Health care innovation & ingenuity


By Pierre-Cédric Crouch, PhD, ANP-BC

2017 was a busy year for the San Francisco AIDS Foundation health clinics. As demand from our community continues to grow, we are challenged every day to find creative ways to deliver the quality health care we are so proud to offer.

Here’s a quick re-cap of new services we introduced this year.

Stronger and faster: Routine testing for sexually transmitted infections (STI) and our PrEP Health Program

Magnet, our sexual health clinic, sees 70 – 100 clients every day and the demand never slows. People who only need routine lab tests can often find it difficult to get a walk-in appointment when they need it. To make routine STI testing easier, we created a new service called Magnet Express.

With Magnet Express, you can come in at any time the service is open, self-register at the Magnet Express kiosk, get your blood drawn, swab yourself for gonorrhea and chlamydia, and then leave. It’s a quick in-and-out, labs-only service where you can be tested for HIV, hepatitis C, syphilis, gonorrhea, and chlamydia.

Fret not over the self-swabbing! We partnered with the famous mr. Pam and filmed instructional videos with five community members who will walk you through swabbing your throat and your butt. You’ll be a swabbing pro in no time.  

In addition to making it easier to get a routine test, Magnet Express has an added benefit for our PrEP Health Program.

Since we started offering PrEP in late 2014, we’ve had a steady stream of people enrolling in the PrEP Health Program. We now have about 2,200 people currently getting PrEP at Magnet, when we expected to have only 1,500! This is incredible progress, but also a lot of work for the clinic since our PrEP clients come to the clinic every three months.

To increase our capacity, our PrEP clients will use Magnet Express for their follow-up appointments. They will still come in every six months to meet with a nurse to discuss how they are doing on PrEP. In between these visits, they get an email reminder to stop by Magnet Express for a quick in-and-out visit. Our clients have absolutely loved this new model, which saves everyone time and makes staying on PrEP easier.

Labs, labs, and more labs

In order to provide services that better meet our clients’ needs, we reached a point where we had to upgrade our lab licensure. Now, in addition to our other services, we can provide these important tests while clients wait. 

  • Rapid syphilis testing. When clients have rashes that may look like syphilis, we can now do a rapid syphilis test (BD Macro-Vue) in-house to confirm if it’s really syphilis. Getting a negative result can spare you the famously uncomfortable penicillin shots. If you get a positive result, well, then you know you are getting the famously uncomfortable penicillin shots for a good reason.

  • Bacterial vaginosis and trichonomiasis testing. We added tests with the intention of improving our health services for trans and gender non-binary individuals. The clinic has rapid tests for bacterial vaginosis (BV) and trichonomiasis (trich), common causes of vaginal discharge, and a microscope to assess the discharge. We can treat all the common causes of vaginitis and we provide Plan B (morning after pregnancy pill), if it’s needed.

  • HIV confirmatory testing. Rapid HIV tests generally do a good job but they aren’t always perfect, and can sometimes have false positives, so a test to confirm the result is needed. When clients get a positive HIV screening test, we used to send the sample to an offsite lab for additional confirmatory testing and wait three to five days for the results. As you can imagine, it can be a challenging wait.

We wanted to do a better job of handling positive screening tests so we added a rapid confirmatory test that can be done in 30 minutes. While this doesn’t replace the full confirmatory tests, it does give us a better idea if the initial test result was a false positive and helps us better support our clients. This also allows us to more effectively link newly diagnosed individuals to our health navigation services.

This new lab license allows us to keep exploring additional lab tests as they become available to provide better care to the community.

More anal health services, including treatment for anal fissures and genital warts

Anal fissures are tears that may happen in the skin lining the anus. Many people who bottom get anal fissures, but may not seek help out of embarrassment or because they accept it as something that just happens if you have anal sex. I hope we can change these misconceptions and talk more about our butts! We now ask clients about pain or tearing, and can prescribe treatment if people do experience anal fissures.

Genital wart treatment was a service that the community asked for and certainly deserved. We now have liquid nitrogen in the clinic to freeze off warts. Some clients will still need a referral to a proctologist for internal anal warts, but we can get treatment for genital warts started in the clinic now.

Hepatitis C testing & treatment

Of everything we’ve done this year, I’m most proud of our expanded hepatitis C testing and treatment services. If you have a risk for hepatitis C, you can now ask to be tested at any of our locations including our Mobile Testing Unit. If you test positive, we will help you get into care so you can get treatment and get cured.

There is an easy cure for hepatitis C, but many people who have hepatitis C don’t know they can be cured. Getting into hepatitis C care isn’t easy for everyone as clients often face challenges accessing services or they are not comfortable disclosing substance use to their providers. To address some of these issues, we developed a hepatitis C treatment program to deliver care where clients are most comfortable at Magnet, 1035 Market, and our 6th St Harm Reduction Center.

At our 6th Street Harm Reduction Center, we provide the medical care and extensive case management to successfully cure hepatitis C for clients who use substances or face challenges that prevent them from accessing care in the traditional settings. Providing hepatitis C treatment at the Harm Reduction Center is an important part of the city’s End Hep C initiative since we are reaching clients who would otherwise never get treatment. And we do it fast because our hepatitis C navigation program is so experienced at engaging and readying individuals for treatment!

We are taking the lessons we’ve learned in HIV and bringing them to the hepatitis C world. Clients often wait months or years to get treated for hepatitis C but we’ve been able to start people on hepatitis C treatment soon after they’re diagnosed—the same as we do for people living with HIV. It not only improves people’s health, but it helps prevent further infections. We even installed lockers at the 6th Street Harm Reduction Center and at Magnet where marginally-housed clients can store their medications in a secure place. It’s a simple service that makes hepatitis C cures attainable for more people.

Rapid HIV treatment

Although San Francisco has a city-wide rapid HIV treatment program, where people start on HIV treatment as soon as they’re diagnosed, there are just a few situations when people “slip through the cracks,” and are stuck without medication for one reason or another.

In the next year, we’re starting a rapid HIV treatment program to help take care of people who aren’t able to access HIV medications as soon as they’re diagnosed with HIV. Getting people on treatment when they are diagnosed leads to better health outcomes for the client and prevents passing the infection on to your partners. This is one of the goals of San Francisco’s Getting to Zero initiative that we are excited to support.

 

We did a lot last year and plan to keep doing so much more next year! I’m coming up on my fourth year at Magnet and I’m continuously humbled by the community support for the work we do. None of this could happen without the amazing staff and volunteers or the community who trusts us to take care of them. I want to thank everyone who makes all the innovative care we provide possible, and I can’t wait to share what we have planned for 2018.

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Pierre-Cédric Crouch, PhD, ANP-BC is the nursing director at San Francisco AIDS Foundation. In 2017, Pierre was awarded the ANAC Excellence in HIV Prevention Award by the Association of Nurses in AIDS Care (ANAC) for his significant and outstanding contributions to the prevention of the spread of HIV infection. The PrEP Health Program that Pierre developed and implemented at Magnet is the world’s largest nurse-led PrEP Health Program.

Stop in for a visit! There are a variety of ways to access sexual health services at San Francisco AIDS Foundation. Find out more about the PrEP Health Program, free HIV testing services, and more.

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