Summary
What do they do? Face to Face provides HIV-related support, housing assistance, testing, prevention supplies, overdose education and referral services in Sonoma County. This narrow health model credits only incremental overdose-survival benefit, while charging the whole organization. More
Why this approach interests us
- Low-barrier naloxone access can reach a witnessed overdose before an effective alternative. The organization describes ongoing county outreach and hundreds of reversals.
Our main reservations
- The favorable 10% world contributes 92.6% of signed expected health; central is $3,598,461 per 10. Absolute reporting, recurrence, alternatives and cash response are not verified.
What do you get for your dollar?
Signed prior-weighted estimate: $1,328,757 per 10 Bay QALYs, or 0.075258 per $10,000. This is not measured Face to Face impact. Inspect the model, assumptions and scenarios.
- gross annual cost
- $2,263,089 — All programs and netted fundraising costs included.
- survival model
- One finite trajectory per person — A reported rescue is not equated with a death prevented.
- subjective scenario mass
- 10% below $1M per 10 QALYs — 0% below $100K; judgment weights, not calibrated probabilities.
1. What do they do?
Face to Face provides HIV-related support, housing assistance, testing, prevention supplies, overdose education and referral services in Sonoma County. This narrow health model credits only incremental overdose-survival benefit, while charging the whole organization.
Fund additional access
A small unrestricted gift may expand or maintain delivery beyond existing public/donor support; the fraction is uncertain.
Reach a genuinely different rescue opportunity
Reported events are discounted and converted to unique-person equivalents; alternatives and nonfatal overdoses reduce causal mortality benefit.
Compare finite survival
Integrate with-versus-without survival for each unique person, one support year and a finite common-risk follow-up. Subtract independent morbidity harm.
Scope of this review. No added HIV prevention, PrEP, housing, MOUD referral, drug-checking or other health credit. These omissions may understate true portfolio benefits, but no defensible nonoverlapping local outcomes were identified. Whole-cost dilution remains. Medication, volunteers, EMS and partner resource values are not fully reconciled.
2. Monitoring and information sharing
Unspecified last-year overdose activity
Current official organizational service page. Hundreds of reversals and thousands of kits claimed; exact year, verification, repeated people and numerator definitions absent.
Our assessment. 100/200/500 event equivalents are analyst priors, not observed precision. Reporting validity and unique-person recurrence are separate assumptions.
Mixed harm-reduction/HIV-HCV participants
Provider report to public funder. 425 cumulative unduplicated participants; 121 quarter, with inconsistent term and quarter labels.
Our assessment. Not naloxone-specific people, rescue events, deaths prevented or an extra additive cohort; not used in survival denominator.
Communities with overdose education/naloxone rollout
Massachusetts interrupted time series, 19 communities, 2002–2009. Adjusted mortality ratios .73(low) and .54(high) versus no implementation; acute-care differences nonsignificant.
Our assessment. Observational pre-fentanyl community effect does not identify current Sonoma net rescue probability or donor marginal impact.
67 communities in four states during fentanyl/pandemic period
HEALing Communities cluster-randomized multicomponent intervention. Primary opioid mortality reduction not statistically significant; a RR.91,95% CI.76–1.09. Naloxone distribution increased 79%.
Our assessment. Not proof naloxone pharmacology fails; shows more distribution need not translate into demonstrated marginal mortality reduction. Supports explicit null and alternatives.
Synthetic unique rescued-person cohort
Analyst finite survival model, not a clinical study. Counterfactual excess hazard only during one support year; common post-support mortality; finite 2–8 years and 3% discount.
Our assessment. No source validates the org-specific hazard, utility, recurrence, finite horizon or capacity coefficients. Cohort mathematics prevents repeated rescue double credit but does not make those inputs empirical. During the one-year active interval, survival with rescue is exp(-otherHazard*t), and counterfactual survival is exp(-(otherHazard + repeats*fatality)*t). The repeats parameter serves both as the event-to-person divisor and as a modeled annual Poisson rescue-opportunity rate. Neither that prospective rate nor net fatality is statistically inferred from reported successful reversals; both are explicit analyst transfers from a selected-survivor activity description.
3. Qualitative assessment
Low-barrier naloxone access can reach a witnessed overdose before an effective alternative. The organization describes ongoing county outreach and hundreds of reversals.
Key reservations
- The primary categorical event claim is weaker than an audited annual rescue ledger.
- Whole portfolio costs are dated 2024; current prices and program mix can differ.
- Reported successful rescues are selected survivors, not a prospective at-risk denominator.
- EMS, peers, pharmacies and state-supported distribution are real alternatives.
- Unique-person and hazard assumptions are not measured.
- Favorable world drives 92.6% of expected benefit.
- No verified donation route is included; donationUrl omitted.
Benefits not included in our estimate
- HIV transmission prevention and PrEP treatment
- Housing and non-medical case-management health
- Referral contacts counted as completed MOUD
- Drug checking credited independently
- Unlimited lifetime survival or repeated rescue restart
4. What do you get for your dollar?
$1,328,757 per 10 Bay QALYs
Six correlated judgment worlds, including funding-null, rescue-null and harm, are averaged in signed QALYs before inversion. No coefficient tuned after first output.
A better life is our comparison unit of 10 additional quality-adjusted life years (QALYs), potentially spread across people. These are uncertain estimates, not measured returns or verified donation offers.
How we calculate the estimate
Unique-cohort signed health: gift / gross expense × (reported events × validity / events per person) × funding × [utility × integral(discounted survival with rescue − survival without rescue) − harm] × Bay share
0.07525830883941727 Bay QALYs/$10,000
Model inputs and assumptions
- Gross whole annual expense
- 2263089 (range: 2024 historical basis). Part IX plus netted event costs; all portfolio costs, no public-revenue subtraction. High accounting.
- Reported rescue-event equivalent
- 200 (range: 100–500). Analyst numerical interpretation of undated hundreds, not observed exact annual throughput.100 discounts stale/ambiguous claim; no inflation for unreported rescues. Low.
- Credible relevant-event fraction
- .5 (range: .3–.8). Discounts uncertain reporting year, duplicate reports of same event, and misclassification; distinct from repeated genuine events in same person. Very low.
- Rescue opportunities per unique person
- 2 (range: 1.5–3; diagnostic 10). Unobserved recurrence; unique cohort=events×validity/repeats. Each person has one finite survival trajectory. Very low.
- Otherwise-fatal probability per opportunity
- .15 (range: .05–.25 plus zero). Net of equally timely alternative naloxone/EMS, spontaneous recovery and attribution. Not certainty of death after an observed reversal. Very low.
- Common mortality hazard in support year
- .2/year (range: .1–.3). Includes other competing fatal risks; active incremental hazard removed is repeats×fatality. No org-specific mortality estimate. Very low.
- Common post-support mortality hazard
- .25/year (range: .15–.5). Both arms face same hazard after one year; accounts for later overdose and other mortality without assuming continuing donor support. Very low.
- Finite follow-up
- 5 years (range: 2–8 years). One year active support, finite subsequent survival credit, 3% discount; favorable 8 years is assumption not measured life expectancy. Very low.
- Utility while alive
- .7 (range: .6–.8). Judgment, not measured QALYs or valuation of a person; only health-adjusted survival in this model. Very low.
- Gift capacity response
- .3 (range: 0–.6). Unknown additional service versus funded public/donor baseline, reserves and substitution; no verified marginal tranche. Very low.
- Bay health fraction
- .98 (range: .95–.99). Sonoma service footprint; rescue location and residence not census-verified. Moderate.
- Independent harm QALY per additional person
- .001 (range: 0–.01). Judgment for morbidity such as precipitated withdrawal or delay; no measured incidence, no repeat event harm multiplier. Very low.
Small $10,000 diagnostic; no linear $100,000 capacity assurance
- funding_null: Undefined per 10; weight 0.2. Bay QALYs 0; unique baseline person-equivalents 50; finite Q per unique 0.42882628927998306. Full matrix saved.
- rescue_null: Undefined per 10; weight 0.2. Bay QALYs 0; unique baseline person-equivalents 50; finite Q per unique 0. Full matrix saved.
- harm: Undefined per 10; weight 0.1. Bay QALYs-0.0006495546573731746; unique baseline person-equivalents 50; finite Q per unique 0. Full matrix saved.
- cautious: $300,914,228 per 10; weight 0.2. Bay QALYs 0.00033232061024485073; unique baseline person-equivalents 10; finite Q per unique 0.08116538079141149. Full matrix saved.
- central: $3,598,461 per 10; weight 0.2. Bay QALYs 0.027789655874849602; unique baseline person-equivalents 50; finite Q per unique 0.42882628927998306. Full matrix saved.
- favorable: $143,474 per 10; weight 0.1. Bay QALYs 0.696988690081357; unique baseline person-equivalents 266.6666666666667; finite Q per unique 0.9963001500300053. Full matrix saved.
- half_events: Half categorical event rate. $2,657,514 per 10; Bay QALYs 0.037629154419708634.
- repeat10: Ten rescue opportunities per person. $2,828,569 per 10; Bay QALYs 0.03535356767227561.
- one_year: No survival credit after support year. $10,500,290 per 10; Bay QALYs 0.009523546282645678.
- half_fatality: Half otherwise-fatal probability after alternatives. $2,445,781 per 10; Bay QALYs 0.040886731249627634.
- half_funding: Half gift response. $2,657,514 per 10; Bay QALYs 0.037629154419708634.
- full_funding: Full response except funding-null world. $739,977 per 10; Bay QALYs 0.1351393419314912.
- double_resources: Double whole expense for hypothetical omitted resources. $2,657,514 per 10; Bay QALYs 0.037629154419708634.
Uncertainty. Without favorable world, renormalized cost is $16,188,681 per 10. Prior weights are subjective. Event opportunity counts are modeled as a constant hazard in a closed aligned cohort, not recovered person-time; selection of survivors and actual event timing are unknown. First-year full removal applies only to the net otherwise-fatal component after alternatives, not every overdose. Repeated events never restart follow-up. During the one-year active interval, survival with rescue is exp(-otherHazard*t), and counterfactual survival is exp(-(otherHazard + repeats*fatality)*t). The repeats parameter serves both as the event-to-person divisor and as a modeled annual Poisson rescue-opportunity rate. Neither that prospective rate nor net fatality is statistically inferred from reported successful reversals; both are explicit analyst transfers from a selected-survivor activity description.
5. Funding and previous grants
HOLD giving recommendation. Exploratory publication is defensible; no verified marginal funding offer or measured mortality benefit.
2024 gross cost $2,263,089 includes $59,068 event costs netted from reported revenue and excluded from Part IX. Government grants $132,330, noncash contributions $397,827, net assets $1,482,170 and public investments $920,149 are not a funding gap. State medication supply and city-funded activities already exist. In-kind contributions cannot be subtracted without expense reconciliation. Paid/donated inputs, restricted public contracts, current allocation and complete societal cost remain incompletely identified. A general donation mechanism, if offered, would not establish a cash-priced additional cohort, current expansion capacity, or the modeled funding response.
This review does not establish a verified marginal funding offer or a complete history of grants.
We have not verified a suitable donation route for this reviewed activity. Confirm the legal recipient and intended allocation before donating.
6. Sources
- Current overdose prevention services. Face to Face. Primary. Published: Undated; retrieved 2026-09-11; retrieved: 2026-09-11.
- Original FY June 2024 Form 990. IRS via ProPublica. Primary. Published: Submitted 2025-05-09; retrieved: 2026-09-11.
- Opioid Settlement Funds status report. Face to Face via City of Santa Rosa. Primary. Published: Signed 2025-07-17; retrieved: 2026-09-11.
- COPHRI. Face to Face. Primary. Published: 2026-07-22; retrieved: 2026-09-11.
- Massachusetts overdose education and naloxone study. Walley et al.. Primary. Published: 2013-01-31; retrieved: 2026-09-11.
- HEALing Communities randomized trial results. NIH. Primary. Published: 2024-06-16; retrieved: 2026-09-11.
- Exploratory community-level cohort analysis. HEALing Communities investigators. Primary. Published: 2026; retrieved: 2026-09-11.
- Naloxone Distribution Project. DHCS. Primary. Published: Current program; retrieved: 2026-09-11.
- Syringe services. Face to Face. Primary. Published: Undated; retrieved: 2026-09-11.
Annual expenses: years and sources
Average annual expenses (three consecutive fiscal years): $1,903,012. Organization size is separate from the modeled cost-effectiveness of a donation.
Face To Face Sonoma County Aids Network
Form 990/990-EZ reported whole-entity expenses; includes program, administration and fundraising costs, but excludes any costs netted against revenue.
Latest original return and prior-year comparative combined with earlier filing data.