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.
