State Office of AIDS Update May 3, 2017 Juliana Grant, MD MPH Chief, Surveillance, Research, and Evaluation Branch Office of AIDS California Department of Public Health 1

Office of AIDS (OA) California Dept of Public Health (CDPH) Lead responsibility for coordinating state programs, services, and activities relating to HIV/AIDS HIV prevention HIV care HIV treatment: ADAP and OA-HIPP HIV/AIDS surveillance, research, and program evaluation 2

Source: HIV/AIDS Surveillance, eHARS data as of Mar 16, 2017 The Big Picture Source: HIV/AIDS Surveillance, eHARS data as of Mar 16, 2017

Source: HIV/AIDS Surveillance, eHARS data as of Mar 16, 2017 Demographic Characteristics of Persons Living with HIV/AIDS: California, 2015 Risk Category Gender Race/Ethnicity Source: HIV/AIDS Surveillance, eHARS data as of Mar 16, 2017

Source: HIV/AIDS Surveillance, eHARS data as of Mar 16, 2017 Demographic Characteristics of Persons Newly Diagnosed with HIV/AIDS, California, 2015 Risk Category Gender Race/Ethnicity Source: HIV/AIDS Surveillance, eHARS data as of Mar 16, 2017

Source: HIV/AIDS Surveillance, eHARS data as of Dec 31, 2015 Age Distribution of Newly Diagnosed HIV Infection and Living HIV/AIDS Cases: California, 2014 Source: HIV/AIDS Surveillance, eHARS data as of Dec 31, 2015

California’s Continuum of HIV Care – 2015 Unaware Data were obtained from the HIV surveillance system, for persons diagnosed and meeting CDC case definition for HIV, and living in California as of 12/31/2015. In HIV care includes persons with at least one care visit during 2015. Retained in HIV care includes persons with at least 2 or more care visits 3 months apart during 2015. Achieved viral suppression includes persons with most recent viral load test results <=200 copies /mL during. Source: HIV/AIDS Continuum, eHARS data as of Mar 16, 2017

Office of AIDS Guiding Documents National HIV/AIDS Strategy (NHAS) President’s HIV Care Continuum Initiative Laying the Foundation for Getting to Zero: California’s Integrated HIV Surveillance, Prevention, and Care Plan

Getting to Zero June 2014: New York State’s Plan to End AIDS December 2014: San Francisco’s “Getting to Zero” Initiative July 2015: National HIV/AIDS Strategy updated August 2015: California Assembly Select Subcommittee on Infectious Diseases in High Risk Disadvantaged Communities’ hearings on “A California Plan to End AIDS” October 2016: Laying a Foundation for Getting to Zero: California’s Integrated HIV Surveillance, Prevention, and Care Plan

Getting to Zero: Why now? Affordable Care Act Availability of preventive services Access to comprehensive health coverage for PLWH through Medi-Cal Expansion and Covered California HPTN 052 and START trials Early treatment reduces risk of transmission by 96% New HIV test technologies can detect acute HIV infection Broaden window for intervention during time when HIV most likely to be transmitted to others FDA approval of HIV Pre-Exposure Prophylaxis (PrEP) Reduce risk of HIV acquisition by over 90%

Getting to Zero: Why Now? Scientific tools now exist Modeling shows that can end transmission by rapid diagnosis, treatment, and viral suppression Modeling shows that increasing the proportion of at-risk negative persons on PrEP further improves the rate of prevention of new infections Actual data from California and elsewhere suggest that already seeing declines in new infections due to increased viral suppression

Getting to Zero in California Zero new HIV infections Zero AIDS-related deaths Zero stigma and discrimination against people living with HIV (PLWH)

Laying a Foundation for Getting to Zero: Overall Approach Vision and possibility Challenging but potentially achievable objectives Broad support throughout Governor Brown’s administration—all state partners, including Medi-Cal, Covered California, California Department of Corrections and Rehabilitation, California Department of Education Broad support from local public health partners Broad support from community Add prior slide – What do we mean by “get to zero”?

Laying a Foundation for Getting to Zero: Goals Goal 1: Prevent new HIV infections Goal 2: Increase access to care and improve health outcomes for PLWHA Goal 3: Reduce HIV/AIDS-related health disparities Goal 4: Achieve a coordinated response to the HIV epidemic in California

Laying a Foundation for Getting to Zero: Objectives to be achieved by 2021

Laying a Foundation for Getting to Zero: Objectives to be achieved by 2021 Add slide after this of the objectives focused on health disparities.

Laying a Foundation for Getting to Zero: Fifteen Strategies Improve PrEP Utilization Increase and Improve HIV Testing Expand Partner Services Improve Linkage to Care Retention in Care Overall Quality of HIV-Related Care Availability of HIV Care Integration of HIV Services with STD, TB, Dental, and Other Health Services Case Management for PLWH with High Need

Laying a Foundation for Getting to Zero: Fifteen Strategies Increase Rates of Insurance/Benefits Coverage for PLWH or on PrEP HIV Prevention and Support Services for People Who Use Drugs General HIV Education & Awareness and Reduce Stigma around HIV, Sexual Orientation, and Gender Identity Improve Usability of Collected Data Enhance Collaborations and Community Involvement Further Leverage Existing Resources to Better Meet the Needs of People at Risk for and Living with HIV in California

Laying a Foundation for Getting to Zero: Activities to date Executive summary Designated leads within Office of AIDS for each strategy Monitoring plan Set annual and local targets for each objective Will publish statewide progress annually

Laying a Foundation for Getting to Zero: Highlights of activities to date PrEP PrEP assistance program - January 2018 Funding multiple PrEP-related projects Linkage to care Local jurisdictions receiving ‘out of care’ lists to identify newly diagnosed PLWH not in care Acute HIV infection reportable to local health department within 1 business day

Laying a Foundation for Getting to Zero: Highlights of activities to date Quality of HIV care Collaborating with Medi-Cal to monitor viral suppression among Medi-Cal enrollees by plan Integration of HIV services with STD, TB, dental, and other health services Quality improvement project on extragenital STI screening among PLWH Case management ADAP case management program – under development

Laying a Foundation for Getting to Zero: Highlights of activities to date Prevention and support for people who inject drugs Naloxone distribution from CDPH OA to California syringe exchange programs Approval to use federal funds for syringe exchange

Laying a Foundation for Getting to Zero: California’s Integrated Surveillance, Prevention, and Care Plan http://www.cdph.ca.gov/programs/aids/Pages/GettingtoZeroCalifornia.aspx 23

Acknowledgments Office of AIDS Surveillance, Prevention, Care, ADAP, and Support staff Local AIDS Directors and local surveillance, prevention, care, and ADAP staff HIV providers, advocates, and stakeholders State and local HIV planning groups Persons living with and at risk for HIV/AIDS 24

Juliana Grant juliana.grant@cdph.ca.gov Thank you