aetc_ncrc_hard_to_reach_presentation_08_09_2016.pptx

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Defining & Working with Hard-to-Reach Populations: Innovation & Game Changing Ideas

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DEFINING & WORKING WITH HARD-TO-REACH POPULATIONS: INNOVATION & GAME CHANGING IDEAS
Facilitators:
Catalina Sol, MPH
John Nelson, PhD, CPNP
Tisha Wheeler, MSc
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Identifying "Hard-to-Reach" Populations
Who are the "key populations" or HIV most-at-risk populations?
Who is not fully accessing HIV-related healthcare?
What social determinants make accessing HIV-related healthcare easier or harder?
What attributes make some within key populations harder-to-reach than others?
What policies promote access to healthcare for hard-to-reach individuals/populations?
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Evaluating "Reach"
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Increase the % of PLWH who KNOW their status to at least 90%
Increase the % of newly diagnosed persons LINKED to HIV medical care within 1 month of diagnosis to at least 85%
Increase the % of persons with diagnosed HIV infection who are RETAINED in HIV medical care to at least 90%
Increase the % of persons with diagnosed HIV infection who are VIRALLY SUPPRESSED to at least 80%
U.S. NHAS 2020 Goals

UNAIDS Global Targets

Current Global Stats1

57% (diagnosed)
46% (treated)
38% (virally suppressed)
Global Disparities: % in eastern Europe, central Asia and western and central Africa < all other regions

1UNAIDS. Progress Report. July 2016. http://www.aidsmap.com/Progress-towards-90-90-90-targets-is-promising-bu.... Accessed July 20, 2016.

Identify Key Populations
Reach Key Populations
Test Key Populations
Link to appropriate services based on test results

* Based on recommendations by UNAID 2014 Report: http://www.fhi360.org/sites/default/files/media/documents/CascadeGuide-U...
First Steps in Connecting to Care Services
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Source: LINKAGES/USAID Global Project. https://www.fhi360.org/projects/linkages-across-continuum-hiv-services-k...

Social Determinants of Health

Social Determinates of Health Components
World Health Organization (2016):
The person's social and economic environment (laws, policy, culture, social capital, education, social status, income)
The person's physical environment (water, sanitation, pollution, safety, health care service availability)
The person's individual characteristics and behaviors (age, race, gender, gender identity and expression, sexual orientation , genetics. . . )

Operational Definition of HIV-Infected Hard-to-Reach Populations

Operational Definition
Why? To assist in making sure HIV services are inclusion of HIV at-risk and HIV-infected subpopulations whom traditionally have been marginalized to some degree in receiving services

How will this help? Will allow for broader inclusion of those at greatest risk of being neglected at the front line of outreach, engagement, and direct services to the public health level of policy and legal rights

Examples of subpopulations whom may fit this definition: MSM, sexual minority persons, gender minority persons, sex workers, substance users, domestically victimized persons, minor adolescents, immigrants, incarcerated persons , rural residents. . .

Next Steps
What interventions work to increase testing and diagnosis in hard-to-reach subpopulations?
Which hard-to-reach subpopulations are missed with these interventions?

What interventions work to increase engagement of hard-to-reach HIV-infected populations in linkage, retention, and ongoing HIV care?
Which hard-to-reach subpopulations are missed with these interventions?

What interventions work in increase the prescription of antiretroviral therapy (ART), accession of ART, and administration of ART to increase viral suppression?
Which hard-to-reach subpopulations are missed with these interventions?

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BREAKOUT GROUPS
Testing, Diagnosis, and Linkage

Linkage, Engagement, Retention, and Treatment

Viral Suppression attainment and maintenance

Group Considerations
Based on "what works" for identified hard-to-reach key populations, what are recommendations for the following :
LAW
POLICY
RESOURCES
STIGMA REDUCTION
PUBLIC HEALTH MESSAGING
HEALTHCARE PROVIDER EDUCATION
COMMUNITY-BASED INTERVENTIONS/SUPPORTS
EFFECTIVE, INNOVATIVE INTERVENTION DISSEMINATION & UPTAKE

Focus also on: Continuation, Sustainability, and Replicability
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Recommendations for HRSA HAB
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