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DPH details "Getting to 0" strategy as new HIV diagnoses fall
Summary
Dr. Buckbinder reported sustained declines in new HIV diagnoses and described the Getting to 0 initiatives three committees (PrEP expansion, RAPID linkage, retention), funding commitments including $1.1M local DPH support and a $1.9M/year CDC application, and a focus on racial and age disparities in retention.
Dr. Buckbinder presented a progress report on San Francisco's "Getting to 0" initiative, defining the programs three goals: 0 new HIV infections, 0 HIV-associated deaths and 0 stigma. She told the commission the city has seen a substantial decline in new diagnoses since 2006, reporting a drop from over 1,000 in earlier years to about 302 in the most recent year cited, which she characterized as roughly a 70 percent reduction.
Buckbinder said the initiative uses a collective-impact model and launched in 2014 with three priority work streams: expand pre-exposure prophylaxis (PrEP) citywide, scale the RAPID program (same-day linkage to care and initiation of antiretroviral therapy) and strengthen retention programs for people diagnosed with HIV. "We started the first PrEP demonstration project in 2012," she said, and DPH has dedicated roughly $1.1 million to PrEP navigators and clinic delivery. Buckbinder also said DPH has applied to the Centers for Disease Control and Prevention for $1.9 million per year for three years to expand PrEP and retention work.
She described the PrEP committees workstreams: provider capacity expansion, outreach to high-risk but underserved users, and measurement of impact and harms (monitoring breakthrough infections, antiretroviral resistance and reports such as the one case cited where a person was denied life insurance while on PrEP). The RAPID pilot at San Francisco General enrolled 55 patients and the department plans citywide expansion to close gaps between diagnosis and care. The retention committee is focused on groups with lower viral suppression and follow-up—particularly African Americans, young people under 30 and injection-drug users.
Commissioners pressed on representation and reach. Buckbinder said the steering committee recently added four members representing heavily impacted communities, identified Native American providers and community partners, and is working on cultural-humility training. In response to questions about metrics and resource allocation, Buckbinder said each committee has interim goals and that ARCHES (DPHs epidemiology unit) is expanding measurement capacity to create surrogates and person-level metrics to find those the system is missing.
The commission did not vote on this information item; commissioners requested annual progress reports and suggested interim check-ins to track metrics and community engagement.
