1) āIncrease the estimated percentage of Californians living with HIV who know their serostatus to at least 95%.
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- āRacial Equity, Strategy 2: Monitor and adjust programming to eliminate disparities.
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Housing First, Strategy 2: Multi-disciplinary housing teams can facilitate peopleās knowledge of their status.
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Health Access for All, all 5 Strategies.
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Mental Health and Substance Use, Strategies 2,3,4,5: Increase addressing knowledge of status in mental health and substance use treatment sessions.
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Stigma Free, all 5 Strategies.
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2) āReduce the number of new HIV diagnoses in California by at least 50%, to fewer than 2,500 per year.
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āAll key Indicators and Strategies: The essence of the entire proposed framework.
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3) āIncrease the number of Californians at high risk for HIV infection who are on PrEP to 60,000.
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Racial Equity, Strategies 2,3,4: Involve PrEP eligible people in the planning and implementation of PrEP promotion, enrollment, and sustaining PrEP usage.
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Housing First, Strategy 2: Multi-disciplinary housing teams can facilitate peopleās knowledge of their status.ā
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Health Access for All, all 5 Strategies.
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Mental Health and Substance Use, Strategies 2,3,4,5: Increase identification of PrEP eligible people and facilitate linkage to PrEP providers in mental health and substance use treatment sessions.
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Economic Justice: Strategies 2,3,4: Employ PrEP users in PrEP education, navigation, and support others on PrEP.
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Stigma Free, all 5 Strategies, with a focus on Strategy 5: Diffusing PrEP promotion in other organizations such as SNAP, probation and parole, LGBTQ+ centers, etc.ā
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4) āDecrease the percentage of persons with new HIV diagnoses in California that are diagnosed with Stage 3 (AIDS) within 12 months of diagnosis (i.e., late diagnosis) to less than 17%.
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Housing First, Strategy 4,5: Increase HIV screening during street medicine visits and work with staff in public housing and migrant worker communities to promote HIV knowledge and benefits of early detection.ā
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Health Access for All, all 5 Strategies, with a focus on Strategy 5: Increase HIV testing as a part of the initial work up in people who are ill with symptoms that may be related to HIV. Currently, many missed opportunities are identified in people diagnosed late.
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Mental Health and Substance Use, Strategies 2,3,4,5: Increase benefits of ongoing knowledge of status in mental health and substance use treatment sessions.
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Economic Justice: Strategies 2,3,5, with a focus on hiring and housing policies: Not only ban the box, but clearly inform individuals of eligibility regardless of immigration status.
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Stigma Free, all 5 Strategies: Especially use of peers to promote testing routinely to avoid late diagnosis.āā
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5) āIncrease the percentage of sexually active PLWH in care who are tested at least once in a year for gonorrhea, syphilis, and chlamydia to at least 75%.
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āThis objective should be expanded to include not only sexually active PLWH but also PrEP eligible individuals as well.ā
- āāRacial Equity, Strategy 2: Monitor STI disparities and develop programs to eliminate those disparities.
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Housing First, Strategy 1,2: Increase Electronic Medical Record assistance in recording STI screening with prompts for routine screening as needed and combining orders for STIs, HIV, and HCV for easy ordering by health care professionals.ā Strategy 4: Increase STI screening in street medicine visits.
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Health Access for All, Strategy 1: Increase Electronic Medical Record assistance in recording STI screening with prompts for routine screening as needed and combining orders for STIs, HIV, and HCV for easy ordering by health care professionals. Strategy 3: Make seeking STI screening efficient and easy. Strategy 5: Increased promotion of sexual health and screening for STIs as needed.
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Mental Health and Substance Use, Strategies 2,3,4,5: Increase addressing knowledge of status in mental health and substance use treatment sessions.
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Stigma Free, all 5 Strategies: Increase the use of sex-positive health education campaigns.āāā
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6) āIncrease the percentage of newly diagnosed persons in California linked to HIV medical care within 1 month of their HIV diagnosis to at least 85%.
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- āāRacial Equity, Strategy 2: Emphasis on tracking days between knowledge of new diagnosis, first medical visit, and commencement of ART.
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Housing First, Strategy 5: Quickly house people without housing at time of diagnosis.
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Health Access for All, all 5 Strategies, especially 3 and 4.
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Mental Health and Substance Use, Strategies 2,4: Quick access to mental health and substance use treatment as needed for newly diagnosed individuals.
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Economic Justice: Strategies 2,3.
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Stigma Free, all 5 Strategies: Using people recently diagnosed to share their experiences to assess facilitators and barriers to early access to care.āāāāā
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7) Increase the percentage of Californians newly diagnosed with HIV who are virally suppressed within 6 months of diagnosis to at least 75%.
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- āRacial Equity, Strategy 2: Emphasis on tracking days between knowledge of new diagnosis, first medical visit, and commencement of ART.
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Housing First, Strategy 5: Quickly house people without housing at time of diagnosis.
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Health Access for All, Strategy 2: Increase health care providers awareness of brief assessment for trauma and cultural approach to receiving health care.
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Mental Health and Substance Use, Strategy 2: Strong emphasis of working with people using drugs who are not choosing health care after diagnosis.
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Economic Justice, Strategies 2,3: Ensure peer employees are supporting newly diagnosed individuals.
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Stigma Free, Strategy 4: Increase skills in assessing for and responding to medical mistrust.āāāāāā
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8) āIncrease the percentage of Californians with diagnosed HIV infection who are virally suppressed to at least 80%.
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Racial Equity, Strategy 2: Emphasis on identifying populations with disparities in viral suppression. Identify all individuals not on ART.
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Housing First, Strategy 5: House people with sustained viral load who do not have housing, as well as engage housing partners to support residents who are living with HIV who are not virally suppressed. Strategy 4: Increase services via street medicine for PLWH served who are not virally suppressed.
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Health Access for All, Strategy 2: Increase health care providers awareness of brief assessment for trauma and cultural approach to receiving health care. Strategy 3: Ensure PLWH not virally suppressed have medical coverage. Strategy 5: Increase providers of other services used by PLWH to monitor for viral suppression and support those not virally suppressed.
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Mental Health and Substance Use, Strategy 2: Strong emphasis on working with people using drugs who are not choosing health care after diagnosis. Also ensure routine monitoring viral suppression status of PLWH receiving mental health and substance use treatment by mental health and substance use treatment providers. Strategy 4: Ensure access to MAT as needed.
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Economic Justice, Strategies 2,3: Ensure peer employees supporting PLWH who do not have sustained viral suppression use incentives, including cash, to assist individuals in achieving and maintaining viral suppression.
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Stigma Free, Strategy 4: Increase skills in assessing for and responding to medical mistrust.āāāāāāā Strategy 5: Link non-virally suppressed people to a peer who has sustained viral suppression.
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9) āIncrease the percentage of Californians with diagnosed HIV infection who are in HIV medical care (at least 1 visit per year) to at least 90%.
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Racial Equity, Strategy 1: Increase percentage of staff from the communities they are serving. Strategy 5: Increase a culture that is inclusive and respectful that reflects the communities being served.
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Housing First, Strategy 1: Improve ādata to careā list to respond to out of care individuals more immediately. Strategy 2: Ensure all service providers are monitoring medical care status of PLWH. Strategy 4: Inform street medicine teams of people out of care in order to offer services outside of brick and mortar clinics. Strategy 5: Assess housing status of people out of care and prioritize housing individuals not in care and identifying and removing housing policies that are barriers to homeless entering housing services.
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Health Access for All, all Strategies, with an emphasis on Strategy 5: Ensure more providers are monitoring and assisting individuals returning to care.
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Mental Health and Substance Use, Strategy 2: Ensure rapid linkage as needed for those out of care. Strategy 5: Ensuring providers assess care status of PLWH receiving mental health or substance use treatment services.
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Economic Justice, Strategies 2,3: Provide peer support by PLWH in care to PLWH out of care.
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Stigma Free, Strategy 2: Change policies that āfireā patients or make it difficult to access health care providers. Strategy 4: Increase assessment and response to individuals medical mistrust.ā
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10) āIncrease the percentage of California AIDS Drug Assistance Program clients with public or private health insurance to at least 85%.
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āExpand beyond ADAP programs to assess all PLWHās insurance status.
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Racial Equity, Strategy 2: Monitor and respond to communities with insurance disparities. Monitor geographically, as well as racially, and by transmission modes. Strategy 4: Partner with Covered California to market to PLWH more specifically.
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Housing First, Strategy 1: Ensure all PLWH receiving housing services are assessed for insurance and provide support when insurance is lacking.
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Health Access for All, Strategy 1: Increase simple, quick enrollment in Medi-Cal and Covered California. Strategies 3,4.
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Mental Health and Substance Use: Continue to increase parity of service reimbursement for mental health and substance use treatment, and ensure mental health and substance use treatment access is not impeded by insurance policies and procedures (e.g. no mental health visit on same day as medical visit for Medi-Cal consumers).
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Economic Justice: Ensure insurance is affordable and accessible with reasonable co-pays and deductibles. Ensure all providers (health care, case managers, food bank, etc.) regularly assess insurance status of PLWH.
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Stigma Free: Acknowledge mistrust of receipt of services for those PLWH residing in California, but not legally acknowledged.āā
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11) āReduce the percentage of Californians with diagnosed HIV infection who are homeless to less than 5%.
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Racial Equity, Strategy 2: Routinely assess serostatus of individuals who are homeless to increase accuracy of count of PLWH who are homeless. Strategy 3: Increase financial resources to support expanded housing inventory.
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Housing First, all Strategies, with an emphasis on Strategy 3ā: Replicate models such as TruEvolution.
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Health Access for All, Strategy 2: Assess and respond to traumas that may contribute to individuals not seeking housing. Strategy 5: Broaden the number of service providers who assess for housing status with capacity to refer to housing services.
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Mental Health and Substance Use, Strategy 2: Bring mental health and substance use treatment to the streets to increase the number of homeless who receive mental health and substance use treatment services. Expand number of mental health and substance use treatment providers who prioritize unhoused PLWH for services.
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Economic Justice, Strategy 2: Emphasis of employment development for PLWH who are homeless. Strategy 3: Ensure benefits are not removed because an individual is earning income less than a livable wage.
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Stigma Free, Strategy 1: Bring PLWH with lived experience of homelessness to the table for planning more effective services and pathways toward housing. Strategy 2: Conduct a state-wide media campaign highlighting the humanity of homeless individuals to counter the villainization of homeless individuals (not PLWH specific, but will benefit PLWH who are homeless). Strategy 4: Assess trauma and events that impede individuals living with HIV who are homeless for accepting housing opportunities.āāā
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āā12) Reduce the age-adjusted death rate among Californians with diagnosed HIV infection to less than 650 per 100,000 persons per year.
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Racial Equity, Strategy 2: Identify disparities in rates of death among PLWH and work with the medical system to eliminate the disparities. Routinely monitor causes of death and work with the medical system to prevent the conditions.
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Housing First: Identify cohorts with disparate rates of death and assess housing status with prioritization of those individuals with disparate rates of death who are homeless. Strategy 4: Increase support of street medicine programs to access needed medical care to decrease likelihood of death among PLWH. Strategy 5: Expand respite housing to those with critical conditions to improve likelihoodā of restoring health.
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Health Access for All, all 5 Strategies: Increased identification of groups with disparate death rates for more intensive medical case management and medical services.
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Mental Health and Substance Use: Increase overdose prevention for substance users living with HIV, including cross-sector collaboration to expand the variety of providers who assess substance use and provide overdose education and supplies.
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Economic Justice: Analyze rates of death among PLWH for income status and create financial support programs to those communities with disparate rates of death to raise income levels to practical levels to address expenses of daily living.
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Stigma Free, Strategy 2: Develop suicide and overdose prevention messaging to the community that facilitate a decrease in both. Strategy 4: Identify and eliminate medical mistrust that is preventing individuals from sustaining health through utilization of health care services.āāāā
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