Entire electronic records requirements it is a very complex we have a very complex series of means and the universities experts will be able to upon our contracting with them to tell us h how they could meet the need and meet a 10 year cost analyze it is to determine whether the ethics system can work for us as the department is looking at several of the contractors and so this is before you also in future at our consent calendar lastly as our processes is in the Third Quarter dpw Financial Report to have copies of this we are at this point ahead of the budget by 28 million much of that was related to increased revenues from our medical business and also reduced costs over at San Francisco general so ill be happy to answer any questions on any of those subject that were presented and any of my fellow commissioners may wish also to add to the report. Are there any questions . No okay then well proceeded to the next item and item six the consent calendar that excludes u includes the items you respect throw in reference to the Planning Committee okay. So the consent calendar is before you is there any extractions from the consent calendar not seeing any well vote on the consent calendar all in favor, say i. I. In those it is passed. Going getting to the zero update. Thank you very much commissioners for having me to speak about our getting to zero initiative i wanted to provide you with an update on where we are with this collaboration in which the department of Public Health is playing a key role hopefully whoops lets go back so our goal is to get to zero new hiv infections and zero stigma an Association Associated with hiv theyre thats our primary goal in San Francisco i want to tell you were getting towards zero im going to tell you how we ambulance to get to zero so weve actually made tremendous progress we started with over one thousand infections in the year 2000 so i am showing you through 2008 to 2014 the 2014 numbers are not out pubically ensue i got them if our arc unit the emancipation proclamation dissolution unit the full report is out next month as you can see we have actually decreased the number of new infections the hiv diagnoses from over one thousand down to 3 hundred and 2 last year thats a 70 percent reduction weve also made headway in terms of deaths down to hundred and have 77 deaths amongst people diagnosed with hiv only 1 3rd are hiv associated some are just the normal result of aging and sort of were trying to get them down as closed to zero as soon as possible and there are a couple of things that made a tremendous impact one was that the Health Department come out pubically in 2010 along with the San FranciscoGeneral Hospital clinic recommending everyone with hiv be treated immediately and not wait until their cell phone count was low to be substantive to infections that is now the world Health Associations recommendation global so we really were you are ahead of the curve and the first city to implement the prep demonstration project it is preexposure to taking a daily combination of one pill for people during their seasons of risk of quasi hiv if people take that on a daily basis the success rate maybe over 90 percent so we started the first prep demonstration project in 2012 and think we need both treatment and preservation to get to zero we couldnt get there without you and the help and support of dpupt and the city and county overall this agency as a result of infrastructure that you helped to build from the beginning of the epididymis in treatment and funding entering into collaborations with Community Basis organization and providing ongoing support and multi year commitment to get to zero were building on that very solid base to turn that skufsh to get us to zero we we couldnt have done it without you without the Political Support but everything starting with the community the way to get to zero Initiative Came from a Community Town hall we held we held a Community Town hall every year in celebration of World Aids Day it was called getting to zero in emphasizing a lively safety net presentations with the audience and. Community member said that is all well and good how are you working together this started us thinking we need to move to a collective impact not only the collaborations but commitment of groups for common agenda to solve this problem there is a formalized way that began the launch of getting to zero we started in 2014 and so our vision to achieve this aids vision of getting to zero we believe we can get to the first jurisdiction in the world to get to zero the way were doing that we believe we no idea to improve the health of People Living with hiv and create Additional Initiative programs to bring down new infection rates and address stigma this is not a hunt alone issue we need the collaborative and the support and funding from multiple entities and were already serving as an example to other cities that also come from amsterdam and paris and other cities within the u. S. And presenting our progress in the Society Meeting in vancouver in a week and a half or so i wanted to tell you what ear done most recently weve director Barbara Garcia had a pointed out we had this original group that started the initiative bans this Live Community forum we know we needed to expand and director Barbara Garcia was clear we needed to expand to reach the work with people that are working with those populations that are most challenged people of color and transgender individuals men having sex with men and added four members to the Steering Committee representing those are groups had 7 Consortium Meeting and many smaller meetings weve tried to expand the recommendation on each the committees as well as the development of initiatives to move forward our goal not only to have guaranteeing well get to zero but up u come up with concrete programs with milestones and deliverables and to track our progress we have a commitment to report back every year on our progress and did that on december 1st director Barbara Garcia was at our presentation we start with 3 initiatives we couldnt try to side everything all at once to expand the Prophylaxis Program citywide to expand our Rapid Program feet h getting people that are newly diagnosed back into care and comprehensive program i wanted to point out that the San Francisco department of Public Health is really the first large sponsor of the initiative we have 1 point plus Million Dollars for communitybased organizations prep deliver at dpw clinics and expansion of our linkage Program Citywide and just put in an application to the centers for Disease Control and preservation for 1. 9 million per year to expand prep and the extension efforts and ushering with other foundations and other donors we expect to have large additional grants coming in the getting to zero again, were not reilly solely on dpw but briefly cover the 3 committees the Prep Committee is the faster moving it is the Newest Development and we have a long way to go we have a decline in new hiv diagnoses we dont think that is due to prep but prep placed an Important Role in driving it down weve divide this group into 3 sub groups for the providers and again San Francisco has been at the first and foremost of providing prep the rest of the country is following behind some more slowly than others but we can completely will change the face of epidemic and people that benefit the most from prep are linked to services if they deserve to take prep and measure the impact does it have a positive impact are we seeing break to tell us in preparing or resistance we know of one case of a person denied Life Insurance because he was on preparing we want to minimize the cases of denial for preparing the Rapid Committee is Rapid Initiative for hiv diagnoses we have been doing linkage to care when i talk about that we get people into care but lose them quickly we lose them because theyre not really linked immediately if that if you diagnose someone in a clinical setting but well try to get you into care but at all r call those 5 numbers they can easing easily be lost to care there was a Pilot Program it has been highly successful people find is successful as soon as people are diagnosed to get them to a provider to get them not only the medical services and the treatment but the social and linkage to care those hutchings of rapid linkage and then they can get referred to their medical home there is not a gap while theyre trying to figure out where the home is we will expand that to the rest of the city the goal weve got programs and adapt them to the places and people for the place that are providing Little Services and evaluate them and do a process improvement to make sure were reaching those who most need rapid linkage to care and then the Retention Committee is the other Important Group those are data from 2013 we dont have the ends of 2014 data completely yet but i have gotten preliminary numbers from the group what you can see after being linked to care 36 months after overall were logging a third of all the san franciscans new lettingly diagnosed and done worse with africanamerican and youth in particular ill tell you in terms of retention the africanamericans and in the last year have were retaining them but the rate of linkage to care initially and the viral suppression are the lost in individuals under the age of thirty and africanamericans those are the groups we need to Roanoke County and the retention of low rates has a desperation of viruses a small use of people that infect drugs become enacted but we need to provide them with the services they need and finally weve created this end Stigma Committee that is critical that is the driver of hiv of the hiv epidemic it is certainly why we see increased rate in youth in other communities it is the State Government stigma people feel about going into a test and after the test getting treatment and care and this is true in transgenders communities we have a committee that works on ending the privilege and description offer People Living with hiv and embarked i want to close with two things we have i think is a fantastic we are talking about one of our members of the consortium getting to zero sf. Org i urge you encourage you to look at it weve keeping it updated with the numbers of infections listed as well as the activities of various groups and the membership and serves as a portal and the only this is my personal plug shame also plug the only without objection one eliminated smallpox San Francisco is the only Health Department in the country that as a audited vaccine i hope our proud of that were trying to accelerate that drug towards vaccine. Thank you very much of course, the commission and the depth is appreciative of the enormous work our group is doing any Public Comment we need to take here. Ive not received any Public Comment. Commissioners questions or comments at this point yes. It was an excellent report i might have missed something when you articulated the fact that there was an expansion of the committee i think you added 4 members i was is is there one committee that listed how many are on there and and the Steering Committee is a small font but on the website as well so the original group that formed the committee was dana and diane from ucsf and from the aids institute and the aids foundation we are that all involved in the Community Forum and shannon is working with the committee and 4 new members. So temple then. Yes. The only other question again in sharing our data was pardoning to the retention of care and you give a breakdown of the committees we serve i was wondering i know that thinking back when some of those new pathways started it was concern among the nature africanamerican how for a fact we will be addressing those issues the young people and others coming to the city i wonder, in fact, that cohort had or is that considered a dr. Yes. So i went to the meeting yesterday and one of the work we do as a group i consider part of the group we have to insure that i wanted to take a model of dr. Chow the coalition we provided a sign on to the issue this is 1. 2 is not going to get us to zero but home collective impact of all the work that the communitybased organizations so well do effort in the next couple of months to sign into the effort to educate them everybody is doing a piece of puzzle we have to get them into the vision thats the organizing work so none should be left behind rewith nativeamerican foundations and clinics that provide care to that population were trying to move the hiv preservation treatment and to the larger populations is going to be and the larger providers is going to be an important part and one thing about the that program and reached out to the providers to get them to think about those those at highrisk and the quality of life so i think we still have organizing work to do we dont want any of the programs to not sign on and support arrest im sure youre aware of we spend Million Dollars and Million Dollars on hiv care throughout the city thats the real getting to zero group and those dollars are to help align and get a focus on the key areas. We at bridge hiv are working with nativeamerican organizations on cultural humility training for those who are providing the care some of the groups listed on this graph i showed you on retention and care are people that are newly diagnosed were trying to prevent people from becoming enacted and this sub group needs to move into contingency that are less aware for the Prep Services and may not have the Prep Services delivered to the places they receive care weve asked the committees to say look around the table who are we missing in representation here but who are we missing in delivery of services. I was going to share i think you mentioned in our presentation a Small Task Force look at how to eliminate privilege and bias for many of us are people involved in the pathway so to speak its a double hit people may have aids and latino or documented or undocumented or nativeamerican or whatever so looking at this go you presented selflooks like you have a view and going to address those issues so thats good thank you. Commissioner karshmer. Thank you it is an amazing progress chart two things that strike me one weve learned a lot this collective impact is exactly what goes go to make a difference we at consortium had a presentation an stds how were getting to zero there and we started the issue of treatment and the outreach to the users and the ends user im hoping that given were all in the same public sharing the best practices from what youve done successfully and the std unit is a critical part of getting to zero Stephanie Cohen and others are involved were sharing best practices and theres a Council Town Hall meeting for Community Members will the sexually tramentdz infections and i would mention that the increase in sexually infections began they were high they come down with the hiv epididymis and the late 90s when people were receiving adequate treatment for hiv the rates started to go up again we have a huge road ahead of us to try to address hiv we consider addressing stds diseases hiv is one of them the stigma is one of that. And the other thoughts the Rapid Response i mean this should be the standard for any chronic disease if we took the same analogy with the Health Issues and for the moment the person is diagnosed getting the treatment auto r out. We hope the same thing that the hiv treatment has lead the charge for other diagnoses related we hope that serves as a road map for all the huntington park. It seems we get a little bit commandment listed so if you have suggestions for places or ways to share it well welcome that. Commissioner pating. I think i wanted to ask a few more questions the strategy trying to get hiv drugs and floating this into our immediate population our daily initiatives seems to me but your strategies to get to the populations but populations that are not theyre the homelessness or other ingenuity are we geptd ism linked or assess. The Retention Committee is focused on people that are marginally homeless or delusionally diagnosed thats a group we often do lose and need to find ways to engage them theres been a lot of discussion not to deal with that in isolation we have a big focus on use as i said thats the group that is at least likely to come back in but their for example in preexposure to blacks young people may not have Health Insurance or be on their parents Health Insurance and not want to come out as being on preparing were trying to figure out how to work with the o that are focused on youth. My secondquestion is the Africanamerican Community. Weve got a lot of people that are linked in both and both coming from the housing, land use, environment, and Transportation Committee it in one of the intersection the Africanamerican Community is impacted and the outcomes this is one of them were trying to center jiujitsu the best we teris the best we can. And going 1y506 weve not decreased the rate of infection by more than 50 percent if you did that every year for the next 5 years youll end up with a high transition and not reach our goal presumably the more smaller population the exchange gets so score that we operate in an environment that are many Interest Groups have passionate feelings about the way to deploy those resources if you boil it down to the 3 initiatives two questions how do you think about interim goals and serving at end points and the second and probably more important question how do you think about how to allocate the resources you have unequally among the initiatives so that we do the most good given what we know works and the resources we have. I would say if i had the answer to the last question i could i know rule the world or eliminate all heartache disparities everywhere this is such a challenging question id like idle a say first of all, the interims have goals and metrics part of what we did with the city c grant to ramp up the measure citywide we need to measure some of the sewer gets are we getting the right people on preparing when somebody new bottoms enacted do they know about prep have access to prepare prep when someone is diagnosed late in infection where did we go wrong were goinging doing those individuals levels to see where the system failed those individuals not reaching as you point out it gets harder and harder as we get to smaller and smaller numbers to understand how and why i think the issue of how we distribute resources is a huge issue like i said a very very challenging one what were trying to do to get alignment within the various committees about priorities and then make sure that we all work towards that common goal and realign the resources it didnt mean taking resources away from groups but we may if not successful the commitment of groups to common