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DPH reports declines in new HIV diagnoses but persistent disparities; outlines 'Getting to 0' strategy and STD response
Summary
San Franciscos Department of Public Health presented the 2018 HIV surveillance report showing a 58% decline in new diagnoses since 2012 but ongoing disparities (higher rates among African American and Latinx residents and low viral suppression among homeless people). The department outlined Getting to 0 initiatives, a community RFP (~$8M) to address disparities, and STD interventions including rapid testing and congenital syphilis prevention.
San Franciscos Department of Public Health on Jan. 21 presented data showing substantial progress on HIV but persistent disparities and new operational measures to address STDs.
Ling Su, director of HIV surveillance, summarized the 2018 HIV Epidemiology Annual Report: 94% of people living with HIV in San Francisco were aware of their diagnosis (higher than California and national averages); new diagnoses decreased 13% from 2017 to 2018 and 58% since 2012; nearly 16,000 residents were living with HIV at the end of 2018; and linkage to care within one month rose to 91% in 2018. Su also noted that viral suppression rates and the median time from diagnosis to suppression have improved (median time fell from 135 days in 2013 to 62 days in 2017), while disparities persist: African American and Latinx residents and people who inject drugs experienced increases in new diagnoses in recent years, and homeless people have much lower viral suppression (33% virally suppressed in 2017).
Jaime Scott (Getting to 0 steering committee/Ward 86) described the collective-impact model of Getting to 0 and program pillars: citywide PrEP coordination, rapid ART initiation (same-day ART), linkage and retention supports, stigma reduction, and targeted committees for adolescents and disparate populations. Scott highlighted PrEP delivery interventions (panel management and navigators) and noted large gaps in the PrEP cascade: the presentation cited roughly 15% PrEP adherence among trans women versus about 40% among men who have sex with men, and the STAY demonstration project and clinic-based coordinators were presented as strategies to narrow those gaps.
Nyesha Underwood described an RFP (released Sept. 2019) to fund community health access points serving seven priority populations with approximately $8 million available and 50% of funds directed to Latino and Black/African American populations; the RFP includes performance measures and funds integrated services including testing, navigation and linkage.
Dr. Susan Phillip (STD controller) reviewed rising reportable STDs and outlined a response to increased syphilis in women: a 95% jump in syphilis among women from 2017 to 2018 prompted expanded screening (including third-trimester screening for pregnant women), outreach and activation of an incident command system. City Clinic and partnership teams have ensured treatment for 9395% of women assigned to outreach, though three congenital syphilis cases were reported in 20189 the first nine months of 2019. City Clinic also piloted a rapid gonorrhea/chlamydia testing platform that reduced average days-to-treatment from 6.4 to 1.7; jail-health services implemented a rapid-testing lab that reduced time-to-treatment from 2.5 days to 0.2 days (JulyDec. 2019 figures cited).
Commissioners asked for disaggregated data (age at diagnosis by housing status, facility of diagnosis, race/ethnicity for care-indicator breakdowns) and for more detail about program rollouts and the RFP timeline; presenters said those breakdowns exist and offered to return with additional data. Commissioners and the director emphasized that structural drivers including homelessness, substance use and behavioral-health needs must be addressed to reduce HIV-related deaths and prevent congenital syphilis.
