Implementation of the HIV Prevention Priorities from the 2004 Plan

1
Implementation of the HIV Prevention Priorities
from the 2004 Plan

• Were We Successful?
• July 10th, 2008

2
Background

• SF has a long history of commitment to evaluating
  the work of HIV prevention
• Project STOREE (San Francisco Tells Our Real
  Experience Through Evaluation) grew out of the
  2004 HPPC Strategic Evaluation Plan
• Gather the stories
• Create information bridges
• Use stories to create change

3
Presentation Goals

• To address Community Planning Goal 3
• Community planning ensures that HIV prevention
  resources target priority populations and
  interventions set forth in the comprehensive HIV
  prevention plan.
• Today we will look at the priorities you set in
  the 2004 Plan, and view data showing how they
  have been implemented
• We will discuss some issues that the data raises,
  and consider the implications for prevention

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Presentation Outline

• Part 1 From Epidemiology to Programs
• Are we reaching behavioral risk populations
  (BRPs) as intended?
• Part 2 Client HIV Risk
• Are we reaching the people most at risk?
• Part 3 Snapshot of HIV Prevention Clients
• Who did HERR and PWP programs reach from April
  2007 March 2008?

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Part 1 From Epidemiology to Programs

• Are we reaching behavioral risk populations
  (BRPs) as intended?

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The End

7
The First BarEstimated New HIV Infections

• Estimates developed in 2001
• Arrived at through a Consensus process
• Strengths Takes into account multiple data
  sources
• Limitations Estimates are not exact estimates
  are 7 yrs old
• Used by HPPC to prioritize BRPs and recommend
  funding percentages (Bar 2)

8
The First BarEstimated New HIV Infections by
BRP, 2001
Tier 2
Tier 3
Tier 4
Tier 1
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The Second BarHPPC Funding Recommendation

• recommendations are from the 2004 Plan
• Intended to apply to all programs funded by the
  Prevention Section (CDC, State, Local)
• Based on the of new infections in each Tier

10
The Second BarHPPC Funding Recommendations
73-81
18-22
1-5
lt1
11
The Third BarContracted from 2004 RFP

• Represents all direct service funds
• CDC, State, Local
• HERR, PWP, CTL
• Based on contracts from 06/07 fiscal year and 07
  calendar year
• Approximately 10.5 million annually

12
The Third BarAnnual Contracted from 2004 RFP
in Millions
Tier 3 551K (5)
Tier 4 317K (3)
Tier 1 7.6 million (72)
Tier 2 2.1 million (20)
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The Fourth BarHIV Prevention Clients

• This is the most complicated bar
• Four key things to understand
• Acronyms
• What is the data
• Which clients are represented and which are not
• Data strengths and limitations

A question for discussion
Interpret with caution
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Acronyms

• HERR Health Education/Risk Reduction
• PWP Prevention with Positives
• IRRC Individual Risk Reduction Counseling
• PCM Prevention Case Management
• SSG Single Session Group
• MSW Multiple Session Workshop
• DIG Drop-in Group
• NOC Number of Contacts
• UDC Unduplicated Clients (People)
• BRP Behavioral Risk Population

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The Fourth BarWhat is the data?

• Core Variables data is
• 17 pieces of data (demographics and behavior
  see handout)
• Collected by HERR and PWP direct services
  providers
• Collected on all program participants
• Designed to tell us who prevention is reaching

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The Fourth BarWho is represented?

• Clients of all HERR and PWP programs
  participating in IRRC, PCM, SSG, and/or MSW (with
  some important exceptions)
• The bar represents people (UDC)
• Contacts (NOC) looks a little different, and data
  is less reliable
• Clients who participated in programs between
  4/1/07 and 3/31/08

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The Fourth BarWho is not represented?

• DIG and outreach clients
• Data is on contacts (NOC) not people (UDC)
• Data is not as complete
• Venue-based group outreach clients
• Counseling and testing clients
• Syringe program clients (formerly known as needle
  exchange)
• Non-direct services (e.g., physician training,
  social marketing)
• Any services/programs not funded by the HPS
• Under-represented homeless, disenfranchised

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The Fourth BarData Strengths

• Reflective of most direct service HERR and PWP
  programs funded by the Prevention Section
• Reflects 53 of contracted dollars
• Reflects 35 of contracted NOC
• Good completeness rates for basic demographic
  variables
• Large numbers of clients/contacts

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The Fourth BarData Limitations

• Overall, will tend to overcount the number of
  clients
• High rates of missing data for some variables
• May under-represent client risks
• Data quality assurance processes not fully
  developed

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The Fourth BarHIV Prevention Clients by Tier
Missing data 23
21
The Fourth BarHIV Prevention Clients by BRP
n 10,986 clients
Missing Data 23
22
HIV-Positive HIV Prevention Clients

Missing Data 17
23
HIV Prevention ClientsHIV-Negative, Never
Tested, HIV Status Other/Missing

• FSM MSF (n3,327)
• Clients 43
• New HIV 1

• MSM MSM-IDU (n3,222)
• Clients 41
• New HIV 77

Missing Data 26
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The End

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Why? What Happened?Some Theories

• Contracts vs. HPPC recommendations
• Contracts were on the low end of HPPC range for
  Tier 1 and on the higher end for Tiers 3 and 4
• Contracts 10 flexibility
• Providers do not have complete control over who
  walks through their doors
• Providers may in fact be meeting their BRP
  contract goals, and the FSM and MSF they serve
  are above and beyond the goal

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Why? What Happened?Some Theories

• FSM and MSF may be miscategorized
• Some MSF could be MSM not disclosing sex with men
• Some FSM could be trans females identifying as
  female
• Core variables represents only a subset of
  services
• If all services were included, the data might
  look different

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Why? What Happened?Some Theories

• Missed the forest for the trees
• Did a great job of addressing multiple cofactors
  and vulnerable populations(the trees)
• But the result is a distribution of services
  that is skewed towards lower risk populations
  with multiple cofactors (the forest)
• This is an argument for drivers drivers can
  help us re-focus on higher risk populations

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Part 2 Client HIV Risk

• Are we reaching the people most at risk?

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Risk Level (at first contact)

• At Risk
• Reported any unprotected sex and/or needle
  sharing
• High Risk
• Reported unprotected sex with a partner(s) of
  different or unknown serostatus and/or needle
  sharing

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Risk Level (at first contact)(UDC for HERR
PWP IRRC, PCM, SSG, MSW)
39 of clients with complete data reported no
unprotected sex and no needle sharing.
n 10,582 clients
Missing data 27
31
Risk Level (at first contact)(UDC for HERR
PWP IRRC, PCM, SSG, MSW)
Overall (n10,582)
HIV (n3,067)
FSM MSF (n3,349)
MSM non-IDU (n4,193)
Missing data 12-27
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Part 3 Snapshot of HIV Prevention Clients

• Who did HERR and PWP programs reach from April
  2007 March 2008?

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Overview Clients and Contacts(HERR PWP,
4/1/2007 3/31/2008)

• Unduplicated clients for IRRC, PCM, SSG, MSW
• Overall 14,456 clients 75,208 contacts
• HERR 11,402 clients
• PWP 3,052 clients
• Outreach/drop-in group contacts
• Overall 151,185 contacts
• HERR 146,900 contacts
• PWP 4,285 contacts

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Overview Clients and Contacts(SPs 4/1/2007
3/31/2008 CTL 1/1/2007 12/31/2007)

• Syringe program contacts
• 43,899 contacts
• 2,355,999 syringes accessed
• CTL Network as a whole (includes funded and
  non-funded sites)
• 16,846 tests run
• 344 positive tests
• 309 newly-identified people with HIV (1.8)

35
Overview Intervention Types(NOC for HERR PWP)
Missing Data lt.1
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A Word on the Following Slides

• New HIV Diagnoses represents new diagnoses
  reported to HIV/AIDS surveillance from 2005-2007
• Boxes point out where the proportion of clients
  reached differs substantially from the proportion
  of new diagnoses

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Gender(UDC for HERR PWP IRRC, PCM, SSG, MSW)
New HIV Diagnoses 90 male 8 female 3 trans
persons
Missing Data 2
38
Race/Ethnicity(UDC for HERR PWP IRRC, PCM,
SSG, MSW)
New HIV Diagnoses 16 African Americans 56
whites .
Missing Data 4
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Age (UDC for HERR PWP IRRC, PCM, SSG, MSW)

Missing Data 4
40
Neighborhood(UDC for HERR PWP IRRC, PCM, SSG,
MSW)
Other SF Neighborhoods Include North Beach,
Chinatown, Financial District, Telegraph Hill,
Outer Mission, Excelsior, Crocker Amazon,
Richmond, Sunset, St. Francis Woods, Diamond
Heights, Twin Peaks, Glen Park, Visitacion
Valley, Treasure Island, Potrero Hill, Lake
Merced, Stonestown, Sunnydale, Marina,
incarcerated, and other living situations in SF
(e.g., treatment program).
New HIV diagnoses Castro 14 Tenderloin 19
Missing Data 11
41
Lives Outside SF(UDC for HERR PWP IRRC, PCM,
SSG, MSW)
Missing/Invalid Data 7
42
HIV Status(UDC for HERR PWP IRRC, PCM, SSG,
MSW)
Who Are the 8 Never Tested? 61 under 25 42
report unprotected sex and/or needle sharing
Missing Data 23
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HIV Prevention Successes
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HIV Prevention Successes

• Numbers reached across HERR, PWP, CTL and syringe
  access
• More than 20,000 people
• More than 286,000 contacts
• HIV-positive people are being reached with
  prevention in substantial numbers
• A testament to the success of HPPC prioritizing
  PWP

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HIV Prevention Successes

• Syringe access
• Volume and accessibility of clean syringes has
  and continues to have a substantial impact on the
  epidemic
• Counseling and testing
• In 2007, helped 309 people learn their HIV
  positive status (66 of all new diagnoses in SF)

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Evaluation Successes

• Evaluation and data are helping us
• Gather the stories
• Create information bridges
• Use the stories to create change
• We minimized data collection burden
• Our work together has enabled us to reflect on
  our services and the impact our work is having on
  HIV in San Francisco

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Acknowledgments

• AGUILAS
• Ark of Refuge
• API Wellness Center
• BAY Positives
• Black Coalition on AIDS
• El/La
• Girls After School Academy
• Homeless Youth Alliance
• Hermanos de Luna y Sol

• Institute for Community Health Outreach
• Instituto Familiar de la Raza
• Iris Center
• Larkin Street Youth Services
• Native American AIDS Project
• New Leaf
• Positive SHE
• San Francisco AIDS Foundation

• SF LGBT Center
• Shanti
• STD Prevention and Control
• Stonewall Project
• STOP AIDS
• St. James Infirmary
• Tenderloin Health
• UCSF AIDS Health Project

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Acknowledgments

• HIV Prevention Planning Council (HPPC)
• HIV Prevention Section (HPS) Staff
• Grant Colfax
• Tracey Packer
• Core Variables Consultants
• Kym Dorman
• Rick Green
• Steven LaFrance
• Jennifer Lorvick
• Clare Nolan
• Maricela Piña
• Willow Schrager
• JT Taylor
• Lynn Wenger

• Program Managers
• Elizabeth Davis
• Teri Dowling
• Erik Dubon
• John Melichar
• John Pabustan
• HPS Data Team
• Dara Coan
• Art DeGuzman
• Gemma Deocampo
• Shelley Facente
• Kaitlyn Gam
• Guillermo Gonzalez
• Yanyuan Liu