Fulton County Department of
Health and Wellness High Impact
HIV Prevention Program
City of Atlanta (Fulton/DeKalb Counties)
Jurisdictional HIV Prevention Plan –
November 14, 2012 – December 31, 2016
The City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan, covers multiple
years (2012 – 2016), is a written statement of need developed through a local collaborative
process with other HIV/AIDS prevention, care, and treatment providers and agencies.
11/14/2012
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Funding acknowledgement:
The development of this document was made possible by funding from the Centers for Disease Control and Prevention Funding
Announcement PS12-1201 – Comprehensive HIV Prevention for Health Departments, Grant No. U62 PS003679-01
Disclaimer:
This document was developed from September 2012 to November 2012 and submitted to the Centers for Disease Control and
Prevention on November 14, 2012. Its contents reflect the data and information collected during this time period. The
information used to develop the jurisdictional goals, strategies, and objectives were collected from community stakeholders
that participated in several community engagement meetings and from the Jurisdiction’s HIV Prevention Planning Group.
For more information, contact:
Page
1
Fulton County Department of Health and Wellness
High Impact HIV Prevention Program
99 Jesse Hill Jr., Drive S.E. ● Atlanta, GA 30303
Tel: (404) 613-1411 ● Fax: (404) 730-1499
Web: www.fultoncountyga.gov
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Vision
“When every person in Fulton and DeKalb Counties is empowered to know their HIV status, and if HIVpositive, choose to access high quality care and treatment.”
Mission
Page
2
“To achieve optimal HIV prevention and care services, by mobilizing partnerships and taking strategic
action”
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
TABLE OF CONTENTS
LETTER OF CONCURRENCE
5
EXECUTIVE SUMMARY
9
INTRODUCTION
11
OVERVIEW OF THE HIV/AIDS EPIDEMIC IN GEORGIA
14
EPIDEMIOLOGY OF HIV/AIDS IN FULTON AND DEKALB COUNTIES
20
HIV PREVENTION, LINKAGE TO CARE AND TREATMENT SERVICES
26
27
29
30
31
PROCESS FOR DEVELOPING THE JURISDICTION HIV PREVENTION PLAN
34
FULTON/DEKALB COUNTIES JURISDICTIONAL HIV PREVENTION PLAN
38
REQUIRED PROGRAM PLAN COMPONENTS
39
A. HIV Testing in Healthcare and Non-healthcare settings
 Required Intervention # 1: Opt-Out Screening for HIV in clinical settings
 Required Intervention # 2: HIV Testing in non-clinical settings to identify
Undiagnosed HIV infection
 Required Intervention #10: Implement STI screening according to current
guidelines for HIV-positive persons
 Required Intervention #11: Implement prevention of perinatal transmission
for HIV-positive persons
39
39
B. HIV Prevention with Positives
 Required Intervention #6: Implement linkage to HIV care, treatment, and
Prevention services for those testing HIV positive and not currently in care
 Required Intervention #7: Implement interventions or strategies promoting
retention in or re-engagement in care for HIV-positive persons
 Required Intervention #8: Implement policies and procedures that will
lead to the provision of antiretroviral treatment in accordance with current
treatment guidelines for HIV-positive persons
 Required Intervention #9: Implement interventions or strategies promoting
adherence to antiretroviral medications for HIV-positive persons
 Required Intervention #12: Implement ongoing partner services for
43
40
42
42
43
44
44
45
3
Existing HIV Prevention, Linkage to Care and Treatment Resources and Services
Existing HIV Prevention, Linkage to Care and Treatment Interventions
HIV Prevention Interventions
Needs and Gaps in HIV Prevention, Linkage to Care and Treatment
Page
A.
B.
C.
D.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
46
C. Condom Distribution
 Required Intervention # 3: Condom distribution prioritized to target
HIV-positive persons’ at highest risk of acquiring HIV infection
47
D. Structural and Policy Initiatives
 Required Intervention # 5: Efforts to change existing structures, policies,
and regulations that are barriers to creating an environment for optimal
HIV prevention, care and treatment
48
E. Other Supported Activities
 Recommended Intervention #17: Clinic-wide or provider-delivered
evidence-based HIV prevention interventions for HIV-positive clients
and clients at highest risk of acquiring HIV
 Required Intervention# 16: Promote HIV testing and condom use through
social marketing
 Required Intervention #4: Provision of Post-Exposure Prophylaxis to
populations at greatest risk
 Recommended Intervention #20: Integrated hepatitis, TB and STI testing,
partner services, vaccination, and treatment for HIV infected persons,
HIV-negative persons at highest risk of acquiring HIV, and injection drug
users according to existing guidelines
50
47
48
50
50
51
52
NATIONAL HIV/AIDS STRATEGY – NATIONAL STRATEGIC GOALS
53
ATTACHMENTS
59
60
61
64
4
Attachment A: List of Jurisdictional Planning Group
Attachment B: HIV Prevention Interventions
Attachment C: Community Engagement Report
Page
HIV-positive persons
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
CONTRIBUTORS
The Fulton/DeKalb Counties Jurisdictional HIV Prevention Plan development began with a series of
community engagement meetings, hosted by Fulton County Department of Health and Wellness High
Impact HIV Prevention Program and facilitated by HealthHIV, a national organization that provides
capacity building and technical assistance for health departments, that focused on the local HIV
epidemic and HIV prevention efforts in Fulton and DeKalb Counties, Georgia (Atlanta, GA). The meetings
were convened to engage community stakeholders in the identification and prioritization of innovative
HIV prevention strategies to address the high burden of HIV in the jurisdiction. A two-day community
engagement, September 27 and 28, 2012, and a one-day follow-up meeting, October 17, 2012, was
utilized to engage the community in the planning and development process. This document is the result
of those meetings. The participants that played a critical role in the development of this plan are listed
as follows:
Nyrobi Moss
Patricia Brown
Patricia Parsons
Patrick Daly
Pete Starling
Raymond Duke
Reggie Batiste
Rodriques Lambert
Rudolph H. Carn
Sean Webb
Sheb Bonner
Shelia Lenior
Stacey Bolling
Tabatha Greely
Tarita Johnson
Yolanda Miller
Yotin Srivanjarean
October 17, 2012
Andrea Jefferson-Saboor
Bentley Swenton
Bethe Odom
Charles Sperling
Cheryl Courtney-Evans
Claressa Winston
Darrell Waston
Dea Varsovczky
Laura Donnelly
Eulise White
Gay Campbell-Welsh
Hilda Johnson
Jacqueline Brown
Jonte Carlisle
Kandace Carty
Kathy Whyte
Kenya Taylor
Latonya Wilkerson
Leisha McKinley-Beach
Loreen M. Krug
Martin Becker
Martina Rivora
Michael Banner
Michael Lumand
Michael Seabolt
Miko Jones
Neena Smith-Bankhead
Patricia Parsons
Glenn Fitch
Raymond Duke
Robbyn Kistler
Shelia Lenior
Tarita Johnson
Tequan Berry
Verna Gaines
Willie Pestarling
Zina Age
7
Aleta McClean
Avery Wyatt
Bedane Sentayehu
Benjamin Moore
Bentley Swenton
Brandi Williams
Charles Bazemore
Charles Sperling
Cheryl Courtney-Evans
Darryl Richardson
Dazon Dixon Diallo
Denise Parker
Edwin Blount
Eulise White
Gay Campbell-Welsh
Hana Hawthone
Harvinder Makkar
Hilda Johnson
Jacqueline Brown
Jacqueline Muther
Jane Kelly
Jeselyn Rhodes
John Malone
Kandace Carty
Katherine Lovell
Kenya Taylor
Khafre Kabif
Latoya Wilkerson
Laura Donnelly
Levita Smith
Lisa White
Melanie Thompson
Michael Banner
Michael Demayo
Michael Seabolt
Mona Bennett
Neil Griffith
Page
October 27 and 28, 2012
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
AGENCY PARTICIPATION
October 17, 2012
AHRC, Inc.
AID ATLANTA, Inc.
AIDS Health Foundation
City Wide Project
AIDS Research Consortium of Atlanta (ARCA)
Alpha and Omega HIV/AIDS Foundation
ANIZ, Inc.
ASHLIN Management Group
Atlanta Medical Center
Center for Pan Asian Community Services, Inc.
DeKalb County Board of Health
Empower Young Women
Empowerment Resource Center, Inc.
Essence of Hope, Inc.
Georgia ADAP Pharmacy
Georgia Department of Public Health/ HIV Program
Georgia Department of Public Health/HIV Epidemiology
Georgia STD Program
Here's To Life, Inc.
HOPWA, City of Atlanta
NAESM, Inc.
Project Open Hand
Recovery Consultants of Atlanta, Inc.
Ryan White - Part A Program
SEATEC
SisterLove, Inc.
Saint Joseph Mercy Care
STAND, Inc.
The Edgewood Medical Center, Inc.
T.I.L.T.T, Inc. (Transgender Individuals Living Their Truth)
Tangu, Inc.
Travelers Aid of Metropolitan Atlanta Inc.
West End Medical Center
Wholistic Stress Control Institute, Inc.
Absolute Care Medical Center
AID Atlanta, Inc.
AIDS Research Consortium of Atlanta
ANIZ, Inc.
Atlanta Harm Reduction Coalition
Black AIDS Institute
Club Xhell
Comiza Care
Divinity Internal Medicine
Essence of Hope, Inc.
Georgia ADAP Pharmacy
Georgia Department of Public Health
Greater Than AIDS/Kasier Family Education
Georgia STD Program
Positive Impact, Inc.
Recovery Consultants of Atlanta
Ryan White Part A Program
SEATEC
Saint Joseph Mercy Care
STAND, Inc.
The Empowerment Resource Center, Inc.
T.I.L.T.T, Inc. (Transgender Individuals Living Their Truth)
UCHAPS
Westcare
Wholistic Stress Control Institute
Page
October 27 and 28, 2012
8
The list of participating agencies had never before participated in a structured HIV prevention and care
services meeting for Fulton and DeKalb Counties. The list of participating agencies includes
representation from all sectors and from non-traditional partners. They included, but not limited to,
AIDS Service Organizations, Community-based Organizations, Academia, Federally Qualified Health
Centers, and other agencies. The agencies that participated are listed as follows:
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
EXECUTIVE SUMMARY
Page
9
This section provides a brief overview of the City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention
Plan and the process to development. The section highlights the local collaborative process with other HIV/AIDS
prevention, care, and treatment providers and agencies
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
EXECUTIVE SUMMARY
The City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan, covering multiple years
(2012 – 2016), is a written statement of need developed through a local collaborative process with other
HIV/AIDS prevention, care, and treatment providers and agencies. The City of Atlanta (Fulton/DeKalb
Counties) Jurisdictional HIV Prevention Plan reflects a discussion of existing resources, needs, and gaps
for HIV prevention services, to include key features on how prevention services, interventions, and/or
strategies are currently being used or delivered in the jurisdiction.1
The plan includes a brief overview of
epidemiological data, existing quantitative and
qualitative
information,
and
emerging
trends/issues affecting HIV prevention services
in the jurisdiction. The plan also highlights how
existing prevention resources are allocated and
disseminated locally to the areas with the
greatest HIV burden and includes populations
identified at greatest risk for HIV transmission
and acquisition. The plan also discusses the
responsible agency/group to carry out the goal,
strategies, objectives, and relevant timelines.2
MSM
HRH
NIR
FOA
EMA
PCC
IDP
CD4 T-cell
The City of Atlanta (Fulton/DeKalb Counties)
Jurisdictional HIV Prevention Plan is intended to
serve as a “best practice model” and will be
implemented in the manner that best fits the
needs of the community.
NHAS
FPL
Red Carpet
Linkage
Commonly Used Terms in this document
Sexually Transmitted Infections
Tuberculosis
Human Immune Deficiency Virus
Acquired Immune Deficiency Virus
Metropolitan Statistical Area
Centers for Disease Control and
Prevention
Men who have sex with men
High Risk Heterosexual
No Identified Risks
Funding Opportunity Announcement
Eligible Metropolitan Area
Primary Care Clinic
Infectious Disease Program
CD4 cells or T-cells are the
“generals” of the human immune
system. These are the cells that send
signals to activate your body’s
immune response when they detect
“intruders,” like viruses or bacteria
National HIV/AIDS Strategy
Federal Poverty Level
Rapid linkage program known as the
Red Carpet Entry (RCE). The program
facilitates rapid, efficient and effective
linkage to HIV medical care the same
day of testing positive or re-entry to
care.
1
2
2012 Jurisdictional HIV Prevention Plan Instructions
Ibid
Page
10
STI
TB
HIV
AIDS
MSA
CDC
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
INTRODUCTION
Page
11
This section describes the Atlanta-Sandy Springs-Marietta Metropolitan Area as a whole, including information
about the HIV epidemic in Georgia
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
INTRODUCTION
The Atlanta-Sandy Springs-Marietta Metropolitan Area (MSA) is a 28-county jurisdiction located in the
north and northwest region of the state of Georgia. The Atlanta MSA counties are: Barrow, Bartow,
Butts, Carroll, Cherokee, Clayton, Cobb, Coweta, Dawson, DeKalb, Douglas, Fayette, Forsyth, Fulton,
Gwinnett, Haralson, Heard, Henry, Jasper, Lamar, Meriwether, Newton, Paulding, Pickens, Pike,
Rockdale, and Spalding. Figure 1 highlights Georgia counties, major cities, and public health districts.
Figure 1. Georgia Counties, major cities, and public health districts
3
4
Georgia Department of Public Health, HIV Epidemiology Unit, Surveillance Fact Sheet
Ibid
Page
Georgia has 159 counties ranging in size in 2009 from 1,703 persons in Taliaferro to 949,559 in Fulton.
The four most populous counties were those containing and/or surrounding the city of Atlanta. These
were Fulton, DeKalb, Cobb, and Gwinnett counties. Together, their population made up one-third
(33.6%) of Georgia’s total population table.4
12
Georgia has 18 health districts which ranged in size from one to 16 counties based on the size of the
population. The Fulton Health District (3-2), which has only a single county (Fulton) and contains the city
of Atlanta, had the largest population with 949,599 persons in 2011. Other heavily populated districts
included East Metro (3-4), Cobb/Douglas (3-1), LaGrange (4-0), DeKalb (3-5), Northwest (1-1), North (20), Coastal (9-1) and North Central (5-2), all with over half a million people. The South Central Health
District (5-1) had the smallest population.3
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
The HIV epidemic in Georgia is primarily driven by sexual exposure, especially among men who have sex
with men and high-risk heterosexuals. Injecting drug use is also a high risk category, but less
proportionate than through sexual contact. Communicable diseases pose a risk for HIV/AIDS
transmission.
According to the Centers for Disease Control and Prevention (CDC), Georgia had the 6th highest number
of cumulative AIDS cases in the United States through 20085, and the 9th highest rate of AIDS cases per
100,000 population as of December 31, 2009. The CDC estimated that 28,670 (range 20,008-37,332)
adults and adolescents in Georgia were aware that they were infected with HIV (but did not have AIDS in
that same year).
5
Centers for Disease Control and Prevention. Georgia-2010 Profile
HIV/AIDS Epidemiology Section, Division of Health Protection, Georgia Department of Public Health, Georgia HIV/AIDS
Surveillance Summary, Data Through December 31, 2010. http://health.state.ga.us/epi/hivaids/index.asp
6
Page
13
In 2010, there were 795 newly- diagnosed HIV-Not AIDS cases and 512 AIDS cases in the Atlanta MSA. Of
the HIV-Not AIDS cases, 24% occurred in individuals 30-39 years of age, while individuals 30-39 and 4049 years of age combined to make up 60% of the newly-diagnosed AIDS cases. Seventy- eight percent of
the newly-diagnosed HIV-Not AIDS and AIDS cases in the Atlanta EMA were among Black, Non-Hispanic
individuals. Within the Atlanta MSA, Fulton and DeKalb Counties had the highest 2010 HIV prevalence
rates.6
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
OVERVIEW OF THE HIV/AIDS EPIDEMIC IN GEORGIA
Page
14
This section describes the current state of HIV/AIDS in Georgia.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
OVERVIEW OF THE HIV/AIDS EPIDEMIC IN GEORGIA
HIV/AIDS remains an important public health problem in Georgia. In 2009, Georgia had one of the
highest rates of persons living with a diagnosis of HIV infection in the United States at 32.9 per 100,000
persons. The Atlanta MSA comprised more than 50% of the
Transmission Category Definitions
state population in 2010, and had the highest percentage of
people living with HIV/AIDS in the state (66%). From 2001
 MSM refers to the transmission of HIV by
male sexual contact with another male.
to 2010, 71% of new HIV/AIDS diagnoses in Georgia
 IDU refers to transmission of HIV by receipt of
occurred among males. Seventy-four percent of new
non-prescribed drugs via injection,
intravenously, intramuscularly, or
HIV/AIDS diagnoses were among Black, non-Hispanics.
subcutaneously.
Among Black, non-Hispanics, those in the age group of 30-39
 Perinatal refers to transmission of HIV from
years had the highest rate of new HIV/AIDS diagnoses.
mother-to-child.

The HIV/AIDS epidemic in Georgia is primarily driven by
sexual exposure, especially among men who have sex with
men and high-risk heterosexuals. Injection drug use is also a
high risk category, but less prevalent than sexual contact.
Communicable diseases like sexually transmitted infections
(STI) and Tuberculosis (TB) pose a risk for individuals who
are infected with HIV in Georgia. STDs can increase the risk
for HIV infection from 2 to 5 times. For example, syphilis
leads to decreased CD4 T-cell counts and increased plasma
viral load in patients chronically infected with HIV, and this
has been linked to increased HIV transmission. Equally
important, TB is a leading cause of morbidity and mortality
for people with HIV/AIDS. People who are co-infected with
HIV and TB are at an increased risk of reactivation of latent
TB and acquisition of new opportunistic infections.



Blood recipient refers to transmission of HIV
through blood or blood components.
HRH refers to transmission of HIV through
heterosexual contact with a person known to
have HIV infection or at least with a person at
increased risk of HIV infection (based on a
history of MSM, IDU, or receipt of blood
products).
NIR refers to HIV cases in which an HIV risk
factor cannot be identified or confirmed even
though (1) all available data sources have
been reviewed or contacted or (2)
epidemiological follow-up was either not
initiated or not completed, but 12 months
have elapsed since the date of the initial case
report.
NRR refers to HIV cases that were reported
without any risk factor information.
7
Integrated Epidemiologic Profile of HIV/AIDS, Georgia, 2011 Department of Public Health Division of Health Protection Epidemiology Program
HIV/AIDS Epidemiology Section
Page
15
Newly Diagnosed HIV/AIDS Cases in Georgia Counties
There were 1,294 newly-diagnosed HIV-Not AIDS cases in Georgia in 2010. Of these cases, 260 (20%)
occurred in Fulton County. DeKalb County also had a high number of new HIV-Not AIDS cases. DeKalb
had 258 HIV- Not AIDS cases in 2010, which was 20% of the state’s total. Clayton County had the third
highest number of new HIV-Not AIDS cases in 2010 with 90 cases, or 7% of the state’s total cases. Fulton
(164 cases), DeKalb (160 cases), and Clayton (90 cases) counties combined to comprise 52% of the
state’s new AIDS diagnoses in 2010. (Table 1)7
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Table 1: Newly Diagnosed HIV (not AIDS) and AIDS by Gender, Age and Race/Ethnicity, Georgia from January 1, 2010- December 31,
2010
HIV (not AIDS)
AIDS
Total
Gender
Count
Percent
Count
Percent
Count
Percent
Male
962
74
565
76
1,527
75
Female
332
26
178
24
510
25
Age at Diagnosis (years)
Count
Percent
Count
Percent
Count
Percent
<13
4
<1
0
0
4
<1
13-19
85
7
9
1
94
5
20-24
273
21
68
9
341
17
25-29
223
17
104
14
327
16
30-39
291
22
209
28
500
25
40-49
236
18
226
30
462
23
50-59
141
11
99
13
240
12
60+
41
3
28
4
45
2
Race/Ethnicity
Count
Percent
Count
Percent
Count
Percent
White, Non-Hispanic
218
17
107
14
325
16
Black, Non-Hispanic
1,008
78
578
78
1,586
78
Hispanic/Latino, Any Race
52
4
47
6
99
5
American Indian/Alaskan Native, Non-Hispanic
1
<1
0
0
1
<1
Asian/ Hawaiian/Pacific Islander, Non-Hispanic
9
<1
8
1
17
<1
Multiracial/Unknown/Others, Non-Hispanic
6
<1
3
<1
9
<1
Male Transmission Category
Count
Percent
Count
Percent
Count
Percent
MSM
373
39
249
44
622
41
IDU
7
<1
6
1
13
1
MSM and IDU
3
<1
11
2
14
1
Blood recipient
0
0
0
0
0
0
HRH
14
1
25
4
39
3
Perinatal
1
<1
1
<1
2
<1
NIR/NRR
564
59
273
48
837
55
Subtotal
962
565
1,527
Female Transmission Category
Count
Percent
Count
Percent
Count
Percent
IDU
3
<1
6
1
9
2
Blood recipient
0
0
0
0
0
0
HRH
44
13
31
4
75
15
Perinatal
0
0
0
0
0
0
NIR/NRR
285
86
141
79
426
84
Subtotal
332
178
510
Total
1294
743
2037
8
Integrated Epidemiologic Profile of HIV/AIDS, Georgia, 2011 Department of Public Health Division of Health Protection Epidemiology Program
HIV/AIDS Epidemiology Section
Page
Persons Living with HIV/AIDS in Georgia Counties
Fulton County had the highest number of persons living with HIV-NA or AIDS as of December 31, 2010
with 11,740. Second to Fulton County was DeKalb County with 7,634. Clayton County had the third
highest number of persons living with HIV-Not AIDS or AIDS as of December 31, 2010 with 1,952. (Table
2)
16
Persons Living with HIV/AIDS in Atlanta EMA
There were 27,560 individuals living with HIV-Not AIDS or AIDS in the Atlanta Metropolitan Statistical
Area (MSA) as of December 31, 2010. Of these individuals, 78% were male. Thirty-two percent of the
individuals living with HIV-Not AIDS as of December 31, 2010, in the Atlanta EMA were 40-49 years old.
Twenty percent of the cases in the Atlanta MSA as of December 31, 2010 occurred in females. Of these
females, 26% occurred in high-risk heterosexual (HRH). Sixty-eight percent of persons living with AIDS in
the Atlanta MSA as of December 31, 2010 were Black, Non-Hispanic, and 59% of persons living with AIDS
were MSM.8
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Table 2: Persons Living with HIV (not AIDS) and AIDS by Current Public Health District of Residence, Georgia, 2010
HIV (not AIDS)1
AIDS2
Total
3
4
Public Health District
Count
Rate
Count
Rate
Count
Rate
1-1
Northwest (Rome)
317
49.6
382
59.7
699
109.3
1-2
North Georgia (Dalton)
254
58.0
303
69.2
557
127.2
2
North (Gainesville)
235
38.0
289
46.8
324
52.5
3-1
Cobb-Douglas
1,087
132.5
1,312
160.0
2,399
292.4
3-2
Fulton
4,387
476.5
7,353
798.7
11,740
1275.3
3-3
Clayton (Jonesboro)
949
365.8
1,003
386.6
1,952
752.4
3-4
East Metro (Lawrenceville)
939
94.8
1,082
109.2
2,021
204.0
3-5
DeKalb
3,530
510.2
4,104
593.2
7,634
1103.3
4
La Grange
659
82.3
738
92.2
1,397
174.6
5-1
South Central (Dublin)
360
233.1
268
173.5
628
406.5
5-2
North Central (Macon)
953
183.0
872
167.4
1,825
350.4
6
East Central (Augusta)
918
198.9
1,124
243.6
2,042
442.5
7
West Central (Columbus)
693
186.8
695
187.4
1,388
374.2
8-1
South (Valdosta)
481
190.6
469
185.69
950
376.5
8-2
Southwest (Albany)
678
190.2
764
214.3
1,442
404.6
9-1
Coastal (Savannah)
970
170.2
1,271
223.0
2,241
393.2
9-2
Southeast (Waycross)
418
115.3
546
150.6
964
265.8
10
Northeast (Athens)
301
65.4
417
90.6
718
156.0
GA Cases with Unknown Health District
406
459
865
Total
18,535
191.3
23,451
242.1
41,986
433.4
Note: Case counts include incarcerated persons and may inflate rates in certain geographic regions where there are large
concentrations of HIV-positive inmates.
1
Persons Living with HIV (not AIDS)’ refers to persons living with HIV (not AIDS) as of December 31, 2010, who were currently residing in
Georgia regardless of their state of residence at the time of HIV (not AIDS) diagnosis. Persons are assumed to be alive unless otherwise
documented or reported.
2
‘Persons Living with AIDS’ refers to persons living with AIDS as of December 31, 2010, who were currently residing in Georgia
regardless of their state of residence at the time of AIDS diagnosis. Persons are assumed to be alive unless otherwise documented or
reported.
3
Numbers are based on data entered through June 30, 2011, and are not adjusted for reporting delays.
4
Rates are calculated as the number of cases per 100,000 population and are based on Georgia 2010 population estimates obtained
from the 2010 U.S. Census.
9
Integrated Epidemiologic Profile of HIV/AIDS, Georgia, 2011 Department of Public Health Division of Health Protection Epidemiology Program
HIV/AIDS Epidemiology Section
Page
17
HIV and STI Co-infections
Sexually transmitted infections (STI) co-infection (gonorrhea, chlamydia, or syphilis) in persons with HIV/
AIDS in Georgia in 2010 overwhelmingly occurred among males (82%). People 30-49 years of age had
the highest percentage of co- infections with 63% of the total. Black, Non-Hispanics had the highest
percentage of co-infection of all races/ethnicities, with 79% of cases. White, Non-Hispanics were a
distant second with 16%. In terms of HIV transmission category for males with HIV and STI co-infection,
MSM were the highest with 64% of cases; no identified risk (NIR)/no reported risk (NRR) was second
with 27%. For co-infected females, 23% reported HRH transmission and 10% reported intravenous drug
use (IDU) transmission. The majority of HIV and STD co-infected females reported NIR/NRR transmission
(66%). (Table 3)9
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Table 3: Persons Living with HIV/AIDS Who Were Ever Co-Infected with a New Reportable STD by Gender, Age, Race/Ethnicity, Georgia as of
December 31, 2010
HIV (not AIDS)
AIDS
Total
Gender
Count
Percent
Count
Percent
Count
Percent
Male
4023
80
3218
85
7241
82
Female
1002
20
558
15
1560
18
Age at Diagnosis (yr.)
Count
Percent
Count
Percent
Count
Percent
<13
0
0
0
0
0
0
13-19
76
2
8
<1
84
1
20-24
581
12
128
3
709
8
25-29
942
19
332
9
1274
14
30-39
1555
31
1081
29
2636
30
40-49
1335
27
1578
42
2913
33
50-59
468
9
552
15
1020
12
60+
68
1
97
3
165
2
Race/Ethnicity
Count
Percent
Count
Percent
Count
Percent
White, Non-Hispanic
798
16
595
16
1393
16
Black, Non-Hispanic
3994
79
2971
79
6965
79
Hispanic/Latino, Any Race
157
3
123
3
280
3
American Indian/Alaskan Native, Non-Hispanic
4
<1
6
<1
10
<1
Asian/ Hawaiian/Pacific Islander, Non-Hispanic
10
<1
6
<1
16
<1
Multiracial/Unknown/Others, Non-Hispanic
62
1
75
2
137
2
Male Transmission Category
Count
Percent
Count
Percent
Count
Percent
MSM
2496
62
2141
66
4637
64
IDU
47
1
100
3
147
2
MSM and IDU
113
3
196
6
309
4
Blood recipient
0
0
2
<1
2
<1
HRH
76
2
123
4
199
3
Perinatal
1
<1
1
<1
2
<1
NIR/NRR
1290
32
655
20
1945
27
Subtotal
4023
3218
7241
Female Transmission Category
Count
Percent
Count
Percent
Count
Percent
IDU
79
8
75
13
154
10
Blood recipient
0
0
0
0
0
0
HRH
193
19
172
31
365
23
Perinatal
4
<1
3
<1
7
<1
NIR/NRR
726
72
308
55
1034
66
Subtotal
1002
558
1560
Total
5025
3776
8801
10
Integrated Epidemiologic Profile of HIV/AIDS, Georgia, 2011 Department of Public Health Division of Health Protection Epidemiology
Program HIV/AIDS Epidemiology Section
Page
18
HIV and Tuberculosis (TB) Co-infection in Georgia
There were 27 persons newly diagnosed with HIV/AIDS and TB co-infections in Georgia in 2010. Nearly
75% of these new cases were among males. The majority of newly diagnosed cases with HIV and TB coinfection were Black, Non-Hispanics (67%). Hispanic/Latinos, Any Race had the second highest number
of co-infected cases with 19%. White, Non-Hispanics and Asian/Hawaiian/Pacific Islander, Non-Hispanics
had an equal percentage of cases with 7% each. Persons 30-39 years of age had the highest percentage
of reported TB co- infection with 33%; people 50-59 years of age had the second-highest percentage
with 26%, and people 40-49 years of age had the third-highest percentage with 19%. (Table 4)10
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Table 4: Newly Diagnosed HIV/AIDS and TB Co-infections, Georgia from January 1, 2010- December 31, 2010
Percent
74
26
Percent
0
0
7
7
33
19
26
7
Percent
7
67
19
0
7
0
100
19
HIV/AIDS
Count
20
7
Count
0
0
2
2
9
5
7
2
Count
2
18
5
0
2
0
27
Page
Gender
Male
Female
Age at Diagnosis (year)
<13
13-19
20-24
25-29
30-39
40-49
50-59
60+
Race/Ethnicity
White, Non-Hispanic
Black, Non-Hispanic
Hispanic/Latino, Any Race
American Indian/Alaskan Native, Non-Hispanic
Asian/ Hawaiian/Pacific Islander, Non-Hispanic
Multiracial/Unknown/Others, Non-Hispanic
Total
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
EPIDEMIOLOGY OF HIV/AIDS
IN FULTON/DEKALB COUNTIES
Page
20
This section describes an overview of HIV/AIDS in Fulton and DeKalb Counties. It provides an overview of the
number of newly diagnosed AIDS cases, HIV rates in 2010.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
EPIDEMIOLOGY OF HIV/AIDS IN FULTON/DEKALB COUNTIES
As of 2010, the total population of Fulton County is 920,581 (9.5% of Georgia’ population) and 691,893
for DeKalb County (7.1% of Georgia’ population) (Table 5). 11
Table 5. Distribution of the General Population, by Race/Ethnicity and Health District, Georgia, 2010
County
Total
population
Fulton
920,581
(9.5)
691,893
(7.1)
8,075,179
(83.4)
9,687,653
(100.0)
DeKalb
Georgia
Total
A.
White, NonHispanic
376,014
(6.9)
203,395
(3.8)
4,834,511
(89.3)
5,413,920
(55.9)
Black, NonHispanic
400,457
(13.8)
370,963
(12.7)
2,139,380
(73.5)
2,910,800
(30.0)
Hispanic
Asian/HA
/PI
72,566
(8.5)
67,824
(7.9)
713,299
(83.6)
853,689
(8.8)
51,591
(16.3)
35,418
(11.2)
229,835
(72.5)
316,844
(3.3)
American
Indian
/Alaskan
1,586
(9.7)
1,239
(7.6)
13,454
(82.6)
16,279
(0.2)
Multiracial
Unknown
Other
18,367
(10.7)
13,054
(7.6)
139,791
(81.6)
171,212
(1.8)
Newly Diagnosed HIV (Not AIDS) and AIDS Cases
From January 1, 2010 to December 31, 2010, there were 776 (60.0%) persons newly diagnosed with HIV
(not AIDS)12 and 419 (56.4%) persons newly diagnosed with AIDS in Georgia13; 260 (20.1%) and 164
(22.1%) in Fulton County; and 258 (19.9%) and 160 (21.5%) in DeKalb County respectively (Table 6).
Table 6. Newly Diagnosed HIV (Not AIDS) and Cases in Fulton and DeKalb Counties as compared to
Georgia, 2010
Area
Fulton
DeKalb
Georgia
HIV (not AIDS)
(N=1,294)
260 (20.1%)
258 (19.9%)
776 (60.0%)
AIDS
(N=743)
164 (22.1%)
160 (21.5%)
419 (56.4%)
Total
(N=2037)
424 (20.8%)
418 (20.5%)
1195 (58.7%)
Integrated Epidemiologic Profile of HIV/AIDS, Georgia, 2011 Department of Public Health Division of Health Protection Epidemiology Program
HIV/AIDS Epidemiology Section
12
Includes HIV and/or AIDS
13
Excludes cases in Fulton and DeKalb Counties
Page
11
21
In both Counties, the majority of individuals newly diagnosed with HIV (Not AIDS) cases were male
(Fulton 82%, DeKalb 79%, GA 71%), and Black/Non-Hispanics (Fulton 84%, DeKalb, 79%, GA 75%) who
accounted for the majority of newly diagnosed HIV (Not AIDS) cases among all races/ethnicities (Table
7).
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Table 7. Newly Diagnosed HIV (Not AIDS) Cases by Sex and Race in Georgia, 2010
HIV(not
AIDS)
(N=260)
Sex
Male
Female
Race
White
Fulton
AIDS
(N=164)
Total
(N=424)
HIV(not
AIDS)
(N=258)
130(79)
34(21)
342(81)
82(19)
205(79)
53(21)
212(82)
48(19)
Black
Hispanic
Other
DeKalb
AIDS
(N=160)
Total
(N=418)
HIV (not
AIDS)
(N=776)
131(82)
29(18)
336(80)
82(20)
545(70)
231(30)
GA
AIDS
(N=419)
Total
(N=1195)
304(73)
115(27)
849(71)
346(29)
26(10)
19(12)
45(11)
35(14)
17(11)
52(12)
157(20)
71(17)
228(19)
219(84)
13( 5)
2( 1)
135(82)
10( 6)
0( 0)
354(83)
23( 5)
2( 1)
206(80)
10( 4)
7( 3)
125(78)
15( 9)
3( 2)
331(79)
25( 6)
10( 2)
583(75)
29( 4)
7( 1)
318(76)
22( 5)
8( 2)
901(75)
51( 4)
15( 1)
When compared to the percentage of individuals newly diagnosed with HIV (not AIDS) by age group,
Fulton and DeKalb Counties show somewhat different results. Individuals 20-24 years of age (24.6%)
were the majority of cases in Fulton County, followed by 30-39 (21.5%), 25-29 (18.5%) and 40-49
(17.3%), while individuals 30-39 (28.3%) years of age were the majority of cases in DeKalb County,
followed by 40-49 (19.4%), 20-24 (17.4), and 25-29 (17.1%). Overall, persons who were newly diagnosed
with HIV (Not AIDS) in Fulton County were, on average, younger than those who were newly diagnosed
in DeKalb County (Figure 2). 14
Figure 2. Percentage of individuals newly diagnosed with HIV (not AIDS) in Fulton and DeKalb Counties
compared to Georgia by age group, 2010
30.0
28.3
24.6
25.0
21.5 20.9
21.1
20.0
17.4
18.5
17.1
16.9
19.4
18.2
17.3
Fulton
15.0
DeKalb
11.6 11.2
10.0
7.9
5.0
4.3
5.0
0.0
3.5 3.5
1.9
0.4 0 0.4
13-19
20-24
25-29
30-39
40-49
50-59
60+
14
Integrated Epidemiologic Profile of HIV/AIDS, Georgia, 2011 Department of Public Health Division of Health Protection Epidemiology
Program HIV/AIDS Epidemiology Section
Page
22
<13
GA
9.2
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Male-to-male sexual contact was the most frequently reported transmission category for males while
the majority of female cases were missing risk information or did not meet one of the CDC-defined
transmission categories. Of the Individuals newly diagnosed with HIV disease by transmission category in
Fulton County, 65% reported no risk or no identified risk (NRR/NIR), 33% men who have sex with men
(MSM), 1.2% high risk heterosexual sex (HRH), 1% injection drug user (IDU); 66% NRR/NIR, 33% MSM,
and 1% IDU for DeKalb County as compared to 66% NRR/NIR; 26% MSM; 7% HRH and 1% IDU; for
Georgia (Figure 3).
Figure 3. Percentage of individuals Newly Diagnosed with HIV (not AIDS) in Fulton and DeKalb Counties
compared to Georgia by Transmission Category, 2010
70.0
65.0 65.9 65.7
60.0
50.0
40.0
Fulton
33.1 32.6
DeKalb
26.2
30.0
GA
20.0
7.0
0.0
0.8 0.8 0.8 0.0 0.4 0.3 0.0 0.0 1.2 0.4
10.0
0.0
0.0 0.1
0.0
MSM
IDU
MSM/IDU
Blood
recipient
HRH
Perinatal NIR/NRR
MSM = MEN WHO HAVE SEX WITH MEN; IDU = INJECTION DRUG USER; HRH = HIGH-RISK HETEROSEXUAL SEX
NRR = NO REPORTED RISK; NIR = NO IDENTIFIED RISK
B.
Persons Living with HIV (Not AIDS) and AIDS
From January 1, 2010 to December 31, 2010, there were 22,612 persons (54%) living with HIV Disease in
Georgia, 11,740 (28%) percent in Fulton County and 7,634 (18%) in DeKalb County (Table 8).
Fulton
DeKalb
Georgia
HIV (not AIDS)
(N=18,535)
4,387 (23.7%)
3,530 (19.0%)
10,618 (57.3%)
AIDS
(N=23,451)
7,353 (31.4%)
4,104 (17.5%)
11,994 (51.1%)
Total
(N=41,986)
11,740 (28.0%)
7,634 (18.2%)
22,612 (53.9%)
Page
Area
23
Table 8. Persons living with HIV (Not AIDS) and AIDS in Fulton and DeKalb Counties as compared to
Georgia, 2010
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Overall, the majority of individuals living with HIV (Not AIDS) and AIDS were male (15,550, 68.8%), and
Black/Non-Hispanics (15,562, 68.8%) who accounted for the majority of persons living with HIV (Not
AIDS) and AIDS among all races/ethnicities in Georgia; 9,525(81.1%) and 8,551(72.8%) in Fulton;
6,070(79.5%) and 5,357(70.2%) in DeKalb respectively (Table 9).
Table 9. Persons living with HIV (Not AIDS) and AIDS Cases by sex and race in Georgia in 2010
Fulton
AIDS
N=7,353
Total
N=11,740
HIV(not
AIDS)
N=3,530
3,441
(78.4)
946
(21.6)
6,084
(82.7)
1,269
(17.3)
9,525
(81.1)
2,215
(18.9)
879
(20.0)
3,262
(74.4)
153
(3.5)
93
(2.1)
1,659
(22.6)
5,289
(71.9)
253
(3.4)
152
(2.1)
2,538
(21.6)
8,551
(72.8)
406
(3.5)
245
(2.1)
HIV(not
AIDS)
N=4,387
Sex
Male
Female
Race
White
Black
Hispanic
Other
DeKalb
AIDS
N=4,104
Total
N=7,634
2,725
(77.2)
805
(22.8)
3,345
(81.5)
759
(18.5)
6,070
(79.5)
1,564
(20.5)
838
(23.7)
2,449
(69.4)
154
(4.4)
89
(2.5)
919
(22.4)
2,908
(70.9)
201
(4.9)
76
(1.9)
1,757
(23.0)
5,357
(70.2)
355
(4.7)
165
(2.2)
HIV(not
AIDS)
N=10,618
6,972
(65.7)
3,646
(34.3)
GA
AIDS
N=11,994
Total
N=22,612
8,578
(71.5)
3,416
(28.5)
15,550
(68.8)
7.062
(31.2)
2,426
(22.8)
7,542
(71.0)
472
(4.4)
178
(1.7)
3,098
(25.8)
8,020
(66.9)
656
(5.5)
220
(1.8)
5,524
(24.4)
15,562
(68.8)
1,128
(5.0)
398
(1.8)
When compared, the percentage of persons living with HIV (not AIDS) by age group, the age group of
40-49 (31%, 31.2%, 32.6%) was the majority of cases in Georgia, Fulton County and DeKalb County
respectively followed by 30-39 (23.9%, 26.2%, 26.8%), 50-59 (18.3%, 18.5%, 17%) and 25-29
(10.7%,11.3%, 11.2%) (Figure 4).
Figure 4. Percentage of individuals living with HIV (not AIDS) as of December 31, 2010 in Fulton and
DeKalb Counties compared to Georgia by age group
35.0
31.2
30.0
32.6
31.1
26.8
26.2
23.9
25.0
18.5 18.3
17.0
20.0
0.0
5.5 5.9
GA
6.7
6.0 6.6
4.8
1.0
0.6
1.6
0.3 1.1 1.0
<13
13-19
20-24
25-29
30-39
40-49
50-59
60+
24
10.0
5.0
DeKalb
11.2
11.3 10.7
Page
15.0
Fulton
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Male-to-male sexual contact was the most frequently reported transmission category for
males. Of the persons living with HIV (Not AIDS) by transmission category, 39.7% reported no
risk or no identified risk (NRR/NIR), 44.8% men who have sex with men (MSM), 5.5% high risk
heterosexual sex (HRH), 4.9% injection drug user (IDU) in Fulton County; 41.8% NRR/NIR, 47.8%
MSM, 3% IDU; and 4.5% HRH for DeKalb County as compared to 51.6% NRR/NIR; 28.8% MSM;
4.6% IDU; and 11.8% HRH for Georgia (Figure 5).
Figure 5. Percentage of individuals living with HIV (not AIDS) in Fulton and DeKalb Counties
compared to Georgia by Transmission Category, 2010
60.0
51.6
50.0
47.8
44.8
41.8
39.7
40.0
Fulton
28.8
30.0
DeKalb
GA
20.0
11.8
10.0
4.9 4.6
3.0
4.1
1.8 1.9
5.54.5
1.0
1.0
0.00.10.1
1.1
0.0
MSM/IDU
Blood
recipient
HRH
Perinatal NIR/NRR
25
IDU
Page
MSM
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
HIV PREVENTION, LINKAGE TO CARE, AND TREATMENT
SERVICES IN THE JURISDICTION
Page
26
This section describes the available HIV Testing sites in Fulton and DeKalb Counties, resources allocated to address
linkage to care and treatment services, and estimated level of services gaps among persons living with HIV/AIDS.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
HIV PREVENTION, LINKAGE TO CARE, AND TREATMENT SERVICES IN THE JURISDICTION SERVICES
A. Existing HIV Prevention Resources and Services
The Centers for Disease Control and Prevention (CDC) announced a 5-year HIV prevention funding
opportunity for health departments in states, territories, and select cities. CDC’s new funding
opportunity represents a new direction in HIV prevention, and is designed to achieve a higher level of
impact with every federal HIV prevention dollar.
The purpose of this Funding Opportunity Announcement (FOA) is to support implementation of high
impact, comprehensive HIV prevention programs to achieve maximum impact on reducing new HIV
infections. In accordance with the National HIV/AIDS Strategy (NHAS), this FOA focuses on addressing
the national HIV epidemic, reducing new infections, increasing access to care, improving health
outcomes for people living with HIV, and promoting health equity. The aforementioned will be achieved
by enhancing public health departments’ capacities to increase HIV testing, refer and link HIV positive
persons to medical care and other essential services, and increase program monitoring and
accountability. 15
The goal of this Funding Opportunity Announcement (FOA) is to reduce HIV transmission by building
capacity of health departments to: focus HIV prevention efforts in communities and local areas where
HIV is most heavily concentrated to achieve the greatest impact in decreasing the risks of acquiring HIV;
increase HIV testing; increase access to care and improve health outcomes for people living with HIV by
linking them to continuous and coordinated quality care and much needed medical, prevention and
social services; increase awareness and educate communities about the threat of HIV and how to
prevent it; expand targeted efforts to prevent HIV infection using a combination of effective, evidencebased approaches, including delivery of integrated and coordinated biomedical, behavioral, and
structural HIV prevention interventions; and reduce HIV-related disparities and promote health equity.
The Centers for Disease Control and Prevention funds for a cooperative agreement program for health
departments to develop and implement comprehensive HIV prevention programs in the following three
categories: Category A: HIV Prevention Programs for Health Departments; Category B: Expanded HIV
Testing for Disproportionately Affected Populations; and Category C: Demonstration Projects to
Implement and Evaluate Innovative, High Impact HIV Prevention Interventions and Strategies.16
15
16
PS12-1201 CDC Funding Opportunity Announcement Guidance for Comprehensive HIV Prevention for Health Departments
Ibid
Page
CATEGORY A. Annual goals of FCDHW Comprehensive HIV Prevention Program are to: 1) increase HIV
testing and opt-out testing; 2) increase the proportion of HIV-infected people who know they are
27
Fulton County Department of Health and Wellness (FCDHW) applied for funding under Categories A and
B to support a variety of HIV testing and prevention efforts in Fulton and DeKalb Counties in Georgia.
Fulton and DeKalb have the highest percentage of Persons Living with HIV in the Atlanta Metropolitan
Statistical Area with 43.8% and 27.1% respectively. The epidemic in Atlanta: disproportionately affects
African Americans; is overwhelmingly male; and, has most impacted MSM. The target populations are
African American Men who have Sex with Men (MSM), MSM, and high-risk heterosexuals. FCDHW also
proposed an innovative demonstration project under Category C, focus area (2) innovative testing
activities that increase identification of undiagnosed HIV infections and/or improve the cost
effectiveness of HIV testing activities.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
infected; 3) increase the proportion of HIV-infected persons who are linked to prevention and care
services; 4) increase awareness and educate communities about HIV and how to prevent it; 5) expand
targeted efforts to prevent HIV infection using a combination of effective evidenced-based approaches;
6) reduce HIV related disparities and promote health equity; 7) provide behavioral risk screening
followed by individual and group-level evidenced-based interventions for HIV-negative persons at highest
risk for HIV; and 8) develop a social media communication strategy using guidelines in CDC’s Social Media
Toolkit. Prevention efforts will be supported by an HIV prevention planning process to include the
development of a jurisdictional HIV prevention plan and establishment of an HIV prevention planning
group. FCDHW and the planning group will partner with prevention training centers to conduct a
capacity-building needs assessment, and to monitor the HIV/AIDS epidemic within the jurisdiction for
program planning, resource allocation and evaluation purposes.17
CATEGORY B. FCDHW will provide expanded HIV testing for disproportionately affected populations in
an effective and efficient client-centered HIV prevention program.
CATEGORY C. Project Enhanced Detection to Decrease HIV Infections (Project EDDI) – The Use of Nucleic
Acid Amplification Testing (NAAT) or Fourth Generation Testing in the Early Identification of HIV in
Persons with Sexually Transmitted Infections (STIs) as a Means of Reducing HIV Transmission. This
project will incorporate testing for acute HIV infection in persons from areas of high HIV prevalence who
seeks STIs services because it has been shown that concurrent STI increases the susceptibility and
transmissibility of HIV. FCDHW seeks to augment the existing HIV screening algorithm with enhanced
testing to identify and treat highly-infective persons with acute HIV who would otherwise not be
detected due to the “window period” of standard HIV testing, followed by partner notification and
directed community outreach to prevent other new infections in high prevalence areas. FCDHW will
implement new specimen pooling strategies to reduce the cost of NAAT without compromising capacity
to detect acute HIV infection.
17
PS12-1201 CDC Funding Opportunity Announcement Guidance for Comprehensive HIV Prevention for Health Departments
Page
28
The Centers for Disease Control and Prevention allocated $4,981,443.51 dollars to support the HIV
prevention efforts of Fulton County and neighboring DeKalb County. The funding breakdown is as
follows for Category A and B. Category C funding of $467,317 is for a demonstration project at Fulton
County Department of Health and Wellness. (Figure 6)
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Figure 6. The Centers for Disease Control and Prevention allocated $4,981,443.51 dollars to support the
HIV prevention efforts of Fulton County and DeKalb Counties
Category A and B FY12 Funding
Allocation
2,340,645.96
1,485,638.55
450,320
163,681.60
Indirect
73,839
Contracts
Supplies
Admin
Other
The Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services
Administration (SAMHSA) have allocated approximately $10.5 million dollars to support the HIV
prevention efforts of Georgia’s community-based organizations, AIDS service organizations, county
health departments, and the Georgia Department of Public Health.18
B. Linkage to Care and Treatment Services at Fulton
18
Jurisdictional HIV Prevention Plan Update 2009-2013, State of Georgia, page 27.
Page
The FCDHW/CDPB primary care services include the provision of diagnostic testing, early intervention
and risk assessment, preventive care and screening, practitioner examination, medical history taking,
diagnosis and treatment of common physical and mental conditions, prescribing and managing
medication therapy, care of minor injuries, education and counseling on health and nutritional issues,
29
Ryan White Part A Program for the Atlanta EMA - $1,500,000
Fulton County Government administers the Ryan White Part A program for the Atlanta Metropolitan
Statistical Area (MSA) and is tasked with improving access to care and treatment for people who are HIV
positive, but not in care. Efforts are in process to increase the number of people in care and treatment
who have not been tested for HIV, but are HIV-positive, as well as those who know they are living with
HIV, but are not in care. Fulton County Department of Health and Wellness (FCDHW) Communicable
Disease Prevention Branch (CDPB) is a key partner in the EMA’s linkage to care efforts. Furthermore, as
the service provider for the largest number of persons living with HIV not-AIDS in the MSA, as well as the
largest provider of HIV screenings in the MSA, FCDHW is positioned to play a key role in bridging
medically underserved HIV positive individuals to care and treatment services. CDPB, in concert with the
Primary Care Clinic (PCC) will provide primary care services to individuals who are HIV-positive, and to
ensure that individuals receive the best preventive service and treatment possible whenever they
interact with the PCC providers.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
continuing care and management of chronic conditions, and referral to and provision of specialty care.
Primary medical care for the treatment of HIV infection includes the provision of care consistent with US
Public Health Service Guidelines (USPHS). Care includes access to antiretroviral and other drug
therapies, including prophylaxis and treatment of opportunistic infections and combination
antiretroviral therapies.
PCC provides substance abuse assessments and individual/group counseling for clients identified as
needing further substance abuse evaluation. Referrals are provided to clients needing detoxification
and long-term treatment. To improve access and retention in primary care, PCC provides food assistance
and medical transportation. The PCC staff provides referrals that are consistent with HIPAA, USPHS, and
FCDHW confidentiality guidelines. The PCC will work with Linkage Coordinators to initiate referrals and
provides follow-up with clients to determine if they: 1) kept their primary care medical appointment; 2)
did they received the requested services, and 3) were there services provided in an appropriate and
professional manner as rated on the Client Satisfaction Survey. Follow-up with a client includes face-toface or telephone contact with the client. This also means that the PCC staff or Linkage/Retention
Coordinator (LRC) will accompany the client to his/her schedule appointment.
Merck Company Foundation HIV Care Collaborative $333,333 ($999,999.00 for 3 years)
Fulton County Department of Health and Wellness Bridging the Gap Program focuses on HIV-positive
persons referred to and enrolled in the county’s HIV Primary Care clinic by implementing a communitybased Linkage Coordinator and referral program. The role of the Linkage Coordinators will assist in
enrolling clients into PCC. They will also assist newly diagnosed clients in navigating the system (PCC);
work with the case managers to link newly diagnosed and previously HIV-positive clients to needed
external resources; and making appointment reminder calls.
Test, Link and Care Program - $137,900
Test, Link and Care Program is to ensure that newly identified HIV-positive persons and individuals lost
to care are linked to medical care and prevention services. Through the use of a brief case
management, strengths-based care, Linkage Coordination and a systematic networking among HIV care
providers, this program aim to identify and promptly link to care persons who are living with HIV but not
receiving treatment.
Ryan White Part B Minority AIDS Initiative – $67,839
Ryan White Part B Minority AIDS Initiative is to implement a linkage to care model that will identify and
promptly link individuals living with HIV not receiving treatment.
Enhanced Comprehensive HIV Prevention Plan -$100,000
Enhanced Comprehensive HIV Prevention Plan is to provide partner services in clinical and non-clinical
settings to clients who test positive for HIV, and linking HIV-positive persons to care and treatment.
Page
Currently, there are more than 14 individual and group-Level evidenced-based interventions (EBI)
offered in the state of Georgia. The individual and group-level EBIs offered in Fulton and DeKalb
Counties are highlighted in Attachment B.
30
C. Existing HIV Prevention Interventions
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
D. Needs and Gaps in HIV Prevention
Estimated level of service gaps among Persons Living with HIV/AIDS (PLWHA) in the MSA:
Service gaps were documented in a number of specific needs assessments/consumer surveys carried out
by the Metropolitan Atlanta HIV Health Services Planning Council in the MSA during the past few
years. Using data from the HIV/AIDS reporting system (eHARS), the statewide laboratory database and
the Georgia Department of Public Health, HIV Epidemiology Unit, it has been estimated that 56% of
PLWHA in the MSA had not received primary health care services during 2010.19
Apart from primary health care, there are also two other areas in which there are gaps in services. Data
from the 2008 Atlanta MSA HIV Consumer Survey and the CAREWare database indicate 39% of PLWHA
have mental health problems, specifically depression, but only 21% of clients at Part A funded service
sites received mental health services during 2010. There are 10,485 persons with mental health
needs.20
Data from the same sources indicate that 9% of PLWHA in the MSA (2,420) have substance abuse
problems as a contributing factor in their infection and will need additional care.
The 2008 Consumer Survey conducted by the Southeast AIDS Education and Training Center (SEATEC)
sought data concerning services accessed by PLWHA at 12 Part A and 8 non-Part A funded local AIDS
service organizations (the consumer survey performed in 2011 is still being analyzed). The four services
most needed and not received were “Oral Health Care,” “Food Pantry”, “Home Delivered Meals” and
“Legal Services”. For Hispanics, “Support Groups and Counseling” was high in the most needed and not
received service, and for Whites, “Legal Help” was also in the top five services needed but not
received.21
Of the 26 services examined in 2008, eight services were in high need by at least 15% of all respondents.
Hispanics and females aged between 18 and 44 years reported the greatest number of services in high
need (n=8), followed by African Americans, females and males in general (n=7) and Whites (n=5).
Females and males were similar in their reported service use, service needs, and number of services in
high need.22 In addition, in the 2008 Consumer Survey, people living with HIV for less than three years
perceived a greater need for oral health care, referrals to services, emergency help paying utility bills,
mental health counseling, 1:1 peer counseling, and support groups. People living with HIV for more than
11 years were more likely to use other HIV medications, oral health care, support groups, and
drug/alcohol counseling. 23
2010 Atlanta EMA Ryan White Grant Application to HRSA, page 5
Ibid
21
Ibid
22
Ibid
23
Ibid
20
Page
19
31
Lastly, respondents indicated that if they had a case manager, they were more likely to use services and
report fewer services needed but not received. While 70% of participants reported having a case
manager, Hispanics were less likely than African American and White clients to have accessed this
service. Hispanics also identified more barriers overall to receiving specific services that were needed
but not received, such as oral health care, help paying utility bills or buying groceries, or obtaining free
groceries. Participants who were diagnosed HIV positive for three years were more likely to identify
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
personal and information barriers, whereas those who were HIV positive for more than 11 years were
less likely to report capacity and information barriers. Participants with lower functional health literacy
were more likely to report financial, system, and information barriers.24 (Table 10)
Table 10. Assessment of Emerging Population with Special Need and Unique Gaps in Services
Emerging Populations
Young Men who Have Sex
with Men (15-30 years of
age)
Women of Childbearing
Age(15-49)
Hispanics
Aging PLWHA, 50 Years of
Age and Older
Services
Service gaps include insufficient outreach initiatives that create awareness and educate MSM
about HIV/AIDS and safer sex practices, social support groups that address substance abuse and
mental health issues and the stigma associated with the complexity of multiple health problems.
Other gaps in services identified through the HIV Consumer Survey include primary prevention
services for oral health, transportation, and emergency assistance for paying household utilities.
Services including outpatient ambulatory care, oral health care, mental health counseling, and
family case management are needed for adult and adolescent women. These services, along
with on-site childcare and a Pediatric Care Unit, are provided comprehensively solely at the
Grady Infectious Disease Program (IDP). The centralized case management system facilitates
referrals to other programs such as housing, financial and food assistance programs. Through
the Ryan White Part D program, Grady Hospital’s Obstetrics (OB) program has resources in place
to provide prenatal care to uninsured HIV positive pregnant women. The 2008 HIV Consumer
Survey reports a high rate of primary care usage (80%) among women, yet only 69% use
antiretroviral medications. The top services needed but not received were: oral health care,
food, transportation assistance, home-delivered meals, and referrals to services.
There are existing gaps in the provision of needed services in the general population and the
limited number of culturally appropriate services for Hispanic clients increases these gaps
multiple times. In the MSA there are a limited number of infectious disease specialists, almost
none whom are culturally aligned with the Hispanic population. In addition, many people of
Hispanic origin have culturally directed treatment concepts that are not recognized by the
traditional Caucasian specialist. This includes use of alternative treatments and therapies
(acupuncture, vitamins, bio-identical drugs to name a few). All hospitals do provide translators
which often fall short of cultural sensitivity.
There will be two major effects of the aging population on the medical system. The first is that
the resources required to manage these chronic diseases in PLWHA are limited. In the MSA the
infectious disease specialists currently managing the HIV component of their disease cannot
manage all the other chronic disease aspects. Other specialists who serve low income
individuals are already over worked. The second is the sheer fiscal cost of managing these aging
PLWHA.
24
25
Ibid, page 6
2010 Atlanta EMA Ryan White Grant Application to HRSA, pages 23 -34
Page
Service needs, gaps and barriers to care:
From the results of the unmet need analysis, it is clear that getting individuals into HIV primary care
must be a continuing priority. In the 2008 Consumer Survey, consumers reported using medical and
information services at high rates in the past 30 days (primary medical care – 77% and antiretroviral
medications – 73%). Dental care (46%) was the most frequently reported service needed but not
received. The most commonly reported barriers for consumers were personal (26%), followed by
information (19%) and capacity (16%). Additional analysis revealed that capacity (20%) and other
barriers (20%) were reported by consumers earning an annual income less than 100% of Federal Poverty
Level (FPL). Information barriers were reported more frequently by Hispanics (33%), women (31%), and
especially women of childbearing age (37%). Personal barriers, the most commonly reported of all,
indicated the highest statistically significant rates for men (28%). Participants were asked screening
questions regarding substance abuse and mental health. Of the 313 participants that completed the
32
25
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
screening, 80 (26%) consumers were in need of additional substance abuse assessment and 136 (39%)
were in need of additional mental health assessment.26
Gaps in HIV prevention services
Gaps in HIV prevention services were based on the two-day community engagement forum. Some of
the strategies and recommendations are as follows:
 Identifying point of entry sites to develop a network of service providers offering HIV testing
 Strategic social media messaging for HIV prevention services
 Peer navigators to link HIV infected clients to care services
 Routine HIV testing offered across populations and locations
 On-site confirmatory HIV testing
 Multi-lingual service options and culturally competent services for all clients
 Culturally competent services for all clients
Community forum participants identified specific challenges and needs, including environmental
barriers that include:










Routine HIV testing in healthcare settings
Additional time allotted with physicians during appointments
Integrated community education about value of testing for HIV and other STIs
Health literacy of client
Client adherence to HIV treatment
Lack of services for transgender population
Medicaid restrictions, other treatment funding challenges
Lack of patient navigators to guide clients through healthcare system
At-risk individuals require more tailored prevention education
Knowledge of healthcare providers regarding HIV/AIDS and HIV/AIDS treatment
Ibid
Georgia of Public Health Enhanced Comprehensive HIV Prevention Plan (ECHPP)
28
ECHPP
29
Ibid
30
Ibid
27
Page
26
33
Additionally, gaps in HIV services identified in the 2011 Georgia of Public Health Enhanced
Comprehensive HIV Prevention Plan (ECHPP) are as follows: Lack of established guidelines for directing
resources to areas with high morbidity in the MSA.27 Reach: Lack of guidelines to follow on how
interventions are selected for MSA and statewide use.28 Coordination: Although testing is often provided
at locations requested by community groups or organizations, these efforts have been limited by a lack
of monitoring, tracking and evaluation, and comprehensive, standardized and sustained HIV training and
technical assistance.29 Services: Opt-out testing in clinical settings (public and private) is not being
conducted by all service providers due to “capacity and comfort levels.” Although, the Official Code of
Georgia Annotated supports testing pregnant women for HIV, many providers are unaware of this
regulation and do not routinely offer prenatal HIV testing. Furthermore, high risk individuals with comorbidities (i.e., other STDs, viral hepatitis, and/or tuberculosis) are not consistently being offered optout testing in clinical settings.30
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
PROCESS FOR DEVELOPING THE CITY OF ATLANTA
(FULTON/DEKALB COUNTIES) JURISDICTION HIV
PREVENTION PLAN
Page
34
The section describes the step-by-step process of the development of the City of Atlanta (Fulton/DeKalb Counties)
Jurisdictional HIV Prevention Plan. It highlights information on a series of meetings that were convened to engage
community stakeholders in the identification and prioritization of innovative HIV prevention strategies to address
the high burden of HIV. This section also describes how the planning, development and implementation process
will be monitored.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
PROCESS FOR DEVELOPING THE JURISDICTION HIV PREVENTION PLAN
Vision
“When every person in Fulton and DeKalb Counties is empowered to know their HIV status, and if HIVpositive, choose to access high quality care and treatment”
Mission
“To achieve optimal HIV prevention and care services, by mobilizing partnerships and taking strategic
action”
Guiding Principles
The development of the City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan
2012-2016, is guided by seven principles. These principles ensure the plan and planning process would:
1. Promote an appreciation for the dynamic interrelationships of all components local health
system required to develop a vision of a healthy community.
2. Ensure respect for diverse voices and perspectives during the collaborative process.
3. Form the foundation for building a shared vision around HIV prevention.
4. Provide factual information during each step of the process.
5. Optimize performance and services through shared resources and responsibility.
6. Foster a proactive response to the issues and opportunities facing the system.
7. Ensure that contributions are recognized and sustain excitement for the process.
31
HealthHIV Collaborating to Implement High Impact HIV Prevention: Fulton/DeKalb Counties Community Forum Engagement Report, October
2012
Page
The intended outcomes of the community engagement meetings were to:
1. Increase stakeholder understanding of the changing HIV prevention, care, and
treatment landscape, including high impact HIV prevention and National HIV/AIDS
Strategy.
2. Identify community successes and challenges in implementing HIV prevention
strategies.
3. Inform Fulton and DeKalb counties regarding activities, strategies, and programmatic
directions in addressing the HIV prevention needs of the community.
4. Recommend community strategies for inclusion in the Fulton and DeKalb Counties HIV
Prevention Jurisdictional and Comprehensive Plans (Figure 7).
35
The City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan development began with
a series of community engagement meetings, hosted by Fulton County Department of Health and
Wellness High Impact HIV Prevention Program and facilitated by HealthHIV, a national organization that
provides capacity building and technical assistance for health departments. The meetings were
convened to engage community stakeholders in the identification and prioritization of innovative HIV
prevention strategies to address the high burden of HIV in the jurisdiction. A two-day and one-day
follow-up community engagement meetings, held September 27 and 28, and October 17, 2012, were
utilized (See Attachment C for Full Report).31
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Figure 7. Process for Convening Community Engagement Meetings (September 27-28, 2012, and
October 17, 2012).
Jurisdictional HIV Prevention Community Engagement Planning Process
Step One
Step Two
Step Three
Organizational
Infrastructure
Assessment
Stakeholder
Identification &
Recruitment
Engage Community &
Create Ownership for
Process
Lead organization
(Fulton County
Department of Health
and Wellness) begins
by organizing and
preparing to implement
the community
engagement process.
Assessing structural,
human and financial
resource capacity.
Partners, stakeholders,
and community
residents recruited to
participate in the
community engagement
process. Participation
will require a high level
of commitment to
participate in the
planning process
Community
Engagement meeting
was convened. A
shared vision and
common values were
discussed. Participants
were asked questions
such as, "what would
you like our community
to look like in 5 years
as it relates to HIV?",
What does the health
status of our
community look like?
etc.
Step Five
Step Four
Results-oriented
Engagement Process
A list of challenges
were identified. Once
the list of challenges
and opportunities were
generated from the
participants, the next
step was to identify
strategic issues.
During this meeting,
participants identified
linkages between the
issues to determine the
most critical areas that
must be addressed for
the community to
achieve its vision.
Jurisdictional Plan
Development,
Implementation and
Monitoring
After the issues have
been identified,
participants formulated
goals and strategies for
addressing each issue.
The participants
returned for another
meeting of the
community
engagement process.
The purpose of this
meeting was to allow
participants to finalized
the goals, strategies,
and objectives for the
jurisdictional plan. The
goals, strategies and
objectives are placed in
the Jurisdictional HIV
Prevention Plan. The
plan is disseminated to
the community
engagement
participants for review
and feedback. The
plan is reviewed by the
Jurisdictional HIV
Prevention Planning
Group for a letter of
concurrence.
HIV Planning Group
Page
Fulton County formed and now operates a 33 member jurisdictional HIV prevention planning group that
develops a plan to address for HIV prevention needs across Fulton and DeKalb Counties (Figures 8, 9,
and 10). The City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Planning Group (JPG)
is responsible for developing an engagement process for the jurisdiction. The JPG also participates in
the development or update the local health department Jurisdictional HIV Prevention Plan and
participates as a partner with the local health department to improve the impact of HIV prevention
efforts with the jurisdiction (Fulton/DeKalb Counties), see Attachment A for JPG. (Figures 8, 9, and 10).
36
All funded jurisdictions to include the fifty states, eight cities (Atlanta, Baltimore, Chicago, Houston, Los
Angeles, New York, Philadelphia, and San Francisco), the District of Columbia, Puerto Rico, the Virgin
Islands, and the United states Affiliated Pacific Island jurisdictions are required to have in place a
planning process that includes the development of the City of Atlanta (Fulton/DeKalb Counties)
Jurisdictional HIV Prevention Plan and the establishment of an HIV Planning Group (formerly HIV
Community Planning Group).
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Figure 8.
Figure 9.
Page
37
Figure 10
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
CITY OF ATLANTA (FULTON/DEKALB COUNTIES)
JURISDICTIONAL HIV PREVENTION PLAN
REQUIRED PROGRAM PLAN COMPONENTS
Page
38
This section outlines the specific goals, strategies and objectives the jurisdiction will follow to achieve the goals of
the National HIV/AIDS Strategy. This section also describes how the plan goals, strategies and objectives will be
measured.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
The City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan, and the proposed
interventions, goals, strategies and objectives align with the National HIV/AIDS Strategy such as: 1)
Reducing New Infections; 2) Increasing Access to care and Improving Health Outcomes for People Living
with HIV; and 3) Reducing HIV-Related Disparities and Health Inequities32.
JURISDICTIONAL HIV PREVENTION PLAN
REQUIRED PROGRAM PLAN COMPONENTS
A.
HIV TESTING IN HEALTHCARE AND NON-HEALTHCARE SETTINGS
Required Intervention #1: “Routine, Opt-Out screening for HIV in clinical settings”


32
The National HIV/AIDS Strategy (NHAS) released by the White House on July 13, 2010 is the nation’s first-ever comprehensive coordinated
HIV/AIDS roadmap with clear and measurable targets to be achieved by 2015. By aligning our efforts with the National HIV/AIDS Strategy, we
strive to reduce HIV transmission and better support people living with HIV and their families. Source: NHAS Fact Sheet, 2012
Page

39
Goal 1: Increase the number of residents in Fulton/DeKalb Counties who receive
Funding source:
routine HIV screening as part of ongoing medical care.
CDC-DHAP
Strategy 1: Identify clinical providers and zip codes with highest burden of HIV disease for routine optHIV testing.
Strategy 2: Identify existing training materials regarding routine HIV testing in clinical settings to
promote HIV testing into routine medical care and/or develop provider training materials on routine
HIV testing in the clinical settings.
Strategy 3: Develop a MOU with the Southeast AIDS Education and Training Center (SEATEC) to provide
routine HIV testing education.
Strategy 4: Provide training, capacity building and technical assistance to healthcare providers in
Fulton/DeKalb Counties to increase routine HIV testing in clinical settings.
Strategy 5: Identify types of social media technologies proper to distribute messages encouraging
routine HIV testing in the clinical settings.
Strategy 6: Develop social media messages encouraging routine HIV testing in the clinical settings.
Strategy 7: Identify and partner with medical and nursing associations.
Strategy 8: Develop and utilize a data tracking tool to monitor the number of clinical settings
implementing routine HIV testing.
Objective 1: By December 31, 2012, develop a list of clinical providers to
Data sources:
encourage and conduct routine HIV testing.
Monthly Fulton
and DeKalb HIV
Objective 2: By December 31, 2016, provide routine HIV testing education to
test data reports;
selected healthcare providers.
Ryan White
Objective 3: By December 31, 2016, disseminate messages via selected social
program;
media technologies (using at least 3 different social media technologies) to
participant
encourage routine HIV testing in the clinical setting.
evaluations
Objective 4: By December 31, 2016, distribute brochures, pamphlets, etc., on HIV
testing in medical settings through partnership with medical and nursing
associations.
Objective 5: By December 31, 2016, establish a data tracking system and monitor
the number of HIV testing in the clinical setting.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Goal 2: Increase the number of HIV tests provided in emergency rooms located in
Funding source:
high prevalence communities.
CDC- DHAP
Strategy 1: Collect the information regarding current policies in emergency rooms in Fulton/DeKalb
Counties, and identify any barriers to implement routine HIV testing.
Strategy 2: Identify and list the names of emergency departments in Fulton/DeKalb Counties.
Strategy 3: Identify possible approaches to improve routine HIV testing in emergency rooms.
Strategy 4: Contact identified emergency departments and assesses their needs for implementing
routine HIV testing.
Strategy 5: Work with emergency departments to establish HIV testing protocols to ensure that HIV
tests are routinely provided to emergency room patients.
Strategy 6: Assign Disease Invention Specialist (DIS) weekly to emergency rooms to conduct partner
services on individuals testing HIV-positive.
Strategy 7: Provide training, capacity building and technical assistance to healthcare providers in
emergency departments to increase routine HIV testing.
Objective 1: By February 28, 2013, assess current policies related to routine HIV
Data sources:
testing in emergency rooms in Fulton/DeKalb Counties.
Technical
Objective 2: By May 3, 2013, build collaborative relationships with emergency
assistance logs,
departments and provide technical assistance to encourage routine HIV testing in
completed HIV
the emergency rooms.
counseling and
Objective 3: By December 31, 2016, increase the number of HIV tests provided by testing forms,
emergency rooms in Fulton/DeKalb Counties by 10%.
collaboration
Objective 4: By December 31, 2016, assign Disease Intervention Specialist (DIS)
participation
weekly to community-based organizations, medical settings or emergency rooms
participate list,
to conduct partner services on individuals testing HIV-positive.
HIV testing data
Responsible Parties: Fulton County Department of Health and Wellness High
Impact HIV Prevention Program (HIPP); DeKalb County Board of Health; and
funded community-based organizations.
Page
Goal 1: Ensure HIV testing is focused in non-clinical settings in areas with the
Funding source:
highest burden of disease.
CDC- DHAP
Strategy 1: Analyze client-level HIV testing data to assess outcomes of current HIV testing in non- clinical
settings
Strategy 2: Analyze epidemiologic and surveillance data to ensure HIV testing is targeted in the areas
with the highest burden of disease.
Strategy 3: Increase collaboration with community-based organizations by providing ongoing technical
assistance visits and feedback.
Strategy 4: Create a programmatic calendar for each program year to identify times and venues where
agencies will conduct HIV testing and other services.
Strategy 5: Develop and utilize a data tracking tool to monitor the number of HIV testing implemented
in non-clinical settings.
Strategy 6: Create and implement ongoing performance improvement plans of funded community
based organizations and other providers who do not maintain a 2% newly diagnosed HIV positivity rate.
Strategy 7: Conduct ongoing quarterly program performance reviews of all agencies funded to conduct
targeted HIV testing in clinical and non- clinical settings.
40
Required Intervention #2: “HIV testing in non-clinical settings to identify undiagnosed HIV infection”
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Objective 1: By December 31, 2012, increase coordination of HIV testing and
linkage-to-care programs in non-clinical settings.
Objective 2: By December 31, 2016, increase the number of new HIV testing service
programs to target HIV testing in non-traditional settings and at non-traditional
days and times by 10% compared to baseline 2012.
Objective 3: By December 31, 2016, minimize duplicates in services and HIV testing
at non-clinical/non-traditional venues.
Objective 4: By December 31, 2016, partner with the State HIV Surveillance
Department to review the client-level and epidemiological data to expand and
enhance HIV testing efforts in the jurisdiction.
Objective 5: Increase accountability for HIV testing through enhanced monitoring.
Data sources:
HIV testing
forms, HIV
testing data,
Budget,
contracts,
Page
Goal 3: Increase the percentage of newly-identified HIV-positive persons who learn Funding source:
their serostatus and receive post-test counseling.
CDC- DHAP
Strategy 1: Shift to rapid testing in non-clinical testing programs that are currently utilizing conventional
testing (as feasible and appropriate).
Strategy 2: Pilot 5th generation HIV testing technology when economically feasible.
Objective 1: By December 31, 2016, ensure that 80% of all newly-identified Data sources:
confirmed HIV-positive test results will be returned to the client.
HIV Counseling
Objective 2: By December 31, 2016, ensure that 75% of all newly-identified, and Testing
confirmed HIV-positive tests results returned to the client are referred to partner forms, HIV
services.
testing data;
Objective 3: By December 31, 2016, ensure that 80% of newly-identified HIV- STD*MIS, and
positive persons who learn their serostatus and receive post-test counseling are SENDSS
referred to medical care and confirm attendance to their first appointment
Responsible Parties: Fulton County Department of Health and Wellness High Impact
HIV Prevention Program (HIPP); DeKalb County Board of Health; and funded
community-based organizations.
41
Goal 2: Increase HIV testing among the populations at greatest risk for HIV infection Funding source:
in Fulton/DeKalb Counties.
CDC- DHAP
Strategy 1: Request peer-to-peer technical assistance via UCHAPS to develop effective testing strategies
for reaching African American MSM, injecting drug users, high-risk heterosexuals, and other high-risk,
hard-to-reach populations.
Strategy 2: Work with local community-based organizations that conduct targeted HIV testing to
develop strategies to increase reach to high-risk populations.
Strategy 3: Recruit and fund community-based organizations for new outreach testing programs serving
the populations at greatest risk for HIV infection in the jurisdiction.
Objective 1: By December 31, 2012, develop effective testing strategies for reaching Data sources:
African American MSM, injecting drug users, high-risk heterosexuals, and other Program plans,
high-risk, hard-to-reach populations.
RFP, Contracts,
Objective 2: By December 30, 2012, develop and release Requests for Proposals HIV testing data
(RFP) for new or expanded outreach testing programs.
Objective 3: By December 31, 2012, establish contracts with community-based
organizations and/or other service providers for new or expanded HIV testing
programs.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Required Intervention #10: “Implement STI screening according to current guidelines for HIVpositive persons”
Goal 1: Increase the percentage of persons living with HIV who received
Funding source:
recommended initial and ongoing STI screening as part of ongoing HIV medical care. CDC- DHAP
Strategy 1: Inform medical providers about the latest STI Treatment Guidelines and the
recommendations for initial and ongoing STI screening for HIV-positive persons in care.
Strategy 2: Work with the Ryan White Planning Council, and provide and screen individuals accessing
STD, TB and Ryan White Clinics for HIV.
Strategy 3: Develop and use a tracking tool to monitor STI screening by HIV care providers and eligible
community-based organizations, and provide technical assistance as needed.
Objective 1: By December 31, 2016, ensure that medical providers for HIV-positive
Data sources:
clients are aware of the latest STI Treatment Guidelines and the recommendations
Meeting notes
for initial and ongoing STI screening for HIV-positive persons in care.
and distribution
Objective 2: By December 31, 2016, partner with the Ryan White Planning Council
timeline
to ensure information on STI screening for HIV-positive persons are disseminated
annually.
Objective 3: By December 31, 2016, continue to implement standards for ensuring
MSMs that access STI, TB and Ryan White Clinics are provided and screened for HIV.
Objective 4: By December 31, 2016, continue to implement standards for ensuring
HIV-positive persons are screened for HIV by local primary care clinics and other
providers.
Responsible Parties: Fulton County Department of Health and Wellness High Impact
HIV Prevention Program (HIPP); DeKalb County Board of Health; and funded
community-based organizations
Page
Goal 1: Increase the percentage of pregnant women who receive HIV testing during Funding source:
their first trimester; and
CDC- DHAP
Goal 2: Increase the percentage of women at high-risk for HIV infection during
pregnancy who receive repeat testing in the third trimester.
Strategy 1: Identify and list any barriers to implement pre-natal testing and HIV reporting.
Strategy 2: Identify, select, and visit a number OB/GYNs and/or providers treating pregnant women in
Fulton and DeKalb Counties.
Strategy 3: Provide OB/GYNs and/or providers with information regarding the CDC revised
recommendations for HIV testing, information and support as to where to access information and
trainings for the treatment of HIV-positive pregnant women (special emphasis on 3rd trimester testing).
Strategy 4: Partner with the State HIV Surveillance Department to identify and report follow-up HIV
prenatal cases and to ensure newborns have received post-natal care and HIV screening.
Strategy 5: Assess existing collaborations and determine the strategic partners.
Strategy 6: Visit labor and delivery hospitals and link women who test positive during birth to HIV care
to ensure that the baby receives post-natal care and HIV testing (birth, 2 weeks, 6 weeks, and 4
months).
Objective 1: By January 31, 2013, conduct an assessment of existing laws and gaps
Data sources:
related to prenatal testing and HIV reporting.
State HIV
42
Required Intervention #11: “Implement prevention for perinatal transmission for HIV
positive persons”
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Objective 2: By February 28, 2013, disseminate recommendations regarding HIV
testing intervals for high-risk pregnant women to all providers that provide prenatal
care in the jurisdiction.
Objective 3: By January 31, 2013, establish a tracking system to identify, contact,
and provide follow-up to HIV-positive women who have recently given birth.
Objective 4: By March 4, 2013, recruit partners from licensing boards, providers,
professional associations and organizations to increase the capacity of preventing
HIV infection through perinatal transmission.
Objective 5: By December 31, 2016, continue to partner with the state Perinatal
Workgroup.
Objective 6: By December 31, 2016, continue to support outreach and HIV/STI
partner services to provide HIV testing to high-risk women and connect pregnant
women to prenatal care.
Responsible Parties: Fulton County Department of Health and Wellness High Impact
HIV Prevention Program (HIPP); DeKalb County Board of Health; and funded
community-based organizations.
B.
Surveillance Case
Reporting Forms,
Notes
HIV PREVENTION WITH POSITIVES
Page
Goal 1: Increase the percentage of HIV-positive persons who are successfully linked Funding source:
to HIV medical care and support services.
CDC- DHAP
Strategy 1: Coordinate between HIV testing programs, linkage to care programs and HIV care providers
to support effective referral and linkage to care.
Strategy 2: Refer all confirmed HIV-positive persons to medical care and confirm attendance to their
first appointment.
Strategy 3: For all persons testing HIV-positive or currently living with HIV/AIDS who are linked to care
and treatment, provide brief prevention intervention services.
Strategy 4: Ensure continuity of care among persons living with AIDS.
Strategy 5: Ensure that newly-identified, confirmed HIV-positive persons tested in clinical and nonclinical settings who regularly visit a HIV clinic or HIV medical care providers are referred for partners
services, when eligible.
Objective 1: By December 31, 2012, develop and implement “Red Carpet” linkage
Data sources:
to care services to persons newly diagnosed with HIV.
CareWare, CD4,
Objective 2: By December 31, 2016, increase linkage to care among newly
viral loads,
diagnosed individuals in the jurisdiction by 10% compared to baseline 2012.
appointments
Objective 3: By December 31, 2016, increase the proportion of newly-diagnosed
persons linked to clinical care within three months of their diagnosis by 10%
compared to baseline 2012.
Objective 4: By December 31, 2016, increase the percentage of HIV-positive
persons who are in continuous care (at least 2 visits for routine HIV medical care in
12 months) by 10% compared to baseline 2012.
Objective 5: By December 31, 2016, reduce the proportion of individuals who have
tested positive for HIV, but who are not in care by 10% annually (50% baseline).
43
Required Intervention #6: “Implement linkage to care, treatment and prevention service for
those testing HIV-positive and not currently in care”
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Responsible Parties: Fulton County Department of Health and Wellness High
Impact HIV Prevention Program (HIPP); DeKalb County Board of Health; and funded
community-based organizations.
Required Intervention #7: “Implement interventions or strategies promoting retention in or
engagement in care for HIV-positive persons”
Goal 1: Develop and support innovative providers and programs that improve
Funding source:
access to HIV care and treatment.
CDC- DHAP
Strategy 1: Implement linkage/retention collaboration with other HIV service providers in the
jurisdiction.
Strategy 2: Identify individuals in need of re-linkage to care and address re-linkage to care.
Strategy 3: Contact each person that has fallen out of care for participation in Anti-Retroviral Treatment
and Access to Services (ARTAS) individual-level behavioral intervention sessions.
Strategy 4: Assess the percentage of Ryan White clients who are in continuous care and provide
technical assistance as needed.
Objective 1: By March 22, 2013, launch coordinated evidenced-based
Data sources:
linkage/retention collaboration with other HIV services providers in the jurisdiction. CareWare, eHars,
Objective 2: April 1, 2013, apply HIV surveillance and HIV Care Data Matching
Mitchell and
Protocols to identify individuals in need of re-linkage to care, as well as the
McCormick, STDprovider-and system-based factors that precipitated falling out-of-care.
MIS, and Ryan
Objective 3: By December 31, 2016, increase the number of people participating in
White
in ARTAS individual-level behavioral intervention sessions by 10% annually.
Appointment
Objective 4: Increase the percentage of Ryan White clients who are in continuous
Scheduler
care and have technical assistance by utilizing clinical quality management (CQM)
mechanisms by 10% annually.
Responsible Parties: Fulton County Department of Health and Wellness High Impact
HIV Prevention Program (HIPP); DeKalb County Board of Health; and funded
community-based organizations.
Page
Goal 1: Maintain and monitor standards of care that support the provision of
Funding source:
treatment in accordance with Public Health Service (PHS) guidelines
CDC- DHAP
Strategy 1: Utilize data from the State Department of Public Health, and the local health department
HIV Primary Care Clinic AIDS Drug Assistance Program (ADAP) to issue periodic reports to providers on
compliance with PHS guidelines.
Strategy 2: Utilize webinars to provide the information about the PHS guidelines.
Strategy 3: Meet with local health department Ryan White Primary Care Clinic Pharmacist and discuss
using the Med Dispensing System.
Strategy 4: Continue to monitor compliance with PHS guidelines through clinical record reviews
conducted by the State Department of Public Health and Ryan White as part of Quality Management
site visits with funded providers.
Objective 1: By January 31, 2013, increase the awareness of providers in Fulton and Data sources:
44
Required Intervention #8: “Implement policies and procedures that will lead to the provision
of antiretroviral treatment in accordance with the current guidelines for HIV positive
persons”
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
DeKalb Counties about the PHS guidelines.
Objective 2: By January 31, 2013, discuss opportunities to develop mechanisms for
utilizing the Med Dispensing System to monitor compliance with PHS guidelines.
Objective 3: By December 31, 2016, continue the provision of clinical record
reviews conducted by the State Department of Public Health and Ryan White for
compliance with standards of care (including PHS guidelines).
Responsible Parties: Fulton County Department of Health and Wellness High Impact
HIV Prevention Program (HIPP); DeKalb County Board of Health; and funded
community-based organizations.
Site-visit reports,
meeting records
Required Intervention #9: “Implement interventions or strategies promoting adherence to
antiretroviral medications for HIV positive persons”
Page
45
Goal 1: Increase the percentage of HIV-positive persons who are adherent to their
Funding source:
antiretroviral treatment regimen.
CDC- DHAP
Strategy 1: Identify the list of HIV-positive persons and monitor their adherence to antiretroviral
treatment.
Strategy 2: Conduct ADAP orientations for newly diagnosed and recently enrolled HIV-positive persons
in care.
Strategy 3: Monitor persons newly diagnosed with HIV about their “Red Carpet” linkage to care services
status.
Objective 1: By February 28, 2016, increase the proportion of HIV-positive persons
Data sources:
on antiretroviral therapy for more than 3-months with undetectable viral load by
CareWare, eHars,
20% (from 60% to 80%), thereby contributing to reductions in new HIV infections in Mitchell and
the jurisdiction.
McCormick (M &
Objective 2: By December 31, 2016, work with the local health department Ryan
M)
White Primary Care Clinic ADAP Program and provide ADAP orientations for newly
diagnosed and recently enrolled HIV-positive persons in care.
Objective 3: By December 31, 2016, continue to offer “Red Carpet” linkage to care
services to persons newly diagnosed with HIV.
Objective 4: By December 31, 2016, continue to offer Patient Navigators to assist
HIV-positive persons adhere to their antiretroviral treatment regimen.
Responsible Parties: Fulton County Department of Health and Wellness High Impact
HIV Prevention Program (HIPP); DeKalb County Board of Health; and funded
community-based organizations.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Required Intervention #12: “Implement ongoing partner services for HIV-positive persons”
Goal 1: Increase the number of newly-diagnosed HIV-positive persons who are
Funding source:
provided with HIV/STI partner services.
CDC- DHAP
Strategy 1: Identify providers in the jurisdiction who are diagnosing HIV-positive persons and not
currently requesting HIV/STI partner services for their clients.
Strategy 2: Conduct targeted provider outreach to educate private providers and community-based
organizations in high prevalence areas in the jurisdiction about the benefits of HIV/STI partner services
and mechanisms for requesting follow-up for their clients.
Strategy 3: Provide targeted providers with trained HIV/STI partner services field staff.
Strategy 4: Reduce barriers related to the initiation of partner services for newly-diagnosed HIVpositive persons.
Objective 1: By December 31, 2012, assess the effectiveness of current mechanisms Data sources:
for HIV/STI partner services referrals by private providers and community-based
STD-MIS,
organizations.
SENDSS, Partner
Objective 2: By December 31, 2016, increase the number of providers to implement service logs and
HIV/STI partner services for their clients by 10% compared to baseline 2012.
field records
Objective 3: By December 31, 2016, increase the number of newly-diagnosed HIVpositive persons who are provided HIV/STI partner services by 10% compared to
baseline 2012.
Goal 2: Increase the quality and effectiveness of HIV/STI partner services
Funding source:
CDC- DHAP
Page
46
Strategy 1: Collect data regarding partner services data using SENDSS.
Strategy 2: Manage and analyze data to identify whether HIV/STI partner services are provided as
planned.
Objective 1: By December 1, 2012, participate in state training in preparation for
Data sources:
transition to SENDSS.
SENDSS data
Objective 2: By December 31, 2012, transition from STD-MIS to SENDSS in Fulton
system
County.
Objective 3: By December 31, 2012, develop and utilize a data tracking tool based
on the data from SENDSS and monitor the status of HIV/STI partner services
Responsible Parties: Fulton County Department of Health and Wellness High Impact
HIV Prevention Program (HIPP); DeKalb County Board of Health; and funded
community-based organizations.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
C.
CONDOM DISTRIBUTION
Required Intervention #3: “Conduct targeted based condom distribution to HIV positive persons and
persons at highest risk for acquiring HIV infection”
Page
47
Goal 1: Increase the number of condoms distributed to HIV-positive persons and
Funding source:
persons at highest risk of acquiring HIV infection.
CDC- DHAP
Strategy 1: Make free condoms available to agencies and organizations in the jurisdiction that service
high risk negative persons.
Strategy 2: Identify and recruit clinical and non-clinical agencies to distribute condoms
Strategy 3: Develop a campaign to promote condom use in clinical and non- clinical settings using
YouTube (link distribution mobile applications/social media), social networking sites; sex clubs
(Swingers), provider offices, college/university freshman orientation, etc.
Strategy 4: Review available data sources to identify and recruit additional agencies, i.e., clinical and
non-clinical settings, and venues that can distribute condoms to HIV-positive persons and persons at
highest risk of acquiring HIV infection.
Strategy 5: Develop and use a data tracking tool to track condom distribution.
Strategy 6: Develop and disseminate education materials for correct condom use.
Strategy 7: Provide female condoms for HIV-positive and high-risk persons.
Objective 1: Increase the number of condoms distributed in jurisdiction Data sources:
Fulton/DeKalb Counties by 10% annually.
Condom
Objective 2: Increase the number of agencies, clinics, and other sites distributing
distribution log;
condoms to HIV-positive persons and persons at the highest risk of acquiring HIV
Number of
infection by 10% annually.
condoms
Objective 3: By February 28, 2013, begin expanded condom distribution in
targeted to
partnership with community-based organizations, STI clinics, private clinical
specific
providers, clubs, bars, beauty and barber shops, and other clinical and non- clinical
populations
agencies, and venues that serve high-risk persons.
(High-risk HIV
Objective 4: By January 31, 2013, improve the data collection process to effectively negatives/Unkno
track condom distribution to high-risk persons.
wn, HIV positives,
Objective 5: By December 31, 2016, increase education and availability of female
general
condoms for HIV- positive and high-risk persons.
population)
Objective 6: By December 31, 2016, distribute more than 9,064,509 condoms to
HIV-positive, high-risk negative persons and the general population in the
jurisdiction.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Goal 1: Increase correct and consistent condom use among HIV-positive persons
Funding source:
and persons at highest risk for acquiring HIV infection in the jurisdiction
CDC- DHAP
Strategy 1: Set targets and standards for prevention programs to distribute condoms and conduct
condom education.
Strategy 2: Develop and provide new educational materials and approaches to promote condom use by
HIV-positive persons and specific target populations at high risk.
Strategy 3: Strengthen HIV education along with condoms availability for those re-entering the
community from prison or jails.
Strategy 4: Increase education and availability of female condoms for HIV positive and high risk
populations.
Objective 1: By January 31, 2016, began conducting weekly peer education trainings Data sources:
within social networks of high risk population groups (African American MSM, IDU,
Questionnaires,
high risk heterosexuals and other high-risk, hard to reach populations).
log of HC& NHC,
Objective 2: By January 31, 2016, implement weekly behavioral, biomedical and
# & % HIV (+)
structural interventions to HIV-negative persons at highest risk for HIV that present persons & HIVto the STD/TB clinic each day.
high risk people
Objective 3: By December 31, 2016, ensure that HIV negative persons at highest risk receiving PCC,
for HIV will be offered a behavioral, biomedical or structural intervention, i.e.,
RESPECT, VOICES,
RESPECT, Personalized Cognitive Risk Reduction Counseling Intervention,
Safe in the City,
VOICES/VOCES, Safe in the City, and/or Focus on the Future.
interventions
Responsible Parties: Fulton County Department of Health and Wellness High Impact
HIV Prevention Program (HIPP); DeKalb County Board of Health; and funded
community-based organizations.
D.
STRUCTURAL AND POLICY INITIATIVES
Page
Goal 1: Identify and prioritize options for minimizing or overcoming internal
Funding source:
weaknesses to creating an environment for optimal HIV prevention, care, and
CDC- DHAP
treatment.
Strategy 1: Identify the barriers within the targeted population living within the high risk zip codes to
participating in routine Pre-natal screenings.
Strategy 2: Identify barriers to partnering with adult and juvenile correctional institutions physically
located within the jurisdiction regarding HIV testing.
Strategy 3: Increase the awareness of the importance of receiving prenatal care in the targeted zip
codes, so that mothers opt to participate in prenatal care and thus create the opportunity to be
screened for HIV.
Strategy 4: Assist the local chapters of professional associations (American Medical Association, nursing
schools, Nursing assistance training programs, etc.) in promoting adherence to testing (prenatal and
opt-out) recommendations.
Strategy 5: Close the loop in data reporting such that healthcare providers can realize a benefit to
complying with testing regulations.
Objective 1: By January 4, 2013, create an advocacy package targeting institutions
Data sources:
located within the high risk areas that provide obstetric and delivery services to
Meeting notes,
48
Required Intervention #5: “Efforts to change existing structures, policies, and regulations
that barriers to creating an environment for optimal HIV prevention, care and treatment”
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
persons from high risk areas.
Objective 2: By January 4, 2013, create an advocacy package and/or advocacy
campaign targeting healthcare providers within the jurisdiction who have the
capacity to perform HIV/AIDS testing of persons from the targeted high risk areas.
Objective 3: By January 18, 2013, work in concert with others advocating in the
areas of adolescent health and teen pregnancy prevention to ensure that patient
rights messaging with regards to HIV prevention and treatment are included in their
advocacy efforts.
Objective 4: By February 29, 2016, compile into one resource, existing policies that
present as barriers to, and existing policies that would favor or facilitate the
creation of a jurisdictional coordinated effort to ensure incarcerated persons within
a correctional facility and upon leaving a correctional facility know their status.
packages of
information
Page
49
Goal 2: To improve, on the institutional/ local/state level, the legislators/policy
Funding source:
makers use of evidence-based data in decision making by facilitating access to this
CDC- DHAP
data.
Strategy 1: Identify and provide advocacy support to HIV/AIDS stakeholders that work with our
legislative liaison.
Strategy 2: Identify and provide advocacy support to HIV/AIDS stakeholders in clinical settings within
the jurisdiction
Strategy 3: Create a mechanism (web portal/ work group) where schools of health policy can link with
advocates and share resources (interns, data, etc.).
Objective 1: By December 31, 2013, supply the Fulton County Legislative Liaison
Data sources:
with up-to-date evidence-based information on HIV counseling, testing, and care.
Meeting notes,
The success of this objective is to be measured by the percentage of on-time
packages of
delivery of responses to liaison requests.
information
Objective 2: By June 30, 2013, create a portal with aggregate level data accessible
by these supportive individuals to assist them in their advocacy efforts and their
ability to transfer knowledge of evidence-based data.
Objective 3: By December 30, 2013, work with the legislative liaison to educate
legislators on Medicaid expansion as is relates prevention and care for HIV-positive
persons.
Responsible Parties: Fulton County Department of Health and Wellness High
Impact HIV Prevention Program (HIPP); and Fulton County Legislative Liaison.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
E.
OTHER SUPPORTED ACTIVITIES
Recommended Intervention #17: “Clinic-wide or provider-delivered evidence-based HIV
prevention interventions for HIV-positive clients and clients at highest risk of acquiring HIV”
Goal 1: Increase the percentage of high risk negative persons at risk for HIV who
Funding source:
receive prevention interventions as part of access to medical care
CDC- DHAP
Strategy 1: Conduct provider-based HIV prevention intervention (i.e., Partnership for Health,
Personalized Cognitive Counseling, etc.)
Objective 1: By December 31, 2016, all HIV negative persons at highest risk for HIV, Data sources:
that seek services in a STI/TB/Ryan White clinic, will be screened and offered a
# clients
evidenced-based intervention, i.e., RESPECT, Personalized Cognitive Risk Reduction participating in
Counseling Intervention, VOICES/VOCES, Safe in the City, and Partnership for
interventions,
Health, during each clinic visit.
evaluation
Objective 2: By December 31, 2014, formalize plans for evaluation of the clinicanalysis
wide or provider-delivered evidence-based HIV prevention interventions for HIVpositive clients and clients at highest risk of acquiring HIV.
Responsible Parties: Fulton County Department of Health and Wellness High
Impact HIV Prevention Program (HIPP); DeKalb County Board of Health; and
funded community-based organizations.
Page
Goal 1: To implement targeted, multi-platform social media outreach HIV testing
Funding source:
and prevention campaigns for targeted groups in Fulton and DeKalb Counties.
CDC- DHAP
Strategy 1: Develop and implement a social marketing campaign (i.e., I Know My Status)
Strategy 2: Mobilize community-based organizations to review and implement social marketing tools to
support and promote community use of credible, free, downloadable HIV media technology such as
widgets, podcasts, and Real Simple Syndication (RSS Feeds).
Strategy 3: Partner with agencies and others to script personalized HIV testing and prevention messages
for persons likely to respond to HIV testing options and HIV prevention messages.
Strategy 4: Designate social media and marketing teams to engage individuals around all HIV prevention
services.
Strategy 5: Use auto-texting technology to build an online community and promote HIV prevention
activities (i.e., HIV testing mobile unit, HIV prevention events, etc.)
Strategy 6: Utilize outside marketing and advertising agencies to create and disseminate cultural
appropriate messages for targeted populations concerning HIV testing, condom distribution, and
Prevention for Positives.
Strategy 7: Work with the State Department of Public Health HIV Section to increase the distribution of
HIV and sexual health social marketing campaigns (i.e., Greater than AIDS, Taking Control)
Strategy 8: Work with the Centers for Disease Control and Prevention to increase the distribution of HIV
and sexual health social marketing campaign (i.e., Testing Makes Us Stronger).
Strategy 9: Develop a tracking system that keeps records of social marketing campaign material
distributions to service providers and other agencies in the jurisdiction.
Objective 1: By July 1, 2013, establish a contract with a marketing firm.
Data sources:
Objective 2: By July 30, 2013, convene a Community Advisory Group comprised of
Social Media
50
Recommended Intervention # 16: “HIV and Sexual Health Communication or Social Marketing
Campaigns targeted to relevant audiences”
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
persons living with HIV to partner in the development and implementation of a
social marketing campaign for the jurisdiction.
Objective 3: By October 30, 2013, recruit and select African American MSM,
transgender persons, high-risk negative persons and the general population as
campaign spokespersons.
Objective 4: By November 29, 2013, mobilize community-based organizations to
review and implement social marketing tools to support and promote community
use of credible, free, downloadable HIV media technology such as widgets,
podcasts, and Real Simple Syndication (RSS Feeds).
Objective 5: By December 31, 2013, fully implement “I Know My Status” campaign.
Responsible Parties: Fulton County Department of Health and Wellness High Impact
HIV Prevention Program (HIPP); DeKalb County Board of Health; and funded
community-based organizations
metrics (e.g.
Likes, Followers,
comments, etc.)
Qualitative
evaluations,
tracking systems
Required Intervention #4: “Provision of Post-Exposure Prophylaxis to populations at greatest
risk”
Page
51
Goal 1: Issue guidance related to the provision on non-occupational post-exposure Funding source:
prophylaxis (nPEP) to medical providers in the jurisdiction.
CDC- DHAP
Strategy 1: Develop jurisdictional guidelines for non-occupational post-exposure prophylaxis for medical
providers in the jurisdiction.
Strategy 2: Discuss specific capacity building assistance needs or training on nPrEP-related activities.
Objective 1: By January 31, 2013, develop a MOU with the Southeast AIDS Training
Data sources:
and Education Center (SEATEC) to develop webinars, workshops and trainings on
MOU, Guidelines,
non-occupational post-exposure prophylaxis for medical providers in the
Distribution logs
jurisdiction.
and list serves
Objective 2: By April 30, 2013, review CDC guidelines and best practices for the
provision of post-exposure prophylaxis after sex, injection-drug use or other nonoccupational exposure to HIV.
Objective 3: By April 30, 2013, incorporate communications about nPrEP into the
services provided to MSMs and to high risk heterosexual persons presenting at
clinical settings.
Objective 4: By July 31, 2013, disseminate guidelines to medical providers in the
jurisdiction.
Responsible Parties: Fulton County Department of Health and Wellness High Impact
HIV Prevention Program (HIPP); DeKalb County Board of Health; and funded
community-based organizations.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Recommended Intervention #20: “Integrated hepatitis, TB and STI testing, partner services,
vaccination, and treatment for HIV infected persons, HIV-negative persons at highest risk of
acquiring HIV, and injection drug users according to existing guidelines”
Page
52
Goal 1: Increase the integration of HIV, STI, TB, viral hepatitis screening and/or
Funding source:
testing (as clinically indicated) in HIV testing programs and in the local health
CDC- DHAP
departments Fulton/DeKalb Counties.
Strategy 1: Coordinate integrated hepatitis, TB, and STI screening, and partner services, for HIVpositive persons.
Strategy 2: HIV-positive persons that visit healthcare settings monthly is screened for Hepatitis, TB
and STI and offered partner services.
Objective 1: By November 14, 2012, ensure that all HIV-positive clients that access Data sources:
HIV medical care are screened for viral hepatitis as based on Ryan White Program
EvaluationWeb,
protocol.
STD-MIS,
Objective 2: By December 31, 2012, review client-level HIV and STI testing data to
SENDSS
assess the percentage of high-risk clients who are receiving integrated HIV, STI and
viral hepatitis testing.
Objective 3: By December 31, 2012, review results with testing providers and
develop plans to increase the provision of integrated HIV, STI and viral hepatitis
testing.
Objective 4: By July 31, 2013, implement plans to increase the provision of
integrated HIV, STI, TB and viral hepatitis screening and/or testing (as clinically
indicated).
Responsible Parties: Fulton County Department of Health and Wellness High
Impact HIV Prevention Program (HIPP); DeKalb County Board of Health; and
funded community-based organizations.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
National HIV/AIDS Strategy • National Strategic Goals
Page
53
This section is designed to highlight how the elements/strategies of the City of Atlanta (Fulton/DeKalb Counties)
Jurisdictional HIV Prevention Plan work together with specific goals, objectives and quality assurances to achieve
goals set forth in the National HIV/AIDS Strategy
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
National HIV/AIDS Strategy • National Strategic Goals
The National HIV/AIDS Strategy (NHAS) released by the White House on July 13, 2010, is the nation’s
first-ever comprehensive coordinated HIV/AIDS roadmap with clear and measurable targets to be
achieved by 2015. By aligning our efforts with the National HIV/AIDS Strategy, we strive to reduce HIV
transmission and better support people living with HIV and their families. The proposed interventions,
goals, strategies and objectives align with the National HIV/AIDS Strategy such as: 1) Reducing New
Infections; 2) Increasing Access to care and Improving Health Outcomes for People Living with HIV; and
3) Reducing HIV-Related Disparities and Health Inequities.
This section is designed to highlight how the elements/strategies of the City of Atlanta (Fulton/DeKalb
Counties) Jurisdictional HIV Prevention Plan work together with specific goals, objectives and quality
assurances to achieve goals set forth in the National HIV/AIDS Strategy (NHAS). It is acknowledged that
each jurisdiction is in a different position regarding their capacity to reach these goals. Nevertheless, a
critical step toward ensuring that maximum effort is given to achieving these national goals is to make
them a key component in the planning process.
HIV/AIDS remains an important public health problem in Georgia. In 2009, Georgia had one of the
highest rates of persons living with a diagnosis of HIV infection in the United States at 32.9 per 100,000
persons. The Atlanta MSA comprised more than 50% of the state population in 2010, and had the
highest percentage of people living with HIV/AIDS in the state (66%). From 2001 to 2010, 71% of new
HIV/AIDS diagnoses in Georgia occurred among males. Seventy-four percent of new HIV/AIDS diagnoses
were among Black, non-Hispanics. Among Black, non-Hispanics, those in the age group of 30-39 years
had the highest rate of new HIV/AIDS diagnoses.
The HIV/AIDS epidemic in Georgia is primarily driven by sexual exposure, especially among men who
have sex with men and high-risk heterosexuals. Injection drug use is also a high risk category, but less
prevalent than sexual contact. Communicable diseases like sexually transmitted infections (STI) and
Tuberculosis (TB) pose a risk for individuals who are infected with HIV in Georgia. STDs can increase the
risk for HIV infection from 2 to 5 times. For example, syphilis leads to decreased CD4 T-cell counts and
increased plasma viral load in patients chronically infected with HIV, and this has been linked to
increased HIV transmission. Equally important, TB is a leading cause of morbidity and mortality for
people with HIV/AIDS. People who are co-infected with HIV and TB are at an increased risk of
reactivation of latent TB and acquisition of new opportunistic infections.
There were 27,560 individuals living with HIV-Not AIDS or AIDS in the Atlanta Metropolitan Statistical
Area (MSA) as of December 31, 2010. Of these individuals, 78% were male. Thirty-two percent of the
individuals living with HIV-Not AIDS as of December 31, 2010, in the Atlanta EMA were 40-49 years old.
Twenty percent of the cases in the Atlanta MSA as of December 31, 2010 occurred in females. Of these
females, 26% occurred in high-risk heterosexual (HRH). Sixty-eight percent of persons living with AIDS in
the Atlanta MSA as of December 31, 2010 were Black, Non-Hispanic, and 59% of persons living with AIDS
were MSM.
To reduce new infections, the City of Atlanta, Fulton County Department of Health and Wellness, in
partnership with DeKalb County Board of Health and community-based organizations will:
54
Reducing New HIV Infections
Page
1.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Identify clinical providers and zip codes with highest burden of HIV disease for routine opt-HIV testing;
Identify existing training materials regarding routine HIV testing in clinical settings to promote HIV
testing into routine medical care and/or develop provider training materials on routine HIV testing in the
clinical settings; Develop a MOU with the Southeast AIDS Education and Training Center (SEATEC) to
provide routine HIV testing education; Provide training, capacity building and technical assistance to
healthcare providers in Fulton/DeKalb Counties to increase routine HIV testing in clinical settings;
Identify types of social media technologies proper to distribute messages encouraging routine HIV
testing in the clinical settings; Develop social media messages encouraging routine HIV testing in the
clinical settings; Identify and partner with medical and nursing associations; Develop and utilize a data
tracking tool to monitor the number of clinical settings implementing routine HIV testing; Collect the
information regarding current policies in emergency rooms in Fulton/DeKalb Counties, and identify any
barriers to implement routine HIV testing; Identify and list the names of emergency departments in
Fulton/DeKalb Counties; Identify possible approaches to improve routine HIV testing in emergency
rooms; Contact identified emergency departments and assesses their needs for implementing routine
HIV testing; Work with emergency departments to establish HIV testing protocols to ensure that HIV
tests are routinely provided to emergency room patients; Assign Disease Invention Specialist (DIS)
weekly to emergency rooms to conduct partner services on individuals testing HIV-positive; Provide
training, and capacity building and technical assistance to healthcare providers in emergency
departments to increase routine HIV testing.
Page
Fulton County will also inform medical providers about the latest STI Treatment Guidelines and the
recommendations for initial and ongoing STI screening for HIV-positive persons in care; Work with the
Ryan White Planning Council, and provide and screen individuals accessing STD, TB and Ryan White
Clinics for HIV; Develop and use a tracking tool to monitor STI screening by HIV care providers and
eligible community-based organizations, and provide technical assistance as needed; Identify and list
any barriers to implement pre-natal testing and HIV reporting; Identify, select, and visit a number
OB/GYNs and/or providers treating pregnant women in Fulton and DeKalb Counties; Provide OB/GYNs
and/or providers with information regarding the CDC revised recommendations for HIV testing,
information and support as to where to access information and trainings for the treatment of HIVpositive pregnant women (special emphasis on 3rd trimester testing); Partner with the State HIV
55
Fulton County will also analyze client-level HIV testing data to assess outcomes of current HIV testing in
non- clinical settings; Analyze epidemiologic and surveillance data to ensure HIV testing is targeted in
the areas with the highest burden of disease; Increase collaboration with community-based
organizations by providing ongoing technical assistance visits and feedback; Create a programmatic
calendar for each program year to identify times and venues where agencies will conduct HIV testing
and other services; Develop and utilize a data tracking tool to monitor the number of HIV testing
implemented in non-clinical settings; Create and implement ongoing performance improvement plans of
funded community based organizations and other providers who do not maintain a 2% newly diagnosed
HIV positivity rate; Conduct ongoing quarterly program performance reviews of all agencies funded to
conduct targeted HIV testing in clinical and non- clinical settings; Request peer-to-peer technical
assistance via UCHAPS to develop effective testing strategies for reaching African American MSM,
injecting drug users, high-risk heterosexuals, and other high-risk, hard-to-reach populations; Work with
local community-based organizations that conduct targeted HIV testing to develop strategies to increase
reach to high-risk populations; Recruit and fund community-based organizations for new outreach
testing programs serving the populations at greatest risk for HIV infection in the jurisdiction; Shift to
rapid testing in non-clinical testing programs that are currently utilizing conventional testing (as feasible
and appropriate); and Pilot 5th generation HIV testing technology when economically feasible.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Surveillance Department to identify and report follow-up HIV prenatal cases and to ensure newborns
have received post-natal care and HIV screening; Assess existing collaborations and determine the
strategic partners; and Visit labor and delivery hospitals and link women who test positive during birth
to HIV care to ensure that the baby receives post-natal care and HIV testing (birth, 2 weeks, 6 weeks,
and 4 months).
2.
Increasing Access to Care and Improving Health Outcomes for People Living with HIV
Fulton County Government administers the Ryan White Part A program for the Atlanta Metropolitan
Statistical Area (MSA) and is tasked with improving access to care and treatment for people who are HIV
positive, but not in care. Efforts are in process to increase the number of people in care and treatment
who have not been tested for HIV, but are HIV-positive, as well as those who know they are living with
HIV, but are not in care. Fulton County Department of Health and Wellness (FCDHW) Communicable
Disease Prevention Branch (CDPB) is a key partner in the EMA’s linkage to care efforts. Furthermore, as
the service provider for the largest number of persons living with HIV not-AIDS in the MSA, as well as the
largest provider of HIV screenings in the MSA, FCDHW is positioned to play a key role in bridging
medically underserved HIV positive individuals to care and treatment services. CDPB, in concert with the
Primary Care Clinic (PCC) to provide primary care services to individuals who are HIV-positive, and to
ensure that individuals receive the best preventive service and treatment possible whenever they
interact with the PCC providers.
The FCDHW/CDPB primary care services include the provision of diagnostic testing, early intervention
and risk assessment, preventive care and screening, practitioner examination, medical history taking,
diagnosis and treatment of common physical and mental conditions, prescribing and managing
medication therapy, care of minor injuries, education and counseling on health and nutritional issues,
continuing care and management of chronic conditions, and referral to and provision of specialty care.
Primary medical care for the treatment of HIV infection includes the provision of care consistent with US
Public Health Service Guidelines (USPHS). Care includes access to antiretroviral and other drug
therapies, including prophylaxis and treatment of opportunistic infections and combination
antiretroviral therapies.
Page
To increase access to care and improving health outcomes for people living with HIV, the City of Atlanta,
Fulton County Department of Health and Wellness, in partnership with DeKalb County Board of Health
and community-based organizations will: Coordinate between HIV testing programs, linkage to care
programs and HIV care providers to support effective referral and linkage to care. Refer all confirmed
HIV-positive persons to medical care and confirm attendance to their first appointment; For all persons
56
Service gaps were documented in a number of specific needs assessments/consumer surveys carried out
by the Metropolitan Atlanta HIV Health Services Planning Council in the MSA during the past few
years. Using data from the HIV/AIDS reporting system (eHARS), the statewide laboratory database and
the Georgia Department of Public Health, HIV Epidemiology Unit it has been estimated that 56% of
PLWHA in the MSA had not received primary health care services during 2010. Apart from primary
health care, there are also two other areas in which there are gaps in services. Data from the 2008
Atlanta MSA HIV Consumer Survey and the CAREWare database indicate 39% of PLWHA have mental
health problems, specifically depression, but only 21% of clients at Part A funded service sites received
mental health services during 2010. There are 10,485 persons with mental health needs. Data from the
same sources indicate that 9% of PLWHA in the MSA (2,420) have substance abuse problems as a
contributing factor in their infection and will need additional care.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
testing HIV-positive or currently living with HIV/AIDS who are linked to care and treatment, provide brief
prevention intervention services; Ensure continuity of care among persons living with AIDS; Ensure that
newly-identified, confirmed HIV-positive persons tested in clinical and non-clinical settings who regularly
visit a HIV clinic or HIV medical care providers are referred for partners services, when eligible;
Implement linkage/retention collaboration with other HIV service providers in the jurisdiction; Identify
individuals in need of re-linkage to care and address re-linkage to care; Contact each person that has
fallen out of care for participation in Anti-Retroviral Treatment and Access to Services (ARTAS)
individual-level behavioral intervention sessions; Assess the percentage of Ryan White clients who are in
continuous care and provide technical assistance as needed; Utilize data from the State Department of
Public Health, and the local health department HIV Primary Care Clinic AIDS Drug Assistance Program
(ADAP) to issue periodic reports to providers on compliance with PHS guidelines; Utilize webinars to
provide the information about the PHS guidelines; Meet with local health department Ryan White
Primary Care Clinic Pharmacist and discuss using the Med Dispensing System; Continue to monitor
compliance with PHS guidelines through clinical record reviews conducted by the State Department of
Public Health and Ryan White as part of Quality Management site visits with funded providers; Identify
the list of HIV-positive persons and monitor their adherence to antiretroviral treatment; Conduct ADAP
orientations for newly diagnosed and recently enrolled HIV-positive persons in care; Monitor persons
newly diagnosed with HIV about their “Red Carpet” linkage to care services status; Identify providers in
the jurisdiction who are diagnosing HIV-positive persons and not currently requesting HIV/STI partner
services for their clients; Conduct targeted provider outreach to educate private providers and
community-based organizations in high prevalence areas in the jurisdiction about the benefits of HIV/STI
partner services and mechanisms for requesting follow-up for their clients; Provide targeted providers
with trained HIV/STI partner services field staff; Reduce barriers related to the initiation of partner
services for newly-diagnosed HIV-positive persons; Collect data regarding partner services data using
SENDSS; and Manage and analyze data to identify whether HIV/STI partner services are provided as
planned.
From the results of the unmet need analysis, it is clear that getting individuals into HIV primary care
must be a continuing priority. In the 2008 Consumer Survey, consumers reported using medical and
information services at high rates in the past 30 days (primary medical care – 77% and antiretroviral
medications – 73%). Dental care (46%) was the most frequently reported service needed but not
received. The most commonly reported barriers for consumers were personal (26%), followed by
information (19%) and capacity (16%). Additional analysis revealed that capacity (20%) and other
barriers (20%) were reported by consumers earning an annual income less than 100% of Federal Poverty
Level (FPL). Information barriers were reported more frequently by Hispanics (33%), women (31%), and
especially women of childbearing age (37%). Personal barriers, the most commonly reported of all,
indicated the highest statistically significant rates for men (28%). Participants were asked screening
questions regarding substance abuse and mental health. Of the 313 participants that completed the
screening, 80 (26%) consumers were in need of additional substance abuse assessment and 136 (39%)
were in need of additional mental health assessment. To reduce HIV-related disparities, the City of
Atlanta, Fulton County Department of Health and Wellness, in partnership with DeKalb County Board of
Health, community-based organizations and the City of Atlanta (Fulton/DeKalb Counties) Jurisdictional
HIV Prevention Planning Group. Fulton County formed and now operates a 33 member jurisdictional
HIV prevention planning group that develops a plan to address for HIV prevention needs across Fulton
and DeKalb Counties. The City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention
Planning Group is responsible for developing an engagement process for the jurisdiction. The
57
Reducing HIV-Related Disparities
Page
3.
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Page
58
Jurisdictional HIV Prevention Planning Group also participates in the development or update the local
health department Jurisdictional HIV Prevention Plan and participates as a partner with the local health
department to improve the impact of HIV prevention efforts with the jurisdiction (Fulton/DeKalb
Counties) will: Identify the barriers within the targeted population living within the high risk zip codes to
participating in routine Pre-natal screenings; Identify barriers to partnering with adult and juvenile
correctional institutions physically located within the jurisdiction regarding HIV testing; Increase the
awareness of the importance of receiving prenatal care in the targeted zip codes, so that mothers opt to
participate in prenatal care and thus create the opportunity to be screened for HIV; Assist the local
chapters of professional associations (American Medical Association, nursing schools, Nursing assistance
training programs, etc.) in promoting adherence to testing (prenatal and opt-out) recommendations;
Close the loop in data reporting such that healthcare providers can realize a benefit to complying with
testing regulations; Identify and provide advocacy support to HIV/AIDS stakeholders that work with our
legislative liaison; Identify and provide advocacy support to HIV/AIDS stakeholders in clinical settings
within the jurisdiction; and Create a mechanism (web portal/ work group) where schools of health policy
can link with advocates and share resources (interns, data, etc.).
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Page
59
ATTACHMENTS
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Attachment A:
List of Jurisdictional Planning Group
MEMBER
ORGANIZATION
CATEGORY TYPE
B.T.
Fulton County Resident
Trans
Dennis Meredith
Tabernacle Baptist Church
Faith Community
Derek Duncan
Trinity Community Ministries
Substance Abuse
Dolph Ward Goldenburg
Living Room, Inc.
HOPWA
Dr. Elleen Yancey
Morehouse School of Medicine
Academia
Dr. Harvinder Makkar
Travelers Aid of Metropolitan Atlanta, Inc.
Homeless Services
Dr. Natasha Travis
Dr. Natasha Travis
Mental Health
Dr. Phillip Finley
Argosy University
Instructor
Dwight Anderson
Ryan White Planning Council
Ryan White Planning Group/PLWHA
Edwin Blount
Fulton County Resident
MSM/PLWHA
James Freeman
Southside Medical Center
Community Health Center/Clinical Care
Provider
Jeff Graham
Georgia Equality/Equality Foundation of
Georgia
Policy
Jeff McDowell
Atlanta Harm Reduction Center
IDU
Kimberly Hagen
Rollins School of Public Health
Academic Institution
Margaret Renfroe
DeKalb Addition Center
Substance Abuse
Melvin Gaye
Fulton County Jail
Corrections
Michelle Lawrence
Underground Atlanta
Patricia Parsons
Saint Joseph Mercy Care Services of Atlanta
Business/Labor
Community Health Center/Clinical Care
Provider
Rudolph H. Carn
Disease Intervention Specialist
Valencia Beckley
NAESM, Inc.
Fulton County Department of Health &
Wellness
Fulton County Department of Health &
Wellness
Walter Bradley
State Community Planning Group
CPG/PLWHA
Walter Hicks
Fulton County Resident
PLWHA
Dr. Y. Omar Whiteside
Georgia Department of Public Health
Epidemiology
Michelle Broussard
Nutrition/WIC Program
WIC
Daniel Driffin
Community
MSM
Rameses Fredrick
Urban Socialites/Business
Terence McPhaul
Youth Pride
MSM
Lesbian, Bi-Sexual, Transgender,
Questioning Youth
60
Nursing
Page
Tommie Lightfoot Holloway
MSM
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31, 2016
Attachment B
HIV Prevention Interventions
DeKalb
HIV Testing Type
HIV Prevention Services
Advocacy, counseling, case management, clothing,
medical info., prevention education
HIV/STD prevention education, primary care linkages
(PLWHA), pregnancy test, client advocacy
HIV/STD prevention education, primary care linkages
(PLWHA), support groups, TB screening,
Emergency services, shelter, food, case management
Reproductive services, counseling, sexual health
education, referrals,
Aniz, Inc.
x
Conventional, oral
Empowerment Resource Center
x
Fulton County Dept. of Health &
Wellness
Hope Atlanta/Traveler’s AID
Planned Parenthood SE Inc.
x
Center for Black Women’s
Wellness
Saint Joseph Mercy CareEdgewood
x
Conventional, oral,
rapid
Conventional,
rapid
Oral, rapid
Conventional, oral,
rapid
Conventional
X
Rapid, oral
AID Atlanta
X
Making a Way Housing Inc.
x
Conventional,
rapid, oral
Rapid, oral
NAESM Inc.
X
Oral, rapid
Positive Impact Inc.
X
Rapid, oral
SisterLove Inc.
X
Conventional, Oral,
rapid
West End Medical Center
X
Southside Medical Center
Atlanta Harm Reduction Coalition
Inc.
X
x
Conventional, Oral,
rapid
Conventional
Conventional, oral,
rapid
X
X
Effective Behavioral
Interventions
Condom distribution, VOICES,
SISTA, 3MV
Condom distribution, VOICES,
SHILE, WILLOW
Safe in the City, VOICES,
Condom distribution,
Condom distribution,
Condom distribution,
Condom distribution,
HIV/STI Prevention Education, Early Intervention
Clinic, Primary Care & Dental Care, TB Screening, Case
Management, Behavioral Health. EBIs –VOICES,
RESPECCT
Substance abuse, support groups, mental health, HIV
prevention education, advocacy, case management
Emergency shelter, food pantry, case management,
life skills training, group counseling, computer classes
Capacity building assistance, medical referrals, peer
counseling, education and outreach
Substance abuse, support groups, mental health, drug
and alcohol treatment education, HIV prevention
education
HIV prevention education, Positive Women’s
Leadership training, HIV treatment adherence
education
Hep A&B vaccinations, drug/alcohol treatment
assistance, TB screening, Hep C education
Condom distribution,
Condom distribution, Healthy
Relationships
Condom distribution,
Condom distribution,
Condom distribution, CLEAR,
Healthy Relationships,
Community Promise
Healthy Love Party
Community Promise
Healthy Love Youth Network,
condom distribution, PrEP
Condom distribution,
Condom distribution,
Safety Counts, Voices
61
Fulton
Page
Agency
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31, 2016
DeKalb
HIV Testing Type
Youth Pride Inc.
X
Rapid, oral
AIDS Research Consortium of
Atlanta
Essence of Hope
Someone Cares Inc. of Atlanta
x
Rapid, oral
X
x
Rapid
Rapid,
conventional, oral
AIDS Atlanta Evolution Project
x
Absolute Care Medical Center
X
Rapid,
conventional, oral
Rapid, oral
Edgewood Medical Center, Inc.
x
Conventional
LaGender Inc.
x
N/A
Wholistic Stress Control Institute,
Inc.
X
N/A
HIV Prevention Services
Effective Behavioral
Interventions
Counseling, socialization groups, leadership
development, peer education, transgender services
Research, prevention education, referrals
Condom distribution,
HIV prevention education, referrals, health education
HIV/AIDS/STD education & prevention, referral
placement, POZ empowerment group, comprehensive
risk counseling services, outreach
Condom distribution,
condom distribution, VOICES,
3MV, D-UP, CRCS
Primary medical care, peer counseling, STD clinic,
social services, support groups, pharmacy
Primary care, urgent care, health and wellness
education, transgender health
HIV/AIDS education, outreach services, prevention
education, support groups
Treatment services for HIV-positive individuals
Condom distribution,
Mpowerment, condom
distribution
Condom distribution
Condom distribution
Condom distribution
N/A
62
Fulton
Page
Agency
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31, 2016
DeKalb County
DeKalb
HIV Testing Type
HIV Prevention Services
DeKalb CSB Addiction Clinic
X
Rapid
Substance abuse counseling, prevention education,
DeKalb CSB Richardson Health
Center
DeKalb County Board of Health –T
O Vinson Health Center
Atlanta Feminist Women’s Health
Center
x
Conventional, rapid
x
Conventional, rapid
Free condoms, nutrition, dental, prevention education,
medical care, mental health
Free condoms, prevention education, dental, nutrition,
transportation, medical care, mental health
Health education and risk reduction counseling, support
groups, community outreach, case management,
referrals
DeKalb Prevention Alliance Inc.
Recovery Consultants of Atlanta
Inc.
x
X
Oral
Oral, rapid
STAND Inc.
X
Conventional, rapid
Center for Pan Asian Community
Services Inc.
AHF Citywide Project Inc.
X
Rapid
X
Alpha and Omega HIV/AIDS
Foundation
Atlanta STD Clinic (knows as)
Alliance Family Care
My Brother’s Keeper
X
Conventional, oral,
rapid
N/A
Conventional, rapid
Street outreach, pre-treatment for substance abusers,
HIV prevention, partner violence, outpatient drug
treatment
Prevention and risk reduction counseling, support
groups, community outreach, case management,
referrals
Prevention and risk reduction counseling, care and
treatment, support groups, community outreach
Prevention, education, emotional support, mental health
counseling, spiritual
x
X
Effective Behavioral
Interventions
Condom distribution,
Condom distribution,
Condom distribution,
Condom distribution,
Condom distribution,
Condom distribution,
Condom distribution, CRCS
Condom distribution,
VOICES/VOCES
Condom distribution,
Condom distribution,
Condom distribution,
N/A
Training and capacity services
N/A
63
Fulton
Page
Agency
City of Atlanta (Fulton/DeKalb Counties) Jurisdictional HIV Prevention Plan ● November 14, 2012 – December 31,
2016
Attachment C:
Community Engagement Report
Page
64
Intentionally Left Blank
Collaborating to Implement High
Impact HIV Prevention:
Fulton and DeKalb Counties
Community Forum
Engagement Report
A product of HealthHIV’s
Capacity Building for Health Departments Program
October 24, 2012
1
TABLE OF CONTENTS
Introduction.....….……………………………………………………..3
Community Engagement..…………………………………………....4
Community Engagement Phase I………………………….………..6
 Community Forum Day One…………………………………...6
 Community Forum Day Two…..……………………………...11
 Strategy Recommendations…...…………………………..…13
 Next Steps…………..………………………………………….16
Community Engagement Phase II…………………………………17
 Strategy Recommendations Part I…………………........…..19
 Strategy Recommendations Part II…………………………..23
Next Steps…………..………………………………………….…….26
Contributors………..…………………………………………………27
Appendices (A through I)…………………………………………...28
2
INTRODUCTION
This report summarizes a series of community engagement meetings that were focused
on the local HIV epidemic and HIV prevention efforts in Fulton and DeKalb Counties,
Georgia (Atlanta, GA). The meetings were convened to engage community
stakeholders in the identification and prioritization of innovative HIV prevention
strategies for the counties to address the high burden of HIV. A two-phase Community
Engagement model was utilized. Phase I was a two-day Community Forum held on
September 27 and 28, 2012. Phase II was a one-day Community Forum held on
October 17, 2012.
As the HIV prevention, care, and treatment landscape evolves and new public health
systems are put in place, new strategies and interventions must be recognized and
implemented. The National HIV/AIDS Strategy (NHAS), new biomedical approaches,
funding redirection, increased accountability, high impact prevention (HIP), healthcare
reform, and others, must be incorporated into strategic HIV prevention planning in
Fulton and DeKalb Counties. Through a series of meetings, the community was able to
come together to assess the local responses to HIV service delivery and outcomes.
Georgia is ranked the sixth highest in the nation for its cumulative reported number of
AIDS cases through December 2009.1 In 2010, 66% of Georgians living with HIV/AIDS
resided in the Atlanta Metropolitan Statistical Area (MSA). The Atlanta MSA had the 13 th
highest rate of HIV diagnosis in 2010 with a rate of 30 per 100,000 persons. 2 Within the
Atlanta MSA, Fulton and DeKalb Counties had the highest 2010 HIV prevalence rates.3
The Centers for Disease Control and Prevention (CDC) funded Fulton County
Department of Health and Wellness in January 2012 to implement HIV prevention
efforts in Atlanta, GA. It was with this in mind that Fulton and DeKalb Counties initiated
collaboration with HealthHIV and community stakeholders to develop a new strategic
framework and integrated prevention plan for addressing HIV in their community. (See
Appendix A for additional 2011 epidemiological data.)
The intended outcomes of the community engagement meetings were to:
1. Increase stakeholder understanding of the changing HIV prevention, care, and
treatment landscape, including high impact HIV prevention and National
HIV/AIDS Strategy.
2. Identify community successes and challenges in implementing HIV prevention
strategies.
3. Inform Fulton and DeKalb counties regarding activities, strategies, and
programmatic directions in addressing the HIV prevention needs of the
community.
4. Recommend community strategies for inclusion in the Fulton and DeKalb
Counties HIV prevention jurisdictional and comprehensive plans.
1
CDC, HIV/AIDS Surveillance Report, 2009 (Table 20), http://cdc.gov/hiv/surveillance/resources/ reports/2009report/
CDC, HIV/AIDS Surveillance Report, 2010 (Table 23), http://cdc.gov/hiv/surveillance/resources/ reports/2010report/
3
HIV/AIDS Epidemiology Section, Division of Health Protection, Georgia Department of Public Health, Georgia HIV/AIDS
Surveillance Summary, Data Through December 31, 2010. http://health.state.ga.us/epi/hivaids/index.asp
2
3
COMMUNITY ENGAGEMENT
In July 2012, after detailed conversations with Fulton County Department of Health and
Wellness (FCDHW), HealthHIV developed a community engagement framework to be
implemented in order to identify HIV prevention strategies that should be considered for
inclusion in the Comprehensive HIV Prevention Program Plan to be submitted to CDC.
After initial conversations and meetings in August 2012, the community engagement
dates, location, speakers and participants were identified.
On September 27 and 28, HealthHIV sponsored the first phase of community
engagement meetings, “Collaborating to Implement High-Impact HIV Prevention: Fulton
and DeKalb Counties Community Forum”, titled after FCDHW’s High-Impact HIV
Prevention Program. The second, and final, phase of the community engagement
process was a follow-up meeting held on October 17.
The Community Forum goal is to:
 Engage community stakeholders in the identification and prioritization of
innovative HIV prevention strategies for Fulton and DeKalb Counties to address
the high burden of HIV in the community.
HealthHIV Director of Prevention and Policy, Michael Shankle, MPH, and Prevention
and Policy Manager, Marissa Tonelli, served as facilitators for the meetings along with
support from Fulton County Department of Health and Wellness staff members.
The facilitators sought to engage participants in assessing existing capacity on the
community level in the following areas:
 Strategic Planning: Responding to evolving public health systems
 Recruitment: Approaches to outreach and early intervention
 Testing: Efforts to identify and diagnose persons currently infected or at-risk
 Linkage to care: Referring and ensuring HIV-positive persons are connected to
HIV clinical care
 Treatment Access: Ensuring all HIV-positive persons wanting and needing ART
are able to access medication and clinical care
 Supporting: Innovative efforts in providing HIV programs and support services to
a diverse population of HIV-positive persons
 Retention in care: Retaining HIV-positive persons in care, whether they are on
ART or not
The Community Forum objectives are to:
1. Inform the community of the jurisdictional planning process and assess interest in
the process
2. Identify successes and challenges in addressing the HIV epidemic in Fulton and
DeKalb Counties
3. Engage community stakeholders in identifying local strategies for meeting the
goals of the National HIV/AIDS Strategy
4
4. Engage stakeholders in community driven initiatives to reduce the burden of HIV
in Fulton and DeKalb Counties
5. Provide models (high impact prevention, prevention with positives, targeted
testing, municipal scale-up, linkage and retention in care) to improve HIV
treatment cascade outcomes
6. Provide stakeholders an opportunity to engage in the development of the
jurisdictional planning framework and the comprehensive HIV prevention plan
5
COMMUNITY ENGAGEMENT PHASE I
Community Forum Day One – Thursday, September 27, 2012
When arriving on the first day of the Community Forum, participants were asked to write
down one word on a note card that described their view of HIV prevention, care, and
treatment in Fulton and DeKalb Counties. The responses varied greatly with the most
common words being “challenging” and “necessary”. Below is the word cloud that was
generated from the responses.
Figure 1. Participant views of HIV prevention, care, and treatment in Fulton and DeKalb Counties. Sept 2012.
Marissa Tonelli, HealthHIV Prevention and Policy Manager, welcomed the community
stakeholders and introduced Veronica Hartwell, Health Program Administrator, Fulton
County Department of Health and Wellness, to provide opening remarks. Veronica
Hartwell emphasized the importance of these community engagement meetings, and
community input, in the development of the Fulton and DeKalb Counties Jurisdictional
HIV Prevention Plan. She then introduced the Director of the DeKalb County Board of
Health, Dr. Sandra Elizabeth Ford, who reiterated the significance of the Community
Forum and subsequent meetings. Dr. Ford stated that she was eager to hear ideas and
feedback from the community and to be able to re-connect with the local level HIV
prevention, care, and treatment providers. Michael Shankle, MPH, Director of
Prevention and Policy at HealthHIV, concluded the opening remarks by presenting the
goals, objectives and intended outcomes of the Community Forum as well as
highlighted the necessity to put aside differences and past conflicts to focus on the
outcomes.
Following the welcoming remarks, participants were asked to identify themselves and
announce what they hoped to achieve from the Community Forum meetings.
Representation in the room ranged from community-based organizations, community
health centers, epidemiologists, state health departments, health educators, consumers,
6
and more. (See Appendix B for full list of attendees.) Overwhelmingly, the participants
responded that they hoped to achieve increased collaboration and information sharing,
decreased duplication, and keep up with the changing HIV prevention landscape. Below
is the word cloud that was generated from the responses. (See Appendix C for
complete list.)
Figure 2. What Community Forum participants hope to achieve throughout the 2-day meeting. Sept 2012.
Drs. Jane Kelly and Omar Whiteside of the Georgia Department of Public Health
(GDPH) Epidemiology Branch presented Fulton and DeKalb Counties epidemiological
data to the participants. It is important to note that Fulton County Department of Health
and Wellness (FCDHW) was challenged in assembling epidemiological data for the
county because most HIV data is housed at the state health department level. FCDHW
is currently working with the GDPH Epidemiological Branch to streamline the process
for requesting county-level data, and is also developing internal surveillance capacity.
Fulton and DeKalb Counties have almost half of the total newly identified HIV cases in
the state of Georgia, and 58% of the persons currently living with HIV. Of the newly
identified cases in Fulton and DeKalb Counties, over 80% of the epidemic is among
males. More than 75% of the epidemic is among Blacks. Epidemiological data from the
Georgia State Health Department has significant gaps, with a disproportionate number
of HIV cases that have no known risk identified. However, where there is a reported risk
category, 94% of newly identified HIV cases are among men who have sex with men
(MSM). The majority of newly identified HIV cases are also between the ages of 20 and
49 years.
Drs. Kelly and Whiteside pointed out that of those currently living with HIV, and where
risk category has been reported, 73% identify as MSM. Of those currently living with
HIV, the majority of cases fall between the ages of 30 and 59 years.4 Trending indicates
that the epidemic is becoming younger and increasingly more common among MSM.
4
HIV/AIDS Epidemiology Section, Division of Health Protection, Georgia Department of Public Health, Georgia HIV/AIDS
Surveillance Summary, Data Through December 31, 2010. http://health.state.ga.us/epi/hivaids/index.asp
7
(See Appendix A for detailed epidemiological data)
Drs. Kelly and Whiteside answered questions from the participants regarding the
epidemiological data. The major concerns of the participants were that the data isn’t
thorough, particularly in the area of risk/transmission categories. Without complete data,
it is even more challenging to focus HIV prevention efforts. Expanding the
epidemiological profile is critical for targeting of populations and identification of
strategies.
After a short break, Jeff Graham, Executive Director of Georgia Equality, spoke to
participants about the changing landscape of public health and HIV prevention, care,
and treatment. He emphasized that the future is changing rapidly and community
organizations must be flexible in their planning. As a result of sequestration threats and
possible FY2013 funding cuts, federal funding is uncertain, and neither the state of
Georgia, nor Fulton and DeKalb Counties, knows how much money will be allocated for
the next year. Other challenges ahead are the re-authorization of the Ryan White Care
Act in 2013, and the Affordable Care Act (ACA), which includes the implementation of
state health exchanges and Medicaid expansion. With new insurance systems, the
community will need to take responsibility for navigating clients through the new health
insurance systems. The ACA will also bring increases in future prevention funding,
although not necessarily for HIV. Programs need to diversify funding streams by looking
at what other prevention dollars exist. Mr. Graham concluded by stressing that Fulton
and DeKalb Counties come together to set up a legislative agenda for the next session.
HIV/AIDS, Medicaid, and many other issues must be included in that agenda to ensure
HIV programs in the community can be sustained.
Michael Shankle, Director of Prevention and Policy at HealthHIV, took the podium to
discuss new strategies in HIV prevention and the new era of accountability. The
National HIV/AIDS Strategy (NHAS) plays a large role in the direction of HIV prevention,
care, and treatment activities. Jurisdictions are expected to prevent new HIV infections,
increase access to care and optimize health outcomes, and reduce HIV-related health
disparities by the year 2015. This must happen with potentially reduced funding to
health departments, since simultaneously, the federal government is aligning resources
with the epidemic. Jurisdictions are expected to implement High Impact Prevention
(HIP) and focus on interventions that will have the greatest impact on the epidemic; all
based on epidemiological HIV prevalence data. Treatment as Prevention science and
other biomedical interventions will also guide the development of new HIV prevention
strategies. Mr. Shankle concluded that with funding realignments and the increased
accountability from NHAS, the HIV treatment cascade, and healthcare reform, it is more
important than ever to collaboratively identify and implement new strategies to meet the
goals and deliverables set by federal partners.
After lunch, participants were brought back together and asked, What HIV prevention
efforts have been challenging in Fulton and DeKalb Counties?
During the initial brainstorming session, the participants identified system challenges:
8
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There are no true collaborations, no sharing of resources or information, which
leads to duplication of services and competition between organizations
o Defining and implementing an effective structure for collaborations
 Social barriers such as homophobia and stigma, and lack of acceptance, cultural
competence or acknowledgment from political leadership, faith-based
community, healthcare providers and the media
 Political barriers to implementing school-based testing or sex education (very
conservative state legislature)
 Navigation: Lacking seamless linkage for new clients
 Absence of routine testing in healthcare settings
 Reluctant coordination between HIV prevention, care, and treatment as well as
between HIV and other chronic illnesses
 Inefficient healthcare data systems, which makes it difficult to target high-risk
populations or maximize resources
 Agencies need more accountability
(A full list of these programs, activities and actions can be found in Appendix D)
Participants were then divided into four groups to further discuss challenges with HIV
prevention, care, and treatment in Fulton and DeKalb Counties. The four categories
mimicked the four required program components of PS12-1201.
1. Challenges to HIV Testing
 Implementation of routine testing in healthcare settings
 Workflow challenges in healthcare settings, does the nurse or the physician offer/
deliver the HIV test?
 Perceived barriers to testing reimbursement (in healthcare settings and in nonclinical settings)
 Provider or patient complacency (just don’t care about testing/being tested)
 Time restrictions during doctor’s appointments
 Providers still testing based on risk assessment of the patient
 When implementing testing efforts in non-traditional settings-- Are we targeting
the at-risk populations?
 Not enough funding for testing efforts
 General population needs more education around the importance of HIV testing
 Providers and testing staff need annual training and updates on HIV testing
 There is no universal understanding/definition of what linkage to care means
 There is inadequate tracking for linkage to care
2. Challenges to HIV Prevention with Positives
 Interruption of adherence due to circumstances beyond control such as personal
finances (job loss), imprisonment, or geography (not close enough to clinic or
cannot easily reach clinic/pharmacy
 Stigma
 Health literacy among persons living with HIV/AIDS
9
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Intimate partner violence can influence the effectiveness of partner notification/
disclosure services
Medicaid restrictions for reimbursement for STD or hepatitis screenings
Inadequate staffing/hours of CBOs and clinics
Lack of navigation/navigators to guide clients through the (changing) healthcare
system, especially when their method of paying for services changes
3. Challenges to Condom Distribution
 People don’t want to use condoms because of stigma, they are not comfortable,
cultural reasons, or they are “not sexy”
 Inability for CBOs/clinics to reach to certain populations, such as schools/youth,
prisons inmates, members or congregations of faith-based agencies/churches
 Need to determine where condom education is currently occurring, where it is
most effective, and where it should be included
o Discuss with individuals the proper utilization of condoms as well as the
importance of using condoms as protect from HIV/STDs/hepatitis
 There are not enough condoms available for distribution, specifically the more
favorable types (female, flavored, lube)
 Criminalization of condoms may deter individuals from carrying or using condoms
4. Challenges to Structural and Policy Initiatives
 Individuals at-risk and the general public require increased education
 Healthcare providers do not have regular education (or education at all) around
HIV prevention, care, and treatment
 Legislators lack knowledge of HIV to make informed policy decisions
 Schools do not allow organizations to implement school-based condom
distribution, testing programs, or sex education
 Lack legislation or enforcement of legislation for HIV testing, prevention, and care
in correctional facilities
 Inadequate enforcement of HIV/AIDS case reporting
 Inadequate enforcement of prenatal HIV/STD testing
 Lack of communication among agencies and absence of policies or regulations
to require data sharing and streamlining of reporting systems
 Conservative state legislators are not making decisions based on evidence, but
rather on political or moral values
(A full list of all challenges identified can be found in Appendix E)
At the conclusion of Day One, Michael Shankle reminded participants of the agenda for
Day Two and the importance of coming back to the Community Forum to develop
strategies, which is the most integral part of the process.
10
Community Forum Day Two – Friday, September 28, 2012
Dr. Matthew McKenna, Medical Director for the Fulton County Department of Health
and Wellness provided the welcome and greetings for Day Two of the Community
Forum. Dr. McKenna highlighted that HIV attacks vulnerable populations, HIV testing
reduces risky behaviors by 70%, and HIV testing, linkage to care, and treatment
ultimately leads to healthier lives.
Michael Shankle lead the introduction of new participants before beginning a discussion
of the previous day’s activities. Participants reflected that they are learning to let the
past go and appreciated not dwelling on funding issues so much. They felt as if the first
day covered a lot of new information and they are looking forward to the strategic
planning piece. There was a sense of “hope” among participants that collaboration
between agencies will truly occur and the community will come together as a
collaborative force to fight the epidemic. Mr. Shankle then reminded participants that
this meeting isn’t about funding, but how we can fight the epidemic here in Atlanta, GA.
Dr. Jane Kelly, Georgia State Department of Health epidemiologist, returned to the
Community Forum to provide additional information about data and other statistics from
specific zip codes. The top 10 zip codes affected are 30318, 30310, 30314, 30324,
30308, 30032, 30311, 30312, 30344, and 30331. There were approximately 350 newly
infected HIV cases in those 10 zip codes in 2011. Dr. Kelly supposed that the top 10 zip
code list probably has not changed in years. How can we ensure that we are testing
where the majority of clients/at-risk individuals live? The GA Department of Public
Health currently asks for the zip code of the testing facility on the case reporting form.
Dr. Kelly informed the participants that the state received a 3-year health information
exchange grant from HRSA. Georgia must look at social determinants of health, partner
with public health better, improve integration of state databases, work with metroAtlanta to develop a linkage to care consortium, fund a public health resource hub that
will provide all STD data and advertising, and fund a private hub for providers.
Michael Shankle then led the participants in a discussion of what the successes have
been in Fulton and DeKalb Counties around HIV prevention, care, and treatment.
What are your successes?
 HIV Testing
o The community has tested a lot of people
 Caucasian, African American, MSM, young
 Difficult populations to reach, we have reached!
 Long running, sustaining organizations in Atlanta
 Evidenced behavioral interventions, Healthy Love- will identified by the CDC,
comes from Atlanta!
 Harm Reduction growth in Georgia (and in the south)
 Spirit of cooperation; can come together to pull off major testing events; contrary
to the belief that there is disharmony in Atlanta
11
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
Project Getting Connected 2- focus on testing for men of African descent
Transitioned from prevention to something much larger; increase capacity;
education; increased skill; effectively intergraded STD screening within HIV
intervention
 Housing has become a priority
 Recovery/Transition support program (substance abuse, support) with United
Care “Pretreatment”
 Linkage has been a success also; patients received care that would not have
gotten it outside of the programs such as Grady IDP. Linkage is a model that
needs to stay- Empower Link (15 people linked so far)
 Rapid testing in non traditional settings such a the pharmacies Walgreens,
RiteAid, CVS; train nurse practitioners
 FQHC centers
 Grady IDP has a holistic approach to services for patients (mental health,
pastoral care, primary care, treatment) “wrap around services”
 Atlanta change project SAMHSA)- mental health, substance abuse, linkage
network
 Short term housing transition to permanent housing programs
 Creating new strategies and new systems together; sharing ideas
 Trained nearly 500 providers (testers, counselors, linkage workers) in the state
 Role of advocates/activists play in GA; southern AIDS strategy
(A full list of these programs, activities and actions can be found in Appendix F)
Before the strategy development could begin, Michael Shankle presented to the group
various best practices that would help to guide the afternoon discussion. He presented
the In+Care Campaign video developed by HRSA/HAB, and a Get Screened Oakland
testing campaign video from ABC News. These videos were meant to demonstrate two
different best practice strategies for HIV prevention in a community. Mr. Shankle also
discussed how will OraSure home HIV testing kits, which will be in stores beginning
October 1, 2012, may effect pre- and post-test counseling.
In order to most effectively lead the development of HIV prevention strategies, the
participants were divided into five groups, each with it’s own topic. The groups would
develop strategies for Recruiting, Testing, Linkage to Care, Retention in Care, and
Supporting. The full list of strategy recommendations from the Community Forum
Participants can be found on page 13.
12
STRATEGY RECOMMENDATIONS
Group 1: Recruiting
 Routine testing; identify new providers to agree to routine testing
 Identify point of entry sites to develop network of providers offering testing and
linkage; any organization that is providing a service to those at high risk
(incarceration, substance abuse)
 Social media usage (who the sites will target); creating messages and
strategically marketing them, airport and bus pockets
 Utilizing peer navigators- recruit and train peers, provide incentives for linkage to
care or for bringing persons in for testing
 Offering services in non traditional settings (nightclubs, sex venues, pretrial jail
setting, correctional facilities)
 Within one year, identify nonclinical and clinic providers/partners to increase
rapid testing by 30%
 Identify social media, and internet sites that will be used for marketing and
advertising
 Identify and train peer navigators for linkage to care
Group 2: Testing
 Testing itself is smart- specific, measurable, attainable, time specific
 Who are we going to test? How often? Where?
 Take testing to nontraditional places, such as 8am at Ptree and Pine; 7:30pm in
the event in the Bluff; Piedmont Park (not on Sundays) before 11pm; testing for
concert tickets
 On-site confirmatory testing results, without having to wait
 Capacity building and acceptance by private physician; pamphlets and brochures
in the doctor’s room
 Establishing a master calendar to reduce redundancy
 Campaign why it is important to test
 Test everyone who is willing; those testing for the first time
o How to prioritize testing- black MSM, IDU, hard drugs, high risk
heterosexual, transgender
o Where to find them within Fulton and DeKalb Counties (Savannah Suites);
Piedmont Park, Midtown, Cypress, bathhouses, gas stations, housing
authorities, community centers, ball/pageants, Glenwood Rd, LA Fitness,
focus on hook up internet sites
o How often to test? Once a month, time of a major ball/pageant, Wed-Sat
on Cypress Street
o Begin implementation within 18 months
Group 3: Linkage to Care
 Place linkage to care and testing information in the prescription and purchase
bags; develop relationship with drug stores
 ARTAS (EBI) being the standard across the state
13
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Develop a community service linkage network
Organize infrastructure and capacity to facilitate linkage
Mobile application tied to service hours, application, client needs
Culturally competent services for clients
In-language services
Rapid response linkage coordinators
Engage nontraditional partners; schools of nursing, social work (train the
students to ask the questions once they enter their field)
Transportation
Identify the insurance/payment barriers
How will Affordable Care Act effect linkage
Group 4: Retention in Care
 Ensure healthcare setting is welcoming
o Educate the staff and physicians
 Schedule ongoing training and education provided by the federal and state health
departments, local AETCs, CBOs, or webinar/DVDs
o Interpersonal/culturally competent communication and facilitation
o Science of HIV and STD education
o How to navigate the healthcare system and eligibility requirements
 Accessibility
o Expanded clinic hours
o Transportation reimbursement and food vouchers
o ADAP waiting list (advocacy)
o Educate the patient about medicine, adherence, side effects
o Nutrition classes
o Offer routine yearly STD exams
 Peer Support
o Offer certified peer counselors (utilize a proven-effective model)
o Reminder calls, well chats, facilitate support groups, increase outreach
efforts individuals at-risk for being lost to care or already lost to care
 Social Support
o Offer childcare during appointments, transportation to appointments
o Determine patient needs
o Disclosure training
o Mental health support
o Have counselors on staff at all times
o Improve communication between agencies that provide social support
services
o Patient advocacy line
 Identify patients who have fallen out of care
o Computer systems/tracking
 Identify those who are at risk for falling out of care
 Empower the client to want to remain in care
14
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Utilize a chronic care model to learn from diabetes and heart disease selfmanagement and care support
Decision support for healthcare providers with HIV information specific to
healthcare providers
Link healthcare providers to community support and encourage care team
management and medical home models
Train physicians around health literacy
o How to check in with clients
o How to review lab work with patients
Group 5: Supporting
 Goal: Every HIV+ person living in Fulton and DeKalb Counties receives care and
support services so they may become and remain virally suppressed
 Address and decrease service barriers at every level of intervention
 Improve customer service by utilizing QA, surveys, focus groups, consumer
advisory boards, anonymous comment lines, and champions or advocates
 Provide culturally competent services, training, workforce development, engaging
families
 Establish strategic formal versus informal relationships between agencies, such
as calling ahead for personalized need (i.e. talking to a live person)
 Creative/innovative client engagement, such as videos in lobby, resource room,
computer access (Wi-Fi), or books/periodicals
 Wellness approach (nutrition, exercise, reduce stress, sleep)
15
NEXT STEPS
At the conclusion of the second day of the Community Forum, Michael Shankle led
participants in discussing what the next steps will be moving forward. An effective
continuum of care in Atlanta is essential. The need for services has not changed, and
will not change, only increase. The vision, ideas, and talent to make changes and
improve outcomes is already there and needs to be utilized. He encouraged participants
to not get stagnant. They must reach another level, address structural barriers and the
evolving healthcare systems. As the epidemic changes, the community that is
addressing the epidemic must also change.
All information gathered from the last two days will be organized in a plan that will help
to develop a successful system to deliver HIV prevention in Fulton and DeKalb
Counties.
Mr. Shankle announced that the participants would be invited to return on October 17,
2012 to re-examine the plan, gather more feedback and input, re-define or refine the
goals and strategies. This process will move forward. On November 14, 2012 a plan
must be submitted to the Centers for Disease Control and Prevention, and this is nonnegotiable date. The community will come together again to make further
recommendations and ensure that the best strategies are being utilized.
16
COMMUNITY ENGAGEMENT PHASE II
COMMUNITY FORUM Day Three – Friday, October 17, 2012
Marissa Tonelli, HealthHIV Prevention and Policy Manager, welcomed the Community
Forum participants and thanked them for returning to the second phase of the
community engagement process. Veronica Hartwell, Health Program Administrator,
Fulton County Department of Health and Wellness, provided opening remarks and
reminded the participants of their valued role in the process.
Participants were asked to introduce themselves, and share what they took away from
the September meetings (if they had attended) or what they hoped to achieve from the
meeting (if they were new to the process). Representation in the room ranged from
community-based organizations, community health centers, epidemiologists, state
health departments, consumers, and more. (See Appendix B for full list of attendees.)
Participants who attended the September meetings responded that they left the
meetings with hope of collaboration, a sense of community and pride, and a renewed
purpose. Those who did not attend the September meetings responded that they hoped
to achieve increased collaboration and bridge the gap between HIV prevention, care,
and treatment programs. For the complete list of responses, see Appendix F.
Following introductions, Michael Shankle, MPH, Director of Prevention and Policy at
HealthHIV, provided a review of the September community engagement meetings. He
reminded participants of the overall sentiments regarding HIV prevention, care, and
treatment activities in Fulton and DeKalb Counties (see page 6 for word cloud), the
jurisdictional successes and challenges across HIV activities, and the strategy
development process that occurred in September.
He re-iterated why HealthHIV and the Fulton County Department of Health and
Wellness are leading community stakeholders through this process. There are new
guidelines and systems in place that the health department needs to respond to.
Michael Shankle then introduced Dea Varsovczky, Program Manager at UCHAPS
(Urban Coalition for HIV/AIDS Prevention Services), who shared two best practice
examples from Washington, DC and Chicago, IL with the community stakeholders.
In Washington, DC, the health department rolled out a “re-capture blitz” to re-engage
HIV-positive patients who were lost to care. The health department worked with eight
primary care providers over three months to identify a list of patients who were lost to
care and bring them back into care. The health department matched the list of patients
lost to care against other existing data to identify who was truly lost to care (rather than
deceased, etc.). Of those contacted, 64% were actually receiving care elsewhere, and
those who were not, 36%, were re-engaged in care.
In Chicago, IL, the health department modeled an event being implemented in Houston
(Hip Hop for HIV) and started a “Step Up, Get Tested: Chicago for 5K” campaign that
17
took place from June 1 until July 4, 2012 with the goal to test 5,000 persons. The health
department brought together 23 agencies in successful collaboration and will be
repeating the event next year. The health department has also decided to incorporate
STD testing into next year’s event.
Following Dea Varsovczky’s short presentation, Veronica Hartwell, Fulton County
Department of Health and Wellness, discussed the Jurisdictional HIV Prevention
Planning process with the meeting participants.
Ms. Hartwell highlighted the change that has occurred in the last year, with Fulton
County Department of Health and Wellness (FCDHW) becoming directly funded from
the Centers for Disease Control and Prevention (CDC) for HIV prevention activities.
This has been a huge change and is a complex process to maneuver. In January 2012
FCDHW started at ground zero with no HIV prevention staff and a long list of targets
and benchmarks that needed to be reached by the end of the year. She explained how
the community engagement process is an essential part of developing the jurisdictional
and comprehensive HIV prevention plans, and can also contribute to other processes
required by the CDC Funding Opportunity Announcement (FOA) PS12-1201.
Marissa Tonelli introduced the draft challenges and strategies that were developed
during the September meetings and also distributed the interventions and goals
identified for the jurisdictional HIV prevention plan by Fulton County DHW. She
prompted the group to think about strategy development and identification to
implementing the intervention. The participants were divided into five groups. Each
group focused on specific topic areas with different public health interventions. The
groups were directed to review the identified interventions and goals, and brainstorm
strategies to push the intervention forward and meet the identified goals.
The groups reported feedback and identified the following strategies from pages 19-24.
18
Strategy Development Part I
Group 1: Testing in Clinical Settings
Intervention #1: “Routine, opt-out screening for HIV in clinical settings”
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Develop educational campaign to primary care providers (PCPs) as well as
dentists and mental health/substance abuse providers about why and how they
should offer HIV tests to their clients
o DIS worker could visit the PCP/physician offices to deliver positive results
and link newly positive clients to confirmatory tests or HIV care
o Work with primary care associations, Southeastern AIDS Education and
Training Center (SEAETC) to develop and distribute training to physicians
o PCPs should be required by law to report positive HIV tests to the county
Increase testing in emergency departments
o Describe routine, opt-out HIV testing on the registration form that indicates
individuals will be given an HIV unless they “check the box” to opt-out
o Deliver an education pamphlet with the registration form to substitute for
pre-test counseling
o Contract a full-time CBO staff member to offer and implement HIV testing
in hospitals/EDs (eliminate cultural competency/work flow challenges)
Utilize pharmaceutical representatives to educate physicians and encourage
implementation of HIV testing
Testing can occur at hospital pharmacies
Group 2: Testing in Non-Clinical Settings
Intervention #2: “HIV testing in non-clinical settings to identify undiagnosed HIV
infection”
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Note: Testing strategies should be closely tied to linkage to care strategies
Define target populations and sub-populations in EMA at greatest risk for HIV
and least likely to access services
o 50+, youth, transgender, incarcerated, homeless
o Compare Atlanta epidemiological data, socio-economic level, multi-cultural
populations, zip code, and at-risk group
o Host focus groups (capture those at greatest need that may not be in the
identified risk categories or gender/sexuality demographics)
Utilize social networking outlets
Increase efforts around partner services
PSCI
Enhance education provided in pre-test counseling sessions and maintain
emotional support services
Utilize testing algorithms that can increase access to care, such as 5th generation
and rapid-rapid model
19
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Possible non-clinical settings might include; nightclubs, bars, Kroger parking lot,
Walmart parking lot, Piedmont Park (ARCA), the strip, DMV, Unemployment
Office, and food stamp office
Host city-wide meeting to discuss the standardization of HIV testing
Group 3: Structural Barriers to HIV Testing and Perinatal Testing
Intervention #5: “Efforts to change existing structures, policies, and regulations that are
barriers to creating an environment for optimal HIV prevention, care, and treatment”
Intervention #11: “Implement prevention of perinatal transmission for HIV-positive
persons”
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Legislators should have the proper education
Increase compliance with existing laws/regulations
o Conduct a comprehensive assessment of existing laws and regulations ad
they relate to perinatal testing, HIV reporting, testing and care in
corrections, etc.
 Determine levels of compliance
 Identify gaps and challenges
 Recommend revisions/clarifications/changes
 Identify resources that are needed
o Reinforce laws by tying a review of existing regulations into recertification
or renewing licensure
o Educate providers by providing ongoing in-services/training around the
changing regulations and changing codes
 Having CBOs go out to different OB/GYNs and have conversations
with physicians
Assess barriers to provider HIV reporting to the county or state in order to
improve reporting
o Is it that the physicians think the lab is doing the HIV reporting (dual
reporting)?
o Is it that they don’t have the capacity to do the reporting?
o What does effective HIV reporting look like? (checking all the boxes)
Assess and increase testing accessibility (school systems)
Examine and/or reconsider existing collaborations and partnerships
o Strategic partners might include licensing bodies and professional
associations or organizations to provide and disseminate information to
healthcare providers
o CBOs partnering with providers
Educate pregnant women around prenatal HIV-testing laws (not just physicians)
o Follow-up with women in third trimester and find out if HIV-positive women
of childbearing age are receiving ongoing care and regular testing
20
Group 4: Linkage to Care and Retention in Care
Intervention #6: “Implement linkage to HIV care, treatment, and prevention services for
those testing HIV positive and not currently in care”
Intervention #7: “Implement interventions or strategies promoting retention in or reengagement in care for HIV-positive persons”
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Define “linkage to care” and “entry into care”
o Develop a standard practice for linkage to care
Develop a red carpet process (Washington, DC)
Assist with barriers to linkage/retention in care (pre-linkage services)
o ID, income verification, proof of residency
o Utilize peer navigation
Work with provider networks to develop expedited enrollment in medical care for
HIV-positive individuals
Bring a case tracker (from a CBO) that will be part of the care team and will
collaborate with the physician/primary care site to support individual in care and
when individual is lost to care
Make Antiretroviral Treatment Access Study (ARTAS) a standard of care, and
educate clinical providers around what ARTAS is
Atlanta Change Project model (SMART)
Group 5: Treatment Initiation and Adherence
Intervention #8: “Implement policies and procedures that will lead to the provision of
antiretroviral treatment in accordance with current treatment guidelines for HIV-positive
persons”
Intervention #9: “Implement interventions or strategies promoting adherence to
antiretroviral medications for HIV-positive persons”
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Identify client-level barriers to treatment
Treat everyone, but must first assess readiness level
o Support services should come first, such as housing, to stabilize clients
prior to receiving treatment
Utilize patient navigators, peer educators, or health educators to improve client
access to medication (navigation services along with medication education
provided by nurses or health educators)
o Utilize case workers throughout the continuum of care, from linkage
through treatment
Develop trainings for infectious disease doctors and primary care doctors to
increase compliance with PHS guidelines (utilize SEAETC, primary care
associations, etc. for outreach)
o Distribute best practice models for adherence and viral suppression to
providers
21
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Develop web-based services that provide “on-demand” services for housing,
detox, HIV treatment, and more (go online and find a bed for the night, have
someone pick you up for detox, find a provider for HIV treatment)
SHARE project for community treatment adherence: individuals on therapy enroll
in this program and receive phone calls and incentives
CBOs counsel patients, host support groups, buddy systems, and provide patient
navigation
o Comprehensive patient education
o Incentivizing treatment adherence (Kroger/MARTA card)
Provide CMEs to pharmacists in assisting with medication adherence (they see
the patients every month)—pharmacists contact case workers when patient does
not fill prescription
22
Strategy Development Part II
Group 1: Prevention with Positives
Intervention #3: “Conduct targeted based condom distribution to HIV positive persons
and persons at highest risk for acquiring HIV infection”
Intervention #10: “Implement STD screening according to current guidelines for HIVpositive persons”
Intervention #11: “Implement prevention of perinatal transmission for HIV-positive
persons”
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CBOs should receive free condoms from the health department to distribute in
venues that HIV-positive individuals may frequent
o Condom dispensers in bars, primary care facilities or out-patient facilities,
mental health offices, case management offices, or substance abuse
counseling/treatment centers
o Partnerships with AARP
o Distribute at pharmacies (private and hospital pharmacies)
 Condoms come free with HIV medication
 Request exclusion of distributing condoms at those locations for the
purpose of the interventions
 Train pharmacists to counsel patients
 Advocate with pharmacies to develop an alert that comes up when
pharmacists fill and HIV medication order (to talk about condom
use and give free condoms)
o All condom distribution should be paired with condom education
o Advocate to CDC to develop guidelines that require agencies who do HIV
testing must also distribute condoms
o Distribute condoms at HIV testing events
Develop a standard for STD screening among HIV-positive individuals
o CBOs can deliver the STD testing with their HIV-positive clients so the
clients don’t need to go to a clinic
o Opportunity to re-engage HIV-positive clients into care if they are not
receiving care
Educate clinical providers about standard for perinatal HIV testing in GA and how
to counsel pregnant women who are HIV-positive
Bring young HIV-positive women into perinatal care
o Educate women about the importance of perinatal care
o HIV testing in emergency departments may catch some pregnant women
who are not receiving prenatal care
23
Group 2: Prevention with Positives
Intervention #12: “Implement ongoing partner services for HIV-positive persons”
Intervention #13: “Behavioral risk screening followed by risk reduction interventions for
HIV-positive persons (including those for HIV-discordant couples) at risk of transmitting
HIV”
Intervention #14: “Implement linkage to other medical and social services for HIVpositive persons”
Intervention #20: “Integrated hepatitis, TB, and STD testing, partner services,
vaccination, and treatment for HIV infected persons, HIV-negative persons at highest
risk of acquiring HIV, and injection drug users according to existing guidelines”
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Serodiscordant couples should be counseled and tested together, and educated
on how to engage in safer sex
o Couples voluntary counseling and testing (CVCT)
o Education is really important as well as emotional support
Educate partners of HIV-positive individuals about:
o PrEP
o Testing, should occur every three months
o Safe sexual behaviors
Use social marketing and social networking to re-enforce safe sex between
serodiscordant couples
Focus the prevention strategies to positive individuals in zip codes with the
highest incidence of HIV or STIs
o Utilize ASOs/CBOs in this area and focus funding to those ASOs/CBOs
Use internet websites and street outreach to educate positives
Prison system: release programs, linkages, transitional housing
Distribute condoms
Group 3: Prevention with High-Risk Negatives
Intervention #3: “Conduct targeted based condom distribution to HIV positive persons
and persons at highest risk for acquiring HIV infection”
Intervention #4: “Provision of Post-Exposure Prophylaxis to populations at greatest risk”
Intervention #12: “Implement ongoing partner services for HIV-positive persons”
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Implement a campaign that would be statewide to promote condom use and the
importance of condom use
o Utilize non-traditional strategies for reaching high-risk individuals
 Social marketing using social media such as YouTube links, mobile
app for finding free condoms, social networking sites
 Target sex clubs or swingers clubs
o Distribute within private businesses such as private physicians offices or
dental offices
o Distribute at college orientation, make more condoms accessible around
the campus (not just at health centers) and with resident assistants
24
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 DVDs and packets with instructions (include visuals and education)
o Negotiate deals with private business to get more condoms (for free or
cheap)
Post-Exposure prophylaxis (PEP)
o Training and education for physicians (private providers)
 Make PEP a standard for education (licensing boards, OSHA)
o Distribute information about how to access PEP (i.e. victim fund,
pharmaceutical costs)
o Advocate for PEP and PrEP inclusion in ADAP
Build infrastructure among agencies that provide partner services-- can partner
services be initiated by CBOs and then passed off to the health department?
o Reduce the misunderstanding/lack of awareness around partner services
Target TV shows that young people watch to run PSAs about sexual health
(identify strategic media outlets for marketing campaigns)
Group 4: Prevention with High-Risk Negatives
Intervention #13: “Behavioral risk screening followed by risk reduction interventions for
HIV-positive persons (including those for HIV-discordant couples) at risk of transmitting
HIV”
Intervention #17: “Clinic-wide or provider-delivered evidence-based HIV prevention
interventions for HIV-positive patients and patients at highest risk of acquiring HIV”
Intervention #20: “Integrated hepatitis, TB, and STD testing, partner services,
vaccination, and treatment for HIV infected persons, HIV-negative persons at highest
risk of acquiring HIV, and injection drug users according to existing guidelines”
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Define high-risk negatives
Increase behavioral risk screening in high-risk communities
o Non-traditional places: resident meetings in apartment complexes, house
parties, Tupperware/sex toy parties, etc.
Increase education to negative partners of HIV-positive individuals
o Even if partner is non-detectable, the individual can still get HIV
o Educate serodiscordant couples around what non-detectable means and
what risks still exist
Scale-up partner services, educate providers about the benefits of partner
services
Coordinate FCDHW partner services efforts with CBOs
Educate individuals around disclosure (what laws exist) and provide a disclosure
support system as part of partner notification services through healthcare
providers, DIS, and/or CBOs
Make IEC or other interventions available to serodiscordant couples
Ensure strong referrals to local services with OTC OraSure Home HIV Testing kit
o Partner with OraSure, publicize test locally and advertise state hotline,
develop print materials (posters/flyers) to educate around OTC
Include an intervention/strategy around PrEP
25
NEXT STEPS
At the conclusion of the final day of the Community Forum, Michael Shankle led
participants in discussing what the next steps will be moving forward.
The October 17th meeting concludes the Fulton and DeKalb Counties Community
Forum. All information gathered from the September meetings and the October
meeting will be organized in a report that will assist the Fulton County Department of
Health and Wellness in developing a successful system to deliver HIV prevention to
their jurisdiction. The strategies collected during the Community Forum will contribute to
the development of the Fulton County Jurisdictional HIV Prevention Plan and
Comprehensive HIV Prevention Program Plan.
On October 18th and 19th Fulton County Department of Health and Wellness will
received capacity building assistance from the National Minority AIDS Council (NMAC)
in training the Fulton County HIV Prevention Planning Group. Fulton County will also
continue to receive capacity building assistance from HealthHIV in the further
development of the two plans.
On November 14, 2012 the two plans must be submitted to the Centers for Disease
Control and Prevention.
26
CONTRIBUTORS
Michael Shankle, MPH
Director of Prevention and Policy, HealthHIV
Marissa Tonelli
Prevention and Policy Program Manager, HealthHIV
Fulton County Department of Health and Wellness
27
APPENDICES
Appendix A: GA State Department of Health Epidemiological Data………28
Appendix B: Full List of Attendees..…………………………………………..29
Appendix C: What do you hope to achieve?…...……………………………33
Appendix D: Community Forum Response on System Challenges….…...34
Appendix E: Response on PS12-1201 Implementation Challenges……...36
Appendix F: Community Forum Response on Successes.…………..…….38
28
APPENDIX A
Georgia State Department of Health Epidemiological Data
29
APPENDIX B
List of Attendees
Thursday, September 27, 2012
Agency Name
Participant Name
AHRC
AHRC, Inc.
AID Atlanta, Inc.
AIDS Health Foundation City Wide Project
AIDS Health Foundation City Wide Project
AIDS Health Foundation City Wide Project
AIDS Research Consortium of Atlanta (ARCA)
AIDS Research Consortium of Atlanta (ARCA)
Alpha & Omega HIV Fd.
ANIZ, Inc.
ANIZ, Inc.
Sheba Bonner
Mona Bennett
Neena Bankhead-Smith
Tia Thames
Williams Francis
Reggie Batiste
Bentley Sweeton
Eulise White
Dr. Benjamin Moran
Zina Age
Hana Hanahire
Arthur Cole, Jr.
Neil Griffith
Verna Gaines
John Warhcol
Joseph Holbrooks
Marvin Ghourm
Khafrek K Abif
Sentayehu Bedane
Yolanda Miller
David Gavin
Aur Wyatt
Jacqueline Brown
Hilda Johnson
Michael Seabolt
Jane Kelly
Jeselyn Rhodes
Sean M. Webb
Rodrigues Lambert
Brandi Williams
Kenya Taylor
Jeff Graham
Jacque Muther
ASHLIN Management Group
Atlanta Harm Reduction Coalition
Atlanta Legal Aid Society
Care & Counseling Center of Georgia
CBO Consultant
Cycle for Freedom
DeKalb County Board of Health
DeKalb County Board of Health
DeKalb County Board of Health
DeKalb County Board of Health
Empowerment Resource Center, Inc.
Essence of Hope, Inc.
Georgia Department of Public Health
Georgia Department of Public Health
Georgia Department of Public Health
Georgia Department of Public Health
Georgia Department of Public Health
Georgia Department of Public Health
Georgia Department of Public Health - STD Office
Georgia Equality Foundation of Georgia
Grady IDP
Omar Whiteside
Project Open Hand
Project Open Hand/Atlanta
Recovery Consultants of Atlanta
Ryan White Part A Program
Ryan White Part A Program
Ryan White-Part A
SEATEC
Sister Love, Inc.
Aleta McLean
Katherine Lovell
Michael Banner
Uliecia Bolton
Kathy Whyte
Kandace Carty
Michael DeMayo
Lisa White
30
Sister Love, Inc.
Someone Caes
St. Joseph Mercy Care
STAND, Inc.
STAND, Inc.
T.I.L.T.T, Inc. (Transgender Individuals Living
Their Truth)
Travelers Aid of Metropolitan Atlanta Inc
West End Medical
Wholistic Stress Control Institute
Wholistic Stress Control Institute
Dazon Diallo
Edwin Worthington-Blount
Patricia Parsons
Raymond Duke, Prevention Services
Program Manager
Charles Sperling
Cheryl Courtney-Evans
Harvinder Makkar
W.J. Pete Star
Tabatha Gneely
Sheila Lenior
Tarita Johnson
Bao Trinh
List of Attendees
Friday, September 28, 2012
Agency Name
Participant Name
AID Atlanta, Inc.
AID Atlanta, Inc.
AIDS Health Foundation City Wide Project
AIDS Research Consortium of Atlanta (ARCA)
AIDS Research Consortium of Atlanta (ARCA)
Alpha & Omega HIV AIDS Fd
ANIZ, Inc.
ASHLIN Management Group
Atlanta Harm Reduction Coalition
Atlanta Medical Center
Center for Pan Asian Community Services
Centers for Disease Control and Prevention
Cycle for Freedom
DeKalb County Board of Health
DeKalb County Board of Health
DeKalb County Board of Health
LaTonya Wilkerson
Neena Bankhead-Smith
Reggie Batiste
Eulise White
Bentley Sweeton
Benjamin Moran
Hara Hawthorne
Neil Griffith
Mona Bennett
Levita Smith
Yotin Srivanjarean
Pete Starling
Khafrek Abif
David Gavin
Darryl Richardson
Avery Wyatt
Denise Parker
Michael Seabolt
Jacqueline Brown
Hilda Johnson
Brandi Williams
John Malone
Sean M. Webb
Melanie Thompson
Kenya C. Taylor
Department of Public Health
Empowerment Resource Center
Essence of Hope, Inc.
Georgia Department of Public Health
Georgia Department of Public Health
Georgia Department of Public Health
Georgia Department of Public Health
Georgia Department of Public Health - STD Office
Georgia Department of Public Health/HIV
Epidemiology
Grady IDP
Dr. Jane Kelly
Stacy Bolling
31
Here's To Life
Mac Dadi
NAESM
Recovery Consultants of Atlanta
Ryan White Part A Program
Ryan White Part A Program
SEATEC
Sister Love, Inc.
STAND, Inc.
T.I.L.T.T, Inc. (Transgender Individuals Living Their
Truth)
Tangu
Travelers Aid of Metropolitan Atlanta Inc
Wholistic Stress Control Institute
Wholistic Stress Control Institute
Wholistic Stress Control Institute
Pat Brown
Center Care
Matthew McKenna
Rudolph H. Carn, Executive Director
Michael Banner
Uliecia Bolton
Kandace Carty
Laura Donnelly
Dazon Dixon Diallo
Raymond Duke, Prevention Services
Program Manager
Cheryl Courtney-Evans
Charles Bazemore
Harvinder Makkar
Tarita Johnson
Shelia Lenior
Tarita Johnson
32
List of Attendees
Wednesday, October 17, 2012
Agency Name
Participant Name
Absolute Care Health
ADAP Pharmacy
ADAP Pharmacy
AID Atlanta, Inc.
AID Atlanta, Inc.
AID Atlanta, Inc.
AIDS Health Foundation City Wide Project
AIDS Research Consortium of Atlanta
(ARCA)
AIDS Research Consortium of Atlanta
(ARCA)
ANIZ, Inc.
Atlanta Harm Reduction Coalition
Black AIDS Institute
Club Xhell
Club Xhell
Club Xhell
Club Xhell
Comizia Care
Divinity Internet Medicine
Empowerment Resource Center, Inc.
Empowerment Resource Center, Inc.
Essence of Hope, Inc.
Georgia Department of Public Health
Georgia Department of Public Health
Georgia Department of Public Health- STD
Office
Greater Than AIDS/Kaiser Family
Foundation
Positive Impact, Inc.
Positive Impact, Inc.
Recovery Consultants of Atlanta
Ryan White Part A Program
Ryan White Part A Program
SEATEC
St. Joseph Mercy Care
STAND, Inc.
STAND, Inc.
T.I.L.T.T., Inc.
UCHAPS
Urban Socialites
West Cure
Wholistic Stress Control Institute (WSCI)
Wholistic Stress Control Institute (WSCI)
Andrea Jefferson-Saboor
Tequan Berry
Gay Campbell-Welsh
Neena Smith-Bankhead
Loreen Maiorino Krug
LaTonya Wilkerson
Reggie Batiste
Eulise White
Bentley Sweeton
Zina Age
Verna Gaines
Leisha McKinley Beach
Claressa Winston
Jonte Carlisle
Bethe Odom
Darrell Winston
Miko Jones
Martina Rivera
Jacqueline Brown
Denise Parker
Hilda Johnson
Willie Pestarling
Michael Seabolt
Kenya Taylor
Robbyn Kistler
Martin Becker
Glenn Fitch
Michael Banner
Kathy Whyte
Kandace Carty
Diane Weyer, FNP-BC
Patricia Parsons
Charles Sperling
Raymond Duke
Cheryl Courtney Evans
Dea Varsovczky
Rameses Frederick
Michael Jamand
Shelia Lenior
Tarita Johnson
33
APPENDIX C
Community Forum Response to: What do you hope to achieve from the meetings?
 Increase collaboration
 Networking with others in the field
 Share information
 Decrease duplication
 Get direction for how to move forward with the changing landscape
 Understand new strategies
 Gather information for planning committee
 Re-acquaint/connect with work on the local level
 Identify priorities
 Explore the intersection between HIV prevention, care, and treatment
 Understand innovative HIP strategies
 Determine how what we have already been doing can be maximized, and what we can
do to compliment the existing services
 Integration among agencies
 GA State DOH wants Fulton County to blow it’s mind
 Provide a consumer perspective
 Ensure coordination of services
 Collect information to more successfully make referrals
 Identify ways to leverage resources
 Best practices
 How to better serve HIV+ clientele and provide HIV testing
 Speak for the people who cannot be here—homeless, substance abusers, and others
 What resources can CBOs bring to this process? What can CBOs take away?
 Learn about other harm reduction activities in the state
 Administration will listen and coordinate with the community
 Create a healthy relationship between Fulton and DeKalb counties
 Be a part of the solution, not the problem
 Build attack on co-infection (with STDs, etc.)
 Offer resources
 Take full advantage of existing resources
 To get insight
 Sustainability
 Free lunch
 See things get done/See outputs
 Walk the walk, not just talk the talk
 SMART plan to address HIV
 Speak about what is really going on. Have offline conversations in the room.
 What is coming down the pike? PrEP. PEP.
 Stigma
 Change the status quo: meet people who are concerned and motivated to make change
 Keep up with changing HIV prevention, care, and treatment landscape
 Share resources ($ and staff)
 Network to bring in Asian community
 Legal perspective
 To become better at what I do
34
APPENDIX D
Full Community Forum Response on System Challenges:
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Too much focus on one group of people (one risk group—with regards to testing)
o With funding, funding restrictions (grant restrictions), organizational restrictions
o Multiple hats and tasks in organizations
o Use government funding for free tests
o Let’s target, but not turn away someone of another population that comes in for
testing
Duplication of services, no true collaborations
Faith-based agencies/churches not wanting agencies to provide testing r give out
condoms
School systems want to maintain abstinence programs
Using evidence-based strategies for decision making
o Who is making these decisions?
ADAP is not fully funded
Lack of support for transportation
Complex and ineffective gov’t policies
Weak leadership in power
Ultra-conservative state legislature
Competing organizations
Someone says “this is such a waste of time”
Barriers to care (transport, homelessness)
Sharing resources
Routine testing in health settings
Research opportunities without boundaries
Waiting list, times for appointments
o Any health care organization is like that—any doctor’s office
o Can’t access their first appointment for months
o Newly diagnosed and those who move into GA and need to access care
Silos between prevention and care
Competition for limited resources
Inefficient data system—partner services can be completed more quickly
Identifying strengths and expertise
Inconvenient testing
HIV prevention and treatment are not viewed as priority by state leadership
Homophobia in some communities
Not enough affordable housing
Address initial need so that clients can hear and adhere to prevention messages
Acceptance and acknowledgment of leadership and media
o Education and awareness
Not enough collaboration
Lack of standardized policies across programs
Inefficient health care systems: surveillance and programs
Flexible hours
Stigma
Work with the school systems
35
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Poverty
Homelessness
Unemployment
Substance abuse
Access to care
Impact areas of highest need to reduce duplication and waste
Ensure that there is accountability for use of funds document outcomes
Sustainability
Lack of agencies commitment to deliver EBIs to high-risk populations
Stigma
Stable housing
Focus on MSM misses the NIR (transgender, youth, etc)
No ID means no services
Working with the same populations—duplication of services
More integration with other health challenges
Gaps in prioritizing populations with comprehensive services trans, youth, elderly, MSM
of color outside of Atlanta proper
Sex education
Leadership among elected officials
Defining and implementing an effective structure for collaborations
Seamless linkage for newly tested
Cultural competence
Not sharing information with other organizations
Racism
Homophobia
Lack of service coordination
Lack of peer navigation/advocates
Mental health
Transgender surveillance data from MSM data
36
APPENDIX E
PS12-1201 Funding Categories: What are the Challenges to Meeting the Goals?
1. Challenges to HIV Testing
 Testing in healthcare settings
o Who is responsible? Doctor or Nurse? What does the workflow look like?
o Does testing in healthcare settings happen uniformly? Is everyone offered a test
or do physicians “screen” patients based on perceived risk factors?
o Is testing not happened due to provider complacency, perceived reimbursement
barriers, or because there isn’t enough time?
 Testing in non-traditional settings
o Is it in the community, is it targeted?
o Perceived reimbursement challenges
o Funding challenges
 Testing education
o Individuals do not see the need to get tested (self risk assessment)
 What is the patients’ responsibility? Entitlement.
o Annual training and updates for testers/physicians
 Linkage to Care (LTC)
o Not having the same understanding/definition of what LTC means
 Do you take them yourself or do you make a phone call?
o Lack of tracking for LTC
2. Challenges to HIV Prevention with Positives
 Interruption of adherence due to circumstances beyond control
o Finances (co-pays, lost job/insurance, not enough money that month)
o Prison
o Geography (moving, living far from clinic, pharmacy, etc.)
o Client accountability/responsibility
 Stigma
o Teens living with fear of taking meds
 Health literacy (specifically among PLWHA)
 Partner notification/disclosure (legal implications, intimate partner violence)
 Medicaid restrictions (for reimbursement) for STD screenings, etc.
 Inadequate staffing of CBOs and clinical health settings
o Lacking crisis service availability during non-standard hours (especially when
large-scale testing occurs during non-standard hours)
 Client navigation through the (changing) healthcare system
3. Challenges to Condom Distribution
 People don’t want to use them because: stigma, comfort, cultural, not sexy
o Normalize condom use—eroticize condom use
 Inability to reach to certain populations: schools/youth, prisons, faith-based
agencies/churches
 Condom Education
o Importance condom-use
o Proper utilization of condoms
 Distribution, number of condoms available for distribution, specifically related to the
certain types (female, flavored, lube)
37
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o How do you get access to different types of condoms?
Criminalization of condom use
4. Challenges to Structural and Policy Initiatives
 Education for: people at risk, general public, healthcare providers, legislators
o Normalization of HIV testing
 School-based condom distribution/testing/ sex educations
 Lacking legislation/enforcement for:
o Testing/care in correctional facilities
o HIV/AIDS case reporting
o Prenatal HIV/STD testing
 Lack of communication among agencies—absence of policies/regulations to make
official practices for data sharing, etc.
o Enforcement of practices
o Streamlining reporting systems—link all the information
 Criminalization (What do you do? What types of policies can you create?)
 Legislating evidence-based decisions
o Evidence-based interventions are being banned (syringe-exchange)
o School-based sex education
o Policy doesn’t include technological advances/current science
o Ultra conservative legislators
38
APPENDIX F
Community Forum Response on Successes in HIV Prevention, Care, and
Treatment in Fulton and DeKalb Counties:
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We have tested A LOT of people
Caucasian, African American, MSM, young
Difficult populations to reach, we have reached!
Long running, sustaining organizations in Atlanta
Evidenced behavioral interventions, Healthy Love- will identified by the CDC,
comes from Atlanta!
Harm Reduction growth in Georgia (and in the south)
Spirit of cooperation; can come together to pull off major testing events; contrary
to the belief that there is disharmony in Atlanta
Project Getting Connected 2- focus on testing for men of African descent
Transitioned from prevention to something much larger; increase capacity;
education; increased skill; effectively intergraded STD screening within HIV
intervention
Housing has become a priority
Recovery/Transition support program (substance abuse, support) with United
Care “Pretreatment”
Linkage has been a success also; patients received care that would not have
gotten it outside of the programs such as Grady IDP. Linkage is a model that
needs to stay- Empower Link (15 people linked so far)
Rapid testing in non traditional settings such a the pharmacies Walgreens,
RiteAid, CVS; train nurse practitioners
FQHC centers
Grady IDP has a holistic approach to services for patients (mental health,
pastoral care, primary care, treatment) “wrap around services”
Atlanta change project SAMHSA)- mental health, substance abuse, linkage
network
Short term housing transition to permanent housing programs
Creating new strategies and new systems together; sharing ideas
Trained nearly 500 providers (testers, counselors, linkage workers) in the state
Role of advocates/activists play in GA; southern AIDS strategy
39