FY2019 EHE Supplements

Our supplement application addresses the “Respond” pillar of the plan to End the HIV Epidemic (EtHE) by strengthening inter-county epidemiological data to identify, characterize, and act upon the final cases of HIV transmission. San Francisco and Alameda counties (two of the 48 priority counties in the US) propose to conduct joint surveillance analyses, expand National HIV Behavioral Surveillance (NHBS), and field test an mHealth open cohort to track changes in risk and preventive behaviors among people who inject drugs (PWID). In our planning grant, we identified an emerging challenge facing both counties’ efforts to end the epidemic: increasing HIV cases among PWID. Case-based surveillance data showed an overall decline in new HIV infections in San Francisco (58% decrease in the last seven years), while new infections among PWID increased (40% increase over the same period). NHBS data indicated low awareness of PrEP efficacy for preventing injection-related transmission(39%) and minimal uptake in PrEP use in the last year (3%)among PWID. Meanwhile, Alameda’s overall HIV epidemic curve has plateaued, with only a 15% reduction in new cases over the last seven years. Clusters of HIV transmission are occurring among PWID in Alameda, particularly among persons experiencing homelessness. Unfortunately, NHBS is not implemented in Alameda to identify underlying causes.Our proposed aims progressively build towards an enhanced epidemiological surveillance system for PWID across counties. First, we will conduct in-depth analysis of case surveillance data on PWID, aligning measures and data sources, identifying migration between counties, and characterizing clinical and demographic factors associated with loss of engagement at each step of the HIV care continuum. Second, Alameda’s HIV epidemiology team will twin with San Francisco’s team to implement NHBSin both counties. Third, our project will culminate in the development and field testing of a novel mHealth cohort of PWID that will rapidly and efficiently track changes in risk and preventive behaviors, particularly with regard to uptake and adherence to PrEP, use of syringe service progr ams (SSP),other harm reduction practices, HIV testing, and and retention in care. We call this open cohort approach to surveillance “BLISS”: Brief Longitudinal Injection Sentinel Surveillance. We will use the Consolidated Framework for Implementation Research (CFIR) to assess pre-implementation barriers and facilitators to NHBS implementation and the use of data to address PWID needs, and to build a regional response to the HIV epidemic.