Getting to Zero San Francisco: A Collective Impact Approach

Area of Science:

• Public Health
• Epidemiology
• Health Policy

Background:

• San Francisco has a history of innovative HIV prevention and treatment programs.
• The Getting to Zero San Francisco consortium was established in 2014.
• The consortium aims to eliminate HIV infections, deaths, and stigma.

Purpose of the Study:

• To evaluate the effectiveness of a collective impact strategy in reducing HIV diagnoses and improving viral suppression.
• To assess the impact of citywide pre-exposure prophylaxis (PrEP) and rapid antiretroviral therapy (ART) initiatives.

Main Methods:

• Implementation of a collective impact model with a common agenda, shared measurement, and coordinated activities.
• Citywide scale-up of pre-exposure prophylaxis (PrEP).
• Rapid antiretroviral therapy (ART) upon diagnosis.

Main Results:

• New HIV diagnoses decreased by over 50% between 2013 and 2018.
• Time from diagnosis to viral suppression significantly reduced.
• Persistent racial/ethnic disparities and lower viral suppression rates in specific populations noted.

Conclusions:

• A collective impact strategy can lead to significant reductions in new HIV diagnoses and time to viral suppression.
• Addressing racial/ethnic equity and disparities in vulnerable populations remains critical.
• Further evaluation is needed to understand the optimal conditions for this approach.