Last September, Broward County Ryan White Care (Broward-RWC) and the Florida Department of Health-Broward (FL-DOH-Broward) Prevention program submitted their “Integrated HIV Prevention and Care Plan 2017-2021.” This 128-page plan outlines Broward’s five-year plan to control HIV. While this plan will allow its funders to monitor their “investment,” it will also allow the public to monitor progress in the epidemic.
Monitoring progress has special importance for those communities that HIV has ravaged. This plan aligns with the National HIV/AIDS Strategy (NHAS). This article briefly summarizes and simplifies the major points of the plan.
Broward-RWC and FL-DOH-Broward plan to reduce annual new infections from 993 to 745 by 2021. Under this plan, HIV testing would become part of routine medical care. This tactic targets the public. People at high-risk would increase their use of Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP).
FL-DOH-Broward plans to educate high-risk groups about PrEP and PEP. FL-DOH-Broward plans to educate medical providers about routine HIV testing and PrEP/PEP. When medical providers learn about PrEP and PEP, these options should become more available.
In 2014, only 53.7 percent of people entered care within 30 days of testing positive. Broward-RWC and FL-DOH-Broward plan an aggressive “Test and Treat” strategy to improve this. This will involve integrating data systems, accessing the referral networks of HIV-testing sites, and increasing cultural competencies.
When providers fail to keep people in HIV care, the health of these dropouts will worsen. They may also infect others. Broward-RWC and FL-DOH-Broward propose five corrective tactics:
- Data systems must provide real time data.
- That data must identify those providers with high numbers of dropouts.
- That data must identify those clients lost to HIV care and their characteristics. Broward-RWC can examine those characteristics to see if certain groups dropout more than others.
- If so, cultural competency issues may be involved. That data should be geo-coded to identify areas with many care dropouts.
- Disease Intervention Specialists should locate HIV care dropouts.
This plan proposes to make the recertification process simultaneous for Broward-RWC and ADAP.
Disparities refer to differences in outcomes between social groups. The plan identifies three groups with disparities in death rates needing reductions of 15 percent: Black Males, Black Females, and White Males.
When a provider’s staff lacks cultural competence, the client may avoid or dropout of care. Cultural competence refers to knowing the slang, norms, and behaviors of a given group. Broward-RWC and FL-DOH-Broward plan to increase cultural and linguistic competences, including LGBT cultural competencies. An LGBT cultural competency would involve saying “bottoming” rather than “taking the female role.” Educating providers should increase their competencies. Peer Specialists and Community Health Workers from the affected groups should increase competencies. Broward-RWC and FL-DOH-Broward plan to develop a certification process and career path for Peer Specialists and Community Health Workers.
Broward-RWC and FL-DOH-Broward have ranked nine priority groups for HIV prevention and treatment (see chart). Broward-RWC and FL-DOH-Broward developed these rankings comparing new infections to current infections among racial and risk groups.
Broward-RWC and FL-DOH-Broward wrote this plan this year, but the baseline data is from 2014. Despite increased demands for data-based decisions in health care, real-time HIV data is seldom available.
This plan provides an ambitious, yet realistic, set of targets. Reports of progress towards these targets should be publically available. It is now up to the people affected by HIV to hold Broward-RWC and FL-DOH-Broward to it.
For information about public meetings of The Broward HIV Planning Council, call 954-561-9681 ext. 1343 or 1295
For information about public meetings of The Broward County HIV Prevention Planning Council, call 954 467-4700 ext. 4991.
To read the National HIV/AIDS Strategy updated to 2020, please visit, bit.ly/2grMFC8
To read the full 5-year plan, please visit bit.ly/2f8K0Y9.