Integrated SCSN/Comprehensive Plans and How a Range of Integrated HIV Planning Activities Can Contribute Harold J. Phillips, MRP Deputy Director Division of State HIV/AIDS Programs HIV/AIDS Bureau Health Resources and Services Administration Angel Ortiz Ricard, JD Associate Deputy Director for Prevention Programs Division of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention Centers for Disease Control and Prevention
Upcoming Guidance on Integrated SCSN/Comprehensive Plan In February 2014, the Centers for Disease Control and Prevention (CDC)/Division of HIV/AIDS Prevention (DHAP) and the Health Resources and Services Administration (HRSA)/HIV/AIDS Bureau (HAB) issued a joint letter indicating that guidance will be provided to allow grantees to submit an Integrated Statewide Coordinated Statement of Need (SCSN)/Comprehensive Plan that would fulfill the legislative and programmatic requirements for the Ryan White HIV/AIDS Program (RWHAP) and the HIV Prevention Programs The guidance will address the content and structure of the Integrated SCSN/Comprehensive Plan The guidance will not address the planning process that grantees use to develop the Integrated SCSN/Comprehensive Plan 2
Upcoming Guidance on Integrated SCSN/Comprehensive Plan March July 2014 HRSA/HAB Workgroup and CDC/DHAP Workgroup Integrated SCSN/Comprehensive Plan Discussions July 8-9, 2014 NASTAD/CDC/HRSA Integrated Data & Integrated SCSN/Comprehensive Plan Consultation Meeting August 2014 HRSA/HAB Workgroup and CDC/DHAP Workgroup Reconvene Spring 2015 Release New HRSA/HAB CDC/DHAP Guidance on Integrated SCSN/Comprehensive Plan September 2016 Integrated SCSN/Comprehensive Plan Due 3
HAB DHAP Letters Supporting Integrated Planning and Plans May 22, 2013 (Planning) o Encourages planning groups to streamline approaches to HIV planning o Supports planning as an important part of developing systems of HIV care and prevention February 24, 2014 (Integrated SCSN/Comprehensive Plan) o Establishes new due date for plans and SCSN September 2016 o Encourages streamlining and lists some activities 4
HAB DHAP Integrated SCSN/ Comprehensive Plan Workgroup Shared information regarding requirements Shared sample plans Held two discussions on the tasks and some of the outputs Meeting this summer and fall to develop Integrated SCSN/Comprehensive Plan guidance for release spring 2015 5
RWHAP Part A and Part B Integrated SCSN/Comprehensive Plan Challenges Multiple plan requirements o RWHAP Part A Comprehensive Plan Requirements o RWHAP Part B Comprehensive Plan Requirements o Statewide Coordinated Statement of Need RWHAP Part A Planning Councils mandated membership RWHAP Part B planning models and membership vary Integration takes leadership and lots of work 6
Next Steps for Integrated SCSN/ Comprehensive Plan Workgroup Continue to review the legislative and programmatic requirements for the jurisdictional plans, SCSN, Comprehensive Plans Encourage the use of surveillance and program data Align terminology Exploration of technical assistance (TA) needs and resources Issue guidance for content and structure 7
Integrated Planning What is it and how can it contribute to an Integrated SCSN/Comprehensive Plan? Integrated planning is the process by which HIV planning groups work together to: review information about the HIV epidemic in the jurisdiction; provide recommendations for and/or allocate resources for interventions and services to address the epidemic; and review needs assessments and/or service utilization to further inform recommendations May be accomplished through collaboration on joint projects, sharing planning products, sharing members, or totally integrating into one planning body 8
Why Integrated Planning Activities? To develop a coordinated jurisdictional response to HIV To avoid duplication of processes Many points of intersection and shared knowledge, data and processes (e.g., epidemiological profile, by-laws, nominations, community involvement) More economical (sharing resources) Increased collaboration and communication 9
Why Integrated Planning Activities? Prevention and care are increasingly overlapping in both activities and funding o In order to coordinate efforts and maximize funding, it is helpful if everyone is at the table Fosters integration of prevention into care services Allows monitoring of outcomes across the Continuum of Care 10
Why Integrated Planning Activities? Key National Policy Initiatives support it: o President s Executive Order on the Continuum of Care (2013) o CDC s High-Impact HIV Prevention (HIHP) (2011) o The White House s National HIV/AIDS Strategy (2010) o HHS focus on reducing reporting burden for grantees Improve efficiency and effectiveness of federal programs 11
Why Care & Treatment Planners Should Pay Attention to Prevention New strategies for HIV prevention impact care settings o PrEP o Treatment = Prevention Strategies to encourage knowledge of sero-status Facilitate linkages Maximize service provider capacity Maximize resources for overlapping activities 12
Why Prevention Planners Should Pay Attention to Care and Treatment CDC s HIP expands counseling, testing and referral (CTR) and partner services Strategies for prevention with people living with HIV (PLWH) Treatment = prevention Provide behavioral interventions in clinical care Facilitate linkages Maximize service provider capacity Maximize resources for overlapping activities 13
CDC Stages of Care 2009 National HIV Surveillance System & Medical Monitoring Project CDC. HIV in the United States: Stages of Care. July 2012. Hall HI, Frazier EL, Rhodes P, et al. JAMA Internal Medicine. Jun 17 2013:1-7.
Ryan White Services Report, 2010-2012 Retention in Care & Viral Suppression Retained in care: had at least 1 OAMC visit before September 1, 2012, of the measurement year and had at least 2 visits 90 days or more apart Viral suppression: had at least one OAMC visit, at least one viral load count, and last viral load test <200
Partnerships and Collaboration HRSA & CDC expect collaboration, partnering, and coordination in planning and implementation of services between multiple sources of treatment, care and prevention service providers o HIV testing sites o Non-Ryan White HIV/AIDS Program providers o All Ryan White HIV/AIDS Program Parts (A, B, C, D, and F) o Medicaid and Medicare o VA 16
Common Goals of Prevention and Care To ensure that individuals learn their HIV status To ensure that HIV positive individuals are linked to medical care, supportive services, and prevention services that meet their unique needs To ensure that high risk HIV negative individuals are linked to prevention and other services 17
Common Goals (cont.) Plans are comprehensive and promote coordination and linkages of services Ensure planning reflects the diversity of local epidemic Assure meaningful involvement of PLWH in planning processes Assess effectiveness of plans and processes 18
Possible Barriers to Integrated Planning Competing agendas (turf issues, mistrust) Over-dominance by either care or prevention More meetings for members who had only been on one group prior Categorical funding/requirements from CDC and HRSA Transition phase requires initial influx of resources to increase knowledge about care and prevention 19
Benefits of Integrated Planning Allows development of common mission/vision Encourages sharing of knowledge and data Combines/maximizes limited resources Reduces planning costs in the long term Creates comprehensive services/encourages linkage of services Fosters integration of prevention into care services and vice versa 20
Range of Integrated Planning Activities 1. Information Sharing 2. Cross Representation 3. Joint Information Gathering/Data Analysis 4. Other Joint Projects 5. Joint Prevention/Care Plan 6. Joint Planning Committee 7. Unified Prevention/Care Planning Body 21
HIV/AIDS Planning Models (July 2014) AK WA OR NV CA ID UT AZ MT WY CO NM ND SD NE KS OK MN WI IA MO AR IL MS MI IN OH WV KY VT NH NY PA VA NC TN SC AL GA ME DE MD NJ MA RI CT Prevention Planning TX LA FL Integrated Prevention- Care Planning HI Directly funded city Prevention Planning Atlanta Baltimore Chicago Fort Lauderdale Houston Los Angeles Miami New York City Philadelphia San Francisco Puerto Rico U.S. Virgin Islands District of Columbia U.S. Affiliated Pacific Jurisdictions
Examples of Integrated Planning Activities Los Angeles California Minneapolis Minnesota 23
Next Steps for Integrated Planning HRSA\HAB and CDC\DHAP will continue to encourage a range of integrated planning activities Jurisdictions should assess the range of activities and determine which are most beneficial and cost effective to implement Exploration of TA needs and resources 24
Next Steps for Integrated Plans HRSA\HAB and CDC\DHAP will continue to encourage a range of integrated planning activities Jurisdictions should assess the range of activities and determine which are most beneficial and cost effective to implement Guidance on the SCSN/Comprehensive and Jurisdictional Plans will be released spring 2015 Exploration of TA needs and resources 25
References CDC/HRSA Letter Supporting Integrated Planning Models, In progress Illinois Department of Public Health CAPUS Demonstration Project PowerPoint, M. Williamson, 2/21/2013 Integrated HIV Planning webinar, NASTAD, 02/21/2013 Fact Sheet: The Care and Prevention in the United States (CAPUS) Demonstration Project, CDC website, http://www.cdc.gov/hiv/topics/funding/ps12-1210/resources/factsheet/ NASTAD HIV/AIDS Planning Models (as of 12/2012), B. Pund, 4/19/2013 Toolkit: Integrated, Collaborative or Merged Prevention and Care Planning Processes, NASTAD, May 2007 Trends in Collaborative Care and Prevention Planning PowerPoint Presentation, NASTAD, C. Jorstad, 06/05/2006 Target Center: Tools for the Ryan White Community https://careacttarget.org/topics 26
Discussion/Questions 27
Thank you! 28