By Jen Hecht, MPH
In January 2016, San Francisco AIDS Foundation opened a new health and wellness center in the Castro, called Strut. By co-locating, integrating, and expanding a variety of complementary programs and services—including sexual health services, substance health counseling, health navigation, and community engagement programs—the site expanded our capacity and strengthened the quality of care we provide to our community.
Now, we have quantitative and qualitative data demonstrating the positive impact of the service expansion at Strut on our community. A recently published evaluation report, by Learning for Action, describes changes in health behaviors and health outcomes over the first year of operations at Strut, comparing to data collected from the same programs before the opening of Strut.
Evaluation is essential to all aspects of our work. When we invest in a new model, we want to see if it’s working how we intended and use the data to improve as we go. The data inform programmatic activities so that we can use our resources as wisely as possible.
Here’s what we learned from the evaluation.
We’re serving more people of color
Over year one, the percentage of clients of color has increased. In a representative sample of clients, a quarter (25%) identified as Latino in 2017 (16% identified as Latino in 2015). The proportion of Asian clients and African American clients also increased.
We’re helping people test more regularly for HIV and STIs
Among people who have been accessing services for at least three months, 94% reported testing for HIV and STIs in the previous six months in 2017 (78% reported testing in the past six months in 2015).
There are a few reasons why we have seen an increase in testing. First, people in our PrEP program (which began at the end of 2014 and has expanded rapidly) test for HIV and STIs once every three months, so the increase is driven partly by this. But we also saw this increase among non-PrEP users, meaning the clinic’s extra capacity is also allowing the people who need and want to access testing services to easily get them. Second, we’re probably seeing more people access testing services because the rates of STIs (particularly gonorrhea, chlamydia and early syphilis) are increasing in San Francisco, especially among men who have sex with men.
Medical care & viral suppression rates are high
People living with HIV accessing services at Strut are also more likely to be receiving regular medical care now than in 2015. Nearly all (99%) of people reported having a medical visit in the past six months in 2017, compared to 88% in 2015.
Being virally suppressed is the goal of HIV treatment: In addition to improving health, viral suppression means that the person living with HIV will not transmit HIV to others. The percentage of clients who are living with HIV who are virally suppressed has increased significantly. In 2017, 97% of HIV-positive clients (who had been a part of services for 3 months or more) surveyed report being virally suppressed. This represents an increase from 2015, when 82% of HIV-positive clients receiving at least 3 months of services were virally suppressed.
Positive Force, a San Francisco AIDS Foundation program that offers services at Strut, provides educational, social support and social events for people living with HIV. The program also offers health navigation counseling services to support people in accessing HIV care and treatment, which likely has contributed to the better health outcomes of our clients living with HIV.
PrEP uptake is high
Pre-exposure prophylaxis (PrEP) is an HIV risk reduction strategy that includes taking daily HIV medications to prevent infection. PrEP use is high among HIV-negative clients at Strut: 38% report taking PrEP. A total of 1,112 people were enrolled in the PrEP Health Program between March 2016 and February 2017, the time period evaluated for this report.
Better referrals and warm hand-offs
One of the benefits to co-locating services has been the increased potential for collaboration between staff managing different programs, the potential for more “warm hand-offs,” and the reduction of “missed opportunities.” At Strut, it’s possible for staff to directly connect clients interested in a specific service to the staff in charge of that service. For instance, a person accessing substance use or behavioral health counseling has an opportunity to get on PrEP, or might inquire about a social support group for HIV-positive people. A person enrolling in PrEP as a result of binge drinking might also have a chance to speak with our harm reduction staff.
During the evaluation, one member of our staff said, “Before, we would tell people informally about other programs, but there weren’t warm hand-offs. Now there are more intimate connections between staff, so they are more invested in each other and each other’s program and making referrals.”
I am proud of how we are working more closely as a team to provide the highest quality of care, the most innovative services, and meeting as many needs as we are able. I am also proud that we are using data to improve and inform our services.
Here’s an example of how we solved something our community had become accustomed to seeing: a line of folks in front of the building waiting to get in and get tested. In our focus groups, clients noted that some felt uncomfortable standing in that line, sometimes for over an hour, while commuters waited for the bus. When I shared this finding at a team meeting, our staff immediately devised a “deli counter” number system that enables people to hold their place in line while waiting for the building to open. It was set up within a week of hearing the feedback. Now that’s putting the data to work.
Find more information about services available at Strut including upcoming events, health services and other health resources.
Jen Hecht, MPH is the senior director of program strategy and evaluation at San Francisco AIDS Foundation.
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