LA County: Los Angeles County PATH: PrEP and TLC+ for HIV Prevention

The overarching goal of the proposed LA County PrEP and TLC+ for HIV Prevention (PATH) program is to implement a coordinated response to the local HIV/AIDS epidemic through a set of innovative, evidence-based interventions across the continuum of HIV prevention and care, targeting individuals and communities at highest risk of and affected by HIV in Los Angeles County (LAC). The PATH Consortium is led by the Division of HIV and STD Programs at the LAC Department of Public Health, and Consortium partners are the University of California, Los Angeles, the Los Angeles Gay and Lesbian Center (LAGLC), the OASIS Clinic/Charles Drew University, and AIDS Project Los Angeles. The Consortium is uniquely positioned to leverage existing public health systems, academic partnerships, and community resources in order to implement pre-exposure prophylaxis (PrEP) as a part of a comprehensive and customized HIV prevention package, as well as to enhance key elements of the local Testing-Linkage to Care-Plus (TLC+) strategy with the goal of improving health outcomes and reducing HIV viral load.

The LAC PATH PrEP program aims to enroll 375 high risk men who have sex with men (MSM) and male to female transgender individuals of diverse racial/ethnic backgrounds, who will be delivered a customized prevention package (CPP) that may include PrEP, in addition to risk reduction counseling, sexually transmitted infection (STI) screening and treatment, substance use and mental health screening and referral, as well as non occupational post exposure prophylaxis (nPEP) if PrEP is not prescribed. Participants will be delivered the CPP over 48 weeks, and 300 of the participants will receive PrEP based on study risk stratification and PrEP eligibility requirements. Daily Tenofovir/FTC based PrEP will be delivered in accordance with the CDC guidance, along with the other CPP components. The PrEP demonstration project will be assessed for safety, feasibility, and acceptability, and participant adherence, HIV risk behavior, and seroconversions will be monitored. The per-participant cost of the CPP model will also be estimated, providing a benchmark for comparisons to other jurisdictions and for public health planning purposes.

The LAC PATH TLC+ strategy aims to implement targeted enhancements in the existing system of HIV testing and care. In order to identify persons living with HIV/AIDS (PLHA) who are unaware of their status, a protocol driven social network testing intervention among high risk MSM will be implemented. To improve timely linkage to care for newly diagnosed HIV+, a clinical linkage specialist will be placed at one of the highest volume clinical HIV testing sites in the County. To engage PLHA who are out of care, two strategies will be deployed: an innovative approach to re-engaging out of care HIV+ persons utilizing their social network, and a peer navigation program that works with clinics to identify and re-engage patients lost to follow up. Finally, in order to optimize ongoing retention and adherence, an intensive retention case management strategy will be implemented for those recently out of care. It is estimated that 750 participants will be enrolled in the social network testing, and 1242 enrolled in the linkage and retention components. A cost effectiveness analysis of each TLC+ component will also be conducted to inform sustainability and system level adoption of the intervention strategies.