Sønla Clurø Vølley Health & Hospital System
Better
Administration
Healthþr All
SANTA CLARA
2325 EnborgLane, Suite 220
San Jose, Califomia 95 I 28
Phone: (408) 885-4030
Fax: (408) 885-4051
\ATICY
}ICAL'IH & HOSPITAL sYsTEM
DATE:
I|l4ay
16,2016
Board of Supervisors
Jeffrey V. Smith, M.D., J.D., County Executive
TO
FROM:
René G. Santiago, Deputy County Executi
Sara Cody,
SUBJECT:
MD, Health Officer and Director of Public Health
,Ø'*uz'ç--
OfÊAgenda Report related to the Getting to Zero Initiative
BACKGROUND
On February 9,2016, the Board of Supervisors accepted a report on the proposed steps
and potential fiscal and resource needs to operationalize a "Getting to Zero" initiative in
Santa Clara County. The report recommended a comprehensive, collective impact
planning process that included preliminary assessment and best practice review and
engagement of stakeholders to identify and develop goals, objectives and strategies for
Getting to Zero. The Board of Supervisors encouraged the Public Health Department to
proceed swiftly to engage stakeholders and establish priority strategies. Over the months
of February through April 2016, a core Getting to Zero planning group, comprised of the
Public Health Department, Office of LGBTQ Affairs, HIV Planning Council and The
Health Trust, convened two working sessions to draft Getting to Zero Focus Areas and
Strategies. On April 29, abroader group of 45 individuals from 19 organizations
working on HIV prevention and treatment participated in a Getting to Zero forum. The
objective of the meeting was to get input on the plan, which will provide the basis for
better coordinating efforts across partners and seeking funding for new strategies. The
forum was followed by two additional core planning group meetings to further prioritize
strategies and discuss resource needs.
PRIORITY STRATEGIES
The Gettingto Zero strategies are organized within four focus areas, summarized below.
The strategies represent needs and gaps that have been prioritized to-date.
1.
PrEP and PeP Implementation:
a. Assess current activity in clinical settings around PrEP implementation.
b. Identify opportunities (processes and sites) to enable timely initiation of
PrEP.
c. Educate providers and other staff in clinical settings about PreP and PeP;
provide tools to support consistent implementation.
d. Educate the general public about PrEP.
e. Provide navigation services to help patients access PrEP and to support
providers and counselors around access issues.
Santa Clara Valley Health
& Hospital
System is owned and operated by the County of Santa Clara.
f.
Establish a model and systems for PrEP and PeP implementation within
SCVHHS.
g. Disseminate and promote adoption of policies, procedures, and templates
that can be tailored to support PrEP and PeP implementation in clinical
settings.
h. Investigate the need, associated costs, and strategies for providing PrEP to
individuals who are uninsured.
2. Universal, Comprehensive STD Screening and Targeted Testing:
a. Establish policies, procedures and systems to support universal,
comprehensive screening and targeted testing within multiple settings
(clinical and custody) and address institutional barriers to comprehensive
screening and assessment.
b. Provide targeted community outreach and education, tailored to specific
high-risk populations, regarding the importance of HIV testing.
3. Initiation of Care and Retention in Care:
a. Provide information to high-yield sites/providers around the resources
available to ensure individuals are rapidly linked to care after diagnosis
and are retained in care.
b. Improve referral systems and communications between the PACE clinic,
other providers of HIV care, and referring sites/providers to ensure
coordinated care. Set up processes necessary for PACE to provide
specialty consultation around HIV care to primary care providers
managing care for patients with HIV or on PrEP.
c. Provide education and coordination for volunteer peer navigation and
support services that support initiation of and retention in care and
strengthen coping skills for people living with HIV
d. Compile data and conduct action research to better understand and
improve retention in care; data will be used to inform the types of provider
and patient education and institutional changes that may be necessary to
improve retention.
4. Reduce Stigma
a. Leverage school-based efforts and requirements related to sexual health
education to promote prevention and reduce stigma.
b. Incorporate reduction of stigma into provider and staff education, and
implement clinic-based policies, processes and systems as a means to
reduce stigma (e.g., standard HIV wellness check, questions about stigmafree encounters on patient satisfaction surveys).
c. Develop and disseminate a Getting to Zero Campaign(s) focused on the
general public and priority populations across the focus areas of the
initiative, with an emphasis on reducing stigma as a means to promote
HIV prevention and universal screening. Targeted campaigns will
capitalize on social media platforms and tools.
d. Conduct action research to better identifr the nature of stigma surrounding
HIV and how stigma affects specific populations, in order to inform
messaging and identify priority populations.
NEXT STEPS
Each of the priorities were reviewed to determine if resources were needed to begin
implementation. A subset of the strategies can be accomplished with existing resources,
2
but several strategies require new resources. Additionally, there was a subset of
strategies that require further study and input to determine scope, scale, and associated
costs.
In addition to funding requests for specific strategies, the core Getting to Zero planning
group recommends funding for a backbone organization, which will facilitate the further
development of the Getting to Zero plan, including (1) developing overarching vision and
goals for the effort as well as process and outcome metrics for specific strategies, and (2)
coordinating the plan's implementation, which includes managing and facilitating the
implementation structure, communication, coordination with the HIV Planning Council,
and administration of mini-grants.
At this time, the specific resource requests
a
total $526.815 of new, multi-year General
Funding and include:
1.
2.
3.
4.
5.
6.
Health Education Soecialist (1.0 FTE) to educate providers at high yield sites rn
the SCVHHS , Federally Qualified Health Centers, and private practices about
PrEP implementation, strategies for linking and retaining patients in care, and
post-exposure prophylaxis (PEP). The HES will leverage opportunities to expand
sexual health education for youth in schools with an emphasis on reducing stigma.
No new funding is needed to for this position as it can be funded with existing
funding within the Public Health Department HIV budget.
Public Health Community Specialist (1.0 FTEI to provide PrEP & PEP
Navigation, including provider engagement and technical assistance, consumer
linkage to services, and PrEP retention and follow up support. The PHCS will
also collaborate with the Custody Health and the Re-Entry Center to ensure
linkage to screening and prevention services. This would be an ongoing position.
Contract Services for Public and Patient Outreach, Education and Support for one
or more organizations to provide targeted community outreach and education,
tailored to specific high-risk populations regarding the importance of HIV testing;
and, provide education and coordination for volunteer peer support services that
support retention in care and strengthen coping skills for living with HIV. This
funding would be needed for four years over the life of the Getting to Zerc
initiative plan.
Contract Services for Mini-Grants to fund Clinic-Based Systems Chanses to
provide mini-grants to clinics/providers to establish policies, procedures, and
systems changes to support universal screening, effective referral mechanisms to
HIV Providers, PrEP implementation, and stigma reduction measures. This
funding would be needed for four years over the life of the Getting to Zerc
initiative plan.
Contract Services for Mini-Grants Innovation Challenge to provide mini-grants to
support innovative strategies for Getting to Zero. Strategies can address any of
the focus areas of the GTZinitiative and can be implemented in clinics, schools,
community-based organizations, etc. This funding would be needed for four
years over the life of the Getting to Zerc initiative plan.
Contract Services for Education Campaign to develop and disseminate a Getting
to Zero Campaign(s) focused on the general public and priority populations across
J
7.
8-
9.
c:
4
the focus areas of the initiative, with an emphasis on reducing stigma as a means
to promote HIV prevention and universal screening. Targeted campaigns will
capitalize on social media platforms and tools. This funding would be needed for
two years to allow time for the development and dissemination of the campaign
components.
Contract Services for GTZ Backbone Organization to coordinate the Getting to
Zero implementation, including managing and facilitating the implementation
structure, communication (website), coordinating with the HIV Planning Council,
and administration of mini-grants. This funding would be needed for four years
over the life of the Getting to Zero initiative plan.
Contract Services for
Research and Evaluation to conduct action research
to understand challenges to retention in care among non-Ryan White patients,
better understand the nature of stigma surrounding HIV, and evaluate PrEP
outcomes. This funding would be needed for four years over the life of the
Getting to Zero initiative plan.
Contract Services for Community Engagement Components of Reducine Stigma
to design and implement community engagement strategies for reducing stigma.
Cost would go toward coordinating community input via focus groups, survey,
deep dive conversation and yearly summit and would be administered by the
Office of LBTQ Affairs. This funding would be needed for four years over the
life of the Getting to Zero initiative plan.
Megan Doyle, Clerk of the Board
Erica Kelly, Office of Budget Analysis
Proposal Name
Getting to Zero (GTZ)
Branch
Infectious Disease & Response
Program
STD/HIV Program
CC
2910
2910
GL
Object 1
and GL
5255500
Object 1
FTE Job Code
Position Title/Object GL
1.0 J27/26
Health Ed Associate/Health Ed
Specialist (alternately staffed)
1.0 E04
Description
Add 1.0 Health Ed Specialist in the HIV/STD
Program.
The HES will educate providers at high yield
sites in the SCVHHS , Federally Qualified Health
Centers, and private practices about PrEP
implementation, strategies for linking and
retaining patients in care, and post-exposure
prophylaxis (PEP). The HES will leverage
opportunities to expand sexual health
education for youth with an emphasis on
reducing stigma.
Updated FY17 Cost
No new funding needed for
Health Ed Specialist; create
position with HIV/AIDS Object 2
funding from Cost Center 2910
and GL 5255500.
Ongoing=$132,828; 9
months cost in FY17
is $99,010
Cost is for J26 (higher
level)
2910
5255500
Public Health Community Specialist Add 1.0 Public Health Community Specialist
(PHCS) in the HIV/STD Program.
The
PHCS will provide PrEP & PEP Navigation,
including provider engagement and technical
assistance, consumer linkage to services, and
PrEP retention and follow up support. The
PHCS will also collaborate with the Custody
Health and the Re-Entry Center to ensure
linkage to screening and prevention services.
Contract Services
Contract Services for Public and Patient
Outreach, Education and Support.
One or more organizations will provide
targeted community outreach and education,
tailored to specific high-risk populations
regarding the importance of HIV testing; and,
provide education and coordination for
volunteer peer support services that support
retention in care and strengthen coping skills
for living with HIV.
$76,815 Ongoing=$102,999;
9 months cost in
FY17 is $76,815
2910
5255500
Contract Services
Mini-Grants Clinic-Based Systems Changes.
Provide mini-grants to clinics/providers to
establish policies, procedures, and systems
changes to support universal screening,
effective referral mechanisms to HIV Providers,
PrEP implementation, and stigma reduction
measures.
$50,000 Annually for 4 years
(FY17-FY20)
2910
5255500
Contract Services
Mini-Grants Innovation Challenge. Provide
mini-grants to support innovative strategies for
Getting to Zero. Strategies can address any of
the focus areas of the GTZ initiative and can be
implemented in clinics, schools, communitybased organizations, etc.
$50,000 Annually for 4 years
(FY17-FY20)
2910
5255500
Contract Services
Contract Services for Education Campaign.
Develop and disseminate a Getting to Zero
Campaign(s) focused on the general public and
priority populations across the focus areas of
the initiative, with an emphasis on reducing
stigma as a means to promote HIV prevention
and universal screening. Targeted campaigns
will capitalize on social media platforms and
tools.
$75,000 Annually for 2 years
(FY17,FY18)
$75,000 Annually for 4 years
(FY17-FY20)
Office of LGBTQ Affairs
TOTAL
2910
5255500
Contract Services
Contract Services for GTZ Backbone
Organization. Coordinate the Getting to Zero
implementation, including managing and
facilitating the implementation structure,
communication (website), coordinating with
the HIV Planning Council, and administration of
mini-grants.
2910
5255500
Contract Services
Contract Services for Action Research and
Evaluation. Conduct action research to
understand challenges to retention in care
among non-Ryan White patients, better
understand the nature of stigma surrounding
HIV, and evaluate PrEP outcomes.
$50,000 Annually for 4 years
(FY17,FY18)
Food; Office Expense; Contract
Services
Contract Services for Community Engagement
Components of Reducing Stigma. Design and
implement community engagment strategies
for reducing stigma. Cost would go toward
coordinating community input via focus
groups, survey, deep dive conversation and
yearly summit. Food and Office expense are in
support of these efforts.
$50,000 Annually for 4 years
(FY 17-FY20)
1331
Object 2:
GL
5210100,
GL
5250100,
GL
5255500,
2.0
$100,000 Annually for 4 years
(FY17-FY20)
$
526,815