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

Community & Public Health Committee, San Francisco Health Commission June 21, 2011

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

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 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 clinical care which effectively prevents, screens, treats, and monitors HIV,

• ther 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.

• 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

Mission: Vision: Principles:

• 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- infections

• Highest syndemics within-

disease rates: Syphilis, Gonorrhea, and Chlamydia

• Highest syndemics within-

population rates for San Francisco: HIV, Hepatitis B, Hepatitis C, and Latent TB

• Demographic categories

correlated with having co- infection: Male, African- American, Latino/a, Age 20- 60

HIV STD

Syphilis Gonorrhea Chlamydia

Viral Hepatitis

Chronic Hepatitis B Hepatitis C

TB

Active TB Latent TB

HIV

13%

Syphilis 1% Gonorrhea 2% Chlamydia 2% Hepatitis C 4% Hepatitis B 3% Latent TB 2% Active TB 1%

• HIV N=16,768
• Highest HIV co-morbidity rates

were HCV, HBV, Chlamydia, and latent TB

• Populations with higher rates of

HIV infection are also at higher risk for co-infection with other transmittable diseases

• Characteristics of those more

likely to have a co-infection with HIV included: Non-white race/ethnicity, middle-aged, IDU, MSM-IDU

Syphilis 62%

HIV 44% Gonorrhea 15% Chlamydia 17% Hepatitis C 4% Hepatitis B 1% Latent TB 3% Active TB <1%

• Syphilis N=508
• Highest Syphilis co-morbidity

rates were HIV, Chlamydia, and Gonorrhea

• The syphilis epidemic in SF is

comprised mostly of MSM

• While a high percentage of MSM

had a co-morbidity with syphilis, there was also a high percentage

• f MSM who did NOT have co-

morbidity with syphilis

Chlamydia 20%

HIV 9% Syphilis 2% Gonorrhea 11% Hepatitis C 1% Hepatitis B 1% Latent TB 2% Active TB <1%

• Chlamydia N=3,890
• Highest Chlamydia co-

morbidity rates were Gonorrhea, HIV, Syphilis, and Latent TB

• Characteristics of those

more likely to have a co- infection with Chlamydia included: male and transfemales, African- American, women, younger age, MSM

Gonorrhea 42%

HIV 19% Syphilis 5% Chlamydia 26% Hepatitis C 2% Hepatitis B 1% Latent TB 1% Active TB <1%

• Gonorrhea N=1,674
• Highest Gonorrhea co-

morbidity rates were Chlamydia, HIV, and Syphilis

• Characteristics of those

more likely to have a co- infection with Gonorrhea included: African- American, and MSM

Hepatitis B 5%

HIV 2% Syphilis <1% Chlamydia <1% Gonorrhea <1% Hepatitis C 1% Latent TB 2% Active TB <1%

• Hepatitis B N=36,195
• Highest HBV co-morbidity

rates were Latent TB, HIV, and HCV

• Characteristics of those

more likely to have a co- infection with Hepatitis B included: African- American and less than 60

Hepatitis C 14%

HIV 6% Syphilis <1% Chlamydia <1% Gonorrhea <1% Hepatitis B 4% Latent TB 5% Active TB <1%

• Hepatitis C N=10,718
• Highest HCV co-morbidity

rates were HIV, Latent TB, and HBV

• Characteristics of those

more likely to have a co- infection with Hepatitis C included: Male, Non- White, 20-60 yrs old

Active TB 6%

HIV 3% Syphilis <1% Chlamydia <1% Gonorrhea <1% Hepatitis B 2% Hepatitis C 1% Latent TB N/A

• Active TB N=4,072
• Highest Active TB co-

morbidity rates were HIV, HBV, and HCV

• Characteristics of those

more likely to have a co- infection with Active TB included: Male, 20-60, and homeless

Latent TB 2%

HIV <1% Syphilis <1% Chlamydia <1% Gonorrhea <1% Hepatitis B 1% Hepatitis C 1% Active TB

• Latent TB N=73,186
• Highest Latent TB co-

morbidity rates were HBV, HCV, and HIV

• Characteristics of those

more likely to have a co- infection with Latent TB included: African- American, 30-60, homeless, and history of incarceration

Overview of each specific disease and data from the Surveillance Baseline Assessment of Syndemics for each disease Discrepancy between current screening guidelines and data New screening and/or vaccination recommendations for HIV, STDs, VH and TB for SF. New screening recommendations for HIV, STDs, VH and TB for SF Data on current level

• f integrated services

to new screening recommendations Discrepancy between current level of integrated servcies to new screening recommendations Educational materials, TA plan. indicators and evaluation plan for measuring the impact of the new recommendations on the level of integrated services Review Compare Identify Develop

Phase 3: Work groups, Evaluation and Implementation Plan

Health Disparities and Clinical/Prevention Guidelines Using Data to Develop Action Plans for Integrated Efforts

Federal and/or state guidelines and/or recommendations (e.g., USPSTF), Recommendations from local planning groups (e.g. HPPC) , and Current DPH Guidelines for each disease

New CDC confidentiality and security standards for integrated surveillance New standards to current efforts Discrepancy between new standards and current polices Recommendations for sharing and/or integrated efforts Currents EMRs for clinical services The current EMRs with the results of

• ur assessment to

measure current integrated efforts Barriers to measuring integrated services in clinical settings Recommendations to improve measuring the outcomes of integrated services in clinical settings Current contracted and supported community delivered services Current efforts with results of the assessments Gaps in populations , new settings, as well as barriers to measuring integrated services in community settings Recommendations to improve measuring the outcomes of integrated services in community settings Review Compare Identify Develop

Phase 3: Work groups, Evaluation and Implementation Plan

DPH Data Systems Using Data to Develop Action Plans for Integrated Efforts

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

Acknowledgments