Community & Public Health Committee, San Francisco Health - PowerPoint PPT Presentation

Tomás J. Aragón, MD, DrPH, Health Officer, Director, Population Health and Prevention (PHP) Israel Nieves-Rivera, PCSI Manager , PHP Priscilla Lee Chu, DrPH, MPH, PCSI Analyst, PHP San Francisco Department of Public Health Community & Public Health Committee, San Francisco Health Commission June 21, 2011

All federal initiatives are asking for the same thing: expand collaboration within and outside of health departments to implement targeted integrated services and programs that promote positive health outcomes for affected communities. • The Affordable Care Act- National Prevention and Health Promotion Strategy. • National HIV/AIDS Strategy • US Department of Health and Humans Services 12 Cities Project • NIH: TNT, TLC+, Mulit-Layered Prevention (etc.) • Ryan White HIV/AIDS Treatment Extension Act of 2009 • Program Collaboration and Service Integration (PCSI) • Enhanced Comprehensive HIV Prevention Plans (ECHPP) • Minority AIDS Initiative Targeted Capacity Expansion (MAI-TCE) • Expanded Testing Initiative (ETI)

Purpose of award: The purpose of this grant is to plan, scale- up, and support the implementation of a syndemic approach to the prevention of viral hepatitis, TB, STD’s, and HIV/AIDS . System Level Intervention: The goal of the grant is to develop system level changes that can be sustained over time. Service Delivery: 1. Reimbursement through third party payers (i.e., insurance) 2. Use existing categorical funding (e.g., current CDC cooperative agreements) 3. PCSI grant is the payer of “last resort”

To collaboratively develop a sustainable system of primary prevention and Mission : clinical care in San Francisco that comprehensively addressing HIV, other STDs, viral hepatitis, and TB to prevent transmission, disease, disability, and death; to reduce co-infections; and to increase health equity. The DPH PCSI project envisions a system of primary prevention and Vision: clinical care which effectively prevents, screens, treats, and monitors HIV, other STDs, viral hepatitis, and TB in a coordinated and efficient manner that maximizes health outcomes. DPH will build on existing best practices and find new ways to foster collaborative work, coordinate disease control and surveillance efforts, expand programmatic flexibility, and facilitate the appropriate integration of service delivery at the client level. Principles : • Client’s first, systems second • We must create a Win-Win-Win-Win Maximizing collective resources across sections • • We must lead, so that others may follow

• Completeness and maturity of registry • Reporting by laboratory • Analytical timeframe – Epidemiology – Reporting standards • Matching fields • Demographic fields in common

• Overall, 3% (N=4,296) of people affected by one disease had one or more co- HIV infections • Highest syndemics within- disease rates: Syphilis, STD Gonorrhea, and Chlamydia TB • Highest syndemics within- Syphilis Active TB Gonorrhea population rates for San Latent TB Chlamydia Francisco: HIV, Hepatitis B, Hepatitis C, and Latent TB • Demographic categories Viral Hepatitis correlated with having co- Chronic Hepatitis B infection: Male, African- Hepatitis C American, Latino/a, Age 20- 60

• HIV N=16,768 Syphilis • Highest HIV co-morbidity rates 1% were HCV, HBV, Chlamydia, Active TB Gonorrhea and latent TB 1% 2% • Populations with higher rates of HIV HIV infection are also at higher risk for co-infection with other Chlamydia Latent TB 13% transmittable diseases 2% 2% • Characteristics of those more likely to have a co-infection Hepatitis B Hepatitis C with HIV included: Non-white 3% 4% race/ethnicity, middle-aged, IDU, MSM-IDU

• Syphilis N=508 • Highest Syphilis co-morbidity HIV 44% rates were HIV, Chlamydia, and Active TB Gonorrhea Gonorrhea <1% 15% The syphilis epidemic in SF is • Syphilis comprised mostly of MSM 62% • While a high percentage of MSM Latent TB Chlamydia 17% had a co-morbidity with syphilis, 3% there was also a high percentage of MSM who did NOT have co- Hepatitis B Hepatitis C morbidity with syphilis 1% 4%

• Chlamydia N=3,890 • Highest Chlamydia co- HIV 9% morbidity rates were Gonorrhea, HIV, Syphilis, Active TB Syphilis <1% 2% and Latent TB Chlamydia • Characteristics of those more likely to have a co- 20% Gonorrhea Latent TB 11% 2% infection with Chlamydia included: male and Hepatitis B Hepatitis C transfemales, African- 1% 1% American, women, younger age, MSM

• Gonorrhea N=1,674 HIV 19% • Highest Gonorrhea co- Active TB Syphilis <1% 5% morbidity rates were Chlamydia, HIV, and Gonorrhea Syphilis 42% Chlamydia Latent TB 26% • Characteristics of those 1% more likely to have a co- infection with Gonorrhea Hepatitis B Hepatitis C 1% 2% included: African- American, and MSM

• Hepatitis B N=36,195 HIV 2% • Highest HBV co-morbidity rates were Latent TB, HIV, Active TB Syphilis <1% <1% and HCV • Characteristics of those Hepatitis B 5% more likely to have a co- Chlamydia Latent TB <1% 2% infection with Hepatitis B included: African- Hepatitis C Gonorrhea American and less than 60 1% <1%

• Hepatitis C N=10,718 HIV 6% • Highest HCV co-morbidity rates were HIV, Latent TB, Active TB Syphilis <1% <1% and HBV • Characteristics of those Hepatitis C 14% more likely to have a co- Chlamydia Latent TB <1% 5% infection with Hepatitis C included: Male, Non- Hepatitis B Gonorrhea White, 20-60 yrs old 4% <1%

HIV 3% • Active TB N=4,072 Latent TB N/A Syphilis <1% • Highest Active TB co- morbidity rates were HIV, Active HBV, and HCV TB 6% Chlamydia Hepatitis C • Characteristics of those <1% 1% more likely to have a co- infection with Active TB Hepatitis B Gonorrhea 2% <1% included: Male, 20-60, and homeless

• Latent TB N=73,186 HIV <1% • Highest Latent TB co- Active TB Syphilis morbidity rates were HBV, <1% HCV, and HIV Latent • Characteristics of those TB 2% Chlamydia more likely to have a co- Hepatitis C <1% 1% infection with Latent TB included: African- Hepatitis B Gonorrhea American, 30-60, 1% <1% homeless, and history of incarceration

Phase 3: Work groups, Evaluation and Implementation Plan Health Disparities and Clinical/Prevention Guidelines Using Data to Develop Action Plans for Integrated Efforts Review Develop Compare Identify Overview of each Federal and/or state Discrepancy between New screening specific disease and guidelines and/or current screening and/or vaccination data from the recommendations guidelines and data recommendations for Surveillance Baseline (e.g., USPSTF), HIV, STDs, VH and TB Assessment of Recommendations for SF . Syndemics for each from local planning disease groups (e.g. HPPC) , and Current DPH Guidelines for each disease New screening Data on current level Discrepancy between Educational recommendations for of integrated services current level of materials, TA plan. HIV, STDs, VH and TB to new screening integrated servcies indicators and for SF recommendations to new screening evaluation plan for recommendations measuring the impact of the new recommendations on the level of integrated services

Phase 3: Work groups, Evaluation and Implementation Plan DPH Data Systems Using Data to Develop Action Plans for Integrated Efforts Review Develop Compare Identify Recommendations Discrepancy between New CDC New standards to for sharing and/or new standards and confidentiality and current efforts integrated efforts current polices security standards for integrated surveillance Currents EMRs for The current EMRs Barriers to measuring Recommendations to clinical services with the results of integrated services in improve measuring our assessment to clinical settings the outcomes of measure current integrated services in integrated efforts clinical settings Current contracted Current efforts with Gaps in populations , Recommendations to and supported results of the new settings, as well improve measuring community delivered assessments as barriers to the outcomes of services measuring integrated integrated services in services in community settings community settings

Acknowledgments SFDPH: Tomas Aragon, Karen Anderson, Kyle Bernstein, Bill Blum, Deb Borne, Noah Carraher, Grant Colfax, Moupali Das, Susan Fernyak, Maureen Flaherty, Barbara Garcia, Jennifer Grinsdale, Lisa Golden, Barbara Haller, Emalie Huriaux, Sandra Huang, Ling Hsu, Lisa Johnson, Masae Kawamura, Bob Kohn, Julia Marcus, Maria X Martinez, Kate Monico-Klein, Kathy Murphy, Tracey Packer, Mark Pandori, Susan Phillip, Susan Scheer,Arfana Sogal, Fred Strauss, Frank Strona, Albert Yu and Janet Zola Harder + Co.: Kym Dorman, Michelle Magee, Clare Nolan, and Mariana Saenz