3. 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
4. High Impact HIV Prevention
“Using combinations of scientifically proven, cost-
effective, and scalable interventions targeted to
the right populations in the right geographic
areas”
5. CDC Resource Allocation Model
Intervention Cost Per New Infection Averted
Targeted Testing MSM $17,965
Testing in Healthcare Settings $51,293
Targeted Testing IDU $53,935
Prevention 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
6. Estimated Incidence Rates - 2010
Population Population in
2010 (13 +)
ESTIMATED
Incidence
Estimate,
2010
Estimated
Case 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
8. Geographic
analysis
Targeting sites to high
prevalence areas
Subpopulation analysis
Tracking distance to care
Identifying areas with
significant co-morbidities
Monitoring the epidemic at
the census tract level
9. Funding constraints
75% 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 exchange
No clinical labs or drugs for nPEP or PrEp
Emphasis on reimbursement for testing in healthcare settings
Overall decrease in both care and prevention resources
10. Prevention plan strategies to
decrease HIV transmission
Syringe Exchange
Condom distribution
Test and link to Care/Prevention with Positives
Reducing individual and community viral load
Preventing maternal to child transmission
Partner Services
Community mobilization; changing community norms
Highly focused behavioral interventions and/or low
threshold messaging
11. 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
12. Condom distribution
Youth, 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
14. HIV screening in healthcare
Implement CDC and USPTF guidelines for routine screening
in a variety of healthcare settings
City Jails
Emergency departments
Other outpatient settings
Community health care settings
Policy projects
Monitor and ensure linkage to HIV medical care
15. Targeted HIV testing
Hard to reach populations:
MSM and IDU
Mobile testing
Identification of venues for
testing
Neighborhood saturation
strategies – Do One Thing
Social network strategies
16. Test and Link to Care
Ensure HIV+ persons are linked to medical care
Support and retain HIV+ persons in medical care
Provide ART, support adherence, decrease viral load
Provide risk reduction support to HIV+ persons
Leverage the HIV medical care system to support HIV prevention
goals (e.g. Ryan White case management)
Improve voluntary partner services
Decrease over time the HE/RR targeting only HIV-negative
persons
17. Emerging initiatives
Social Marketing, Media and Mobilization
PrEP and nPEP
Structural changes, policy initiatives
Using surveillance data for public health purposes
surveillance-assisted retention activities
18. Collaboration, coordination, and
integration
Other systems
Ryan White Program Continuum of Care
Prison Health
Behavioral health
Schools
Private partnerships
Do One Thing
Patient navigation
HPG and stakeholder engagement
Hinweis der Redaktion
Elaborate on “scalable” Reference Kathleen’s presentation on epi data Use cost effective interventions Focus on activities that can be brought to full-scale in the targeted population Apply the right combination of interventions for the targeted population Prioritize programs that will have the maximum impact on reducing new HIV infections