HomeMy WebLinkAboutMINUTES - 09092003 - C.131 • -31
FHS #61
TO: BOARD 4F SUPERVISORS � Contra
FROM: FAMILY AND HUMAN SERVICES COMMITTEECosta
DATE: SEPTEMBER 9, 2003 " A•_
SUBJECT: HIV PREVENTION - NEEDLE EXCHANGE County
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
Recommendation:
1. ACCEPT the attached reports presented by the Public Health Director dated April 16 and July 28,
2003 providing options for continuing needle exchange for HIV prevention.
2. DIRECT the Health Services Director to negotiate an annual contract with Community Health
Empowerment in the amount of$60,000 to provide needle exchange and HIV prevention services.
Fiscal Impact:
$60,000 County General Fund
Background:
Community Health Empowerment (CHE) has been providing needle exchange services in Contra
Costa County for several years. Contra Costa Health Services Department had provided
approximately $25,000 per year to CHE to purchase needles. The amount was increased to $35,000
in fiscal year 2002/2003. CHE indicated they were losing funding from other sources and would
require approximately $180,000 to continue services in Contra Costa County, These issues were
discussed at a series of meeting with the Family and Human Services Committee, and in reports to
the Committee dated February 26, March 13, April 16 and July 28, 2003.
Contra Costa Health Services Department is Committed to continuing needle exchange as an
important component of HIV prevention in the County, and to attempting to expand exchange services
to meet community needs for this program.
After further discussions at the Family and Human Services Committee meeting of August 4, 2003, it
was agreed that Health Services Department shall provide $60,000 annually to support the on-going
provision of needle exchange services in East and West County on a weekly basis. AIDS Program
staff will continue to provide prevention outreach services.
CONTINUED ON ATTACHMENT: X YES SIGNATURE:
" � Q
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE. OTHER
SIGNATURE(S):
F DERAL D. GLOVER 4d—GICOIA
ACTION OF BOARD ON Septed)er 9, 2003 APPROVE AS FUOMMENDED X OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
X UNANIMOUS (ABSENT V } AND CORRECT COPY OF AN ACTION TAKEN
AND ENTERED ON THE MINUTES OF THE BOARD
AYES: NOES: OF SUPERVISORS ON THE DATE SHOWN.
ABSENT: ABSTAIN:
ATTESTED SePtr 9, 2003
JOHN SWEETEN,CLERK OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
Contact Person: Dorothy Sansoe(5-10019)
CC: GAO 1
HSD %
BY:'jj" r f f DEPUTY
L
WILLIAM WALKER,M.D. CONTRA COSTA
HEALTH SERVICES DIRECTOR
W04DEL BRLtNNER,M.D. PUBLIC HEALTH
PUSLlc HEALTH DIRECTOR � � 597 Center Avenue,Suite 200
Martinez, California
CONTRA COSTA 94553-4675
HEALTH SERVICES X9253136721
wbrunner§hsd.co.contra-costa.ca.us
To: Family and Human Services Committee Date: July 28, 2003
Supervisor Federal D. Glover, District 5
Supervisor John Gioia, District 1
From: Wendel Brunner, MD �'"�' Re: Further Options for Continuing
Director of Public Health Needle Exchange for HIV Prevention
Community Health Empowerment {CHE} has been providing needle exchange services in Contra
Costa for some years. Contra Costa Health Services had provided approximately $25,000 per year to
CHE to purchase some of the needles exchanged. This year, CNE indicated that they were losing
funding from other sources and would require approximately $180,000 from CCHS to continue
services in Contra Costa. These issues were discussed.at a series of meetings with the F&HS
Committee and in three reports to the Committee on February 26, March 13, and April 16, 2003.
In anticipation of the closure of the CHE exchanges, the CCHS AIDS Program prepared to begin
needle exchange activities one night a week each in East and West County starting the first week in
May. However, CHE has continued to provide needle exchange services. AIDS Program staff, while
fully prepared to exchange needles, have provided prevention outreach services only, as it would
have been an unnecessary competition with CHE. We have since cut back our presence to every
other week in East and West_
We have had additional discussions with CHE and are recommending that CHE is provided with
$40,000 annually to support the on-going provision of needle exchange services in East and West
county on a weekly basis. AIDS Program staff will continue to provide prevention outreach services
every other week in two locations, but will not attend those sites fully prepared to conduct needle
exchange. In the event that CHE would be unable to conduct needle exchange, the AIDS Program is
prepared to provide the service after receiving notice that CHE is no longer able to conduct the
exchange.
Contra Costa Health Services is committed to continuing needle exchange as an important
component of HIV prevention in our county, and to attempting to expand exchange services to meet
community needs for this program. Attached is our most recent update that discusses the actions of
the last several months and our recommendations in more detail.
cc William Walker, MD, Director, Contra Costa Health Services
Contra Costa Community Substance Abuse Services 0 Contra Costa Emergency Medical Services C Contra Costa Environmanta;Health E Contra Costa Haalth Pian
G Contra Costa Hazardous Materials Programs C Contra Costa Mental Health ii Contra Costa Public Health 0 Contra Cosia Regional Meaicai Center CJ Contra Costa Heath Cante
Contra Costa Health Services i
Program Update, Needle Exchange
7/28/2003
Community Health Empowerment (CHE) has provided needle exchange services in Contra Costa
for some years. Most of CHE's budget has come from private grants, with Contra Costa Health
Services providing $25,000 - $35,000 / year to purchase some of the needles exchanged,
Earlier this calendar year, due to losses in grant support, CHE requested $180,000 from the
Health Department to continue needle exchange in Contra Costa. Discussions were held at the
Family and Human Services Committee, and reports issued to the Committee in February,
March and April of this year.
In April, in anticipation of the closure of CHE, the Health Department prepared to begin needle
exchange activities one night a week each in East and West County. Supplies were ordered,
van rental was organized, and staff outreach service calendars were adjusted to accommodate
the additional activities effective the first week in May.
CHE has continued its needle exchanges in East and West County. AIDS Program outreach
staff have attended two exchange sites (one in East and one in West) fully prepared to
implement needle exchange, but have not interfered with CHE exchange activities. Rather,
they have provided outreach and prevention case management services to the participants at
the exchange sites. To reduce duplication of effort, outreach workers have cut back on their
scheduled trips to the sites, now going out to East and West county prepared to exchange
needles every other week instead of weekly.
Data Update:
Recent trends analysis of data from Urban Health Studies shows stable prevalence rates with a
declining trend in Injection Drug Use as the mode of transmission. The average prevalence
found in the early nineties was 23%, compared to 15% in the more recent years. It is difficult
to draw specific conclusions from these data, as the results are influenced by sampling factors
and other variables that are hard to control.
The current State-wide HIV (only) rate attributed to injection drug use is estimated to be 8%.
Very preliminary local HIV epidemiology (as of 12/02} shows that approximately 37% of the
newly reported HIV (only) infections in Contra Costa are attributed to injection drug use, This
data is very preliminary and is likely not reflective of the total population of HIV infected
individuals in Contra Costa.
Costs Associated with Needle Exchange this Calendar Year:
CHE supplies and expenses for the period January — March of 2003 totaled $5,064, including
$4,127 for purchase of syringes and sharps containers. The remainder of the costs included
payment of CHE rent, storage and phone bills through March 2003.
Health Department needle exchange costs from May 1 through June 30 include $5,593 for the
purchase of syringes, sharps containers and other supplies for needle exchange. These
supplies remain on hand in the AIDS Program.
Status of CHE Operations;
In a July meeting with CHE, the agency reported the following:
Contra Costa Health Services 2
Program Update, Needle Exchange
7/28/2003
� Closure of the West County office but retention of the CNE phone number;
➢ Elimination of one needle exchange site (Cutting Street in Test County);
➢ Weekly service remains intact at 4 sites: Richmond (Monday nights), Bay Point (Monday
nights), North Richmond (Wednesday nights) and Pittsburg (Thursday nights);
➢ Some modest support has been received from other needle exchange providers in the
region;
A The continued support of about $30,000/year from the Comer Foundation, primarily for
purchase of supplies, including needles;
)o, The continued research and submission of grants applications: Horizon and California
Wellness have recently sent funding rejections;
)o. The services of a pro Mono grant writer;
The process of obtaining a 501 (c) 3 is still ongoing. CHE anticipates submitting the
required paperwork at the end of the month.
Specific details about East County were shared:
CHE reports that significant health disparities are in evidence at the East Contra Costa exchange
sites, where they see a number of soft tissue injuries. No mobile health van services are
available at the exchanges. Most individuals do not access health care except when confronted
with a health crisis. There seems to be more poverty in evidence and the population appears to
be more "underground"than in the West County area. Approximately 35 individuals show up at
a given exchange in East County -- of these, about half are women, many of whom are sex
industry workers. AIDS Program outreach workers also report a significant client interest in the
provision of HIV prevention outreach services in East County.
CNE Support Concerns:
CHE still requires financial assistance. They indicated that they would prefer that support for
general operating costs, as they have a line item for supplies in their foundation grant. They
wish to do more extensive outreach into shooting galleries and other locations in which IDUs
congregate. They would like to expand services into far East county and other areas, and
would like to provide more user-friendly (safe) services for women in East County. CHE is
interested in applying for Gill funds — this grant maker provides funds for rural population
services and CHE may be able to frame East County needs in conjunction with requests for their
services in Stockton, Marysville, and other rural areas.
CHE discussed again their interest in a joint (Board of Supervisors, Health Department, and
Community Health Empowerment) presentation to various cities to promote awareness of the
need and support for CHE. CHE says they feel they have the support they need from Richmond
and San Pablo in West County, and they would like to put together a presentation to the
governing committees in preparation for the public hearings that would be required,
Following the discussion, CNE submitted a budget that includes a $60,000 line from the Health
Department to support supplies, a grant writer and accounting support (see attached). CHE
was asked to consider, and is still considering at this time, a smaller amount of funding on a
quarterly basis to ensure that needle exchange services would be provided to East and West
County on a weekly basis.
Contra Costa Health Services 3
Program Update, Needle Exchange
7/28/2003
Recommendations:
In the interest of retaining direct services without duplicating effort, the Health Department
recommends the following actions:
Establish a fee-based contract with Community Health Empowerment's fiscal agent in
the amount of $10,000 per quarter. Allow CHE to use those funds as they see fit as
long as they ensure that needle exchange services will be provided in East and West
Contra Costa on a weekly.basis. CHE would submit quarterly data reports, and the fiscal
agent would submit fiscal reports in the time and manner required by the County.
➢ Explore the availability of &R.I.P. funds to provide limited support for a grant writer for
CHE.
➢ Retain AIDS Program outreach staff availability at needle exchange sites for the
purposes of HIV prevention outreach only at this time.
Retain commitment to be available to provide safety net needle exchange services
should CHE not be able to continue providing exchange services. Services would require
some notice time to reactivate.
AIDS Program staff to develop simple database tool for CHE to implement in their data
collection and reporting.
AIDS Program staff remain available to provide support for grant writing activities
including review of CHE applications, provision of letters of support for CHE applications,
and participating in any joint planning discussions as requested by CHE.
y Conduct joint presentations to cities to educate local policy makers and encourage
financial and other support for needle exchange.
Contra Costa Health Services 4
Program Update, Needle Exchange
• 7/28/2003
Budget submitted by fax July 15, 2003 from Lou Ann Lucre and copied for purposes of email
submission by Christine Leivermann
Community Health Empowerment
Organizational Budget July 2043 —June 2003 (sic)
EXPENSES:
Item Amount
Salaries and Wages $72,000 (Executive Director @$40,000 and Outreach Director $32,000)
Employee benefits/payroll taxes $15,120
Subtotal gersonnel 87,120
Consultant/professional fees
Fundraising consultant $10,000
Bookkeeper $15,000
Volunteer Stipends $10,500
(2 sites x 100 weekly x 52 wks)
Equipment
Syringes $50,000
Biobuckets $ 1,500
Alcohol wipes/condoms, etc. $ 4,580
Printing/copying $ 500
Telephone/fax $ 1,000
Postage/delivery $ 400
Storage $ 2,400
Audit $ 2,000
TOTAL EXPENSES: $185,000
INCOME pending *1
Contra Costa County $60,000 (support for supplies,fundraising consultant and bookkeeper cost)
Comer Foundation $30,000
`fides (Drug Policy Reform)* $35,000
San Francisca Foundation* $15,000
Kaiser* $1.5,000
Vanguard Public Foundation* $ 5,000
Gill Foundation * $15,000
Colin Higgins Foundation* $10,000
TOTAL PENDING (sic) INCOME $185,000
WILLIAM B.WALKER,M.D. CONTRA. COSTA
HEALTH SERVICES DIRECTOR
WENDEL BRUNNER,M.D. PUBLic HEALTH
PUBLIC HEALTH DIRECTOR w►a
597 Center Avenue,guFte 200
- CONTRA
Martinez,California
COSTA 94553.4675
FX93;671HEALTH SERVICES FAx 25 2
wbrunner@hsd.(-.o.contra-costa.ca.us
To: Family and Human Services Committee Date: April 15, 2003
Supervisor Federal Glover, Chair
Supervisor John Gioia, Member
From: Wendel Brunner, MD Re: Captions for Maintaining Needle
Director of Public Health Exchange in Contra Costa County
We were directed by the Family and Human Services Committee to return with additional options for
continuing needle exchange programs in Contra Costa to help prevent the spread of HIV and Hepatitis C.
We were also asked to investigate more extensively how other needle exchange programs are operated in
Bay Area counties. As some of the needle exchange in other counties includes outreach, education, and
treatment services for IV drug users at risk for HIV, we included information on some of those programs
also funded in Contra Costa through Contra Costa Health Services (CCHS) to facilitate comparison.
OTHER BAY AREA NEEDLE EXCHANGE SERVICES
Alameda is the county most directly comparable to Contra Costa, and many IV drug users move back and
forth between our two counties. In Alameda, three health department contracts with two CBOs totaling
$330,000 provide needle exchange services. The scopes of work (attached) indicate that 350,000
syringes are to be exchanged annually. The funding is County General Fund and Tobacco Master
Settlement(TMS) dollars. In Contra Costa, all TMS dollars are used to provide health care for the
uninsured, including HIV patients. In Alameda County, categorical HIV funding is used for treatment
services.
PROVIDING NEEDLE EXCHANGE SERVICES THROUGH CCHS
The CCHS AIDS Program can directly provide needle exchange services using experienced community
outreach workers familiar with HIV prevention issues among IV drug users. The exchanges can be
implemented one night a week in both East and West County for approximately $75,000. That is $40,000
than CCHS provided for needle exchange this fiscal year. While we proposed to use existing staff who
are knowledgeable about Contra Costa County and its impacted communities, as well as experienced in
HIV outreach and education among IV drug users, these staff are currently funded by state monies which
are being reduced next fiscal year. Therefore, if we were to implement this needle exchange option, it
would result in an increased net county cost of$40,000 to the CCHS AIDS Program for next year. No
source for this funding has been identified. The attached report discusses this proposal in more detail and
compares some of its advantages and disadvantages with the Community Health Empowerment proposal.
0 Contra Costa Community Substance Arouse Services 0 Contra Costa Emergency Medical Services 0 Contra Costa Environmental Health 0 Contra Costa Health Pian
CJ Contra Costa Hazardous Materials Programs C Contra Costa Mental Health .Contra Costa Public Health:u Contra Costa Regional Medical Center 0 Contra Costa Health Centers
OTHER HIV-RELATED-SERVICES TO INJECTION DRUG USERS IN CONTRA COSTA COUNTY
Comparing the CCHS-proposed needle exchange program with those of other counties is complicated by
the fact that other counties, notably Santa Clara, combine other HIV prevention services with needle
exchange programs in their described budget. To provide some comparison, we included partial
description of some HIV prevention services in Contra Costa County for injection drug users. Contra
Costa County's integrated health care system facilitates collaboration between the Public Health AIDS
Program, Alcohol & Other Drug Services Division, and the hospital and health centers, which allows us to
develop a comprehensive system of prevention, intervention, and treatment for HIV injection drug users.
cc William Walker, MD, Director, Contra Costa Health Services
Page 2
..................................................
Update to the Family and Human Services Committee on Activities to
Maintain Threshold Needle Exchange Services in Contra Costa County
April 21, 2003
The Family and Human Services Committee has directed the Health Department to
identify potential options to maintain needle exchange services in Contra Costa County.
The Health Department was also asked to provide information on needle exchange
programs in other Bay Area Counties.
The Contra Costa Board of Supervisors established a State of Emergency pertaining to
HIV in December 1999. In the first years of the State of Emergency, the Health
Department provided approximately $25,000 in County General Funds per year to
purchase syringes for the needle exchange sites. Nearly $25,000 was spent on syringes
in the first half of fiscal year 02/03. At the Supervisors' request in February this year, an
additional $1.0,000 in County General Funds was put in place to retain services while
options were explored. Financial support this calendar year, including syringes and
payment of rent and storage through April 2003, has been $10,601.17.
Other Bary Area providers of Needle Exchange Services
Note: San Francisco needle exchange is not comparable -- San Francisco operates 12
sites per week and exchanges approximately 2,000,000 syringes per year. Each
program below is structured very differently; information for highly accurate program
comparisons is incomplete and/or not available.
County Exchange e Approx. funds r '
Alameda 2 CROs under 3 contracts. Some wound care $333,000
provided. 350,000 syringes at 4? sites
1 San Mateo 2 CROs under Alcohol and Other Drug Division $180,000
'
supervision.
Santa Clara County Health Dept. for comprehensive services ; $435,000
including Public Health nurse manager and i
substance use treatment beds,
Sonoma 1 CBO — 3 sites, approximately 35,000 syringes $ 38,000
per month. Prima rily_private funds.
Marin 1 CBO, no county support. First quarter of FY $0
0203- a rox. 15,300 syringes
Solano No exchange services 0
Neither State nor Federal funds may be used to support needle exchange activities, so
counties must use General Funds, private funds, or a combination of both to support
exchange activities. As Alameda County is the most proximate county providing
exchange services, their budgets and scopes of work are attached.
Provision of Needle Exchange Services through the Health Services
Department
Two people are needed to provide needle exchange services in East County, and 1-2
people are needed in West County. Two staff would support needle exchange in West
County on the nights that the Health On Wheels (HOW) van does not operate, and one
staff would support exchange activities in West County on the nights the HOW van is
operating. The immediate impact is 12 — 15 hours of time per week depending on
HOW van staffing time. As the HIV prevention budget was cut 25% this coming year,
we can redirect 5-10% FTE from other HIV prevention services to support needle
exchange activities without violating existing State and Federal funding restrictions.
However, that means that continued employment of these staff in needle exchange
would come at increased county cost in the AIDS Program.
Prevention activities that will be eliminated due to the redirection of staff time include
outreach services to local merchants involved in condom distribution, some general
outreach services, some presentations and participation in some health fairs.
Two experienced Disease Intervention Technicians with established links to the
community will provide the exchange services. Services will be provided weekly: one
night per week in East County and one night per week in West County. This would be a
net reduction in services from the current level, but will allow a threshold level of
services to be retained in the community.
As part of the provision of needle exchange services, basic demographics and syringe
exchange numbers will be collected, as will referrals to health and support services for
exchange participants who are interested in such services. We expect that referrals
provided through the anonymity of the HOW van will be easier to document than
referrals provided without the HOW van, and we will need some time to determine if
any referral documentation process of reasonable value can be established at the site
operating without the support of the HOW van.
The total direct cost to the county for this service, using Community Health
Empowerment figures as the basis for the estimated cost of supplies, should be
approximately $74,000 per year, with the capacity to distribute roughly 380,000
syringes in a year. Some of the unknown variables include community acceptance of
Health Department administration of the program, the ramifications of further budget
cuts, and the impact of any policies that may limit the scope of established services,
such as eliminating secondary exchanges.
CHE County
186,240 for 5 sites $73,987 for 2 sites
500,000 syringes 384 000 syringes
2
Risk reduction, health education and Risk reduction, health education and
referrals referrals to health and_support services
Community sypport and trust Experienced Health Outreach workers
Greater flexibik in service delivery Greater monitoring and reporting capacity
One of the strongest arguments in support of a county operated needle- exchange
service is the potential to establish better linkages to health care and support services
operated under contract to or directly by the Health department. These linkages could
allow for better documentation of referrals and services being used by participants. It
may tame some time before we will be able to document fully referrals directly from the
needle exchange program, as.-clients may want greater anonymity. However, both the
outreach workers and the HOW van already have a good reputation in the community,
and the Health Services Department is well known for maintaining confidentiality.
None-the-less, it is expected that the development of a level of trust with exchange
participants would take some time before documentation of referrals and accessing of
services could be implemented.
Services provided to Injection Drug Users in Contra Costa County.
Substance use services for In'ecl tion Drug Users: It is not known how many of the
estimated 700 individuals reported by Community Health Empowerment to have
accessed the needle exchange sites last year are Contra Costa residents or how many
of those individuals actually entered into treatment in Contra Costa. In a 2001 CDC,
survey of California Needle Exchange sites, 21 individuals from the Richmond needle
exchange site were interviewed. Some selection bias was reported in terms of the HIV
status of those interviewed. Slightly more than 10% of those survey indicated that they
had received drug treatment in the past 6 months. The same percentage indicated that
they were currently in treatment. The type of treatment was not reported in the survey
results nor was information provided on whether or not individuals responded to only
one or both of the questions.
Methadone Detoxification services are not provided by the Health Department. These
services are offered by a private provider on a fee for service basis. Most injection drug
users are reported to be heroin injectors and require Methadone treatment as part of
their addiction management. It has been the experience of the AIDS Program that most
HIV positive individuals entering into Methadone treatment are Medi-Cal eligible.
Other Substance Use treatment modalities are provided directly or under contract with
the Health Services Department. Individuals receiving these services may be Medi-Cal
eligible. As residential treatment programs are filled to capacity, most injection drug
users entering care would likely receive several types of services, Pretreatment services
1 Exchange Works,CalSEP Results,2001. R.Bluthenal,and K.Anderson,RAND;R. Andersons et al,UC Davis;A.
Kral et al,UCSF
3
might include outpatient counseling services, 12 step support group services or other
programs geared to assist an individual while waiting for space in a residential program.
In comparing the total number of individuals accessing substance abuse treatment
services in 2001-20022 who stated that they had used needles in the past year with the
cost of selected services those individuals used, an annual minimum cost for substance
abuse treatment services provided to needle users is estimated to be $3,379,450.
Modality Cost per Episode in Total needle users Annual Cost in
01/02 treated in 01/02 01/02
Outpatient Counseling $1950 for 90 days 335 individuals _$6531250
Day treatment $6,840 for 90 days 44 individuals $300 960
Residential Detox $325 for 5 days 400 individuals $130,000
Residential Treatment 4680 for 90 days 268 individuals $1,254,240
Methadone Maintenance $250 for 1 month 347 individuals 1 $1 ,041 ,000
Total cost $ 3,37%,
Again, it is clearly not known how many of these individuals are also participants at the
needle exchange sites. It is also not known how many of these services are reimbursed
through Medi-Cal.
Health On Wheels Van: During the past fiscal year the HOW van provided 156
exchange site participants with clinic services during 39 exchange site nights in West
Contra Costa. The How van estimates the direct cost of a two hour clinic to be
approximately $411 (approximately $301 in salaries, $100 in supplies and meds, and
$10 in gas/maintenance charges), totaling approximately $16,029 per year in direct
health care charges for exchange participants. The actual allocated costs of running the
HOW van are much higher.
Condoms and information materials, as they are available in the AIDS Program, have
been made available to needle exchange services and other services targeting injection
drug users. Cost is approximately $3,000 per year. State and federal funds are used to
purchase these materials for all high risk populations.
HIV Support Services: While it is difficult to separate out services provided to injection
drug users in those agency budgets in which services were provided to more than one
population, it is estimated that approximately $200,000 in HIV prevention funds were
applied to HIV Prevention services targeting injection drug users and their partners in
fiscal year 01/02. Services included:
2 Data and cost estimates obtained from FY 2001-2002 admissions data provided by Alcohol and Other Drugs
Division of the Contra Costa Health Services Department
4
General HIV prevention information and referrals: Trained Community Health Outreach
Workers provide information on risk reduction and referrals to testing and other
services such as alcohol and drug service programs, social/community service centers,
health care, prevention case management and other services provided in Contra Costa
County. Outreach to injection drug users (IDUs) and high risk sex workers who are
injection drug users or who associate with injection drug users, occurred at agencies
serving substance users, on the street in areas frequented by IDUs, in detention
facilities and other facilities identified by outreach workers. Pittsburg preschool
Community Council, Neighborhood House of North Richmond, and Contra Costa Health
Department AIDS Program staff provided 4585 contacts during fiscal year 01/02.
In Depth and On-Going Risk Reduction Prevention Case Management PCM HIV
Prevention Outreach Services: Trained Community Health Outreach Workers conducted
risk reduction assessments, supported the development of detailed risk reduction goals
and provided follow up support services to promote individual capacity to reduce risk
for HIV. In Depth and PCM services were provided to injection drug users and to high
risk sex workers who are injection drug users or who associate with injection drug
users, through street-based contacts and through agencies providing services to IDUs.
Pittsburg preschool Community Council, Neighborhood House of North Richmond, and
Contra Costa Health Department AIDS Program staff provided 546 contacts in 01/02.
Grou Presentations and Group Prevention Support Services: Presentations were
provided to IDUs in treatment and through structured group venues for female
substance users to build skills for safer sex and drug use as part of a series of
workshops for women entering substance abuse treatment programs. Pittsburg Pre
School Community Council and Ujima Family Recovery Services provided 2477 contacts
during FY 01/02.
HIV Testing services: were offered through the Mobile testing van during street based
outreach and through substance abuse treatment centers, homeless shelters, soup
kitchens, etc. Contra Costa Health Department AIDS Program staff provided services.
Direct case management and support services: Provided by community based agencies
and the AIDS Program Nurse Case Management team. In FY 01/02, the AIDS Program
managed a service budget of approximately $1,638,000 in Ryan White CARE Act and
Housing Opportunities for People With AIDS (HOPWA) resources for people living with
AIDS. Services were provided by the Health Department and a network of 8
community based agencies. While figures fluctuate annually, an average of 39.5% of
all those receiving Ryan White CARE Act and HOPWA services identify injection drug
use or partner of an injection drug user as their mode of transmission.
5
ATTACHMENT
APRIL 21,2003 UPDATE TO FAMILY AND HUMAN SERVICES COMMITTEE
Summary comparison of other needle exchange activities. All activities are
funded solely through county general funds. Wrap Around services such as HIV
testing are not included in the program budgets.
Major Activities Cost Source
Tri Cities 30,000 syringes $100,000 "County
(Alameda) 5 workshops General
50 health education encounters Funds"
500 outreach contacts I
Research
HEPPAC 3 sites on a weekly basis $233,260 Tobacco
(Alameda) 320,000 syringes Tax and
Mobile wound rare (volunteer Realignment
providers) Funds
Santa Clara Syringe exchange $435,423 Some mix
Health Health Education ($35,000 for of above
Dept. Public Health Nursing syringes)
Drug Treatment beds
PROGRAM DESCRIPTION
Contractor: HEPPAC Contract Period: 7/01/02-6/30/03
Service Category: Education & Prevention IDUs Funding Source: Tobacco Tax Settlement
The primary goal of HEPPAC'S project is to stop the spread of HIV infection among injection
drug users (IDUs), their sexual partners and their children by integrating a Farm reduction
modality with the spectrum of HIV services offered.
As part of this modality HEPPAC will use a two pronged approach that will include a mobile
clinic vehicle and street and community-based outreach targeting IDUs and or their sexual
partners, living in West, East and Deep East Oakland. HEPPAC also will operate syringe
exchange sites in these areas of three areas of Oakland. Primary emphasis will be placed on
reaching African American IDUs and their sexual partners to provide HIV/STD prevention and
harm reduction education. This will be achieved by utilizing culturally appropriate staff and
volunteers from the community.
Activities provided at Casa Segura include needle exchange; HIV education and prevention
through one-on-one encounters; unstructured groups, prevention case management (PC-N/1); harm
reduction workshops and educational activities addressing the needs the needs of IDUs; HIV anti-
body testing and pre- and post and service linkage to other providers. Memoranda of
Understanding have been established with other provides to offer services at Casa Segura.
Activities covered in this contract are defined as:
Syringe Exchange: Casa Segura will exchange at least 70,000 sterile syringes for used syringes at
three exchange sites in West Oakland, East Oakland (Fruitvale}, and Deep East Oakland.
At least 480 IDU client contacts will occur at HEPPAC's mobile wound care clinic at three
exchange sites in West Oakland, East Oakland (Fruitvale), and Deep East Oakland. Referral and
follow-up services will be provided in at least 320 of those client contacts.
The annual cost of this program will be $88,260.
=ROM :-PUSLIC HGRLTH FAX NO, :925-313-6799 Apr. 16 2003 09:S1AN P3
HEPPAC: Tobacco Tax Settlement
Alm County Office of AM A.dminisiration
BUDGETFORM
ACEMCY; NEPPAC
Personnel Annual Direct 'Indirect Total Amount
Cate o 1P itior►ttntumbent FtE S*Laq Costs Admin Costs
Executwe Director Joy Rinker 0.15 $70,000 $10,5110 $10,500
Oversight of all ea of contract
FlIscal Manager:Siephanie Daniels 0.10 SM,000 $5,000 $5,000
Mari bmq buqppt Andfiscal reports
Peer Educator: 0.25 $28,0010 $7,000 $7,000
Staff s 'n a exch.a e
Health Educator. 0.25 $35.000 S$.750 $8,750
Coordinatewound and abscess clinic
ubtotel Personnel Costs $25 254 $51000 � $31,7$0
Fringe Beneftts $6,563 $1,250 $7,813
Fringe benefits @ 25%include MA.Worker's Cornp,Insurance,SUI,
501 k,payroll costs and Health Insurance
Travel
E ut ent $8 Oslfl ___W S6 0110
Needle exchange van maintenance and reOr $1,000 $1 ow
Abscess and wound care van maintenance and repair $$4,000 $4,000
Ughting and generators $1,200 $1,200
Tent for support and education groups $1.5m $1,50()
Folding chairs for support and education groups $300 $300
Supplies $22,9+17 $22L947
Syringes&Biohaxardovs Waste Buckets 311,000 _ $11,000
Other Harm Reduction Supplies:cookers,cation,rip protectom,vermins, Sf'Wa $6,900
condoms,rubber bands, paper bags
Suture Removal Trays for abscess clinic(300 @$3,50) $1,060 $1,050
in}ectabie Antibiotics for abscess clinic $1,000 $1,000
Client incentives(food,hygiene kits,vouchers,bus tokens,socks,eek.) V.SM $2.9£17
ContractuallSubcontract
Other $11f tail $t i3 2'.50
Abscess van expenses(fuel and insurance) $3,0M $3,000
Storage($2501 nth) $3,000 $3,0001
Register whit Waste Management S2,s00 $2.1500
Staff development and training $2.750 $2,750
Letterhead,business cards,webshe $2,000 $2,000
Rent $5,000 $5,000
GRAND TOTAL $82,101 t3 $� 26tI _$881280 i
FROM :PUBLIC HEALTH FAX NO. :925-313-6798 Apr. 1.6 2003 08:52RN P4-.
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;1 rr►vvr%^m NL.i%,rmr i ivri
Contractor: HEPPAC Contract Period: 7101/02-6130103
Service Category: Harm Reduction--Needle Fxchange Funding Source: Realignment
The primary goal of HEPPAC'S project is to stop the spread of HIV infection among injection
drug users (IDUs), their sexual partners and their children by intergrating a harm reduction
modality with the spectrurn of HTV services offered.
As part of this modality HEPPAC will use a two pronged approach that will include a mobile
clinic vehicle and street and community-based outreach targeting TDUs and or their ,sexual
partners, living in West, East and Deep East Oakland. HEPPAC also will operaTe syringe
exchange sites in these areas of three arcs of Oakland. Primary emphasis will be placed on
reaching African American IDUs and their sexual partners to provide HIV/STD prevention and
farm reduction education. This will be achieved by utilising culturally appropriate star and
volunteers from the community.
Activities provided at Casa Segura include needle exchange; HIV education and prevention
through one-on-one encounters; unstructured groups, prevention cage management (PC'M); hann
reduction workshops and educational activities addressing the needs the needs of IDUs; RIV anti-
body testing and pre- and post and service linkage to other providers. Memoranda of
Understanding have been established with other provides to offer services at Casa Segura.
Activities covered in this contract are defined as:
Syringe Exchange: Casa Segura will exchange at least 250,000 sterile syringes for used syringes
at three exchange sites in West Oakland,East Oakland(Fruitvale), and Deep East Oakland.
The annual cost of this program will bre S 145,000.
0'' '
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FROM :PUBLIC HEALTH F AX NO. :925-313-679e Apr. 16 2003 09:53AN P7
REPPAC: Realignment Funds
Alameda County Offic*of AIDS Administration
BUDGET FORM
AGENCY: HEPPAC
Porsonnel Annual Direct 'indirect 'Total Amount
CategorytPositionllncumbent FTI: S Ialry costs Admin Costs
Exchange Coordinator: Michael Northcut 0.90 $35.000 $31,500 _.__. $31,500
Coordinate three existing syringe exchanges
Executive Director: Jay Rucker 0.05 $70.000 $3,500 $3,500
Oversight of all aspects of contract
CM Outreach Worker: Donna Hatch 4.54 530.000 $15,000 � $15,01001
Deputy Director:Ratiki Franklin 13.25 $55,000 $13,7501 $43,750
Supervise all exchange staff and coordinate
Contract reporting
Subtotal Personnel Costs _ $60,250 $3,5013 $63,750
Fringe Benefits. 515,0}83 $875 $16,938
Fringe benefits @ 25%include FICA.Worker's Comp,Insurance,SUI.
501k,payroll costs and Health Insurance
Travel
Equipment
u lies
$48,236 � 48,239
Syringes& E iohazardous Waste Buckets $46,016 $46,016
Office Supplies $2,220 $2,220
Contractual/Subcontract
Other $17,076 $174076
Needle exchange vara expenses(fuel and insurance) $1,500 � $1,5403
Occupancy for administrative offices $13,076 $13,0176
Communications $2,5001 $2,500
G R A R D T 6 T h L. $14E1,625 $46375 X146 C}QfJ
4
FROM :PUBLIC HEALTH FAX NO. :925-313-5799 Apr. 16 2003 08:53AM P9
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3.PROGRAM DESCRIPTION
(Short summary)
C`.ontracttsr:Tr#-City Health Center Contract Period: 10/l/02-6/30/03
Service Category: IDU Funding Source: County
Generations Project is designed to provide a full spectrum of harm reduction services,
including syringe exchange and focused true-on-one and group services. Program goalii
include reducing,the spread of HIV, Hepatitis C and other blood borne infections and
educating and empowering IDUs to reduce drug-related harm to thernsclves and the
community. Drop-in harm redaction sites will be located in Downtown and South
Hayward. Anonymous HIV and HCV screening,lane-on-tine risk/harm reduction Sessions
and group sessions will be available at these sites,as well as a variety of tither social
services,including Veteran's Assistance and food and clothing limns. Wound/abscess care
and tither medical services will be provided by a licensed clinician.
Project activities will be delivered by a staff team of Health Education
Coordinators rind Health Education Specialists. Anonymous HIV and I ICV testing and
wound care will be provided on site. The HIV Prevention Manager will train staff and
provide on-site services as well as backup staffing,and the Clinic Director will provide
assistance to the ItIV Prevention Manager with negotiating the perlitic.11 climate in
collaboration with DACD staff.
The primary goal this year is to kx:ate a new harm reduction chap-in site and open it by
April 1, 2003. An extensive formative evaluation will take place that Nvill allow for
involvement of stakeholders and IDUs in providing input into where thc:site could be
located.
The following activities will be conducied:
1, At least 30,000 new syringes will be exchanged for used syringes.
2.At least.600 street and venue-based outreach encounters will take place.
3.At least 50 one-on-one encounters focusing on helping clients maximize their education
and use of harm reduction strategies,as well as increase their use of medical services.
4. At least 15 clients will attend S unstructured we time workshops.
Special emphasis will be placed on Latina IDUs and their sex partners. At least one of the
Health Education Specialists will be bilingual in Spanish.
00
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FRO$l :PUBLIC HEALTH FAX NO. :925-313-679e Apr. IS 200-3 0E:53A"1 F10"
D" ON OF AMS AND COMMUNICABLE DISEASE
OFFICE OF AIDS
PROGRAM BUDGET AND NARRATTV'E JUS'TIFICA'TION
2002-2003
AGENCY'1r1:9ih+die. M Ccf Mr Servlce Category; IDU
PERSONNEL AArAW 17iret! 1nditvtV Total
t=TE Costu Admin Cost Amount
H**Kh Education Coor.(T.tl,r1de.J.8Iod9ott):6vorsses 1,33 $25,130 $26.718 so S2G,71R
and coordinates harm reduction drop-in sitn.Trairg vatuntereta.
irnptemems a `+Mies and de8mfc dl assessn+ rft
Health Education Specialist O'BA):Delivers odivt and 1 x72,581 S18.W5 s0 $18,$565
as_sfst in concucdN next&asscssmera.
Hfv Pmvention manager(L.Carver):Develops comrlx.n*y 02 Se 1.067 $8.316 S8,9t6
strategy for foc»tion of$Yarm reduction drop-in Oez,t=aciiitzoes
collaboration with commuri stakeholders.
Clinic Director(K.Liovre):Providers conSu3lation to project*nd 0.0ts $82.000 $1,250 $1,230
assists In tacllitating collaboration with oomrnti,nity
stakcttotdcrs.Provides backup xt)pervision for staff.
Accounting(L.SBrmiento,kt.Catambay,V.Catbety) 0.04 $38.493 53,757 $3.757
Maintain all Unantial rocwds,imWing ir-,voices,a000vn s
payable anti pa, crit. 991 of;VOWMAN lirne spent oo arrt)
s0
so
SO
4`,0
Subtotal Poreonnot Coats S53.099 S4,987 $58.086
Fringo Senefiis
Q 25."'A htSvding FICA A MerA=e taxes,unevrVfaMw& %13:&40 $1.272 $14,612
workm cOtt*r,Cned)C1,ti getrtaE iri3tlrttnCe:r+etieernt!rX
Ttltai W'irlwCr*atri Caids i66,639 $8,2.'gi $72,BU
Suppilrrs(Condom*,lubtkaKsyrkMos..bioilarsrd coma sw%) $16,233 518233
tEQuipmont(Doak and storage cabbteO $800 38$70
CoMrsctu3VSubcontrac% $240 $240
Audlt ,0199 of total a audit
00W s0
Space Utflfxation(Prt jw office and Dtoirtn Site ReniCsi ONA) $4,104
Local Weage(BART tickets tend travel to ouv esafte WI $1,000
Pow oelFAXAntemet Access $975
Incentives(for Forrrtadvea Evaluations Rinse) $1,000
Skvhazard D►tposat $750
Su6loSsi' $7,82 $0 $7,8;0
GPLOW TOTAL $03,501 14110#400,000 i
93.51 b.5 100.t
0 0.. toI
Rom :-PUDL i C HGAL TH FAX NO. :925-313-6799 Apr. 16 2003 X 8:54AM
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FROM :PUBLIC HEALTH FAX NO. :925•-313-67ge 16 2003 oe:55RM R14;'
04/04/2003 12:28 FAX �asrs
.. Adar+lnfsfratian
SANTA CLARA 2220 moor,arty Avenut
ditxted to the Neatat Sar,.lost,Catittsrrrls MIS
of the whole Crsmmu tltyVAU 141.(4081 W-4202
`�' 1f6M11N t Ff�t I.iM[T�l F;;x.f408)AIIS-4244
(*PARTWNW
J 11. d Prepared by: Martin Grimes,HIV/AIDS Prog,
Reviewed by: Audrey Brener,HIV/AWS Prog, Mgr,
Dena Dickinson, Sr.P.H. Mgr.
Submitted by: Guadalupe S. Oliva$,ph,D., Dir. Public Health
,wv,�! ocwpraci Acrnptac! Ornlad Fns+tntad
DATE: December 21, 1999BYTHs BOARD
oxO, SUPEsO.VItSOAS
FT 4COU . ARA
! tkaof �
lis A.P
TO: Santa Clara County Boar I f Sorg 'C ►-
F w + �, t LIDO `
FROM: Robert Sillt n, Executiv' bst+t:
Santa Clara Valley Heal ozpital System 1
SUBJECT. Adopt Resolution Declaring a State.of Local Emergency and Approval of F din
g
to Develop a Substance Abuse Naga.Reduction Prognm; Approve Sala
UrdinaAce Amendment to Add Various Positions to HIV/AIDS Progra , BU 410,
Index 2911
RE!gQM€M[EED AQUO
1.L . Adopt the resolution to declare a state of local emergency in Santa Clara County and to conduct
substance abuse harm reduction program,
2. Approve the Salary Ordinance Amendment to add 1,0 FTE Health Education Specialist/Health
Education Associate(J26427),2,0 FM Public Health Community Specialist/Mobile Outreach
Driver(E04/E60), 1.0 FTE Clinical Nurse VIVI (S76),and. 1.0 FTE Community Worker/Public
Health Assistant(E07IE32),Budget Unit 410, Index'2911
FISCAL IMPLICATIONS
The cost of the program for the remainder of FY 99100 is$131,930*and will be funded by salary
savings from the Health and Hospital System. The annualized cost of the program is$435,423 and
will be included in the FY 00/01 recommended budget-
COIY`I"RACT LUSTO Y
IMYI/W�III YMYIiIrtIi1Y�1Ntr�lY!
Not Applicable.
The Public Hestth Ueparrnant is a dluision of iv 5aM Clara VS?Wy Ktallh&HMp0f Svshm.Owned and operated by the Count'of Sana Ciera.
aa,i
FROM -*PUPLIC HEALTH FAX �C :925-313-~6798 Apr. 16 2003 013:55AN x'15
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FROM :PUBLIC HEALTH FAX NO. '925-313-6798 Apr. 16 2003 08:55P>~t
04/04/2003 12:29 FAX it �ttt
HHC
DEC 0 9 1999
Item#
:tA CLAM �dm�nlaer.t►on
2M I'll— ark Menot
Deetlrtttd to OV r math San low.canpelrttf§ie2a
ia4..40M 495.4101
of the Whol�Cat munity V lei. fa=.�4041065.4Za8
PURK KAM
00*RtMW
Date: December 9, 1999
To: Han. Blattca Alvarado
Hon.Jim scall
Co-Chairs, Health and Hospital Committee
From: Guadalupe 5. Olives,Ph.D.,Director, Public Haft Deet
Maitin D. Fensteersheib, M.D.,Sante,Clam County Health Office
,91
Re: Report to Health and Hospital CoMm"ttee regarding Needle Exchange
Governor Gray Davis recently signed a bill(AH 136—Ma=oni)which protects public entities
from criminal prosecution for distributing by retic needles or syringes pursuant to a
decluation of a local public health emetgerzcy. Exchanging dirty needles for clean ones has been
proven to reduce the spread of HIV without inc sing drug use. The current local needle
exchange program(NEP) has struggled to secure funding for this important component of the
county's HIV prevention strategy. Despite impre wive:results,without full County support, this
program is only able to reach a fraction of the county's injection drug used (IDUs), The agency
that presently operates a b1FP in this county has asked that the County take over the service.
In 1994-.:the Board of Supervisors-declared a local public hmealdi t thiribircy it Santa Clara
County due to the continued spread of HTV and other communk rtble dues, This Bast action
establishes-the condition rt&x4xary-for!the-Public Heslfh Departmeritto,impliement a riretlle
e change prrrgran,givtrc the reccrtt Stade: legislatiorL
The HIV/AIDS Control and Pmvention Program(HAP) requests els mid-year budget
augmentation of S 131;930 to reassume the rale of administering a needle exchange grogram that
will be known as the Subscartce Abuse Harm Reduction Progtaattt(SAHRP). This proposal
includes a budget which would allow for ar program that will better meet the needs of a
population at high risk for infection with HIV,hgxtitis 8 and C,and ocher blood-borne
pathogens, as well as for grater linkages with ether County pro rusts and services. Ear more
than just exchasgtrsg needles,this program affords an oppottwttity to encourage drug treatment,
link clients to available services,and reduce risky behavior,
Thank you for your consideration of this propnaatl, which was developed its partnership with
County Counsel,Department of Alcohol and Drag Seer4ceea,,HAP and the AIMS Flask Reduction
Project.
qp The hbl;c Healih D"mr" 1,it dwlskm of Sana Clan vaifey l WO*i f %O&r.OWnW and OW&Ied by the County of Santa Cissa.
PRC,-t ,pUEL I C HEATH
FAX NO. :925-313-6798 Apr. 16 2003 08:56W P17
.
04/04/2003 1.2;28 FAX l�otta
Support for needle exchange programs is overwhelming:
• In a Field Institute Survey in August 1999,83%of Bay Arca respondents and 69% of Californians
favored needle exchange programs.
• Law enforcement organizations Such-as the Califamia State Sheriffs' Association, the California
Police Chiefs' Association, the California Puce OffScer's Association, and the California Narcotic
6flicers' Association supported AB 136 in principle.
• State health organizations including the California Medical.Association,the California Nurses
Association,and the California Conference of Local Health Officers supported AB 136,
• Leading national organizations have,made stmements in support of needle exchange including the
American Bar Association,the Artie icaa Medical Association, the American .Public Health
Association,the U.S. Conference of Mayors, and the Ameriew Academy of Pediatrics.
Now that the law allows this public health intervention. the time is ripe for the County to establish a
broad harm reduction program that will reach mare people and will be likely to greatly reduce the
spread of HIV and other blood beanie pathogens among IDUs and their sexual partners in Santa Clara
County.
In Santa Clara County,there have been over 3,000 cases of ALBS diagnosed since 1983 and over 17%
of cases are a result of injection drug use. Over 524'a of women with AIDS have been cxposed through
injection drugs either directly or with an infected injection chug-using partner. Hepatitis C is alio
transmitted the majority of times through sharing of infected syringes. Screening in county drug
treatment programs has shown that up tip 80%of clients are Hepatitis C positive. Countywide,there
may be as many as 15,000 Hepatitis C positive injection drug,users who could transmit the infection.
The cost,of syringes for a year for an injection drug user is less than$75.00; treatment costs for
Hepatitis C or HIV disease are well over 520,004 for a year. Harm reduction programs not only reduce
needle-sharing potential, but also allow for greater access to health education,early medical
intervention, and drug treatment.
CONSE CE N EGA ACT1
Failure to approve the recommended actions will prevent the HIV/AIRS Prevention and Control from
developing a comprehensive halal reduction prowarn that includes the exchange of
syringes and needles in Santa Clara County. "the existing,privately operated needle exchange program
could continue with a limited scope. Due,to the lack of availability of private funds, however,there
are no assurances that it would continue.
STEIaS lE0LL0W1N_Cx A,pPR# SAL
Return approved transmittal and Salary ordina=Amendment to SCV'HHS Administration.
DI