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The Strategy to End AIDS in Fulton County: Objectives and Actions Priorities of the Strategy to End AIDS in Fulton County | Print |

 

Setting and reevaluating priorities for the Strategy will be an ongoing process. Input for initial prioritization of objectives was obtained through community engagement sessions, face to face meetings with stakeholders and leaders providing direct HIV-related services and care, discussions with Task Force members and contributors, and responses to an online survey offered to Task Force contributors, the Metropolitan Atlanta HIV Health Services Planning Council (Ryan White Planning Council), the High Impact Prevention Program (HIPP) list serve, the HIPP Jurisdictional Prevention Planning Group, and employees working in HIV-related fields at Fulton County and the State of Georgia Department of Public Health. The Executive Committee was responsible for developing the initial Top Ten priorities listed below, based on this comprehensive input. Additional input from all communities will be collected and will assist in ongoing prioritization.

The following priorities are the guiding principles of this Strategy:

Stigma Kills. Don’t Tolerate It.

Eliminate stigma and discrimination associated with HIV, sexual orientation, gender identity and expression, race/ethnicity, gender, socioeconomic status, and mental health and substance use disorders from our healthcare settings, faith communities, educational institutions, government institutions, media coverage, and from all policies and laws.

Make Care and Services

Client-centered Re-focus HIV services and care systems on the holistic needs of those being served to create compassionate environments that are culturally competent, customer service-oriented and where meaningful patient feedback matters.

Make it Easy to Get into Care Fast and Stay Healthy.

Eliminate health system barriers that make it difficult to get into care, stay in care, access life-saving medications, and reduce the virus to undetectable levels.

Everyone Should be Tested for HIV.

Provide free, routine opt-out HIV testing in all healthcare settings and jails, and coordinate targeted (or risk-based) HIV testing so that people at highest risk of infection always have easy access to free, safe, and confidential screening.

HIV is Preventable.

Provide PrEP/PEP for people without HIV, syringe services for injection drug users regardless of HIV status, immediate access to HIV treatment for PLWHIV, and condoms and lubricants for all.

No More Babies Born with HIV.

Link pregnant women to prenatal care, test all pregnant women for HIV, and treat all HIV positive pregnant women with ART to ensure that no babies are born HIV positive.

Education is HIV Prevention.

Require scientifically accurate, evidence-based HIV and sexual health education in schools so that youth learn skills to protect themselves against HIV and other sexually transmitted infections, and pregnancy.

Housing is HIV Prevention and Treatment.

Provide immediate, barrier-free access to housing for PLWHIV who are unstably housed.

Mental Health and Substance Use Services are Care, Too.

Expand access to mental health and substance use services to prevent HIV transmission and improve care continuum outcomes. Create Policies that Promote Health. Close the current coverage gap that denies too many PLWHIV private insurance or Medicaid, advocate for adequate federal funding for HIV care and prevention, and reform HIV criminalization laws to further destigmatize HIV.

Achieving these priorities will require dramatic improvement in the “continuum of care” in Fulton County. Among all PLWHIV, the care continuum tracks, at a minimum, rates of serostatus awareness, linkage to care, retention in care, and viral suppression. Each of these landmarks is necessary to achieve optimal care outcomes and to decrease HIV transmission. The 2014 continuum for Fulton County, based on outcomes of persons diagnosed in 2013, shows three-quarters linked to care within 30 days (see definitions in the graph), 59% meeting minimal standards of engagement in care over a year, only 46% being retained in care, and 42% being virally suppressed. Clearly, there is a dramatic drop off between linkage and retention, translating to approximately 8710 patients known to have HIV who are not optimally engaged in care.

Reflecting these priorities, new key Care Continuum objectives were selected.

Increasing serostatus awareness will likely result in increased numbers of new diagnoses before decreases are seen. Our aim is to decrease the number of new HIV diagnoses by at least 25% by 2020, and reduce disparities by at least 15% in young black gay and bisexual men, gay and bisexual men regardless of race/ethnicity, black females, and transgender women, although we do not yet even have a good baseline for transgender women. We also aim to increase serostatus awareness to 90%. A concentrated effort to implement routine opt-out testing and to target testing more effectively toward disproportionately affected populations and high prevalence geographic areas will be required to achieve this end. Saturation of testing will decrease rates of persons with AIDS at the time of diagnosis (to less than 10%), currently estimated at approximately one-quarter of new diagnoses, but higher in most vulnerable populations such as at the Grady Hospital Emergency Department where, in 2014, half of new diagnoses had AIDS. (Unpublished data GDPH, 2016)