As a result of hard-fought accomplishments in prevention, care, and treatment services informed by a robust HIV 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’: zero new HIV infections; zero HIV deaths; and zero HIV stigma. SF has implemented a data-driven high impact prevention (HIP) strategy over the last decade, and HIV surveillance data has shown significant reductions in new HIV diagnoses and increasing linkage to care and number of people living with HIV who are virally suppressed. In 2018, new HIV diagnoses dropped below 200, to 197, the lowest number ever recorded, which represents a 63% decrease since 2006. City-wide successes include SF City Clinic (SFCC), a nationally recognized center of excellence in the provision of Quality sexually transmitted infection (STI) Clinical Services. SFCC is the sole municipal STI clinic in SF and a critical access point for low-barrier, confidential and culturally sensitive clinical HIV prevention services. While SF’s progress is encouraging, some communities experience significant and persistent disparities in HIV-associated indicators. Most new infections continue to occur among gay men and other men who have sex with men (G/MSM); however, disparities persist among Black/African Americans, Latinos/Latinas/Latinx, trans women, people experiencing homelessness (PEH), and people who use/inject drugs (PWU/ID). Many of these populations also experience high rates of other STIs and hepatitis C (HCV). The interconnectedness of HIV/HCV/STIs and the related social determinants of health demand coordinated strategies and more fully integrated systems and programs. SF has a rich network of services and efforts that must be maintained; yet shifts in policies and approaches are needed to realize the goals of getting to zero for HIV, ending HCV, and turning the curve on STIs. SF will take bold new steps to im
prove focus and responsiveness to the specific needs of communities of color and PEH, while maintaining existing focus on high prevalence populations. The fundamental innovation of SF’s Component A proposal is the deep alignment of HIV/HCV/STI prevention and care, using a racial and social equity lens, and integrating systems and programs that are person-centered, not disease-centered. Building upon the HIP strategies funded by 18-1802, SFDPH will (1) address overlapping vulnerabilities, health disparities, and inequities and (2) use a community- and person-centered approach, integrated strategies, status-neutral services, and disruptive innovation to increase access to treatment and prevention, address the root causes, and to keep up with changing times. SF proposes to reduce new HIV infections by 75% by 2025 and by 90% by 2030 and SFDPH will meet the short-term and intermediate outcomes from the CDC Logic Model. SF’s Component C proposal describes SFCC Project Expand and Elevate (ExEl). Building on successes and lessons learned from prior and ongoing efforts, Project ExEl will enhance and expand integration of STI and HIV prevention care services by: 1) Strengthening SFCC’s infrastructure for billing, more timely identification of HIV status and care needs for people living with HIV (PLWH), and addressing service gaps; 2) Increasing capacity through the expansion of express visits; 3) Increasing PrEP uptake among populations disproportionately affected by HIV and improving PrEP retention with enhanced outreach and case management; 4) Improving retention in HIV care by scaling up access to same-day anti-retroviral treatment for PLWH who are not in care and implementation of routine viral load testing for PLWH; and 5) Reducing HIV disparities by increasing the proportion of patients seen at SFCC who are most vulnerable to HIV, including G/MSM of color, PEH and PWU/ID.