FY 2021 ending the HIV epidemic - primary care HIV prevention - the proposed project is a multi-faceted approach to increase the number of patients counseled and tested for HIV, the number…

FY 2021 ending the HIV epidemic - primary care HIV prevention - the proposed project is a multi-faceted approach to increase the number of patients counseled and tested for HIV, the number prescribed PREP, and the number linked to HIV care and treatment within 30 days of diagnosis. The sacramento county health center (SCHC) is a federally qualified health center serving a diverse population including people living with HIV (PLWH). The SCHC has approximately 12,600 assigned patients and also serves 4,000 undocumented patients, predominately latinx and other persons of color (POC), who do not qualify for insurance. As a designated 330(H), SCHC operates a drop in clinic for individuals experiencing homelessness. The SCHC is building a two room mobile medical van to provide HIV testing, primary care, and outreach to homeless and underserved populations. Between 2018 and 2020, SCHC diagnosed HIV infections in four assigned patients, an annualized incidence rate of 2.1 per 100,000. By contrast, the annual incidence rate in sacramento county was 7.2 per 100,000. Given the historically higher rates of HIV infection in some of the population groups served by SCHC-homeless, POC and those living close to or below the poverty line-IT is likely that SCHC is not adequately identifying PLWH. The SCHC will address under-identification by 1) educating health professionals and staff on the importance of routine OPT-out HIV testing and normalizing the patient/provider discussion on HIV risk factors and testing; 2) educating providers on HIV risk factors and CDC's testing guidelines; and 3) expanding HIV testing of homeless and other high risk individuals who seek care from SCHC. Increasing the number of patients who know their HIV status will help reduce infection of sexual partners and those who share needles for intravenous drug use (IDU). SCHC will provide sexual health education for patients, and increase prescribing and monitoring of pre-exposure prophylaxis (PREP) and post-exposure prophylaxis (PEP) to reduce virus T ransmission. SCHC will collaborate with sacramento county public health (SCPH) and community-based organizations to link/RE-engage PLWH, and provide anti-retroviral therapy and regular testing to ensure viral load suppression. These patients will receive services for CO-occurring disorders and social needs. CO-location of the main SCHC site with the sacramento sexual health clinic and the ryan white care program, enables a warm hand-off of patients. SCHC activities: 1) to increase patient testing and counseling, SCHC will: a. Provide education to SCHC providers (via aids education & training center) and staff (via SCPH) on how social determinants of health factor into HIV prevention; to be more comfortable having conversations about sexual health and STI's to include HIV, and to provide meaningful counsel to patients and their partners; B. Train providers on HIV testing guidelines, PREP and PEP best practices; C. Partner with SCPH to increase and expand patient counseling and HIV testing at SCHC primary care sites, homeless encampments, and other venues via the mobile medical van. 2) to increase the number of individuals prescribed PREP, SCHC will a. Provide education to high-risk patients on the benefits of PREP and PEP; B. Prescribe PREP to the partners of newly diagnosed HIV+ patients if the partner is a SCHC patient; C. Give unassigned patient partners a PREP starter kit and referral to SCPH for PREP continuation and adherence monitoring. 4) to improve engagement and retention in care, SCHC will utilize a linkage to care navigator to successfully: a. Refer PLWH to SCPH's sexual health clinic or to a specialist within 30 days of diagnosis; B. Inform non-patient's primary care provider or SCPH (if no PCP) of the diagnosis to provide care; C. Link SCPH's sexual health clinic clients without a medical home to primary care services. This project will focus efforts on the greater sacramento area and will include outreach to…