HIV Prevention Section (HPS)
Request for Proposals (RFP)
“HIV Prevention Programs for Communities
Highly Affected by HIV”
Bidders’ Conference
December 10, 2010
Presentation Overview
RFP vision
Overview of service categories
Examples of new efforts and requirements
Conclusion
Key dates
Presentation abbreviations
RFP Vision
The vision of the RFP is a “system of
prevention” that:
Is based on the local epidemiology
Is grounded in the priorities identified in the 2010
HIV Prevention Plan
Reflects the New Directions introduced by the HIV
Prevention Section (HPS)
Is in line with national priorities, including the
National HIV/AIDS Strategy (NHAS)
Examples of What Is Different
Clients are “system of prevention” clients
Services are anonymous when there is a need
HIV prevention messaging is current and consistent
Accountability for outcomes as well as process
Increased emphasis on behavior changes other
than sexual behavior change (e.g., substance use,
treatment adherence, testing frequency)
System of Prevention
“System of prevention” = combined efforts of all
HPS-/DPH-supported HIV prevention programs
The “system of prevention” for people at risk for and
living with HIV that results from this RFP will
promote the following citywide goals:
Increase HIV status awareness
Increase viral load suppression
Maintain or increase levels of protected sex
Increase access to safer injection supplies
System of Prevention (cont.)
The system is a combination approach to
prevention:
Community-based HIV testing will be supported both as
distinct programs (Category 1) and as an integral part of
HIV prevention programs (Categories 4-7)
Prevention with positives (PWP) will be supported in both
clinical and community settings (Category 3)
HIV health disparities will be addressed through holistic
health models that include health education/risk
reduction (HERR) and testing, as well as other appropriate
strategies (Categories 4-7)
Drivers of HIV will be addressed with intensive HERR
(Category 2)
Syringe access will be supported through Category 8 and
also integrated across all programs
Overview of Service Categories
Category 1: Community-Based HIV Testing
Why?: Increase status awareness
Programs will expand access to testing for MSM,
IDU, and TFSM and increase frequency of testing
Category 2: HERR to Address Drivers Among
MSM
Why?: Reduce the effects of drivers on HIV risk
Programs will provide intensive HERR services
addressing drivers
Overview of Service Categories (cont.)
Category 3: PWP
Why?: To improve health outcomes and reduce
opportunities for HIV transmission among PLWH
Programs will provide services that will lead to viral load
suppression (e.g., treatment adherence, engagement in
care)
Categories 4-7: Special Projects
Why?: To address HIV-related disparities in SF
Programs will be holistic health models designed to meet
community needs and prevent new HIV infections
Overview of Service Categories (cont.)
Category 8: Citywide Syringe Program
Why?: To ensure maximum access to safer
injection equipment in SF
Two parts:
Syringe access and disposal services
Program coordination & bulk purchasing
This program will provide syringe access and
disposal services citywide, including coordination
of services at programs funded in other categories
Examples of New Efforts and
Requirements
1. Syringe access and disposal
2. Condom access
3. State-certified individual risk reduction counseling (IRRC)
4. Prevention with positives (PWP)
5. Data management & evaluation staff
6. HIV prevention names-based system
7. Engagement and Support Efforts (EASE) Program
8. Collaboration
1. Syringe Access and Disposal
Programs funded under Categories 1-7 must
provide syringe access and disposal services to
clients
HPS will provide training and certification
The program funded in Category 8 will coordinate
this effort and provide the supplies (supplies costs
should not be included in the proposal budgets for
Categories 1-7)
Programs can opt out with justification (e.g., don’t
serve IDUs)
2. Condom Access
All funded programs must provide free
condoms and safer sex supplies
Supplies costs should be included in the
proposal budget
3. State-certified IRRC
(Categories 1 and 4-7)
In order to promote new models and scale up
testing efforts, state-certified IRRC is limited to one
third of HIV-negative tests
State-certified IRRC is required for all people who
test HIV-positive
State-certified IRRC counselors must make a
minimum 1-year commitment and provide at least
100 tests annually
4. Prevention with Positives (PWP)
New emphasis
New emphasis on connection to clinical settings
New required activities
New focus on treatment adherence and
engagement/retention in care
New target population
New focus on people with unsuppressed viral load
5. Data Management & Evaluation Staff
All programs are required to include data
management and evaluation staff
HPS will work closely with these staff to
ensure accurate and timely data submissions
and accountability to process and outcome
objectives
See service category descriptions for details
6. Names-based HIV Prevention System
This service utilization system will eventually
replace CTL and core variables
Category 1-7 programs will be required to use the
system
The system will be CDC-compliant
HPS will begin working on system development
now, with the goal of pilot testing it beginning July
1, 2011
A 2011 HIV Prevention Planning Council (HPPC)
committee will give input
7. EASE Program
EASE = Engagement and Support Efforts
Services delivered by DPH
Two parts to EASE:
Linkage to primary care and partner services
Navigation to support re-engagement in care for
individuals lost to care
7. EASE Program (cont.)
Linkage and partner services:
When someone tests HIV-positive at a community-based
test site, an EASE staff person will directly offer linkage and
partner services to the client
Linkage and partner services will no longer be the
responsibility of the site
The site’s responsibility will be to ensure the client is solidly
connected with the EASE staff person
For Category 1 programs, the EASE staff person will work
at the program site and operate as part of the HIV testing
team
7. EASE Program (cont.)
Navigation:
EASE staff will identify clients lost to care using various
methods (e.g., contacting primary care providers and PWP
programs)
EASE staff will support these clients to re-engage in care
using navigation and case management strategies
This will supplement and not duplicate other re-
engagement in care efforts (e.g., PHAST Team, Centers of
Excellence, PWP)
7. EASE Program (cont.)
Why is the EASE Program a DPH and not a
community-based program?
The EASE Program will require a great deal of coordination
and collaboration across city departments and private
medical providers
DPH is in the best position to provide a system-wide
approach to linkage, partner services, and re-engagement
in care
Partner services must be provided by DPH or DPH-
deputized staff, by law, and DPH has this expertise within
the STD Section
Only DPH has access to city databases that can be used to
help locate people lost to care
8. Collaboration
As promised, we are not requiring agencies
to submit collaborative applications
Collaboration is an option and is encouraged
when it would improve program quality or
enhance capacity to provide the proposed
services
Collaboration should result in one cohesive
program
For guidelines, see RFP p. 132 and Appendix
A-3
Conclusion
We believe the combination prevention approach
represented in the RFP, in concert with DPH-
delivered services and other developments such as
the PrEP, has the potential to end new HIV
infections in SF
All eyes are on SF – we can rise to the challenge
Let’s be the first jurisdiction in the U.S. to end new
HIV infections
Key Dates
Letter of intent due:
12 noon on December 15th
Proposals due:
12 noon on February 2nd
Must include the qualifications statement and all
required components (see pp. 142-144)
Presentation Abbreviations
CDC – Centers for Disease Control and Prevention
DPH – Department of Public Health
EASE – Engagement and Support Efforts
HERR – Health education/Risk reduction
HPPC – HIV Prevention Planning Council
IDU – Injection drug user
IRRC – Individual risk reduction counseling
MSM – Males who have sex with males
NHAS – National HIV/AIDS Strategy
PHAST – Positive Health Access to Services and Treatment
PLWH – People living with HIV (including AIDS)
PrEP – Pre-exposure prophylaxis
PWP – Prevention with positives
TFSM – Transfemales who have sex with males