Michael Kharfen
Bureau Chief, Partnerships, Capacity Building, Community Outreach
DC Department of Health
HIV/AIDS, Hepatitis, STD and TB Administration
2. SYNChronicity
DC HIV Public-Private Partnerships
“Offer the Test”
Michael Kharfen
Bureau Chief, Partnerships, Capacity
Building, Community Outreach
DC Department of Health
HIV/AIDS, Hepatitis, STD and TB Administration
3. Partnership Portfolio
• Corporate
▫ HIV Testing and Gilead
Department of Motor Vehicles
Social Service Center
• Foundation
▫ DC Female Condom Project and MAC AIDS Fund
Education/Distribution
• Government/Academic
▫ DC Partnership for HIV/AIDS Progress and NIH
Research
Clinical Services
4. HIV/AIDS in DC
Prevalence of HIV/AIDS in the 1.9%
District of Columbia, 2009
• 16,721 reported living with HIV/AIDS in the 0.4%
District at the end of 2009 2.7% 3.0%
• 5,505 new HIV cases reported between 2005
and 2009
• 3.2% of the District’s population diagnosed with
HIV/AIDS 2.3%
• One-third to one-half of people (locally) may be 3.0% 2.7%
unaware of their HIV status. (Source: DC NHBS
data)
DC Resident Living with HIV/AIDS as of 2009, by Gender and
Race/Ethnicity
Black Hispanic White Other Total
Male 8,325 756 2,620 350 12,051 3.1% Percentage
Female 4,256 156 141 117 4,670 0-1.4%
1.5%-2.4%
Total 12,581 912 2,761 467 16,721
2.5%-3.4%
DC% 75.2% 5.5% 16.5% 2.8% 100.0%
US% (2008) 49.3% 20.0% 27.8% 2.9% 100.0%
5. HIV/AIDS in DC
8.0%
7.1%
7.0%
6.0%
Overall DC
5.0% 4.7% HIV/AIDS
prevalence
Among Adults
and
4.0% Adolescents
3.4% 3.2%
2.9% 2.8%
3.0%
2.1%
2.0% 1.8%
1.0% 1.0%
0.0%
Black Males All Blacks Hispanic White Black All All Whites
Males Males Females Hispanics
HIV Prevalence by Race/Ethnicity (diagnosed cases)
7. Public Health Imperative
• Generalized Epidemic
▫ Missed Opportunities
• DC Policy Recommendation
▫ Routine annual testing for all adults and adolescents
(ages 13 to 84)
• DC Routine HIV Testing Program
▫ Hospitals (EDs)
▫ Primary care clinics
▫ Outreach testing
• Success
▫ More than 40 partners
▫ 43,000 in 2007 to 122,000 in 2011
8.
9. Private Sector Approach
• Pharma inspired components
▫ Consumer Driven “Ask for the Test”
▫ Provider Driven “Offer the Test”
• Gap
▫ Private Practitioners
• New Partnership
▫ GBC Health
▫ Pfizer
• Private Sector Core Competency
▫ Detailing
10. “Offer the Test”
• Department of Health Materials
▫ Handbook
▫ Poster
▫ Patient Information Cards
▫ Button
• Sales representative training
• ~200 primary care practices
11. Provider Survey
• Details
▫ Period: 12/1/10 – 2/11/11 (3 months)
▫ Method: Internet / Phone
▫ Respondents: 106
• Focus
▫ Provider & Patient Demographics
▫ Provider Understanding of HIV/AIDS in DC
▫ Provider Testing Practices
▫ Provider Knowledge of Testing Guidelines
12. Provider Survey
Which DC quadrant(s) meet the UN Which age groups would you say have an
threshold for a “generalized and severe” HIV/AIDS prevalence of above 1% in
HIV epidemic? (Select all that apply). Washington, D.C.? (Select all that apply).
80% 80%
70% 70%
60% 60%
50% 50%
40% 40%
30% 30%
20%
20% 10%
10% 0%
0%
30 – 20 – 40 – 50 – 60+ 13 – Don't None
SE NE SW NW I don't None 39 29 49 59 19 know
know
What percent of heterosexual HIV+ DC What percent of HIV+ DC residents test
residents do not know their HIV status? “late” for HIV/AIDS?
45% 45%
40% 40%
35% 35%
30% 30%
25% 25%
20% 20%
15% 15%
10% 10%
5% 5%
0% 0%
51 – 75% 26 – 0 – 25% I don’t 76 – 51 – 75% 26 – I don’t 0 – 25% 76 –
50% know 100% 50% know 100%
13. Provider Survey
It is important to incorporate routine What % of your patient population would
HIV screening in the medical care of you estimate you offered an HIV test?
all my adult patients/clients: 25
20
Neither
Agree 6% 15
22%
10
Disagree
2% 5
Strongly Strongly
0
agree disagree
69% 1%
14. Provider Survey
• DC Testing Recommendation
▫ Aware: 69%
▫ Implementing: 49%
• Barriers
▫ Limited time to perform HIV counseling
▫ None
▫ Cost or reimbursement concerns
▫ Limited time to perform HIV testing
▫ HIV is not an issue for my patient population
15. Lessons Learned
• Partnerships work
▫ Shared health missions
▫ Shared health goals
• Data/Evaluation
▫ National model significance
▫ Challenges
• Sustainability
▫ Communication
▫ Refresh design, training, materials
