High Impact HIV Prevention and Surveillance Programs for Health Departments - The City of Houston (COH), located primarily within Harris County, experiences a higher burden of HIV than both the state of Texas and the whole nation. People of color with male-to-male sexual contact (MSM) especially African American and Hispanic residents, and youth of color (ages 13- 24) have been disproportionately impacted by both HIV and other STIs. In 2022, the rate of new diagnoses among the people of color was 3 times that of whites. The majority of the people newly diagnosed with HIV were identified as having MSM. Of these, a majority (83.7%) was MSM of color (MSMOC), with 32.1% African American, 51.6% Hispanic/Latino, and 4.7% Other/Multiple Races. White MSM made up 11.6% of new HIV diagnoses among MSM that year. Evidence indicates increases in HIV transmission are highly plausible without extensive uptake of preexposure prophylaxis (PrEP) and increases in viral suppression. In December 2019, the COH signed the Fast-Track Cities Paris Declaration to end the epidemic by 2030 and committed to meet set of targets. These targets are to ensure that 90 percent of people living with HIV (PLWH) will know their status, that 90 percent of all PLWH will receive sustained anti-retroviral treatment and that 90 percent of all PLWH on anti-retroviral treatment will achieve viral suppression. The current burden in Houston calls for enhanced strategies and activities to achieve these goals and end the epidemic. Of those diagnosed, 76.2% had at least one HIV medical visit/lab or prescription for treatment in 2021, 58% had been retained in care over the course of the year, and 62.8% had a suppressed viral load. In the phase of ending the HIV epidemic by 2030, utilizing PS20-2010 (Integrated HIV Programs for Health Departments to Support Ending the HIV Epidemic [EHE] in the United States) and PS18-1802 (Integrated HIV Surveillance and Prevention Programs for Health Departments) the Houston Health Department (HHD) in collaboration with other stakeholders has initiated the implementation of evidence-based HIV surveillance and prevention strategies. To further implement the activities informed by the Houston EHE plan, the HHD prepared this funding application. In this application, the HHD proposes enhanced and new innovative high-impact HIV surveillance and prevention activities. Specifically, the HHD will: (1) increase and expand HIV testing through community-based screenings and routine opt-out screenings; (2) rapidly link and treat PLWH to increase viral suppression through rapid ART initiation, and enhancing referrals to care and ancillary services; (3) increasing the uptake and participation in PrEP/nPEP implementing fast track services for PrEP/nPEP, injectable PrEP services, and expanding same-day PrEP initiation to reach vulnerable populations; and implementing a sharps disposal pilot project; (4) collaborating with local planning bodies, community groups and stakeholders to ensure quality prevention and care services. Implementing these activities, the HHD will achieve the EHE Initiative goals by ensuring increased knowledge of HIV status, increased linkage and reengagement to HIV medical care and treatment, increased viral suppression, and increased PrEP uptake.
