outline of the philadelphia prevention plan
DESCRIPTION
Coleman Terrell (AACO)'s presentation on Philadelphia's HIV prevention plan, as presented to the HIV Prevention Planning Group (HPG) on July 24, 2013TRANSCRIPT
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June 2013
Outline of the Philadelphia Prevention Plan
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Philadelphia HIV Prevention
Plan
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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
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High Impact HIV Prevention
“Using combinations of scientifically proven, cost-effective, and scalable interventions targeted to the right populations in the right geographic areas”
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CDC Resource Allocation Model
Intervention Cost Per New Infection Averted
Targeted Testing MSM $17,965Testing in Healthcare Settings $51,293
Targeted Testing IDU $53,935Prevention 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
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Estimated Incidence Rates - 2010
Population Population in 2010 (13 +)ESTIMATED
Incidence Estimate, 2010
EstimatedCase 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
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Scalability of HE/RR
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Geographic analysis
Targeting sites to high prevalence areasSubpopulation analysis
Tracking distance to care
Identifying areas with significant co-morbidities
Monitoring the epidemic at the census tract level
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Funding constraints75% 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 exchangeNo clinical labs or drugs for nPEP or PrEpEmphasis on reimbursement for testing in
healthcare settingsOverall decrease in both care and prevention
resources
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Prevention plan strategies to decrease HIV transmissionSyringe ExchangeCondom distributionTest and link to Care/Prevention with
PositivesReducing individual and community viral load
Preventing maternal to child transmissionPartner ServicesCommunity mobilization; changing
community normsHighly focused behavioral interventions
and/or low threshold messaging
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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
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Condom distributionYouth, 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
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Philadelphia Engagement in Care by Mode of Transmission, 2009
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HIV screening in healthcare Implement CDC and USPTF guidelines for
routine screening in a variety of healthcare settingsCity JailsEmergency departmentsOther outpatient settingsCommunity health care settingsPolicy projects
Monitor and ensure linkage to HIV medical care
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Targeted HIV testing
Hard to reach populations: MSM and IDU
Mobile testingIdentification of
venues for testingNeighborhood
saturation strategies – Do One Thing
Social network strategies
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Test and Link to CareEnsure HIV+ persons are linked to medical careSupport and retain HIV+ persons in medical careProvide ART, support adherence, decrease viral
loadProvide risk reduction support to HIV+ personsLeverage the HIV medical care system to support
HIV prevention goals (e.g. Ryan White case management)
Improve voluntary partner servicesDecrease over time the HE/RR targeting only
HIV-negative persons
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Emerging initiatives Social Marketing, Media and MobilizationPrEP and nPEPStructural changes, policy initiativesUsing surveillance data for public health
purposessurveillance-assisted retention activities
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Collaboration, coordination, and integrationOther systems
Ryan White Program Continuum of CarePrison HealthBehavioral healthSchools
Private partnershipsDo One ThingPatient navigation
HPG and stakeholder engagement