As a result of hard-fought accomplishments in prevention, care, and treatment services informed by a robust HIV and STI surveillance system, there is increasing optimism that San Francisco (SF) will be the first city in the United States to achieve its goal to ‘Get to Zero’ (GTZ): zero new HIV infections; zero HIV deaths; and zero HIV stigma. SF City Clinic (SFCC), SF’s only municipal STI clinic, is a critical access point for low-barrier, confidential and culturally sensitive clinical HIV prevention services for populations prioritized by local and national efforts to reduce new HIV infections, and is an essential player in SF’s GTZ efforts.
In 2020, with support from PS20-2010 Component C, SFCC launched Cycle 1 of Project Expand and Elevate (Project
ExEl). Through Project ExEl, SFCC leveraged many opportunities to increase the complexity and scope of its integrated HIV and STI prevention services. While Project ExEl allowed SFCC to strengthen its syndemic, person-centered, and status-neutral approach to care, there are ongoing opportunities for improving services and strategic partnerships to enhance the delivery of high-quality, affirming, and culturally and linguistically relevant sexual health services accessible to those of all racial/ethnic, sexual, and gender identities both at SFCC and throughout the SF system of care, and to strengthen the partnerships needed to achieve SF’s GTZ goals.
With funding from PS24-0003, SFCC will launch Project ExEl Cycle 2, using two main strategies:
1)Strengthening clinic infrastructure and improving service delivery and 2) Fostering action-oriented and strategic partnerships with community providers, community-based organizations (CBOs), health departments and other entities. Project ExEl will accelerate progress towards the following long-term outcomes:
1) Increased delivery and uptake of stigma-free, quality comprehensive sexual health services
2) Increased viral suppression among persons with HIV
3) Reduced new HIV and STI infections
4) Reduced HIV and STI disparities, including racial, ethnic, gender, and sexual orientation disparities
Project ExEl will be led by Principal Investigator Dr. Stephanie Cohen and will draw on SFDPH and SFCC expertise in using continuous quality improvement (CQI) to optimize clinic workflows and address health disparities; implementing innovations in biomedical prevention (HIV PrEP, PEP,
and doxy-PEP); and ensuring access to rapid ART initiation and re-initiation. In addition, through Project ExEl Cycle 2, SFDPH and SFCC will strengthen partnerships with community-based organizations, build capacity for the delivery of sexual health services in primary care, participate in local HIV planning groups, and undertake new and innovative approaches to meaningfully engage community and incorporate community feedback into planning and CQI work. This collaborative work will further local and national capacity to develop scalable best practices for high impact HIV and STI prevention.