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Background: Cities are mobilizing to address UNAIDS “90,90,90” targets. In 2013, San Francisco formed a new, independent, multisector “Getting to Zero (GTZ) consortium aiming to harness public and private efforts to reduce new HIV infections and related deaths by 90% in San Francisco by 2020.
Description: The consortium activated community, providers, researchers, government and private sector to develop a strategic plan and committees to address gaps in the City''s response. Because 94% of infected persons are already aware of HIV status in San Francisco, the plan emphasized high yield prevention and treatment care cascade strengthening programs to address 4 problems
1) Underdeveloped systems for pre-exposure prophylaxis (PrEP);
2) Inadequate HIV care initiation for new diagnosis;
3) Gaps in retention and re-engagement in care;
4) HIV-related stigma.
Lessons learned: The PrEP committee coordinated
1) “Getting the word out” through media, social network, and PrEP ambassadors
2) “Kick Starting PrEP” through provider training and health navigators.
Over the last year, PrEP delivery sites increased to >30 clinics, >120 providers were trained to deliver PrEP, and community surveys of MSM report PrEP use increased from 15% to 22%. The GTZ “RAPID” committee expanded a pilot public hospital program already achieving time from HIV diagnosis to viral suppression of 65 days through same day linkage and comprehensive medical and social support to 3 sites city-wide, with over 100 enrollees. The Retention and Re-engagement committee identified
1) gaps in support services,
2) need for navigators to re-engagement clients and prevent loss to follow-up and
3) frontline worker capacity-building goals.
After one year, 73% of patients enrolled in navigation have re-linked to care; three public health clinics are implementing an evidence based reengagement and retention package. The stigma committee is developing a city-wide needs assessment through engaging communities affected by HIV. GTZ is supported by the Mayor, Director of Public Health, and private sector.
Conclusions/Next steps: The SF GTZ Consortium has achieved multiple process outcomes of its strategic plan including
1) increased PrEP demand and access,
2) reduced time from HIV diagnosis to viral suppression
3) increased navigator support for retention.

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