Word on the Street: What You Should Know from the Community  | November 2016
Word on the Street, July 2016, from the UCSF Center for AIDS Prevention Studies and Prevention Research Center
"Word on the Street" is disseminated quarterly to inform CAPS/UCSF PRC of new developments, issues, programs, policy agendas, etc. that are happening in, affecting, and are of interest to the community. 

 In This Issue

  1. San Francisco EMA HIV Community Planning Council (HCPC)
  2. Oakland TGA Collaborative Community Planning Council (CCPC)
  3. California Department of Public Health Office of AIDS
  4. Get Screened Oakland and Global Network of Black People working in HIV
San Francisco EMA HIV Community Planning Council (HCPC)
Highlights/takeaways from the July 25th, August 29th, and September 26th meetings:

Getting to Zero
  • The Community Health Equity and Promotion (CHEP) Branch at SFDPH supports use of STD and HIV surveillance data to increase PrEP access for priority populations, including Black MSM, Latino MSM, and transgender women.
  • PrEP priorities and goals for 2016-17 have been identified, including aging and PrEP access, and expansion of PrEP use from 15,000 to 20,000 individuals.
  • Evidence supports the need to focus on individuals who inject drugs and address associated stigma among providers.

      Syringe Exchange
      • The number of syringe disposal boxes in San Francisco are increasing.  A box is now available on the front of Conard House at 150 9th Street, one is being considered for placement between 8th and 9th Street.
      • CHEP is participating on the Mayor’s “Fix It” Team to address concerns of discarded syringes in “hot spots”.
      • San Francisco AIDS Foundation (SFAF) has expanded syringe access services at its 6th Street site to include more directive care for injection drug users and distribution of Naloxone.
      • SFAF and CHEP will participate in the “Building Community Engagement for Syringe Access Programs” webinar in November. 
      Oakland TGA Collaborative Community Planning Council (CCPC)
      Highlights/takeaways from the July27th and August 31st meetings:

      Integrated HIV Prevention & Care Plan is approved.

      Minority AIDS Initiative (MAI)

      • In its final year of services
      • Served 400 clients during the past report year
      • Is not successful retaining substance using clients in care
      • Trauma is thought to be a major issue among client but there is little empirical data to support anecdotal information

      Rapid ART Program

      • Alameda County Public Health Department (ACPHD) Office of AIDS Administration (OAA) Linkage Team connected its 100th client to care including newly diagnosed and lost to care individuals
      • A rapid ART protocol has been created and discussion for a rapid ART model in HIV clinics in Alameda County is underway
      • Contra Costa County (CCC) is exploring a process and protocols for rapid ART as a potential service provision at the health department level
      • Early intervention services have been reinstated in CCC as a Ryan White funded service
      • Alameda County is seeking HRSA’s approval for one-time use of carryover funds ($65,000) for a special project “Needs Assessment on African American MSM, Gay, and Bisexual identified Men Living with HIV in Alameda County”
      • New HRSA RFPs are scheduled for release in November 2016 and spring 2017, including Mental Health, Psychosocial Support Services, the Administrative Support Contract, Substance Abuse, and Transportation; CCPC will respond to Mental Health, Psychosocial Support Services, and the Administrative Support Contract
      • The Fast Track Cities International Initiative kicked off by the United Nations is collaborating with ACPHD OAA and the City of Oakland to develop Oakland focused initiatives, including an HIV data dashboard 
      California Department of Public Health Office of AIDS (CDPH–OA)

      The CDPH-OA presented at both the HCPC and CCPC meetings. 

      Highlights/takeaways include:

      • The California Integrated HIV Surveillance, Prevention and Care Plan “Laying a Foundation for Getting to Zero” is available on the OA website.
      • The HIV Prevention Branch has launched CA’s Syringe Exchange Supplies Clearinghouse.
      • Routine HIV testing in jails is planned.

      Get Screened Oakland and Global Network of Black People working in HIV
      Highlights/takeaways from the October 6, 2016 Summit:

      This Oakland/East Bay HIV Summit “Moving Out of the Shadows” endorsed by the Black Treatment Advocates Network and Bay Area State of Emergency brought together 65 key stakeholders in the fight against HIV, including clinicians, community based HIV prevention and care providers, advocates, local public health departments, academia, policy makers, and people living with HIV/AIDS (PLWHA) to discuss HIV in the Black Community.  The day-long event highlighted presentations and panel talks that discussed: a) HIV from infancy through youth and adulthood; b) the use of testing and program data to understand the local epidemic; c) East Bay community based organization executive directors’ experiences with and knowledge of HIV gaps, challenges and opportunities for synergies across the Alameda County system of care and prevention; as well as remarks from Alameda County Public Health Department’s (ACPHD) HIV STD Director.  See speaker/panelist list below.

      Highlights/takeaways include:
      HIV Testing
       Gilead’s supported and expanded testing/screening program FOCUS: Frontlines of U.S. Cities shows that HIV and HCV testing and the number of participating cities across the U.S. have increased overtime since the program’s inception in 2006.  Twelve Bay Area FOCUS partners exist including: Lifelong Medical Care, Alameda Health Consortium, Sutter Health, La Clinica, UCSF Benioff Children’s Hospital Oakland, UCSF, Asian Health Services, HEPPAC, Center Point DAAC, Tri-City Health Center, Highland Hospital, Tiburcio Vasquez Health Center, Inc. Important national and local findings are highlighted.

      • Expanded testing success is attributed to implementation of the four pillars of routine testing: integrated testing into normal clinic flow; EMR modification; systemic policy change; and training feedback and quality improvement.  
      • More than 3 million HIV tests and more than 250,000 HCV tests have been conducted nationally to date. 
      • Since 2010, there have been 2,623,617 HIV tests and 20,154 positives for an overall sero-positivity rate of 0.77%, a hospital partnerships rate of 0.82%, and a community health center partnerships rate of 0.60%.

      o    African Americans account for 72% of the positives
      o    78% median of total positives were linked to care

      • From January 1, 2014 to August 31, 2016 the
      o    Bay Area HIV care cascade revealed 72% loss to care: 128,080 tests → 299 positives → 215 linked to care
      o    HCV cascade showed a 57% linkage rate: 43,239 HCV Ab tests → 3,259 HCV Ab+ → 2,770 RNA tests → 1,4440 HCV RNA+ → 821 linked to care.
       
      Impending HIV Challenges and Research Prospects
      • Perinatal infected children who are aging into youth/young adult status face many challenges including: parental disclosure of their HIV status to them, familial independence and subsequent retention in care/adherence to HIV treatment regimen. 
      • Significant psychosocial and sociocultural issues need to be addressed in the pediatric patient population
      • Opt out screening remains critical to reduce the effect of HIV among young people/youth.
      • Perinatal HIV remains an issue in the greater Oakland community, primarily because of the international adoption of Black infants and young children.
      • Care linkage and retention challenges continue to exist within the network of federally qualified health centers and the Alameda Health care system.
      • There is a growing concern for the role of opioids in HIV infection.
      • The examination of HIV health disparities must consider the social determinants of health and health equity as well as cultural sensibilities and sensitivities.
      HIV Research
       Programs and research projects (e.g., CRUSH) at the East Bay AIDS Center Downtown Youth Center show success:
      • Building retention in care and prevention services partnerships
      • Integrating biomedical prevention services into the clinical routine
      • Engaging young men of color in both treatment and newly established prevention services
      Incentivized and social network testing research among adults in Oakland…
      • Identified 243 network associates from 10 PLWH seeds
      • Identified new HIV positive persons and those who had been lost to care
      • Resulted in a new collaboration between the University of California Berkeley and Alameda County Public Health Department Office of AIDS Administration where a new testing algorithm was implemented
      • Led to new research that examines gamification as a HIV testing engagement strategy
      Panel Discussion
      As panelists identify and serve those most at risk and living with HIV, gaps in services and challenges facing their agencies include:
      • A lack of substance abuse services and mental health services. 
      • The need for temporary and permanent housing for PLWHA.
      • Collaborations across community and clinical programs – all panelists want more support of this. 
      • The one language fits all approach.  Getting to Zero is not acceptable and translatable to the African American community, given their HIV statistics.  It is recommended that a different language is developed that speaks to the African American epidemic.
      • Dwindling HIV prevention resources and funding to serve the community in general.  Oakland has a somewhat generalized epidemic, yet funding is targeted to the traditional populations and therefore excludes some of those who are at risk for infection.
      Summit organizer, speakers, panelists, and other representatives:
      Marsha Martin, DSW, Summit Organizer
      Xavier Johnson, Greetings on behalf of the Office of Congresswoman Barbara Lee
      Ann Petru, MD, UCSF Benioff Children’s Hospital Oakland;
      Veronica Ramirez, NP, Sutter Health;
      Sandi McCoy, PhD, UC-Berkeley;
      Myra Orzaeta, Gilead Sciences, Inc.;
      Lois Lindsey, Alameda Health Consortium;
      Monica Chadwick, ACMC-Highland Hospital;
      Kathleen Clannon, MD, AC Health Care Services Agency;
      Panelists: Gloria Lockett, CALPEP; Cynthia Carey Grant, WORLD; Stephanie Montgomery, Part D Alameda and Contra Costa Counties; Rob Newells, APEB; Loris Mattox, HEPPAC / Moderator: Barbara Green Ajufo, DrPH, UCSF CAPS;
      Nick Moss, MD, AC Office of AIDS Administration

      Moving out of the Shadows - HIV in the Black Community: An Oakland/East Bay Summit
      If you have questions or need more information, please contact Barbara:

      Barbara Green-Ajufo, DrPH, MPH
      Research Partnership Manager
      Technology and Information Exchange (TIE) Core
      Phone: (415) 476-6362
      Email: barbara.green-ajufo@ucsf.edu
      Quick Links
      The mission of Center for AIDS Prevention Studies is to end the HIV epidemic and associated health and social disparities by conducting high impact HIV prevention science and building capacity among researchers and communities to effectively address HIV. Grant #: 2P30MH062246
      The mission of the UCSF Prevention Research Center is to maintain an interdependent network of community, academic, and public health partners to design and implement prevention research aimed at answering significant and innovative HIV research questions and promoting the wide use of practices proven to promote health for those infected and affected by HIV.  Grant #: 5U48DP004998 
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