June 2013

Outline of the Philadelphia Prevention Plan

Philadelphia HIV Prevention

Plan

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

High Impact HIV Prevention

“Using combinations of scientifically proven, cost-effective, and scalable interventions targeted to the right populations in the right geographic areas”

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

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

Scalability of HE/RR

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

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

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

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

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

Philadelphia Engagement in Care by Mode of Transmission, 2009

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

Targeted HIV testing

Hard to reach populations: MSM and IDU

Mobile testingIdentification of

venues for testingNeighborhood

saturation strategies – Do One Thing

Social network strategies

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

Emerging initiatives Social Marketing, Media and MobilizationPrEP and nPEPStructural changes, policy initiativesUsing surveillance data for public health

purposessurveillance-assisted retention activities

Collaboration, coordination, and integrationOther systems

Ryan White Program Continuum of CarePrison HealthBehavioral healthSchools

Private partnershipsDo One ThingPatient navigation

HPG and stakeholder engagement