Bay Area Network for Positive Health

Cynthia A. Gómez, PhDHealth Equity Institute

San Francisco State UniversityAIDS, 2012

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Background

• Estimated 8,000 individuals in San Francisco and Alameda County (Oakland), CA with known HIV infection not receiving adequate care.

• Little is known about the contextual realities that keep PLWH out of care in the resource-rich setting of the SF Bay Area.

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City and County of San Francisco

Oakland,

Alameda County

SF/OAK Bay Bridge

Bay Area Context

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SF Incidence versus Community Viral Load Maps

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Health Disparities

Health Inequities

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Service Design

PLWH/A

Non-HIV organizations

HIV/AIDS CBOs

HIV Care Providers

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Methods: Network12 CBOs, HIV clinics, and San Francisco and Alameda County Departments of Public Health Health. Serving:• African Americans• Women• IDUs• Incarcerated (State Prison and County Jail systems)• Immigrant Latinos• Burmese Refugees

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Client IdentificationClients are located through: • Street outreach• Syringe exchange• Jails• Prison• Support groups• Review of internal clinic records.

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Survey DataData are collected on:

• Barriers to care• Experience of stigma• Quality of Life• Resource Needs• Demographics

• Mixed quantitative/qualitative method, including voice recordings

• Data entered directly into iPod Touch devices and uploaded automatically to centralized server

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Linkage to Care• Out of care individuals are offered assistance to access HIV care and other support services:

• Linked to HIV Care• Linked to other medical care as needed• Linked to support services as needed

• Follow-up of retention through county surveillance.• Release of Medical Records collected for potential

future chart review.

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Hard to Reach• Known HIV+ average of 10 years• 34% reported no HS diploma or equivalent• 63% over 40 years of age• 66% reported living in someone else’s home, a

treatment center, SRO, shelter, or outdoors.• 10 Attempts on average to engage• 63% linked to HIV care in 56 days (mean) after

initial contact vs. 30-day national guideline goal

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What lessons have we learned?

• Actual time taken to effectively engage and link prospective HIV+ clients

• Resources and capacity needed to “set the stage”

• Intra-agency “cross-pollination” has helped close gaps of client service

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Conclusions• Barriers to care have been persistent and difficult to

remediate. • Other priority needs must be met before linking to HIV

medical care. • Extra time and additional resources are imperative to

reach and link these individuals critical to the containment of the pandemic.