SUBJECT
Title
AUTHORIZE ACCEPTANCE OF INTEGRATED HIV SURVEILLANCE AND PREVENTION FUNDING FROM THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH (DISTRICTS: ALL)
Body
OVERVIEW
For over 25 years, the San Diego County Board of Supervisors (Board) has authorized grants and agreements with the California Department of Public Health (CDPH), Office of AIDS to provide a variety of HIV prevention services to reduce the transmission of HIV in San Diego County. As of December 31, 2022, there were approximately 15,000 people living with HIV in the county and an estimated 1,300 persons living with HIV who are unaware of their HIV status. In 2022, there were 469 new HIV diagnoses indicating that HIV continues to be a major public health concern in San Diego County.
Today’s action requests the Board to waive Board Policy B-29, approve the acceptance of $1,685,980 in Integrated HIV Surveillance and Prevention funding for Health Departments from the CDPH, Office of AIDS for the period of January 1, 2023 to December 31, 2023. Authorization is further requested to apply for additional funding opportunities that would support testing, prevention, and care and treatment needs of individuals and families in San Diego County who are impacted by HIV.
This item supports the County of San Diego’s (County) vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have been historically left behind, as well as the ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities. This will be accomplished through education, prevention, and intervention to interrupt transmission of disease in the region. This item also supports the County’s Getting to Zero initiative by planning and allocating resources dedicated to services for residents who are living with or vulnerable to HIV.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Waive Board Policy B-29, Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery, which requires prior approval of revenue agreement applications and full-cost recovery of grants.
2. Authorize the acceptance of $1,685,980 in Integrated HIV Surveillance and Prevention funding for Health Departments grant funds from the California Department of Public Health, Office of AIDS for the period of January 1, 2023 to December 31, 2023, for HIV services related to prevention, and authorize the Clerk of the Board to execute all required grant documents, upon receipt, including any annual extensions, amendments or revisions that do not materially impact or alter the services or funding level.
3. Authorize the Agency Director, Health and Human Services Agency to apply for any additional funding opportunity announcements, if available, to address the prevention, testing, care and treatment needs of those impacted by HIV.
EQUITY IMPACT STATEMENT
Since the beginning of the epidemic, HIV has disproportionately impacted the most vulnerable residents. Gay, bisexual, and other men who have sex with men, for instance, are currently estimated to comprise less than 2% (LGBTQ+ Identification Rises to 5.6% in Latest U.S. Estimate, gallup.com) of the adult population, and yet they comprise 62% of recent HIV diagnoses and 71% of persons living with HIV. Moreover, in San Diego County, like much of the rest of the United States, HIV has disproportionately impacted Black and Hispanic communities. Blacks comprise less than 5% of the county’s population but comprise 12% of recent HIV diagnoses. Hispanics comprise 34% of the population of the county yet comprise 48% of recent HIV diagnoses.
Since HIV prevention services funding began in the mid-1990s, efforts have largely been focused on what are now the main strategies of the County of San Diego’s Getting to Zero initiative: test, treat, prevent, engage, and improve. In Fiscal Year 2021-22, 487 people enrolled in pre-exposure prophylaxis (PrEP) navigation, 398 completed a visit with a PrEP prescriber within 30 days, and 33 newly diagnosed and five previously diagnosed persons living with HIV were linked to or re-engaged in HIV medical care. Additionally, approximately 20,000 people are tested for HIV through these resources. Efforts are directed at populations disproportionately impacted by HIV, including Black and Hispanic gay and bisexual men and other men who have sex with men. Data of new diagnoses during the years 2017-2021 demonstrated that Blacks were diagnosed at a rate of 34.9 per 100,000 and Hispanics were diagnosed at a rate of 19.9 per 100,000. Comparatively, Whites had a rate of 8.2 per 100,000 and Asian/Pacific Islanders had a rate of 5.3 per 100,000.
The success in reaching residents and communities most disproportionately impacted by HIV is due in large part to the HIV Planning Group, an official advisory board to the San Diego County Board of Supervisors that also has the legislative authority to allocate Ryan White Part A funding to respond to local needs as determined by review of epidemiologic data and extensive engagement to communities.
SUSTAINABILITY IMPACT STATEMENT
The proposed actions align with the County of San Diego’s Sustainability Goal #2 to provide just and equitable access and Sustainability Goal #4 to protect health and wellbeing. This will be done by increasing capacity and services aimed to prevent, identify, and treat HIV. Testing, identification, and treatment of HIV will improve the overall health of communities, reduce the demand of associated care services, while increasing effectiveness of care providers and lowering operating costs.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year (FY) 2022-24 Operational Plan and in the FY 2023-24 CAO Recommended Operational Plan Change Letter in the Health and Human Services Agency. If approved, this request will result in estimated costs of $876,094 and revenue of $842,990 in FY 2022-23 and estimated costs of $876,094 and revenue of $842,990 in FY 2023-24. The funding source is the California Department of Public Health, Office of AIDS Integrated HIV Surveillance and Prevention funding for Health Departments and Health Realignment. A waiver of Board Policy B-29 is requested because the funding does not offset all costs. These costs are estimated at $66,208 for the term of this grant. The funding source for these costs will be existing Health Realignment allocated for this program. The public benefit for providing these services far outweighs these costs. There will be no change in net General Fund costs and no additional staff years.
BUSINESS IMPACT STATEMENT
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Details
ADVISORY BOARD STATEMENT
The HIV Planning Group reviewed this item at its meeting on April 26, 2023, and recommended approval of the recommendations.
BACKGROUND
On March 1, 2016 (25), the San Diego County Board of Supervisors adopted the Getting to Zero initiative, which seeks to end the HIV epidemic. Since its adoption, the Getting to Zero initiative has evolved into a comprehensive approach to ending the HIV epidemic, with five core strategies:
1. Test: Identify everyone living with HIV in San Diego County and link them to HIV treatment and other services that provide support for remaining in treatment.
2. Treat: Ensure that everyone living with HIV in San Diego County has access to HIV treatment services so that persons living with HIV can achieve viral suppression.
3. Prevent: Identify everyone at risk for HIV infection in San Diego County and link them to HIV prevention resources and other services that provide support for remaining HIV-negative.
4. Engage: Continue partnering with communities disproportionately impacted by HIV to achieve collective impact and improve outcomes along the HIV care continuum.
5. Improve: Engage in continuous quality improvement activities to achieve the objectives of the Getting to Zero plan.
As of December 31, 2022, there were approximately 15,000 people living with HIV in the county and an estimated 1,300 persons living with HIV who are unaware of their HIV status. While there had been significant gains in reducing new HIV cases in San Diego County prior to 2020, utilization of HIV testing declined significantly in 2020 and is only now beginning to return to levels seen prior to the COVID-19 pandemic. In 2022, there were 469 new HIV diagnoses indicating that HIV continues to be a major public health concern in San Diego County.
Despite some of the temporary setbacks created by COVID-19, ending the HIV epidemic is still possible due to substantial advances in HIV treatment and HIV prevention. Treatment for persons living with HIV, known as anti-retroviral therapy (ART) is highly effective at suppressing the amount of HIV that can be detected in a milliliter of blood, known as the viral load. The vast majority of persons living with HIV and taking ART will achieve viral suppression, a point at which HIV can no longer do any additional damage to the person’s immune system and at which they can no longer transmit HIV to others through sexual contact. Some of the same drugs that are used to treat HIV can also prevent infection in those who have not acquired the infection. Through HIV pre-exposure prophylaxis (PrEP), HIV drugs can be taken to any potential exposure prophylaxis (PEP), HIV drugs can prevent HIV infection in persons who are HIV-negative but have had a very recent high-risk exposure, within prior 72 hours, to HIV.
The County of San Diego (County) receives funding for HIV prevention services from the California Department of Public Health (CDPH), Office of AIDS, that originates from the Centers for Disease Control and Prevention under the PS18-1802 program. CDPH then awards these funds to local health jurisdictions in California most impacted by HIV using a formula based upon the number of persons living with HIV in each jurisdiction. This funding will support existing HIV prevention contracts providing HIV testing, outreach, health education, and linkage to ART, PrEP/PEP, and other resources. Annually, these contracts provide 20,000 HIV testing encounters and 3,500 outreach encounters. These funds also support a substantial social media presence. During calendar year 2022, contracted websites had over 377,000 hits and social media impressions, number of times content was displayed, were over 472,000.
The services and contracts provided through this funding proved to be a strong base for addressing the MPOX outbreak in summer 2022. Given the substantial overlap in populations vulnerable to HIV acquisition and MPOX acquisition, the County was able to quickly deploy community-based prevention and education activities. This helped the County to rapidly respond to and limit the MPOX outbreak, including expanding outreach, education, social marketing, media, and linkage to services. There were 6,614 online and in-person outreach contacts made, 21,534 social media posts, and 7,625 materials distributed at 104 venues. There were almost 12.7 million social media impressions, resulting in over 234,000 persons linked to information about MPOX, including prevention measures and vaccine information. Although the MPOX public health emergency has ended, health education about MPOX and the importance of vaccination has been folded into the County’s ongoing HIV prevention efforts and will continue under contracts funded by the Integrated HIV Surveillance and Prevention funding for Health Departments.
A waiver of Board Policy B-29 is requested because the funding does not offset all costs. Unrecovered costs are estimated at $33,104 for Fiscal Year (FY) 2022-23 and $33,104 for FY 2023-24. The funding source for these costs will be Health Realignment. The public benefit for providing these services far outweighs these costs, as CDPH, Office of AIDS Integrated HIV Surveillance and Prevention funding for Health Departments funding fills an important gap in the local HIV service delivery system by ensuring support for existing HIV prevention contracts, which provide HIV testing, outreach, health education, and linkage to ART, PrEP/PEP, and other resources. The County Health and Human Services Agency certifies that these services will be worthy of County support if outside funding were not available.
Today’s action seeks authorization to accept $1,685,980 in grant funds from the CDPH for the period of January 1, 2023 through December 31, 2023, for Integrated HIV Surveillance and Prevention funding for Health Departments. Additionally, today’s action seeks authorization to apply for additional funding announcements to secure new funding to further support HIV surveillance and prevention efforts.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions supports the Equity (Health) and Community (Quality of Life) Initiatives in the County of San Diego’s 2023-2028 Strategic Plan. This is accomplished by improving access to high-quality HIV testing and other prevention services that contribute to improved physical and behavioral health.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Interim Chief Administrative Officer
ATTACHMENT(S)
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