PS12-1201: Comprehensive HIV Prevention Programs for Health Departments Program Overview Erica K. Dunbar, MPH Program Leader, Health Department Initiatives National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention Prevention Program Branch CBA Orientation Meeting - August 2014 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HIV/AIDS Prevention
Background With the Launch of National HIV/AIDS Strategy (2010), under PS12-1201, CDC was provided an opportunity to: Address misalignment of HIV prevention resource allocation (funding realignment) CDC created a funding algorithm based on the number of adults and adolescents living with a diagnosis of HIV through 2008 Application of this new funding formula resulted in funding realignment that is based on the magnitude of the HIV epidemic within each jurisdiction Realign CDC funded prevention activities (programmatic realignment) Focus on high impact prevention Decrease the number of FOAs to reduce administrative burden
Goals of PS12-1201 CDC s HIV Prevention Funding Opportunity Announcement for Health Departments Focus HIV prevention efforts in communities and local areas where HIV is most heavily concentrated to achieve the greatest impact in decreasing the risks of acquiring HIV; Increase HIV testing; Increase access to care and improve health outcomes for people living with HIV; increase awareness and educate communities about the threat of HIV and how to prevent it; Expand targeted efforts to prevent HIV infection using a combination approach; and Reduce HIV-related disparities and promote health equity. Project Period: January 2012 December 2016
Health Department FOA Categories The following categoriesare included in the new Health Department FOA: Category A: HIV Prevention Programs for Health Departments (core funding) Required Core Program Components: HIVTesting, Comprehensive Prevention with Positives, Condom Distribution, and Policy Initiatives Required Programmatic Activities: Jurisdictional HIV Prevention Planning, Capacity Building and Technical Assistance, and Program Planning, Monitoring and Evaluation, and Quality Assurance Recommended Program Components: Evidence-based HIV Prevention Interventions, Social Marketing, Media, and Mobilization, and PrEP and npep Category B: Expanded HIV Testing for Disproportionately Affected Populations (limited eligibilityand optional) Required: HIVTesting in Healthcare Settings Optional: HIV Testing in Non-healthcare Settings Optional: Service Integration Categor y C: Demonstration Projects to implement and evaluate innovative, high impact HIV prevention activities (competitive and optional) Focus areas include 1) structural, biomedical, and behavioral interventions (or any combination thereof), 2) innovative testing activities, 3) enhanced linkages to and retention in care, 4) advanced use of technology, and 5) use of CD4, viral load and other surveillance data to assess and reduce HIV transmission risk.
HIV Testing Categor y A: Program Components & Activities Four Required Program Components Comprehensive Prevention with Positives Three Required Program Activities Jurisdiction HIV Prevention Planning Policy Initiatives Condom Distribution Capacity Building & Technical Assistance Evidencebased HIV Prevention Interventions 3 Recommended Program Components Social Marketing, Media, and Mobilization PrEP and npep Services Program Planning, M&E, and Quality Assurance
Category A: Required Core Components and Activities Grantees must implement all four of the core components The distribution of resources and implementation of the elements under each core component should be based on scalability and balance of resources, epidemiologic data, local need, and at-risk and priority populations, including racial and ethnic groups. Grantees must also implement the three required activities to support the core components Approximately 75% of funding must be allocated to the required components and activities Jurisdictions are required to distribute resources within the state/jurisdiction in a manner aligned to the epidemic Using surveillance data for HIV prevention programs
Four Required Program Components HIV Testing Comprehensive HIV Prevention with Positives Condom Distribution HIV testing in healthcare, non health care settings and venues that target undiagnosed HIV infection HIV testing of pregnant women Ensure the provision of test results, particularly to clients testing positive Linkages to care Linkages to prevention services Partner services Interventions for HIV-positive persons Integrated screening Retention and re-engagement in care Target HIV positives persons and persons at risk of acquiring HIV infection Policy Initiatives Support efforts to align structures, policies, and regulations in the jurisdiction with optimal HIV prevention, care, and treatment and create an enabling environment for HIV prevention efforts
HIV Planning Jurisdictional HIV Prevention Planning The FOA requires the development of a Jurisdictional HIV Prevention Plan to include collaboration and coordination of HIV prevention, care and treatment services Collaborative HIV prevention planning process to include the engagement of community stakeholders (prevention planning group process) New approach to HIV Planning: Wider partner engagement and enlistment of a broader group of stakeholders More flexible models for engaging partners and stakeholders Greater continuity across prevention, care, and treatment services within the jurisdiction Streamlined approach to be less resource and time intensive, and more results-oriented
Categor y A: National Goal and Performance Standards National Goal: CDC expects approximately two million HIV tests will be provided annually, among all funded jurisdictions, when the program is fully implemented. Performance Standards: CDC expects each funded jurisdiction to achieve the following performance standards, when the program is fully implemented: For targeted HIV testing in non-healthcare settings or venues, achieve at least a 1.0% rate of newly identified HIV-positive tests annually. At least 85% of persons who test positive for HIV receive their test results. At least 80% of persons who receive their HIV positive test results are linked to medical care and attend their first appointment. At least 75% of persons who receive their HIV positive test results are referred and linked to Partner Services.
Examples of Program CBA/TA Topics Using surveillance data for program implementation (Data to Care) HIV planning Reimbursement and billing, to include obtaining third part y reimbursement for routine HIV tests CBA/TA to support meeting current requirements/performance standards (e.g., targeted testing in non-healthcare settings; linkage to care) CBA/TA that supports health departments with retooling CBOs (in this new era of HIV prevention) Need for improved data coordination, reporting, data systems, etc. Resource allocation
Categor y B: Expanded Testing for Disproportionately Affected Populations The focus of Category B Expanded Testing Program is to expand HIV testing through routine, opt-out testing in healthcare settings, linkages to care, and sustainability of programs (encourage reimbursement for HIV testing). The purpose of Category B is for Health Departments to implement expanded HIV testing efforts for populations disproportionately affected by HIV African Americans, Latino/Hispanic, MSM and IDU. Expanded HIV Testing in Healthcare Settings (required 70%) Expanded HIV Testing in Non- Healthcare Settings (optional up to 30%) Service Integration (optional)
Category B Funded Jurisdictions MT WA OR CA NV ID WY UT AZ CO NM TX ND SD NE KS OK MN IA MO AR LA WI IL MS AL GA FL SC AK HI TN NC KY VA WV IN MI OH PA NY ME VT NH MA RI CT NJ DE MD DC USVI Houston Los Angeles San Francisco NYC Chicago PR Philadelphia Key: Funded Category B Atlanta Baltimore
Categor y B: National Goal and Performance Standards CDC expects that approximately 1.3 million HIV tests are provided and approximately 6,500 HIV-infected persons who were previously unaware of their infection are identified annually. Performance Standards: CDC expects each funded jurisdiction to achieve the following performance standards, when the program is fully implemented: For targeted HIV testing in non-healthcare settings or venues, achieve at least a 2.0% rate of newly identified HIV-positive tests annually. At least 85% of persons who test positive for HIV receive their test results. At least 80% of persons who receive their HIV-positive test results are linked to medical care and attend their first appointment. At least 80% of persons who receive their HIV-positive test results are referred and linked to Partner Services. At least 80% of persons who receive their HIV-positive test results receive prevention counseling or are referred to prevention services.
FY2014 Billing Redirection CDC s FY 2014 budget requests health departments to redirect $10 million in HIV prevention funding to help HIV prevention grantees increase their capacity to seek reimbursement for services covered by private health insurance, Medicare and Medicaid. This redirection effort for HIV programs takes advantage of increases in insurance coverage and aims to help HIV testing efforts become less dependent on federal funding. With these redirected funds, jurisdictions will: Develop the infrastructure to establish or improve systems that allow for third party reimbursement for HIV testing and other related co-infections (e.g. sexually transmitted infections, hepatitis C, tuberculosis) Provide and/or facilitate needed technical assistance
FY2014 Billing Redirection In developing and implementing this redirection activity, health department grantees are expected to: Identify priority facilities (health department clinics and other health care settings) to work on increasing sustainability of HIV testing efforts (based on surveillance, epidemiology, and program data) Conduct a business case analysis Work towards implementing sustainable HIV testing programs that include billing for HIV testing: in 1-3 health department clinics; and in 1-3 other health care settings Identify mechanisms for collecting aggregate information on HIV tests
Examples of HIV Testing CBA/TA Topics CDC HIV Testing Algorithm Needs Assessment HIV Testing Methods HIV Linkage to Care Legal Issues Quality Assurance Third Party Reimbursement Enhancing routine HIV testing in a variety of primary care settings Conducting a business case analysis/assessment
Category C: Demonstration Projects Implement and evaluate existing or promising HIV prevention practices that support achievement of the NHAS goals based on focus areas. Use of CD4 and Viral Load Data for Prevention Individual or Combination Interventions Innovative HIV Testing Efforts Demonstration Projects are competitive and optional for up to 4 years of the project period. Advanced Use of Technology Enhanced Linkages and Retention in Care 30 HDs funded (as of March 2012)
MT WA OR CA NV ID WY UT AZ CO NM TX ND SD NE KS OK MN IA MO AR LA WI IL MS AL GA FL SC AK HI TN NC KY VA WV IN MI OH PA NY ME VT NH MA RI CT NJ DE MD USVI Los Angeles San Francisco NYC Chicago PR Key: Funded Category C Atlanta Baltimore Category C Funded Jurisdictions
PS 12-1201 Category C Demonstration Projects Each HD must address at least 1 of 5 Focus Areas (average is ~3 focus areas per HD) Note: N=80 total Focus Areas
FOA Website Information For more information, please visit: http://www.cdc.gov/hiv/topics/funding/ps12-1201/ Please send any general inquiries and questions to HDFOA@cdc.gov
PPB Health Department Initiatives and Acknowledgements Erica K. Dunbar, MPH, Program Leader, Health Department Initiatives Ted Castellanos, MPH, Program Coordinator, Health Department Initiatives Renee Freeman, MPH, Project Coordinator Expanded HIV Testing Program CDR John Belt rami, MD, MPH&TM, Category C Coordinator Benny Ferro, Team Lead, Category B Coordination Efforts Janet Cleveland, MS, Acting Branch Chief Prevention Program Branch Team Leads and Leadership Staff Prevention Program Branch Project Officers CDC Division of HIV/AIDS Prevention
Thank you! Contact Information: Erica K. Dunbar, MPH edunbar@cdc.gov 404-639-6048 For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD & TB Prevention Division of HIV/AIDS Prevention