HIV/STI Prevention and Treatment Services

The County of Orange (County) Health Care Agency (HCA) is seeking applications from qualified organizations to increase capacity to provide Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STI) Testing, Care, Navigation and Referral Services to people at-risk for or people living with HIV (PLWH). Qualified organizations will optimize their existing HIV/STI programs and services to increase access to care and improve health care outcomes among populations disproportionately impacted by HIV.

This solicitation focuses on the goals and objectives of multiple funding sources including the Health Resource Services Administration (HRSA) Ending the HIV Epidemic (EHE) Initiative, Centers for Disease Control and Prevention (CDC) High-Impact HIV Prevention and Surveillance Programs and California Department of Public Health (CDPH), Sexually Transmitted Diseases Control Branch (STDCB) Sexually Transmitted Infections (STI) Prevention and Collaboration.

The primary goal of the Ending the HIV Epidemic (EHE) initiative is to reduce the number of new HIV infections in the United States by 90% by 2030. The EHE initiative focuses on four key strategies or pillars:

• Pillar One - Diagnose all people with HIV as early as possible;
• Pillar Two - Treat people with HIV rapidly and effectively to reach sustained viral suppression;
• Pillar Three - Prevent new HIV transmission by using proven interventions, including pre- exposure prophylaxis (PrEP) and syringe services programs (SSPs); and
• Pillar Four - Respond quickly to potential HIV outbreaks to get needed prevention and treatment services to people who need them.

Goals of the High-Impact HIV Prevention and Surveillance Programs include:

• HIV and STI testing of Priority Populations who face barriers in accessing testing in medical settings.
• Increase and Improve linkage of individuals to appropriate prevention, treatment, and care services.
• Increase and improve linkage to PrEP/Non-occupation Post-Exposure Prophylaxis (nPEP) services.
• Improve access and utilization of PrEP (HIV per-expose prophylaxis).
• Improve access and utilization of PrEP Navigation services.
• Expand Partner Services (notifying individuals who may have been exposed to HIV or and STI).
• Reducing HIV and STI infection rates in Orange County.

STI Prevention and Collaboration focuses on the implementation of public health activities related to monitoring, prevention, testing, and linkage to and retention in care activities for the most vulnerable and underserved individuals living with, or at high risk for, STIs. Key activities for STI prevention and collaboration include:

• Surveillance and disease investigation activities
• STI prevention, testing, linkages to care, care coordination, and treatment, among vulnerable and underserved clients at high risk for STI, with an emphasis on priority settings and populations

• Increase community-level capacity to deliver STI prevention, testing, navigation, linkages to care, care coordination, and treatment for vulnerable and underserved people at high risk for STIs

The services included in this Request for Applicants (RFA) were identified based on needs assessment, service utilization, and epidemiology data. Furthermore, the services are consistent with local, state, and national plans for providing HIV testing and prevention services to address the goals stated above. All services proposed should address how goals will be measured and achieved. In preparing applications, applicants should take into consideration the following:

1. Priority Populations

Services are intended to reach priority populations, which are individuals from populations disproportionately impacted by HIV to ensure maximum impact and goals of the initiative are met. Priority populations are:

1. 1. Men who have Sex with Men (MSM) population including MSM of color (African American/Black or Hispanic/Latino).
   2. People who are incarcerated or with history of incarceration.
   3. People who use drugs (PWUD) including people who inject drugs (PWID).
   4. People who are experiencing homelessness or at risk of homelessness.
   5. Young people (15-29).
   6. Transgender or gender non-conforming individuals.
   7. People who exchange sex for drugs, housing, and/or other resources.
   8. Cisgender women and other people who can become pregnant.
   9. Migrant and immigrant communities, including people who are undocumented.

2. HIV Continuum of Care

The HIV Continuum of Care provides measurable outcomes for the provision of quality care for PLWH in Orange County (See Figure 1). The stages of the continuum include:

a. Diagnosed with HIV: This is the percent of the total number of PLWH age 13 years and over who are aware of their status.

b. Receipt of HIV care: This is the percent of persons aged 13 years and over diagnosed with HIV who had at least one medical care visit (as indicated by having at least one viral load and/or CD4 count blood test) during the measurement year.

c. Retained in HIV care: This is the percent of persons aged 13 years and over diagnosed with HIV, whose most current address was in Orange County during the measurement year and had at least two CD4 or viral load results with at least three months in-between the first and last result.

d. HIV Viral Load Suppression: This is the percent of persons aged 13 years and over diagnosed with HIV with a viral load test result of less than 200 copies/mL at the most recent viral load test during the measurement year.

e. Linked to Care in 30 Days: This is the percent of persons aged 13 years and over newly diagnosed with HIV in 2023 who had one or more medical care visits (as indicated by having at least one viral load and/or CD4 count blood test) within 30 days of their diagnosis.

Additional information on Orange County’s HIV Care Continuum is available at:

HIV Statistics | Orange County California - Health Care Agency (ochealthinfo.com)

Figure 1. HIV Continuum of Care, Orange County 2023

Lastly, successful applicants must clearly demonstrate, in their application, the ability, expertise, and history of providing services as outlined in this RFA.