The Big Picture - April 2013

This post is part of a monthly series published around the fourth Thursday of every month. It provides an overview of themes and topics from the general meetings and committee meetings of the Ryan White Planning Council and Prevention Planning Group each month. To view meeting materials and presentations, please visit www.hivphilly.org.

Ryan White Planning Council (RWPC)





Do 1 Thing

This month, the Ryan White Planning Council (RWPC) had a bit of a break in its agenda after a very busy and stressful March.  (Read about the funding decisions that the RWPC made in emergency meetings in March here.)  RWPC members received a presentation on the Do 1 Thing project from Dr. Stacey Trooskin.  Dr. Trooskin talked about racial and geographic disparities in both HIV and Hepatitis C (HCV), and how this program was designed to address these disparities.  Do 1 Thing is a comprehensive campaign that includes testing, linkage to care, and treatment for both HIV and HCV.  There is a heavy community outreach component, and a clinical side as well.  View the whole presentation to learn more.  The RWPC also welcomed seven new members.

Meanwhile, the Comprehensive Planning and Finance Committees held their first joint meeting to prepare for this year's allocations meetings.  Each year, the RWPC plans how it will allocate (or spend) its money for the next fiscal year, even though they don't know how much money the Philly area will have.  This way, they'll have a plan in place so they can move quickly once they actually receive an amount.  They always break this planning out into separate meetings around the region, so that the Southeastern PA Counties, the South Jersey counties, and Philadelphia each have their own plans.  (Become an allocations pro here.)  This year will be a little different, since the Affordable Care Act kicks into full gear in January.  The Comprehensive Planning and Finance Committees are trying to decide how to best tackle these issues, since there are still a lot of answers we don't have.  They agreed on what data they want to look at first, and that they should include the treatment cascade in their decision-making.

The Needs Assessment Committee has also been talking about the importance of the cascade, and linkage to HIV care in particular.  They want to find out more about the process that different HIV testers use to get new positives into medical care.  This month, they talked about that process in two different systems.  They also began to work out the questions that they still had, in order to decide what type of needs assessment would be most appropriate.



Project PrEPare

The Positive Committee talked about something a little different - pre-exposure prophylaxis, or PrEP.  PrEP involves HIV-negative people taking antiretroviral medications in order to prevent HIV infection.  Dr. Sarah Wood and Kimberley Desir came to the committee to talk about the Children's Hospital of Philadelphia's PrEP trial, called "Project PrEPare."  They're recruiting young men and transwomen who have sex with men, between the ages of 18 - 22, for this study.  Learn more about Project PrEPare in their presentation.
 

Prevention Planning Group (PPG)

In April, the Prevention Planning Group moved forward in its plans for change for the summer.  The current membership will end on June 30, so the PPG is using this time to draft new bylaws, membership applications, and other documents.  At their April meeting, they agreed upon a name for the new group (the Philadelphia HIV Prevention Planning Group, or HPG), and reached consensus to adopt their new bylaws.  They also approved a membership application, and will be recruiting new members soon.  Keep an eye out!



This is an exciting time to get involved in community planning for the Philadelphia area. To learn more, follow the links in this post, attend one of the meetings listed on our calendar, or email info@hivphilly.org to find out how to get involved. If you have questions, you can also call us at 215-574-6760.

The Science: An HIV Cure

This post is part of a monthly series published on the third Thursday of every month.  In this series, our staff tackle the latest topics and studies related to HIV.   



HIV-infected T cell (image from NIAID_Flickr)

Earlier this month, I attended a webinar on the state of HIV cure research.  Dr. Steven Deeks did a great job presenting in this AIDS Vaccine Advocacy Coalition (AVAC) webinar.  (If you'd like to download his slides or listen to the audio, you can do that here.)  Here's a brief overview of the latest in HIV cure research.

Why do we want a cure?
Antiretroviral therapy (ART) doesn't restore health.  There are lots of side effects to ART.  There are also medication access issues, and adherence can be difficult. 

Why doesn't ART cure HIV?
HIV is great at hiding in the body.  Even when ART is attacking HIV, there are so-called "viral reservoirs" lying in wait.  When treatment is stopped, the hidden HIV springs into action.  It's almost like a game of cat and mouse.  The trick is finding a way to get rid of the hidden virus.

Functional Cure vs. Sterilizing Cure
When we talk about an "HIV cure," it can be one of two kinds:  a functional cure, or a sterilizing cure.  A functional cure can be defined as "long-term health in absence of therapy."  There might be some virus left in the body, but it's not causing any damage.  On the other hand, a sterilizing cure refers to the total eradication of any virus capable of replicating.  This refers to complete annhiliation of any HIV in the body.

Timothy Ray Brown in POZ

The Berlin Patient
Timothy Ray Brown, otherwise known as the "Berlin patient," is the first case of a person cured of HIV.  Doctors are currently trying to prove that he experienced a sterilizing cure after chemotherapy and a dangerous experimental blood stem cell transplant.  The stem cell donor had a CCR5 mutation, which meant that the donor's cells did not have a special receptor that HIV-1 needs in order to take hold.  Brown has been off ART for about five years, and there is no evidence of the virus rebounding.  In fact, his antibody levels have been declining.  Read more about his story here, or get the original study published in the New England Journal of Medicine here.


Baby Cured of HIV in Mississippi
Last month, a new possible cure was announced.  In this case, an HIV-positive mother who was not in care gave birth to a baby girl.  A pediatrician realized that there would be a high risk of transmission, so they started ART in the baby about 30 hours after delivery.  Two blood tests in the baby showed HIV RNA and DNA, so doctors are generally confident that the baby was actually HIV-positive.  The child is now 2 1/2 years old and has been off ART for a year.  Her immune system is healthy and tests are not easily detecting HIV RNA and DNA.  There is debate about what happened - some believe that the virus was only in the mother's cells, others think that only short-lived T cells were infected, and others think that there was something about the baby's immune system that helped eliminate the virus.  There's no published study, but you can read an article about the case here.

14 Adults Able to Control HIV Infection in France
Right on the heels of the news of the toddler in Mississippi, French researchers announced that another 14 adults may have been functionally cured of HIV.  These individuals were all treated shortly after infection, and were on ART for some time.  They then stopped ART, but are able to control the virus without medication.  There do not seem to be any characteristics in these adults that could contribute to their ability to control the HIV, aside from their early treatment.  Read a New York Times article about the study here, or view the full text of the study from PLOS Pathogens here.

2 More Possibly Cured in Boston
Two more adults may be functionally cured of HIV following bone marrow transplants, much like Timothy Ray Brown was.  However, in this case, the donor cells did not have the same CCR5 mutation - so, they were not naturally resistant to HIV-1 like Brown's donor cells.  These patients are still on ART, but doctors are unable to find evidence of HIV in their bodies, and their antibody levels are dropping.  They're not off ART yet, but their cases look promising.  Read an article on the Boston patients here. 

Further reading:
Towards an HIV Cure: People Focused, Science Driven
These are the full recommendations from the International AIDS Society Scientific Working Group on HIV Care, presented in July 2012.

For the Win: Find a Cure Faster
Read the AIDS Policy Project's recommendations for improving the overall research system to encourage scientific advancements in finding a cure.


Is there another topic you'd like to see discussed here?  Please send any suggestions to info@hivphilly.org, or leave a comment below.

Towards more cost-effective HIV prevention planning

Some background: The Philadelphia Prevention Planning Group (PPG) and the City of Philadelphia's AIDS Activity Coordinating Office (AACO) work together to decide which communities have the greatest need for HIV prevention activities, and which interventions work best for those communities.  This is part of what we call "community planning."  AACO decides how the money gets spent and which organizations do the work, keeping in mind the community's needs and what is proven to work best. The PPG provides the community's voice to the process.

In 2011, the Centers for Disease Control and Prevention (CDC) approached the Philadelphia Department of Public Health (PDPH) to participate in the design and testing of a model for how to best spend HIV prevention funds to prevent the spread of HIV. The model was supposed to help health departments make cost-effective decisions to meet the goals of the National HIV/AIDS Strategy.  You can read more about the data used in the model and how the model influenced HIV prevention planning in the 2012 Philadelphia Jurisdictional Plan  (pages 93-95). 

AIDS.Gov recently released a podcast explaining this resource allocation model.  It also talks about the pilot project in Chicago, Nebraska, and Alabama, which is supposed to determine if the model works for those communities and to see if their experiences are similar to Philadelphia's.

The AIDS.Gov blog post explains more about the pilot project, HIV RAMP:

"That model was developed to help Philadelphia’s health department leadership identify the optimal allocation of HIV prevention funds across populations and prevention interventions that would prevent the most new HIV infections. Using local demographic and HIV epidemiological data inputs, and based on calculations of the cost per new infection averted, the model recommended the optimal allocation of the jurisdiction’s HIV prevention budget among several evidence-based interventions for the populations most impacted. Feedback from Philadelphia indicated that the model’s outputs served as a very useful “roadmap” to inform decision making for HIV prevention resource allocation within the jurisdiction, informing both applications for federal funds as well as efforts to strengthen local HIV prevention activities.

The current project, HIV RAMP, involves refining and piloting the original Philadelphia model in three additional jurisdictions that have different local profiles and HIV prevalence rates (Chicago, Nebraska, and Alabama), testing a technical assistance (TA) protocol to support jurisdictions in using the model, and assessing the feasibility of a software or online version of the model that could be more broadly used by other health departments.

“Because making decisions about how to spend HIV prevention funding is never ‘black and white,’ health departments need tools to help them decide how to support the best combinations of effective, evidence-based prevention strategies in their communities,” said Dr. Ronald Valdiserri, Deputy Assistant Secretary for Health and Director of OHAIDP. “Through this pilot project, we hope to develop a practical tool that can help communities apply the principles of the NHAS on the ground.”

Here are some highlights from the Philadelphia jurisdictional plan's discussion of the model development, focusing on the results:

"Cost per new infection averted is an integral part of this resource allocation model. For HIV testing in a clinical setting, the cost per infection averted is $51,293, making it the second most cost-effective intervention for Philadelphia. Testing in non clinical settings for IDU (3) and MSM (1) rounded out the top three most cost-effective interventions for averting HIV transmission at $53,935 and $17,965, respectively. The least cost-effective interventions used in the model were behavioral interventions for HIV- high risk heterosexuals ($15,642,127) and IDU ($2,931,406). Behavioral interventions were not found to be as cost-effective as HIV testing, even for HIV+ individuals. Adherence to ART (4), retention in care (5), partner services, and linkage to care (8) were ranked in the middle of the list of interventions. 

The optimal resource allocations according to those calculations would avert 72 infections in the first year and 245 infections within five years. Testing in clinical settings would receive 39% of the resources and avert 20 infections in one year, 93 infections in five years. Retention in care would receive 29% of the resources and avert 27 infections in year one and 52 infections within five years....Two-thirds of the resources would be allocated to HIV testing in this optimal model, because of the cost-effectiveness of HIV testing (non-targeted), particularly for MSM and IDU communities.  These allocations would serve 1,930 HIV+ individuals and result in 792 new diagnoses. Return on investment ranges (prevention dollars only) from 1.21 in year one to 4.42 in year five....

Recommendations from the model include allocations decisions should be made by both cost and effectiveness. Testing should be prioritized in clinical and non-clinical settings. More resources should be allocated to interventions located in care-settings. Behavioral interventions for HIV- individuals are not allocated resources. Behavioral interventions for MSM can be allocated resources under certain conditions. "

If you want to learn more about the community planning of HIV prevention in Philadelphia, check out the Prevention Planning Group or come to a meeting.

The Team: Michael Dorsey

This post is part of a monthly series published on the second Thursday of every month. It features a member of the community planning team - one of the devoted members of the Ryan White Planning Council or the Prevention Planning Group that volunteers his or her time to improve HIV services in our area. 

This month, we feature Michael Dorsey.  Michael is a Planning Council member and current co-chair of the Positive Committee.  I asked him the following questions.



Michael in the classroom

What made you decide to get involved with the Ryan White Planning Council?
I got involved with the Ryan White Planning Council because I like to give back to my community and I wanted to be a positive voice to improve care for people living with HIV/AIDS.

What is your favorite part of being a RWPC member?
My favorite part of being a RWPC member is serving on the Positive Committee. It helps me educate PLWHA to take care of themselves, stay linked into care, encourage them to take advantage of support groups, access Ryan White Care Act services, and to always be informed about the HIV/AIDS agenda. I also like the idea that the RWPC performs a great deal of work throughout the year to assess needs, evaluate financial and program activities, and participate in planning that is coordinated with other local and state entities.

What is the biggest challenge you’ve had as an RWPC member?
One of the biggest challenges I have been faced with is getting members to serve on various committees, be a voice and participate, and pass information on to educate their communities. If there is ever going to be an AIDS-free generation, those affected/infected must advocate for the cause.

What do you wish more people knew about community planning?
I wish more people knew that community planning supports and enhances the role of PLWHA. They help one to make effective decisions in their community, and that it is made up of people who represent different communities, cultures and experiences.

How has your background as an educator helped you as a member?
My background as an educator has helped me to be a motivated spokesperson to mentor and coach those individuals who need help in any given area. We all come from different background with different skills. With that being said, we all have something to give back. We must continue to “ACT UP, FIGHT BACK, and FIGHT HIV/AIDS!”

What is your favorite thing about the Philly area?
My favorite thing about the Philly area is that we have so much history, geography, cityscape, culture, economy, demographics, law & government, education, as well as the transportation system. Also the diversity and love here. I appreciate that the Philadelphia is the largest city in the commonwealth of Pennsylvania, and the second largest city on the East Coast of the United States. It also played an instrumental role as a meeting place for the Founding Fathers of United states, who signed the Declaration of Independence in 1776.

Anything you like to do while in the neighborhood for meetings?
I would like to just pass on information that is learned through attending professional development workshop or what is learned in support groups in Philadelphia.

Anything else you’d like to add?
One thing that I would like to add would be commending the staff at Office of HIV Planning for the work that they do. The staff has a great vision, passion, outstanding decision makers, builders for the community at large, and have good character. Kudos for being quick, committed, analytical and thoughtful.

To meet our featured community planners or get involved in the process yourself, we invite you to participate in one of our meetings.  You can always view a meeting calendar at http://www.hivphilly.org/calendar.html, or email info@hivphilly.org to learn more.

TEDMED 2013 Comes to OHP

Do you want to learn and be inspired by some of the world's greatest thinkers and innovators in health care and public health? 

It's your lucky day! 

Thanks to the sponsors of TEDMED 2013, the Office of HIV Planning is holding a 2 day TEDMED LIVE event April 17-18th. You are welcome to come over with your lunch and watch sessions from Washington DC live in real time.  

What? You don't know what this TEDMED thing is?! Ok, just check it out for yourself.

The people we will hear from include artists, scientists, doctors, and athletes. We will watch 3 sessions of 5-7 presenters over the two days. We are talking major players: (former) Google execs, the Director of the National Institutes of Health, stars from So You Think You Can Dance?, and so many more entrepreneurs, innovators and leaders.

 

April 17th 11:30am-1:00pm: Translating the Untranslatable

Featuring: ZDoggMD, Mick Cornett, Jill Sobule, David Agus, Jay Walker, Sally Okun,  Richard Simmons (yes, THAT Richard Simmons!)

April 18th 11:00am - 12:45pm: Going Farther While Staying Closer

Featuring: Washington Conservatory of Music, Susan Desmond-Hellman, Roni Zeiger, Elizabeth Marincola, Christopher J.L. Murray, Larry Brilliant

April 18th 1:00 - 3:00pm: What Happens When We Mix Up the Models? 

Featuring: Francis S. Collins, Manzari Brothers, Gary Slutkin, David Odde and Black Label Movement, Zubin Damania

Registration Encouraged.

All you have to do is let us know you are coming by filling out this quick registration form. If you are unable to come in person, please contact Nicole for alternative arrangements.

As a special thank you, all those who attend will receive online access (on demand and streaming) to all the TEDMED 2013 sessions through April 21st. 

Everybody is welcome to join us, no matter your profession. You are bound to be inspired and challenged by the awesome presenters at TEDMED. 

Inspiration is free, you just have to show up.

The Big Picture - March 2013

This post is part of a monthly series (that's usually) published on the fourth Thursday of every month. It provides an overview of themes and topics from the general meetings and committee meetings of the Ryan White Planning Council and Prevention Planning Group each month. To view meeting materials and presentations, please visit www.hivphilly.org.

Ryan White Planning Council (RWPC)

Last month, the Planning Council (RWPC) did some contingency planning for what we'll do once we receive our full award from the federal government.  (Read what happened last month here.)  We don't know how much funding we have for the fiscal year that started on March 1, but we received some new information midway through the month.  We got this information after the RWPC already met, so the Finance Committee and RWPC held emergency meetings. 

In February, we already knew that we should expect a 5.1% cut to Ryan White funds due to the sequester, so the RWPC planned accordingly.  However, in March, HRSA told our area that we should expect an additional 5.2% cut, because our area's portion of HIV/AIDS cases had risen slower than cases in other areas.  All in all, the grantee (otherwise known as AACO, or the AIDS Activities Coordinating Office) suggested that the RWPC plan for an 11% cut.  This would be about a $2.1 million cut to funding for services.  The grantee also developed a suggestion that they believed would minimize the impact of the cuts on consumers.  This suggestion was reviewed at length by the Finance Committee and the larger RWPC, and ultimately approved by both.  The final plan ends funding for early intervention services and care outreach after the first quarter, and spreads the remaining cuts proportionally across the other services.

Earlier in the month, the RWPC received a treatment update from Dr. Chris Vinnard.  They also learned about Early Identification of Individuals with HIV/AIDS from consultant Matthew McClain.  The Comprehensive Planning Committee continued and honed its conversation on Ryan White service categories and their relationship to the continuum of care.  They also talked about reimbursement for Ryan White services and the need for a peer navigator program.  Meanwhile, the Needs Assessment Committee discussed how and where people enter into HIV care. The Positive Committee listened to a podcast on the Origin of HIV and received a policy update.  The Finance Committee (in their first meeting of the month) also got a policy update, before discussing the care continuum chart developed by the Comprehensive Planning Committee last month.  Last but not least, the Nominations Committee met to review applications for RWPC membership.  Seven out of eleven applications were approved, and the new members will take their seats on the Planning Council in April.
 

Prevention Planning Group (PPG)

The PPG met this month to receive a special presentation from AACO epidemiologist Dr. Kathleen Brady.  She gave an overview of the latest data on the HIV/AIDS epidemic in the Philadelphia area in order to help the PPG complete its work.  The PPG also continued its process of reinventing itself.  This month, consultant Matthew McClain presented an updated version of the group's draft bylaws based on the recommendations from the last meeting.  He also developed a draft version of a new membership application.  PPG members were asked to review the draft documents so they could provide suggestions and changes at the next meeting.

The Points of Integration Workgroup, a joint venture of the PPG and RWPC, met at the beginning of the month to develop their work plan for the rest of the year.  They continue to examine the process of linking newly diagnosed HIV cases into the care system.


This is an exciting time to get involved in community planning for the Philadelphia area. To learn more, follow the links in this post, attend one of the meetings listed on our calendar, or email info@hivphilly.org to find out how to get involved.  If you have questions, you can also call us at 215-574-6760.