including basics of community health, primary health care for common conditions, clinical skills, national health programs, and public health management. The course aims to equip community health workers with the skills needed to provide comprehensive primary healthcare in rural areas.
Health Promotion and Education program in prevention and control of H...Arjun Hamal
This document outlines a health promotion program to prevent HIV/AIDS using the PRECEDE-PROCEED framework. It begins with an introduction and objectives. Baseline data is presented on the target population which shows some risky behaviors. A needs assessment is then conducted using the PRECEDE components which examine social, epidemiological, behavioral, educational, and policy factors. Objectives are set and a program is designed which includes awareness activities, condom demonstrations, and monitoring. The program aims to increase knowledge of HIV prevention and promote safe sexual practices to reduce new HIV cases in the target area by 50% by 2022.
This document discusses community health needs assessment and the nursing process. It provides an overview of the steps in assessing a community's health needs which include collecting demographic data, identifying major health issues, planning programs, implementing activities, and evaluating outcomes. The nursing process is also summarized as a systematic method used in nursing practice with the main components being assessment, nursing diagnosis, planning, implementation, and evaluation. Methods of collecting and analyzing health data from communities are also outlined.
This document provides an overview of Parkinson's disease (PD), including its history, diagnosis, management, treatment, and impact on both patients and society. Some key points:
- PD is a chronic, progressive neurological disorder first described in 1817 that affects movement and other brain functions. It has no known cure.
- Symptoms include tremors, rigidity, slowed movement, and impaired balance and coordination. Diagnosis is based on clinical examination and can be difficult, with around 25% of cases initially misdiagnosed.
- Management involves medication, exercise, potential deep brain stimulation surgery, and palliative care in advanced stages. Coordinated support from a multidisciplinary team is important.
Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up
This document discusses different levels of disease prevention including primordial, primary, secondary, tertiary, and quaternary prevention. It defines each level and provides examples of interventions used. Primordial prevention aims to establish conditions that minimize health hazards through measures to inhibit risk factors. Primary prevention removes the possibility of disease through health promotion, immunizations, and reducing environmental risks. Secondary prevention uses early diagnosis and treatment to halt disease progression and complications. Tertiary prevention aims to reduce impairments and disabilities through rehabilitation when disease has advanced.
This document discusses sepsis, post-sepsis syndrome, and the benefits of early hospice referral. Key points include:
- Sepsis affects millions worldwide each year and is a leading cause of death in hospitals. Survivors often experience post-sepsis syndrome with new physical and cognitive impairments.
- Early identification of sepsis and standardized hospital treatment can improve outcomes, but there is no consensus on best post-acute care. Hospice may be appropriate for some patients.
- Over 40% of sepsis patients who die in the hospital meet hospice eligibility guidelines upon admission due to underlying terminal conditions exacerbated by sepsis. Hospice referral rates for sepsis patients remain low compared to non-
Integrating Community-Based Strategies into Existing Health Systems_Judy Lewi...CORE Group
This document discusses information sharing to change policy for child pneumonia treatment in Haiti. It summarizes:
1) In 2000, 40,000 Haitian children under 5 were diagnosed with pneumonia and almost 3,000 died, showing pneumonia was a leading cause of child death.
2) Beginning in the 1980s, the Haitian Health Foundation implemented a community-based primary health care program that treated over 17,000 pneumonia cases in its first 3 years, reducing child pneumonia mortality.
3) Based on the Foundation's data and advocacy, the Haitian government adopted community-based treatment of pneumonia as national policy in 2005.
The study evaluated the success of an intervention in Eastern Visayas, Philippines to strengthen mental health services following Typhoon Haiyan. [1] Between 2014-2015, 1038 community workers were trained in psychosocial support and 290 healthcare providers received mental health training and supervision. [2] By March 2015, 97.5% of primary care units and 87.5% of district hospitals had trained providers, benefiting 50-200 patients each. [3] Regional hospitals added psychiatric beds and provincial hospitals established acute care capacity, improving availability across all levels of care.
Palliative care aims to improve quality of life for patients facing serious illness through comprehensive pain and symptom management and coordination of care across settings. While some view it as a form of rationing, studies show palliative care can help patients live longer while feeling better. It works to resolve conflicts among clinicians and between clinicians and patients/families around goals of care. Implementing a palliative care program at Cape Cod Hospital could help address frequent ER visits and readmissions at end of life through improved symptom control and advance care planning.
This document discusses key concepts in public health including definitions of health, the spectrum of health, concepts of causation, changing concepts in public health, millennium development goals, primary health care, public health in India, and concepts of prevention. It provides definitions and explanations of different models and approaches in public health such as the levels of health, determinants of health, epidemiological triad, risk factors, natural history of disease, and concepts of prevention including primordial, primary, secondary, and tertiary prevention.
Un hombre observaba a una anciana que todos los días tiraba semillas por la ventana del autobús en el que viajaban. La anciana le explicó que quería ver flores a lo largo del camino. Aunque el hombre pensó que la idea era absurda, meses después se sorprendió al ver que todo el camino estaba lleno de flores. Se enteró de que la anciana había fallecido, pero su trabajo había dejado una herencia a todos los que podían disfrutar de la belleza de las flores.
Este documento discute la narcoestética y narco cultura en Colombia. Argumenta que la cultura narco no solo se refiere al tráfico de drogas, sino que también se manifiesta en la música, televisión, lenguaje y arquitectura del país. Describe la estética narco como ostentosa y exagerada, que celebra los autos caros, mujeres hermosas y fincas lujosas. También analiza cómo el presidente Álvaro Uribe ha llegado a encarnar los valores de esta cultura narco en Colombia.
Este documento presenta una guía didáctica para docentes sobre la prevención de prácticas discriminatorias en la escuela. Explica que la escuela tiene un rol fundamental en la transmisión de normas y valores, y puede ser un motor de cambio hacia una sociedad más diversa e inclusiva. Define la discriminación y explica conceptos como estereotipos y prácticas sociales discriminatorias. Finalmente, propone actividades y herramientas para incorporar la diversidad en el aula de manera positiva.
Este documento resume um livro que argumenta que:
1) Moeda é criada por relações de crédito e débito, principalmente entre o Estado e o setor privado;
2) O déficit público naturalmente excede o superávit privado, levando a pleno emprego;
3) Dívida e impostos estabilizam a economia em vez de financiar gastos, e devem ser usados para manter a plena utilização dos recursos.
1) O documento discute a ênfase dada à gestão na formação de professores no Brasil, de acordo com as Diretrizes Curriculares Nacionais de 2006.
2) A gestão passou a ser vista como eixo central na formação de pedagogos, em vez de habilitações específicas. Isso está alinhado com recomendações de organizações multilaterais.
3) A ênfase na gestão reflete a busca por maior eficiência e resultados na educação, em um contexto de reformas neoliberais influenciadas por essas organ
Aula 7 (27/2/2009): Jornais X InternetArtur Araujo
O documento discute os desafios enfrentados pelo jornalismo impresso com o surgimento da internet, como a queda na circulação e receita com publicidade. Apesar disso, defende que o jornalismo continuará existindo em formato digital, com o texto jornalístico persistindo on-line. Também apresenta perspectivas sobre como o jornalismo pode se sustentar financeiramente no ambiente digital.
Based upon:
McIntosh, P. (2009). Gender perspectives on educating for global citizenship. In D. J. Flinders & S.J. Thornton (Eds.), The curriculum studies reader (3rd ed., pp. 399-424). New York: RoutledgeFalmer.
1) The document analyzes the availability of open access to scientific production from Lusophone African countries. It finds that while some journals and articles are available open access, open access initiatives are still limited compared to Anglophone Africa.
2) It identifies 162 journals published in Lusophone African countries between 2002-2012, but only 6.8% are available electronically. It also finds that over 1,700 articles by authors from these countries could be made openly accessible through green open access policies.
3) The authors recommend the creation of an open repository for Lusophone Africa to provide open access to past and future scientific production from these countries, and promote open access policies and awareness.
Este documento contiene ejemplos de código para realizar diferentes tareas en programación como cambiar entre formularios, reproducir sonido y video MIDI, establecer un sonido MIDI como fondo de un formulario, y crear una contraseña para ingresar a un formulario.
Este documento resume los servicios de una compañía de pagos electrónicos en Colombia y América Latina. Procesan más de $70 millones de USD mensuales para más de 7000 clientes. Ofrecen seguridad en las transacciones a través de certificados, firewalls, y encriptación de datos. También tienen expertos en prevención de fraude y han tenido éxito expandiéndose internacionalmente. El comercio electrónico en América Latina está creciendo a más del 40% anualmente, lo que representa una gran oportunidad.
The document describes methods for generating position-specific scoring matrices (PSSMs) and weight matrices from alignments of transcription factor binding sites. It discusses calculating relative frequencies and corrected frequencies of residues at each position, and generating log-odds weight matrices using the Bernoulli assumption. The information content of each position is also described, which represents the specificity of each position based on the entropy of observed residues compared to background frequencies.
La Universidad Itinerante del Mar ofrece tres cursos a bordo del buque escuela "Creoula" que visitarán ciudades portuarias de Portugal y España. El Curso 1 visitará Lisboa, Avilés y Oporto. El Curso 2 irá de Oporto a Ílhavo y Cartagena. Y el Curso 3 irá de Cartagena a Palma de Mallorca y Lisboa. Los cursos combinarán la navegación con conferencias para ampliar los conocimientos sobre la historia y cultura de la Península Ibérica.
Este documento presenta un resumen de varios temas aprendidos en el curso de informática del año lectivo 2009-2010 en la Universidad Nacional de Chimborazo, Ecuador. Los temas incluyen la evaluación de sistemas operativos, ofimática, software libre, bibliotecas virtuales, realidad virtual, software financiero y compiladores.
O documento fornece dicas sobre como criar e gerenciar um blog bem-sucedido. Ele discute a importância de criar conteúdo relevante e singular para os leitores, explorar nichos e estilos diferentes, e manter uma boa política de comentários para engajar a comunidade. Também enfatiza a curadoria de conteúdo de alta qualidade de outras fontes e acompanhar blogs de referência no assunto.
Using HIV Surveillance Data to Inform the ECHPP EvaluationCDC NPIN
The document discusses using HIV surveillance data to evaluate the Enhanced Comprehensive HIV Prevention Plans (ECHPP) project. The ECHPP is being implemented in 12 cities over 3 years to develop enhanced HIV prevention and care plans. The evaluation plan involves monitoring program processes, community-level outcomes, and long-term community-level impact. HIV surveillance data from systems like Medical Monitoring Project and National HIV Behavioral Surveillance will be analyzed annually and compared over time to measure changes in behaviors, access to care, HIV incidence, and health disparities.
This document discusses enhancing collaboration between HIV/AIDS, viral hepatitis, STD, and TB prevention programs. It provides an agenda for a webcast on this topic, including presentations from CDC and health department directors. The presentations will cover the synergistic nature of these epidemics, barriers to collaboration, and strategies for implementing program collaboration and service integration (PCSI) at national, state, and local levels to provide more comprehensive prevention and care.
State health departments play a central role in administering federal HIV/AIDS programs. They are responsible for disease surveillance; administering prevention, care, and treatment programs; ensuring access to healthcare; and partnering with local agencies. Key responsibilities include managing counseling, testing, and partner services programs; ensuring access to treatment; coordinating care; and conducting epidemiological surveillance to monitor the epidemic. State health departments also provide leadership, resources, and technical assistance to local agencies and work with federal, state, and community partners to address HIV/AIDS.
The document discusses India's national sexually transmitted disease (STD) control program. It outlines the program's interventions which include case detection, treatment, health education, and partner notification. The goal is prevention of infections through primary and secondary prevention strategies. Standardized training is provided to healthcare workers on syndrome-based case management. Over 1,100 clinics provide sexual health services. However, studies show partner notification and counseling need improvement. Strengthening diagnostic laboratories, healthcare worker training, and clinic facilities were identified as priorities to better manage STD cases.
Primary Health Care Outreach clinics were initiated in 1994 to improve access to basic health services in communities. These clinics are run by auxiliary nurse midwives and paramedics from health posts and primary health care centers. Services provided at the clinics include antenatal and postnatal care, family planning, child health services, and health education. While over 1.5 million clinic visits were conducted annually, not all planned clinics were functional due to issues. Recommendations include resolving problems to ensure all primary health care outreach clinics are operational.
Thank client for sharing
Remind of test results timeline
Provide contact information
Offer additional support
Providing HIV related services to our community through compassionate direct care, prevention and outreach activities.
ProVIC “Champion Communities”: PMTCT of HIV in the Democratic Republic of CongoAIDSTAROne
More than a decade of conflict has ravaged the health infrastructure and service delivery in the Democratic Republic of Congo (DRC). As a result, prenatal care--including prevention of mother-to-child transmission (PMTCT) of HIV--is often difficult to access and fails to meet the needs of expectant mothers. One program, the DRC Integrated HIV/AIDS Project (ProVIC), is using a community-based approach to link mothers, health care providers, and community caregivers with support and quality service. http://aidstarone.com/focus_areas/pmtct/resources/case_study_series/provic_drc
aids control pgram.pptNurses students jnMANJUPAUL7
This document provides an overview of HIV/AIDS and the National AIDS Control Programme (NACP) in India. It discusses the magnitude of the HIV/AIDS problem globally and in India, the goals and activities of NACP Phase III, and the roles and responsibilities of community health nurses in supporting the program. Key points include statistics on HIV prevalence, the transmission route in India, objectives of reducing incidence rates, activities under NACP III including prevention, care, and treatment, and approaches for nurses to provide multidisciplinary care and support to people living with HIV/AIDS.
1 mon 0900 das hiv prevention final 8.15.2011CDC NPIN
This document summarizes efforts to improve the HIV care continuum and maximize prevention, care, and treatment outcomes in San Francisco. It outlines San Francisco's approach, which includes universal offering of antiretroviral therapy, using data to evaluate the care cascade, and focusing on primary prevention, linkage to care, retention in care, and viral suppression. The goal is to reduce new infections and improve health through combined prevention strategies and ensuring all people with HIV are able to benefit from treatment.
The document discusses priorities for an ELSA on eHealth in Europe including improving chronic disease management, integration of healthcare services, and empowering citizens. It outlines challenges facing European health systems like aging populations and rising chronic diseases. Examples of past health ICT research funded under the EU Framework Programme are provided, but there is a need for large-scale demonstrations and validation of this research in real-world settings to realize its full impact and benefits. An ELSA could provide such a platform to translate research results into products and daily experience.
The document outlines the history and activities of India's National AIDS Control Program (NACP) which was established in 1987 by the Ministry of Health and Family Welfare to prevent the spread of HIV/AIDS. It discusses the objectives and phases of NACP from 1987 to the present, highlighting key activities like surveillance, prevention among high-risk groups, care and treatment, blood safety, and community outreach. The goal of NACP is to provide accessible HIV/AIDS services across India through strategies tailored for different state-level epidemics.
The document discusses the United Nations Millennium Development Goals and focuses on Goal 4 of reducing child mortality. It provides statistics on child mortality rates globally and in Kenya. It then describes an initiative called Goal4 that aims to reduce under-five mortality in the village of Sega, Kenya through establishing a connected community of health practitioners, increasing access to healthcare knowledge and supplies, and implementing programs like an electronic medical record system, connecting community health workers, expanding local health facilities, launching a telemedicine program, and improving public sanitation. The goal is to address the major causes of under-five deaths in the region through an integrated community health approach.
This document discusses strategies to promote population health in the United States. It provides data showing poor control of health conditions like high blood pressure and cholesterol. It also discusses how employers can play a key role in wellness since most Americans get health insurance through work. The document proposes several strategic directions for a National Prevention Strategy including promoting active lifestyles, healthy eating, strong public health infrastructure, and making clinical preventive services more accessible. It seeks input on draft strategic directions to guide federal prevention activities.
Hiv prevention and care program 101 3 5-12Jordan Selha
The document provides an overview of HIV prevention and care funding in Iowa. It discusses:
1) The two main federal agencies that provide funding - CDC and HRSA. HRSA's Ryan White program (Part B) provides care services in Iowa.
2) Iowa receives CDC prevention funding which supports counseling/testing, partner services, health education, and planning. HRSA's Ryan White Part B funds care, treatment, and the AIDS Drug Assistance Program in Iowa.
3) The document reviews goals, requirements, and components of CDC's category A prevention funding for health departments.
Planning the Development of the Singapore National Health PortalAnthony Fanning
The document summarizes the planning process for developing the Singapore National Health Portal. It discusses the goals of creating a unified health portal to empower individuals to better manage their health. The portal will provide personal health records, health management tools, and access for clinicians. It outlines a phased rollout strategy over several years to gradually expand features and user base. Key challenges mentioned are standardizing data sharing across providers and ensuring user privacy, legal issues are addressed, and stakeholders are engaged to support adoption.
Reaching the goals of the National HIV/AIDS Strategy. This presentation was originally conducted at the Office of HIV Planning's Community Empowerment Workshop held at St. Luke's Church on October 16, 2012.
The document discusses the importance of counseling pregnant women in PMTCT programs to reduce mother-to-child HIV transmission and outlines best practices for scaling up counseling services including providing education during antenatal care and ensuring linkages between testing, treatment, and support services. It also identifies challenges in expanding counseling to all women and ensuring quality as well as actions needed to strengthen follow-up and emergency response.
- The document discusses barriers to accessing prevention of mother-to-child transmission (PMTCT) services in many countries, including low status of women, poverty, lack of transportation, stigma, and unsupportive health services.
- To overcome these barriers in Uganda, strategies were employed like quality improvement efforts, integrating PMTCT into other health services, involving people living with HIV, working with communities, and providing psychosocial support for children.
- Key approaches included family support groups, peer educators, task sharing between health workers and lay providers, community outreach, children's groups, and increasing male partner participation. Lessons learned showed that community-based, family-focused approaches improved PMTCT programs.
Metrics for Monitoring and Evaluating the Enhanced Comprehensive Prevention PlanCDC NPIN
This document outlines Tiffany West's work monitoring disease burden and implementing scalable interventions as part of the DC Department of Health Strategic Information Bureau. It discusses expanding HIV testing, including routine opt-out testing, screening in non-clinical settings, and incorporating prevention into care. Key metrics proposed to evaluate programs include the number of HIV tests conducted and positivity rates by site type and high risk population. The goal is to reduce new HIV infections, increase access to care, and achieve a more coordinated local response to the HIV epidemic through data-driven policies and programs.
Similar to State of the science nieves rivera (20)
Kharfen: DC HIV Public-Private Partnershipshealthhiv
Michael Kharfen
Bureau Chief, Partnerships, Capacity Building, Community Outreach
DC Department of Health
HIV/AIDS, Hepatitis, STD and TB Administration
The Health Center Program and the NHAS and VHAPhealthhiv
Seiji Hayashi, MD, MPH, FAAFP
Chief Medical Officer
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Primary Health Care
SYNCing Government Agencies with NHAS and VHAP healthhiv
Warren W. Hewitt, Jr. DrPH, M.S.
Center for Substance Abuse Treatment
Substance Abuse Mental Health Services Administration
U.S. Department of Health & Human Services
Sustainability & Revenue Generation for Nonprofit Organizationshealthhiv
This document summarizes a workshop on sustainability and revenue generation for nonprofit organizations. The workshop agenda covers introductions, definitions of sustainability, examining current revenue sources, methods for diversifying revenue, and involving stakeholders. The training goals are to educate participants on sustaining services through diversified income. Examples of funding types include government, private, foundations, and individual giving. The presentation examines calculating revenue percentages and case studies, and discusses leadership sustainability and strategic partnerships to enhance long-term viability.
This document outlines a 2012 advocacy effort in Delaware to influence the state's implementation of the Affordable Care Act (ACA) regarding "specialty tiers" in prescription drug plans. It provides background on key dates, including passage of the ACA in 2010 and an HHS bulletin in 2011. It details how multiple patient advocacy groups worked with the Delaware Health Care Commission through letters, testimony and comments to quantify the impact of specialty tiers on patients and advocate for their positions. The commission's final report was submitted to the Delaware General Assembly in March 2012 as a result of this advocacy effort.
This document discusses opportunities for hepatitis C (HCV) treatment under the Affordable Care Act. It notes that about 4 million Americans are exposed to HCV, with 85% developing chronic disease and 75% of cases undiagnosed. Only 36% of eligible HCV patients had health insurance previously. The ACA aims to expand access to care through provisions like eliminating pre-existing condition exclusions, free preventive care, increased research funding, and accountable care organizations.
Syn cing chronic disease advocacy greewaldhealthhiv
The document discusses health care reform opportunities and challenges for people living with HIV/AIDS. It outlines the current access to care crisis, including high rates of uninsured individuals with HIV/AIDS and limited Medicaid access in most states. It then describes major opportunities created by health care reform, such as expanded Medicaid eligibility, enhanced Medicaid care coordination, increased access to Medicare prescription drugs, private insurance market reforms, and new investments in prevention and care delivery. Finally, it discusses key challenges in ensuring these opportunities translate into real benefits for people with HIV/AIDS.
The document summarizes key aspects of the Affordable Care Act's implementation for expanding access to health insurance coverage. It outlines the timeline for setting up health insurance exchanges at the state level by 2014 and discusses the ACA's requirements for minimum essential health benefits. It also analyzes how subsidies and out-of-pocket maximums may impact household budgets and affordability under the new law.
The document discusses the diabetes epidemic in America, the health risks of diabetes, and the American Diabetes Association's advocacy efforts. It notes that over 25 million Americans have diabetes and 79 million have prediabetes. Diabetes increases the risk of death and disabilities like kidney failure and blindness. It also places a huge economic burden on the healthcare system. The ADA aims to prevent and cure diabetes through increasing funding for research and treatment, eliminating discrimination, and improving access to affordable healthcare as outlined in the Affordable Care Act.
This document summarizes New York City's experience implementing combination HIV prevention technologies. It discusses using the full range of available tools for HIV prevention, including structural interventions, clinical interventions, long-lasting protective interventions, and socioeconomic factors. It presents models for how various prevention strategies can reach different numbers of people and have varying levels of impact. It also highlights New York City's use of social media, rapid HIV testing technologies, treatment recommendations to offer treatment regardless of CD4 count, and nPEP programs as part of its combination prevention approach.
1. Combination prevention approaches that integrate biomedical, behavioral, and structural interventions may provide the most effective strategy for HIV prevention.
2. While biomedical interventions like PrEP and treatment as prevention have shown promise, their effectiveness relies on optimal adherence which is influenced by behavioral and social factors.
3. Behavioral interventions alone have had questionable effectiveness, so combining them with biomedical approaches could help ensure medication adherence and uptake.
4. Structural interventions are also needed to address social determinants like poverty, discrimination, and gender inequality that fuel the HIV epidemic.
This document summarizes Massachusetts' efforts to make pre-exposure prophylaxis (PrEP) available to prevent HIV transmission. It discusses the state's comparable demographics and challenges to other states. It outlines strategies used, including procuring prevention agencies, distributing guidance on PrEP, defining service packages, and Medicaid demonstration project planning. Next steps include surveying provider demand, linking prevention providers to prescribers, and implementing data collection to support PrEP implementation.
This document summarizes research on pre-exposure prophylaxis (PrEP) and discusses strategies for implementing PrEP. It finds that PrEP has been shown to effectively reduce HIV transmission in multiple clinical trials involving men who have sex with men, heterosexual men and women, and serodiscordant couples. However, concerns have been raised about side effects, risk compensation, and drug resistance that could present barriers to implementation. The document recommends that PrEP be implemented as part of combination prevention, with behavioral interventions to support adherence, and monitoring systems to track side effects, risk behaviors, and drug resistance. It also addresses regulatory approval, coverage under the Affordable Care Act, and targeting high-risk groups to maximize the
This document summarizes guidelines for non-occupational post-exposure prophylaxis (nPEP) for HIV. It recommends that nPEP be offered for exposures over 72 hours prior only if the source patient is known to be HIV positive or of unknown status. For exposures within 72 hours, nPEP is recommended if the source patient is HIV positive or of unknown status. The decision to offer nPEP should be made on a case-by-case basis. The document also discusses factors that influence decisions to start nPEP and reasons some may not start it after exposure. It concludes by providing contact information for the presenting author.
This document discusses the importance of minority healthcare providers in addressing health disparities. It begins by outlining objectives around describing the current state of minority HIV providers and factors affecting their participation. It then summarizes data showing that minority patients comprise a large portion of HIV cases but minority providers are underrepresented in the HIV workforce. Barriers for minority providers include stigma, aging providers, and lack of reimbursement. The role of minority providers is critical for improving outcomes through cultural concordance. Strategies proposed to address issues include increasing numbers of minority HIV providers through incentives, training programs, and recruitment efforts.
Physicians surveyed tended to overestimate HIV prevalence rates in their counties and states. Those who tested more patients (high testers) were more likely to be younger, female, and work in OB/GYN. High testers tended to test more routinely for all sexually active patients. Barriers to testing included concerns about offending patients or having them disclose their status. Physicians were more comfortable discussing testing with patients they saw as higher risk like African Americans or those with STDs. However, risk-based approaches left many patients untested.
The Health Equity and Accountability Act of 2011 (HEAA) is a bill introduced by the Congressional Tri-Caucus to eliminate health disparities among racial and ethnic groups. An advocacy group called the Community Working Group meets weekly to discuss strategies to update and pass the HEAA in the 112th Congress. They analyze how the HEAA complements the Affordable Care Act and conduct outreach to build support for the bill. The HEAA aims to strengthen existing laws and policies to reduce health inequities faced by communities of color.
This document discusses how antiretroviral therapy (ART) reduces HIV transmission by suppressing viral load. Studies show a 92% lower risk of HIV transmission in serodiscordant couples when the HIV+ partner receives ART. Community viral load levels mirror declining new HIV diagnoses rates. Considerations for discussing ART with newly diagnosed patients include adherence challenges, concurrent medical conditions, and psychosocial factors. Widespread ART access and use can help curb the HIV epidemic through treatment as prevention.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
1. The San Francisco Perspective:
Combination Prevention
Technologies
Israel Nieves-Rivera
Director, Community Engagement and Policy Unit
HIV Prevention Section
Manager, Office of the Director of Population Health and Prevention
San Francisco Department of Public Health
SYNChronicity Meeting
Arlington, VA
April 20, 2012
2. IN 2006 THE HEADLINES SAID:
“Pluto Not a Planet,
Astronomers Rule”
4. CITY AND COUNTY OF SAN FRANCISCO
DEPARTMENT OF PUBLIC HEALTH
(PARTIAL ORGANIZATIONAL CHART)
Director of Health
PCSI Co-Champion
Jail Health SF General Hospital Community Health Population Health &
Programs Prevention-Health Officer
PCSI Co-Champion
Forensic AIDS Hospital Based Health Maternal, Child &
Project Centers Adolescent Health
Community Health
STD Prevention & Control
HIV Health Services Promotion & Prevention
UCSF Partnership (Ryan White Programs)
PHP Clinic (ward 86)
Tuberculosis Control
Public Health Preparedness
Community Health Care
& Response
UCSF Partnership
Parnasus Community Oriented Communicable Disease
Primary Care (COPC) Control & Prevention
Environmental Health &
Includes 15 clinics where
OSH
primary care is provided HIV Prevention
SF Community Clinic by the health
Consortium department
Public Health Laboratory
HIV Epidemiology
Emergency Medical
Services HIV Research
4
5. Population Health And Prevention
SF Health Department and Affiliated Clinics
SFDPH manages and implements a robust portfolio of HIV research and works in
5
collaboration with academic, clinical and community partners
6. SF HAS ALWAYS STRIVED TO CREATE A
COMPREHENSIVE RESPONSE TO HIV
•HIV testing •Linkage to medical care
•Partner services •Behavioral Health Services
•STD prevention and treatment •Home Health Service
•Addressing drivers and co-factors of HIV •Non-medical case management
•Linkage to medical •Food Bank / Home-delivered meals
•Risk reduction activities •Client Advocacy-related services
•Community mobilization efforts
HIV and STD HIV Care and •Emergency financial assistance
•Public information efforts Prevention Support •Legal services
•Condom distribution •Housing services
•Syringe access
Services •Oral health care
•PEP •Outreach services
Surveillance,
Primary Care
Evaluation
•Core Surveillance and HIV •Engagement in care
•Incidence Surveillance and •Treatment Adherence
treatment
•Medical Monitoring Research •Medical Case management
•NHBS •ADAP
•Vaccine studies •Community Health Care
•PrEP research •HIV specialty medical care
•HIV drug resistance testing •Treatment Guidelines
•STD and TB
6
Source: Nieves-Rivera, 2010
7. SAN FRANCISCO’S APPROACH TO MAXIMIZING THE
CONTINUUM OF PREVENTION, CARE AND TREATMENT
Primary
HIV Surveillance
Prevention
Efforts Testing Diagnosis Primary Care Treatment
Virologic HIV
Suppression
• PrEP, PEP,
condoms,
syringes Linkage Engagement Engagement
• Drivers / Retention / Retention
1. Substance
use
2. Alcohol
3. Meth
4. Crack Routine Mental Health Treatment
Adherence
Medical Services
5. Poppers
6. STDs, # of Testing
Substance Use Medical Case
partners Treatment Management
Linkage
Community & Partner Housing ART Guidelines
Testing Services Support Uptake
STD &
PCSI
LINCS: Linkage, Navigation Engagement &
Partner Services
& Retention Team 7
8. UNDERSTAND THE HIV EPIDEMIOLOGY IN
YOUR JURISDICTION
• Identify • Identify the • Identify the viral
populations at underlying burden in your
greatest risk for conditions that are jurisdictions
new infection + directly linked to a + • Identify
• Populations with large number of populations living
greatest new HIV infections with HIV /AIDS
disparities in your (PLWHA) with
• Percentage of jurisdictions greatest HIV health
PLWHA that are disparities
unaware of their
HIV status
Identify priority interventions to optimize health outcomes for
PLWHA and avert new HIV infections 8
9. GREATEST RISK FOR ACQUISITION OF HIV
AND UNAWARE OF HIV STATUS
Greatest risk for new infections:
• There are an estimated 723 new HIV infections per year in SF
• An estimated 96% of new HIV infections are among males who
have sex with males (MSM), injection drug users (IDU), and
transfemales who have sex with males (TFSM)
• There are very few cases of non-IDU heterosexual HIV
Greatest Disparities:
• White MSM
• African American MSM
• Latino MSM
• TFSM
Unaware of HIV status:
• It is estimated that 17% (15%-20%) of San Franciscans are
unaware of their HIV status
Source: SF HIV Surveillance and HIV Prevention Plan
10. HIV IS ENDEMIC IN SF
4500
Gay men/MSM: Endemic
4000
3500 Injection drug users: Endemic
3000
2500 Heterosexuals: Neither
2000 epidemic nor endemic
1500
1000
500
0
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2007
2008
10
Source: McFarland, 2009
11. DRIVERS OF HIV IN SF
Driver: An underlying condition that is directly linked to a large
number of new HIV infections in San Francisco
Prevalence of 10% or greater:
• A driver has at least 10% prevalence among one of the high-
risk populations where the bulk of new infections occur (MSM,
IDU, TFSM)
Two-fold increase in risk:
• A driver is an independent factor for HIV making a person in a
high-risk population at least twice as likely to contract HIV as
compared to someone who is not affected by the driver.
Drivers of HIV in SF:
• Cocaine and crack use • Popper use
• Heavy alcohol use • Gonorrhea
• Methamphetamine use • Multiple partners
Source: SF HIV Prevention Plan
13. IDENTIFY SUB-POPULATIONS WITH HIGH
VIRAL BURDEN
Overall N (%) Mean CVL*
San Francisco 12,512 (100) 23,348
Sub-Populations N (%) Mean CVL*
Transgender 291 (2) 64,160
Not on treatment 2924 (23) 40,056
Not engaged in care 4637 (37) 36,992
MSM-IDU 1791 (14) 36,261
IDU 1011 (8) 33,245
Latino 1822 (15) 26,744
African-American 1825 (15) 26,404
*(p<0.001 by Kruskal-Wallis test) in mean CVL by treatment history, race/ethnicity, age, gender, HIV transmission risk category, insurance
status, and clinical status.
Source: Das et al, 2010
14. KEY ELEMENTS IN SELECTING
INTERVENTIONS
Step 1: Evidence-
based
+ Feasible + Scalable +
Has shown efficacy
Cost Leverage Maximize in reducing
effective all + 3rd party + acquisition and/or
resources payer transmission of HIV
Identify priority interventions to optimize health outcomes for
PLWHA and avert new HIV infections
Step 2: Identified Compare to data Allocate
interventions on current efforts additional
and identify gaps resources to
14
efforts
15. SAN FRANCISCO INDICATORS
MSM IDU TFSM
(59,909) (18,942) (1,064)
HIV- HIV+ HIV- HIV+ HIV- HIV+
(46,244) (13,565) (14,820) (4,122) (659) (405)
Free Condoms 79% 70% 67% 69% 76% 84%
Free Needles 76% 97%
Individual
11% 16% 17% 16% 41% 41%
counseling
Group
5% 11% 8% 16% 38% 40%
counseling
15
Source: SF National HIV Behavioral Surveillance Project; Transfemale Needs Assessment; and 2011 HIV Consensus Estimates
16. PREVENTION INDICATORS, 2004-2011
49,789
0.9
0.81 46,101 46,101
0.8 0.75 0.75
0.78
0.7
37,394
0.73 0.72
34,997 34,518
0.6 0.59
0.5 28,285 0.55 0.58
27,806
0.4 26,368
0.3
9,834
0.2 8,605 0.16
5,532 0.14
0.09
0.1
0.06 0.08 4,917 0.07
0 3,688 4,302
MSM1 MSM2 MSM3
Free Condoms Individual Session Group Session NP Test p6m NP Test p12m
# of men reached red= all MSM, blue all non-HIV+ MSM, Population denominator based on
16
mean estimate for entire period Source: SF National HIV Behavioral Surveillance Project
17. SAN FRANCISCO INDICATORS
Parameters 2004-5 (%) 2008-9 (%)
Among MSM, HIV Test in Last 12 mos. 65 71
Among TFSM, HIV Test in Last 12 mos. NA 61 (2010)
HIV-Positive People Unaware of Status 24 17 (15-20)
% NOT tested past Testing deficit, 6
Populations At risk pop. size*
6 mos.** mos.
MSM 46,244 54% 24,972
IDU 15,020 58% 8,712
TFSM 659 63% 415
Min. total additional tests needed every 6 months 34,099
17
Source: SF National HIV Behavioral Surveillance Project; Transfemale Needs Assessment; and 2011 HIV Consensus Estimates: and SF HIV Surveillance
18. SAN FRANCISCO INDICATORS
2009 2010 Total
3M 6M 3M 6M 3M 6M
Total 112(89%) 117 (93%) 131 (92%) 135 (95%) 243 (91%) 252 (94%)
New HIV+ 50 (93%) 51 (94%) 57 (95%) 58 (97%) 107(94%) 109(96%)
Known HIV+ 62 (86%) 66 (92%) 74 (90%) 77(94%) 136 (88%) 143 (93%)
18
Source: HIV Epidemiology Section, SFDPH
19. SAN FRANCISCO INDICATORS
2007 2008 2009
3M 6M 3M 6M 3M 6M
Total 142 (65%) 160 (73%) 103 (64%) 116 (68%) 95 (61%) 105 (67%)
New
128 (65%) 143 (72%) 98 (65%) 109 (73%) 85 (60%) 92 (65%)
HIV+
Known
14 (64%) 17 (77%) 5 (46%) 7 (64%) 10 (67%) 13 (87%)
HIV+
19
Source: HIV Epidemiology Section, SFDPH
20. MEDIAN COUNT OF INITIAL CD4 COUNT
Populations in US Median Initial CD4 Cell Counts (cells/μL)
Total 182
White 239
Other/Unknown 180
African American 175
Below 350
Hispanic/Latino 160
Asian/Pacific Islander 225
CDC HIV Surveillance Supplemental Report, Volume 16, Number 1
Populations in San Francisco Median Initial CD4 Cell Counts (cells/μL)
Total 388
White 426 Below 500
Other/Unknown 464
African American 351
Latino 328 ~350 or below
Asian/Pacific Islander 319
20
SFDPH HIV Epidemiology 2010 Annual Report
21. MAJOR GAPS IN THE IMPLEMENTATION CASCADE:
COMPARING US DATA TO SAN FRANCISCO
120%
United States (Gardner, et al. CID 2011)
100%
100% United States (Cohen, et al. MMWR 2011)
79% 80% 80% San Francisco (SF Dept of Public Health, 2009)*
80%
68%
62%
59%
60% 57%
51%
47%
40% 41%
40% 36%
32% 28%
24%
19%
20%
0%
* SF data is preliminary – Not for distribution. SFDPH HIV Epidemiology & Surveillance 03/2012
22. SHOULD AIDS BE RENAMED “ACQUIRED
INFLAMMATORY DISEASE SYNDROME”?
• Untreated HIV disease is associated with
increased T cell activation/inflammation
• Treatment dramatically reduces inflammation
• The degree of residual inflammation during
HAART is determined in part by CD4 nadir
(strong effect < 200)
THE VIRUS IS MORE TOXIC THAN THE MEDICATIONS
22
Slide courtesy of Steve Deeks
23. UNIVERSAL OFFER OF ART ON WARD 86 AND ALL SFDPH
COMMUNITY HEALTH CLINICS (2010)
“All patients, regardless of CD4 count, will be evaluated for initiation of
antiretroviral therapy (ART)... While randomized controlled evidence
for patients with higher CD4 counts is not yet available, well-designed
retrospective and cohort studies support benefit in these patients. ”
Decision to start ART made
by the individual in
conjunction with their
provider
23
Modified from slide courtesy of Brad Hare, SFGH Community Forum
24. THE DATA
2000 IS IN!
2009
2001
2012 Source: al Sadr CROI 2012
25. WHERE WE WANT TO BE…
120%
and where we are in SF
100% 100% 100% 100% 100% 100%
80%
80%
68%
60% 57%
51%
47%
40%
20%
0%
HIV diagnosis Linked to Care Retained in On ART Undetectable
Care VL
* SF data is preliminary – Not for distribution. SFDPH HIV Epidemiology & Surveillance 03/2012
26. HIV PREVENTION PRIORITIZED
STRATEGIES & INTERVENTIONS
HIV Status Health Education and Prevention With
Awareness Risk Reduction Positives
• Routine HIV Testing • Syringe Access and • Treatment Adherence
in medical settings Disposal Services • Engagement in care
• Community Based • Condom Availability • STD, Viral
HIV Testing (with and Program Hepatitis, and TB
without pretest • Holistic Health Screening and
counseling) Models Treatment
• Linkage to care • Interventions to • Disclosure and
• Partner Services address drivers of Partner Services
HIV • Linkage to Ancillary
Services
Structural Changes
26
Source: HIV Prevention Plan
28. METRICS TO EVALUATE SF’s CONTINUUM OF
PREVENTION, CARE AND TREATMENT
Time to Virologic Suppression
Testing Diagnosis Primary Care Treatment Virologic Suppression
Linkage Engagement Engagement
HIV
/ Retention / Retention
Primary
Prevention
Efforts CD4 Linked to CD4 at ART Engaged Virologic Durable
• Condoms, at HIV Care within initiation in Care Suppression Virologic
• Syringes diagnosis 3 Mo. of Dx Suppression
• Reduction in
drivers of HIV Time to ART Initiation
NBHS and other
study results
Surveillance
Individual Population
28
29. Bold and candid conversations are needed at all levels
Jurisdictions are going to have to make tough choices
This is not simply about how much more money a
jurisdiction will need. If you scale one activity up,
another must be scaled down
This is not about implementing the same protocols and
interventions. You will need to identify new models of
services.
Jurisdictions are going to have to maximize the use of
their surveillance and clinical data
“Do the best you can until you know better. Then
when you know better, do better.” Maya Angelou
30. ACKNOWLEDGMENTS
People living with HIV/AIDS in San Francisco
SFDPH UCSF and PHP-Ward 86 at SFGH
Taylor Maturo, Moupali Das, Priscilla Chu, Diane Havlir, Brad Hare, Steve Deeks,
Glenn-Milo Santos, Susan Scheer, Willi Diane Jones
McFarland, H. Fisher Raymond, Tracey White House Office of National AIDS Policy
Packer, Dara Geckeler, Stephanie Cohen, Greg Millet, Jeff Crowley, Grant Colfax
Nicholas Moss, Noah Carraher, Susan
Philip, Erin Antunez, Tomas Aragon,
Barbara Garcia
Editor's Notes
Public Health AND Health Delivery System AND International Powerhouse of HIV Research
Public Health AND Health Delivery System AND International Powerhouse of HIV Research
Public Health AND Health Delivery System AND International Powerhouse of HIV Research
Public Health AND Health Delivery System AND International Powerhouse of HIV Research
Public Health AND Health Delivery System AND International Powerhouse of HIV Research
Public Health AND Health Delivery System AND International Powerhouse of HIV Research
Public Health AND Health Delivery System AND International Powerhouse of HIV Research
Public Health AND Health Delivery System AND International Powerhouse of HIV Research
Public Health AND Health Delivery System AND International Powerhouse of HIV Research
By the time most ppl are linked to care, the average CD4 cell count in the US is around 200! In SF it’s better at around 400 but we can and must do better. To achieve optimal health outcomes, it is critical that we focus on treatment for treatment’s sake before we talk about treatment as prevention. Once we start having ppl link to care with CD4 cell counts of 500+, then we can focus on TasP.
Nadir predicts both AIDS related and non AIDS related morbiditiesHypothesis :residual inflammation
The data is in- what’s good for the individual is good for the population.
We (collective, not just SF) need to raise the standard and do better at tx for tx sake.
Public Health AND Health Delivery System AND International Powerhouse of HIV Research