adopted. go onto the next item. >> item number seven, it's the overview of process for the d.p.a.'s director of health. >> thank you. commissioners, as you know, two weeks ago we were surprised and saddened by the resignation of our director, barbara garcia. as you know, barbara has served as director over seven years and previously spent several decades here in the department first at tom wooddell and rising to director. during her time as director she oversaw the completion of the san francisco general hospital and the completion of the san francisco health net work along with really driving the integration of the medical and mental health services together, and then, helping to create the ability for us to move into epic and assisting with the funding from the mayor's office and the supervisors to allow us to be

able to actually acquire epic. along with that, she also advocated and pushed for the accreditation of the public health department, which we achieved several years ago. we know her as a champion for the health care of all san franciscans, rich and poor and in particular for our most vulnerable populations, and our city has been well served by barbara's service which was benefited so many, and which we are all grateful. our task today is to select for the mayor three candidates as a new leader to maintain the position of this department as a cutting edge and one of the best county departments in the united states. our goals and the goal of our mayor our aligned as address homelessness, mental health, substance abuse, and continue our efforts to get to zero in

h.i.v. infections, traffic deaths, along with other very important health initiatives. our may i don't remembor has h confidence in our department by naming our chief financial officer as the acting director of health. and as -- and as we carry out our charter duties to help select repetitives to the mayor, we met with the mayor promptly after the resignation with a plan to help fill this very important position. it was clear from our meeting with the mayor that even the progress that we have made towards finding a new director are also in alignment. the charter calls for the

commission to submit up to three names to the mayor for her consideration and selection; and she can accept any or none of them, and then, we would start again. we are believing that we actually will be able to help service the candidates for this very important office within a time frame which is somewhat aggressive, as miss calhlahan has told us, but very important for us to continue to move along because of all the important things, even some of which you heard this afternoon are in progress. this department cannot suddenly stop and wait until we are able to find a suitable candidate, and i know that all of our executive staff has been working very hard in order to

maintain our momentum. as the mayor herself as noted, this is an enormously important department for this city for which we must find the best talent possible. miss callahan's department has assisted several other commissions including the police commission, the park and rec commission, and the library commission, which i understand is continuing right now. and your officers have been working hard with mr. wagner and our staff here to come and recommend to you a proposed schedule in which we would then try to identify and have three candidates for our mayor to consider within the next several months. that schedule is before you, and miss callahan has kindly come to help explain the

process that her department will be assisting us with, commissioners. so miss callahan, thank you for coming and proceed. >> you're very welcome. thank you very much, president chow, vice president loyce, acting director wagner. mickey callahan, acting resources director. as commissioner chow indicated, our department has been working with a number of departments for the last ten years or so such as yours to find top candidates for the positions. we have meet with the mayor and your officers to find out how to proceed, and we have come up with basically a framework. you will see before you kind of a graphic chart that talks about the steps, and what i'd like to do is kind of walk-through that a little bit and provide a little bit more detail if that's acceptable. >> yes, please. >> first of all, recruitment

proposal, we are -- we haven't finished it because we need to get the high sign from this commission that we're going in the right direction. but we have definitely an outline of dates which cull minu -- culminate as early as december december would go to the mayor or potential sending us back to the drawing board, but if we do a good job, and i'm sure that we can, we would be able to identify top candidates, and the mayor will have the difficulty of choosing from a number of excellent candidates. so we will be -- the proposal before you will involve having a public meeting where the public would be invited to

provide input. if it was overflow, the commission could decide it needed to do more, but it would be at least one meeting to hear from the constituents, and the information that comes from that meeting in terms of desired profile and desired characteristics would come in the form of a job announcement which we would present to the commission for approval hopefully by the end of september. it is our plan to use a contractor that we think highly of that specializes in health recruitment called berkeley search consultants to help us do part of the work which would be basically publicizing the announcement, sourcing the announcement, and collecting the applications. for a position of this high level, we always want to have a high level of confidentiality. we don't want curious h.r. analysts or anybody else to be looking through to see who has applied, so we would keep the applications outside of the city's regular h.r. system, and

that's one reason we like to use an outside recruiter. obviously, candidates, we don't want to discourage can't dads from applying if they can't have confidence that the fact that they're applying would be kept confidential potentially until they find out they're potentially a finalist. we -- it would be our -- then, what we do internally here in d.h.r. when the commission -- when we find sufficient number of qualified candidates, we would rank them--good, better, best, is what we like to say. the commission can see all of them, but we certainly would want to show you which ones from what we think are the top candidates, but then, the commission would decide whom you wish to interview. you can interview some of them, probably a side group who meets the minimum qualifications.

when you conclude that process, you would let us know. normally we would have those outside the department of public health for confidentiality reasons, and we would facilitate that process through my office. after the commission then determines which candidates it would like to forward to the mayor, then, you will do so and advise commissioners, please,

callahan is here to explain part of this, but our proposal is that on september 18, we will hold a public meeting, i

think, with -- to ascertain that -- it would be at 2:00 here in the chambers, and it'll be dedicated to receiving public comments in regards to anything the public would like to let us know in terms of the jobs that we are now going to be filling. in the meantime, i've worked with mr. wagner, and we also will be able to receive public comment by written e-mail through, what is it, healthcommission.com? >> it is healthcommissiondph@sfdph.org. it's a lot of d.p.h.'s, but we'll send that information out for anybody who does not wish to come in person. >> so i would ask that the commissioners also receive a copy of that exact address

because a number of commissioners have been receiving inquiries. so that comment on the part of the public can be made on september 18 or even prior to that, they can begin once we also post this, and then, allow our commissioners also to be able to distribute that to those that wish to. yeah. following the 18th, just to reiterate, we would then complete -- we'll have been in the process, working with staff and the officers to develop a draft job description. the input of the public from the 18th, and also any e-mails would then be incorporated, and on our meeting of october 2, we would then accept the -- or modify and -- and then accept the job description, which would be that, which would then

be used in the application. at the same time as miss callahan noted, we'd also be looking at a series of key questions that should be also an alert to candidates as to what we were looking for. for example, if somebody really felt strongly that they did not believe in safe injection sites, this may not be a good match for the city's agenda. so there would be a series of those that would be worked out with the director and with the officers for you, and with your input in terms of areas you thought that would be kind of key that we could ask. so you should provide that to mr. chang during this period of time so that we can always simulate that. the hoping that on october 2 after we have agreed to the job

description, then, the applications would be processed, right, by -- they'll be available -- not here at the department, again, for that confidentiality that we were talking about, but over at the city's department and in miss callahan's office, and she's been kind enough to see that all of her staff is able to do this for us. >> if i can add, also, one piece that we're going to need to do, we don't just say fill out a job application. we want obviously an interest letter, and i think we want to ask some questions. when we put the job description out, we want to say here's an additional questionnaire. what is your opinions on the safe injection site. tell us your experience working in the public arena, tell us your experience working with

the homeless. we would like to you to provide us with what some of those screening questions are, too, and that would allow us to evaluate the applications. >> commissioners, mr. chang is going to remind you of that because we believe we should try to move expeditiously, so please get those in this month because next month, we begin to work them into our application package, right. then, again, just to reiterate as we get the screening and find these groupings of candidates, at some point within perhaps the month of november or very early december, we would then make a decision as to who might be the candidates for interviews.

this is somewhat dependent upon how the pool goes and the availability of candidates at this period of time. our goal is the first part of the year or hopefully the first part of the year, to bring the mayor a proposal. may jar very much wants to find the best candidates, and while she is anxious to have a leader that she can work with toward a number of th veuu@ss@?rr= the best candidates, and while she is anxious to have a leader that she can work with toward a number of t veuu@ss@?rr=q the best candidates, and while she is anxious to have a leader that she can work with toward a number of t veru@ss@?rr=q the best candidates, and while she is anxious to have a leader that she can work with toward a number of tveru@ss@?rrqqúe best candidates, and while she is anxious to have a leader that she can work with toward a number of to veru@ss@?rrq the best candidates, and while she is anxious to have a leader that she can work with toward a number of tr very much wants t the best candidates, and while

she is anxious to have a leader that she can work with toward a number of the -- with -- with the candidates, and it's important time to find the very best candidates for our city. >> thank you, mickey for taking the time to describe this to us. i am a bit concerned about the timeline. this seems a relatively short time frame, particularly if we are going -- if we're considering a national search, as well, to give folks time to -- one, to give us time to sort of develop the criteria, agree on that criteria, provide you with the input, along with the public input so that you can develop an appropriate job description, and then, the duty outreach and especially if you're going to -- it's not going to be as simple as fill out the job application. and then, considering that we will be in the middle of holiday season, i'm just wondering whether you have that high degree of confidence that we're going to be able to complete this as -- as hoped. >> thank you for the question.

as dr. chow alluded, i felt this was an ambitious timeline. what we'll have to do is see how we do. for example, when we bring you the job announcements, is it going to be ready in time after the public input? i hope so, but we're going to ask for your flexibility in terms of calendaring things for approval. one thing is how long should the application period be? if you're being very aggressive, you might assume -- people at a certain level are going to know about this job and be interested in it. they're not going to need to take two months to decide to apply. that's the optimistic view. it's also my experience is that whenever the deadline is, pima ply the day before or that afternoon at almost every level, so i don't know -- i think what we will be doing is communicating with the commission and letting you know

whether we feel there is a rich pool of qualified candidates or whether we host them longer or do more looking. so that would be a circumstance which we recommend pushing the date out. to your comment about the holidays, i agree it's very difficult to have people come to their views in december. what i anticipate is setting up, the interviews will be done by this week. if we can't get it done by the early part of december, then, we would recommend waiting until january because of the very difficult holiday travel, air fare and everything else becomes very difficult. i would ask the commission to maintain some flexibility given that it is a fairly optimistic timeline. >> thank you.

yes, we -- we are concerned, but we thought, and i believe the mayor also thought we need to move forward, and she would understand if we needed to take a little more time. so we appreciate, also, your important notice to us that it may take longer, and we're aware of that. >> particularly as if you say or as we all know and want to be able to have the best pool of candidate that's we possibly can for this type of job. and the uniqueness of this department, i don't imagine there are too many other departments across the country that reflect the breadth and the depth and the innovation that is characteristic of this job. >> i would say we can't assume we're going to find a candidate

who already does everything this department does and has done it. i think you're going to be faced with priorities and varying ways that people become qualified for the position, and which of those you think are the ones that are going to tip the scales for you. >> commissioners, further comments on the process that your officers have put before you? if not, then, we will then proceed with this process, certainly, as i say, and as commissioner guillermo as pointed out, we are going to be mindful of the need to have the right pool of candidates, and we'll bring that information back as we see it and also keep the mayor updated in terms of our progress. so we believe that that will fulfill our obligation. any further questions to miss callahan? we thank you very much for

assisting us with the search. we're looking forward to working with you, i guess, over the next several months very closely. >> let me also introduce kate howard, our managing deputy director who's here today with me. she'll personally be overseeing the process. you may know kate from her time any time mayor's office. >> okay. kate, thank you very much. >> thank you. >> thank you. we'll now move onto our next item, please. >> all right. item eight is for discussion. it's an update on h.i.v. and s.t.d. data. >> okay. please, thank you.

>> thank you, commissioners. i am here to give an update on h.i.v. and s.t.d.'s with my co-workers. i'm going to -- [inaudible] >> -- and nicole trainer who is getting to zero prep coordinator, and then finally, dr. susan phillips who will be giving the update on the s.t.d.s. so what we're going to do is -- one thing we're going to do is pause between sections because they're really long. so any time you have questions, please ask. we're going to give some updates from the recently

updated h.i.v. report. we're going to talk about getting to zero including progress, and talk about the new you equals you campaign. [inaudible] >> we'll talk about programs from getting to zero and from department of public health that address the challenges of housing, mental health, substance abuse, and then, finally ending on the s.t.d. page. so this first slide shows trends and new diagnosis steps improvements for the number of people live with h.i.v. in san francisco. in 2006 to 2014. so the first thing to note is that 94% of the people living with h.i.v. in san francisco are aware of their infections. that compares to about 86% nationally, and that really reflects efforts in san

francisco to have frequent testing and targeted testing of people who are at risk for h.i.v. next thing to note is this blue line that shows declining new diagnosises over time. you can see it's a pretty steep decline. we're at 229 new diagnoses, which is the lowest number ever in san francisco, just as it was last year. the number of new cases continue to decline, but you can notice here the decline here was 5%. the previous two years it was more like 14%. i'm going to show in a minute some particular data on population groups that aren't benefiting from on the decline. [inaudible] >> you can see that deaths over time has been pretty level.

we're at 244 deaths. also, it's interesting to note that in the last two years, the number of deaths has been higher -- just slightly higher than the number of new diagnoses. the survivalal rate with h.i.v. is improving -- survival rate with h.i.v. is improving. we have an ageing population, which 65% of people living with h.i.v. are over the page of 50 and 28% are over the age of -- [inaudible] >> late diagnoses have also declined and late diagnoses is defined as somebody who develops aids within three months of their initial h.i.v. diagnosis, so they're getting tested late. that's declined from 22% in 2012 to 11% in 2014. again, compare that with

national data, 21% nationally. another good piece of news in san francisco is we have not had a perinatal case in the - [inaudible] >> nationally there was he about 15,000 pediatric cases diagnosed in the united states. this slide shows the continuum of h.i.v. care or the care cascade from newly diagnosed people from 2012 to 2016. that's where we look at people who are newly diagnosed and then we follow them over time to see how well they do getting linked to care and getting suppressed. so the first set of bars shows the diagnosis, and the second shows the proportion of those diagnosis who are linked to care. the second set -- or the third

set show people who are retaining care, and that is having another care after that initial linkage care, and then, the next is vital suppression after 12 months. in the earlier years of -- the earlier years, linkage to care was about 72, 73%. it's up to 83%. retention has improved up to 71%. and vital suppression is now much improved. now 85% newly diagnosed with h.i.v. are violation suppressed within a year. in addition to those proportions increasing, the time to each of those care indicators are getting faster. so this shows the care indicators from 2013 to 2016, and it shows medium days. so days from diagnosis to care

decreased from eight to five days. time from care to treatment went from 27 days or about one month to a median of zero days, so that same day, a treatment starts, which is the goal of our rapid programs. treatment to vital suppression decreased from 71 days to 39 days, and time from diagnosis to vial suppression, ultimately what we're trying to get to has been cut in half from 145 days to 66 days or about two months. this slide shows under lying causes of death among people with h.i.v. for three time periods, so across each of the time periods, h.i.v. related causes of death have been decreasing. so in the most recent time period, about 38% of deaths were related to h.i.v., and that compares to 52% in earlier

years. and so as we have few you are h.i.v. related deaths, and we have an ageing populations, deaths that are associated with age related causes, such as cancer or heart disease, are increasing, and that is exactly what we're seeing, so nonaids-related cancer are the second leading cause of death in all three time periods, and heart disease in those most recent time period is the third leading cause of death. we're going to show some data from a supplemental surveillance that we did related to premature death in san francisco. so while the overall numbers are declining, if you look at new cases by race, you can see decline among whites was the most pronounced. whites also have a decline in

number of new diagnose cases, but the other races have been low and steady with no decline -- no significant declines in recent years. and so what i wanted to do is point out six populations where we're not seeing a decline in new diagnosis in recent years. so from 2005 to 2017, if you look at this time period, all six of these population groups had somewhere between 20 and 40 new diagnosis, and they've been pretty level during that time. so african americans, the first group here in purple, after a period of decline, they're now between these three years, somewhere between 35 and 40 new diagnoses a year, so there's kind of a flat. for asians, again, a decline, and then have levelled off in these recent years, between 30 and 35. women never had that decrease

in the number of new diagnoses, and again, they're flat in this time period at about 25 new diagnoses a year. same sort of pattern with people who inject drugs, no decrease over time, and we might even be seeing a slight increase, up to about 25 new diagnosis in 2017. and then, for m.s.m., who also have a history of injecting drugs, they have levelled off and maybe slightly increasing in these recent years, and the homeless, too, after a period of decline, are level. so these are the populations that, going forward, we will be working on so that they can experience the same decline, and we can get that overall decline and new diagnosis on the path that these have been in the past. another way to look at

disparities and diagnosis is to look at rate. so a rate takes into account the number of new diagnosis but also the population size. and this slide shows rates among men. so while whites had the highest number, african american men have the highest rate per-100,000 of new diagnosis at 116, followed by latinos at 68 per-100,000, and white men at 39 per-100,000. the rates are declining among latinos and white men and are fluctuating with high among african american men. when you look at rates for women, the first thing to notice is the scale are different, so the rates are much lower for women than they are for men, but the same kind of pattern. the rates for diagnosis are highest among african american

women which is 43 at 100,000, which is just slightly higher than the rate for white men. we also see the disparities survival on the red line. 86%, which means somebody that's diagnosed with aids, that 86% of people diagnosed with aids will live for five years or more, but not all groups are experiencing that same high level of survival. the african americans are lower, al 80. people who inject drugs and m.s.m. injectors are lower, and women have a poor survivalal rate at 81%. you see disparities in vital suppression. this slide shows vital suppression among everybody living with aids in the city, so overall 74% of people living

with aids are vitally suppressed, but the populations that fall below that red line have lower vital suppression rates. so women and transwomen are 67%. people in all age groups under the age of 50 are less likely to be virally suppressed, and people who inject drugs and m.s.m. injectors are 67%, and the homeless has a very low rate of viral suppression at 32%. so given that we're not seeing declines in the number of new diagnosis among homeless people and whether they have poor care and prevention out comes, i wanted to compare the characteristics of homeless people who are diagnosed compared to everybody else who is diagnosed with h.i.v. in san francisco. so if you compare homeless to the other cases, homeless cases are more likely to be women,

transwomen, african americans, people who inject drugs, including m.s.m. injectors, and while there's no significant differences in age between these two groups, i do think it's interesting to note that about 34% of the homeless cases are diagnosed with h.i.v. before the age of 30, so they're being diagnosed very young. and this is my final slide. so this shows time from h.i.v. diagnosis to viral suppression between the homeless population and the half. so the time to viral suppression is shown in red. what you can see for each year from 2013 to 2016, it takes longer for somebody who is homeless to reach viral suppression. but as we go over time, the

time for both groups is getting shorter. by 2016, the time for both groups has been cut in half, and the difference for the two groups is getting closer. there's not that big of a gap. so i can pause here now before i turn it over for the next part and take questions, if you'd like. >> are there any questions at this point? okay. do we have public comment, by the way? >> no. >> okay. so shall we go onto the presentation of your next section? >> okay. thank you. >> thank you. >> thank you. >> thank you, commissioners. so i'm going to be talking about the getting to zero effort with any colleagues, tracey packer, who's also on the steering committee, and nicole trainer, who is the getting to zero coordinator. i'm susan bucklinder, and i'm

also on the steering committee. so just by way of introduction, just to remind you, getting to zero is this multisector consortium, where you get multiple sections of society together all aligned working on a common solution. we have this getting to zero effort that we launched at the end of 2013 that includes members berz of the health department, ucsf, kaiser, lots of community based organizations, activists, industry, all to come together to work towards getting to zero. what we did was begin to launch these four different initiatives. you can see the four pillars. prep, which was to expand our

capacity to deliver preexposure prophylaxis, which prevents almost all h.i. vichlt infections if it's taken on a daily basis. rapid, which is trying to get people same day diagnosis onto treatment, which is important for their own health, but it's been shown to actually improve the health of the individual themselves as well as to reduce the risk of transmission to sex partners. reengagement and retention in care, to try to make sure that people who are in care stay in care and people who are not in care get reengaged and treated and also virally suppressed, and to reduce stigma and discrimination. now none of this would be possible without this decades long basis of support, which are these community based organizations which you as the commission have supported and

the health department has supported as well as some of our federal funders by providing a brought spectrum of prevention programs and treatment programs. we've done a lot of different work in these committees, and there are just a couple of notes here. for instance, in the prep program, we've got a number of community programs. you're going to hear about some of these later on, navigators who help people to both utilize existing benefits programs and their insurance to get access to preexposure prophylaxis pill. and also, an innovative pharmacy delivered prep program. you've seen the progress that's made with rapid. some of this's the result of this getting to zero program

that we launched that had providers, clinicians go out to other provider's offices and train them on how to provide same day treatment. there's a protocol on our website where asked for repeatedly. it's been distributed around the world. the c.d.c. has also asked for that, to distribute it nationally. in our reengagement and retention in care, there's been great support for a number of community based programs, including intensive case management, a jobs program, providing food support for people who are food insecure. and ward 86, our signature program at zuckerberg san francisco general hospital has a number of programs, including one that particularly serves our ageing population. and then we're working to introduce stigma through trauma

involved care. so now i'm going to briefly go through a cup of data points to indicate where -- couple of data points that indicate where we've been taking the program. so by 2014 in san francisco, we had over 4,000 people on prep. up through 2017, we believed that number had increased four to five fold in terms of the number of people on prep and that's again an outgrowth of the work of the prep committee that's increased the capacity of providers to provide prep as well as to get the word out to individuals who might benefit from using prep. and you'll hear again some more about some innovative prep programs in just a few moments. but we do -- are concerned, again, about issues of disparities. and in particular, we looked at data from our significant prep program here in the city

through our s.t.d. program, through city clinic, which provides probably the most diverse array of preparation provision in the city, and you can see that when you separate it out by african american, latino, white, and asian, and you go from left to right in each cluster, from 2014 to 2017, we've increased everyone who might be elibility for prep, but if you look at the increase just in the prior year, we're not doing as well in the african american group, which is lagging behind, so again you'll hear about some innovative programs to improve uptake in that population. there were data presented this summer that were very exciting that supported a letter that the c.d.c. issued last week about you equals you, and you equals you equals undetectible means untransmittable, and that

means that people who are on h.i.v. treatment for a period of six months and fully virally suppressed cannot transmit h.i.v. to their sexual partners. there's data now on 150,000 sex acts and no transmissions have occurred in all of those episodes, so this is very important to get the word out to individuals, and it's a very important antii go in aum campaign so that people living with h.i.v. recognize that they are not infectious. unfortunately, h.i.v. in many parts of the country are criminalized, and we need to reverse some of these criminalization laws. i'm going to end talking a little bit about homelessness. as dr. sheer presented, 14% of

our diagnoses are homeless. you've seen also that the word viral suppression rates are in people who are homeless, and homelessness is also a substantial contributor to death among people living with h. h.i.v., so i'm going to show you two pieces of data. this is from an innovative analysis done of patients being seen at ward 86, in which if you go from left to right on your screen, from most stably housed, renting and owning, to being in a rehabilitation program, being in an s.r.o., hotel, couch surfing or staying with friends, shelters, and living in the streets or being outdoors, the proportion, the bars show the proportion of people who are virally suppressed. you can see as you become more marginally progressively housed, your viral suppression

goes down, and the average viral load, that red line, goes up. we know that having a higher viral load is bad for the individual in terms of their health and bad for the risk of transmitting to others, so we know that homelessness is a major driver of new transmissions, and that we need to get to zero, to get to zero h.i.v. infections and zero h.i.v. associates deaths, we need to reach our homeless populations. this is an evaluation done under dr. shear's leadership in which we look the at 50 individuals who had recently died in the last couple of years who had been living with h.i. vichlt in section to see what portion of their had substance abuse, or homeslessness. you can see that 60% who died in this subgroup, 60% had substance abuse as a contributing factor, 34% had

mental illness, 30% had homelessness, and 68% or over two thirds, had one or more of these contributory causes. so it speaks to what we need to do in getting zto zero, and i' going to turn it over to traeyy packer about more of the initiatives that we have. >> good afternoon, commissioners. i'd like to speak to you on two areas that we're working onto address the disparities that the doctors described today. you know, and san francisco is doing an amazing job, and we've really seen such change in these years, but there are really important populations that we're not reaching, so that's been our focus. that's what we've been really talking about now, is how can we reach the group communities that we haven't been able to

reach successfully. so we applied for a grant, the c.d.c. grant. it was competitive. it went along with our core grant that we've gotten in san francisco since 1991, and this was a competitive grant that was awarded to san francisco. we were one of two jurisdictions across the country that received $2 million each year for four years. and what we applied for specifically was to reach people who are homeless or otherwise disconnected from the systems that we have here in san francisco. you'll see that the -- we've named it project opt in because we always need cute names for everything, and it's better than calling it component b-e which -- b, which is actually what we often call it. we just got started in july, but we're rolling. but what we'll be doing is outreaching and engaging people who are homeless. i want to stop and talk about

we are engaging people who are homeless, and we know that addressing homelessness is a really important part of this, so we have strong partnerships for those who are in the best city departments. so outreach and engaging people who are homeless, and this is a grant that's addressing h.i.v. and hepatitis c. we've found that people being offered hepatitis c testing and treatment is actually motivating to maintain their hiv treatment. so it's including treatment of hiv, help tpatitis c and stds, figuring out how to reach those in greatest need for prep and treatment, and you've heard the data that's not spirinspired t. and then, thinking about how we can change the system that we

have to make it more accessible, so it's coming from two angles. one is outreaching with people and then making a change in the system. we already have some experience -- i think you've heard about our heath fairs " we've been doing in homeless encampments, and you'll see some of this in the report, the way that we've been able to start some of them on prep and provide health care. so we'll be addressing substance use issues, mental health, in addition to homelessness, and we're working -- show you this slide. this just demonstrates the interventions within interventions. i think what's really important is we're working already with whole person care. also, behavioral health, and their work, and the san francisco health net work to look at how we can shift the

system -- you know, build on the strong system that we already have to reach this population. so that's project opt in. and then, the second thing i wanted to talk with you about is the road map. this was actually inspired by director garcia. in 2018, we received our grant from c.d.c. we received a significant decrease in funds, and while the -- your support and the city's support and the board's support has been incredible to backfill those dollars, we know that that will not always be the case, and that there will be a time when we see significant decrease in funds,

and so director garcia commissioned us to figure out what we're going to do when that happens. so we came together, and we developed a plan for how to address three diseases really coming from a people-centered point of view and not a disease-centered point of view. the idea is not just to get to zero but to stay at zero, and that's not free. that does cost funds. the key thing what this slide is telling you is it's very much a community input process. so we developed ideas and thoughts, and then, we went out to the community, and we had six or eight meetings with different community groups -- actually, it's probably up to ten now with our h.i. vichlt community planning council, and uses something called scenario planning and got input on what needs to happen out there in the community to address the dais parities that you heard

today. -- disparities that you heard today. we're work og that, but left lane be in the r.f.p. that we're going to put out for community based services in the very near future, and that will address the disparities that you heard about today. so that's it for me. and now i'd like to introduce nicole trainer. she's a little bit new with us in the health department. she started with the pride department and she's now the director of community based services for getting to zero and she's going to go into depth on the program that's have been developed to provide prep to the communities, and she's been an amazing champion with these programs. >> good evening commissioners, how are you. as tracey mentioned, i'm nicole trainer. i've been working with city clinic for about ten years, but i've had the pleasure working

with dr. susan phillips and tracey over the past two years. so for the next few slides i'm just giving you a brief overview of our san francisco prep funded programs which provides prep provision and also prep referral programs. as dr. bucklinder mentioned, the prep services that are directly funded to our c.b.o.s are one of the pillars that are influential to getting us to zero. so to increase our access around san francisco, we have collaborated with multiple community based organizations nard to our primary -- d.p.h. primary care clinics, city clinic, and also some of our private partners such as kaiser to expand our prep services here. we've learned that working in our individual silos, we just can't get to getting to zero,

so it truly takes a village and all of us working as a partnership to ensure that everyone has access, specifically for communities of color, we find that when we work in our silos, communities of color tend to fall through the cracks. our current data shows that individuals who are interested in accessing prep, they will seek services at at least three of our community organizations or our d.p.h. care clinics, whether that be for health education, or a direct bridge to prep services at three of the agencies that are listed there before they actually decide to get on prep, so our data shows that one client may go to lyric first, to see what

services are about. then they may go to sf aids foundation, and then, their final stop may be the aids clinic to where the prescription is written. so it's important that all of our organizations are working together so that individuals don't fall through the cracks as they're trying to access services. one of the highlights that i'd like to mention is our new partner which is a pharmacy delivered prep program, ad -- mission wellness pharmacy. so in collaboration with mission wellness pharmacy staff and director and owner maria lopez, san francisco was one of the first cities to implement a pharmacy deliver prep program. this was modelled after a program in seattle, washington. this program, mission wellness pharmacy is located in the heart of the mission district in san francisco with a

capacity to provide same day prep provision at little or no cost. mission wellness pharmacy also provides a full panel s.t.d. testing, h.i.v. and hep-c testing for clients absolutely free. so this is unique in that you don't need to go to a clinic or see a provider to access services. you can go to this pharmacy. this is a community based pharmacy and they are well connected to the community. so far, mission pharmacy laurchled lunched in 2018. seven of the patients are within the priority population, three are african american cis men. one is an african american cis woman, and one is a white cis man. and although 12 may seem very, very low, for this unique

location and the fact that maria and her staff are reaching what we deem as hard to reach, or folks who perceive themselves as low risk, this is really a significant number here, and it's continuing to grow. so in addition to our other existing new pharmacy prifr prep program, i'm pleased to announce of we've launched our second iteration program. this launched in february of 2018. i'm hoping that many of you have seen this campaign around the city where you live or digitally. we have this posted on social media platforms, and we also have some commercial spots as well in private tv shows which reached a lot of our folks in our priority population. this particular prep supports campaign focuses on the african

american community. so after careful analysis of our successes, our challenges, and some of our lessons learned from our last campaign, we realized that over sexualized images of people of color portray a negative narrative of the message we are trying to convey. so thus, during our second iteration, we hired some experts to help lead our efforts. so prior to the creative design process, we used the ethnography method to gain insights. they conducted local and digital ethnography, along with indepth interviews with the community and stakeholders and they also did community observations. so prep supports has a strong community voice along with

strong positive images of people of color, as you can see. the photo in the upper, i think left to you, it's prep support to the powerful. this is terrence wilder. he is a community activist and currently works at the san francisco aids foundation. that's one of our most popular images that really resonated with the young men in the bayview-hunters point area. in addition to the mission wellness start-up, we've launched -- it's not in this power pet yet only 'cause we're just getting it underway, as sunnydale, san francisco department of public health is supporting testing at sunnydale community center, so right now they don't have a place for the community members to get free s.t.d. testing. they will either have to go to southeast or third street or come downtown. so within the next month or so,