Implementing the National HIV/AIDS Strategy (NHAS) via

the CDC Funding Announcement for 2012-2016

SPG Meeting - August 17, 2011Portland State Office Building

Veda LatinSection Manager HIV/STD/TB Programs

Purpose Today

• Mini refresher of the National HIV/AIDS Strategy (NHAS)

• Discuss how the NHAS is reflected in the CDC Comprehensive HIV Prevention Programs for Health Departments funding announcement

• Discuss implications

National HIV/AIDS Strategy Vision

“The United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socioeconomic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination.”

Goals of NHAS

1. Reduce HIV incidence

2. Increase access to care and optimize health outcomes

3. Reduce HIV-related health disparities

4. Achieve a more coordinated national response to the HIV epidemic

NHAS Targets for 2015

Increase proportion of HIV+ persons who know their status from 79% to 90%

Rate of transmission by 30%Annual new infections by 25%

NHAS Targets for 2015

Increase Access to Care and Improve Health

Outcomes of People Living with HIV

Increase:• Clients linked to clinical care within 3

months of HIV diagnosis from 65% to 85%• Ryan White clients in continuous care from

73% to 80% • Ryan White clients with permanent housing

from 82% to 86%

NHAS Targets for 2015

Reduce HIV-Related Health DisparitiesIncrease proportion of diagnosed: • Gay and bisexual men with undetectable

viral load by 20%• HIV diagnosed Blacks & Latinos with

undetectable viral load by 20%

Continue to focus HIV prevention on substance abusers

Role of States in Reducing HIV Incidence

• Intensify HIV prevention efforts (resources) in communities where HIV is most heavily concentrated

• Use a combination of approaches to expand targeted efforts

• Educate all Americans about the threat of HIV and how to prevent it

Role of States in Increasing Access to Care and Improving Health Outcomes

• Foster seamless linkage to care

• Adopt policies increasing diversity of health care and related providers

• Support people living with HIV with co-occurring health conditions

Role of States in Reducing HIV-Related Health Disparities

• Reduce mortality in high-risk communities

• Support innovative community-level solutions to HIV in high-risk communities

• Reduce discrimination and stigma against people living with HIV

Role of States in Achieving a More Coordinated National Response

• Collaborate with federal

partners

• Coordinate planning across agencies

• Distribution of resources to greatest need

• Standardized and streamlined data collection

• Provide progress reports on NHAS goals

CDC’s Comprehensive HIV Prevention Programs for Health Departments – Funding Structure

• Realigns CDC funded HIV prevention activities with the 2010 NHAS

• Focus on high impact HIV prevention targeted to HIV+ and high-risk negative populations

• Moves beyond combination prevention by focusing on improved implementation, coverage, scale and impact

• Increases monitoring and accountability

Funding Structure (cont.)

Category A å HIV Prevention Programs for Health

Departments – (Core funding)Category B • Expanded HIV Testing for

Disproportionately Affected Populations (Oregon not eligible)

Category C å Demonstration Projects

Category A

Capacity Building & Technical Assistance

HIV Prevention Planning

Program Planning,

M & E, & QA

Required Activities

Core ComponentsRequired

Prevention with Positives

HIV Testing

Condom Distribution (Targeted)Policy Initiatives

Recommended Components

Social Marketing

Evidence-Based Interventions

Marketing, Media & Mobilization

PrEP & nPEP

HIV TestingCategory A

Core

Component

Setting in which diagnostic and treatment services are provided

Local health departments, STD clinics, hospitals, primary care clinics, private docs offices

Healthcare Settings Setting in which

diagnostic and treatment services are not provided

Outreach sites, community events, CBOs with no treatment/diagnostic services but that do provide screening services

Non-healthcare settings

HIV Testing (cont.)• Venues reaching persons with undiagnosed

infections;• Ensure provision of test results;• Screening for all pregnant women;• Strengthen/expand current testing efforts;• Include voluntary testing for other STDs

(HBV,HCV,TB);• Ensure laboratory testing quality and

performance;• Use new testing technologies as

appropriate.

Category ACore

Component

HIV Testing (cont.)

• For targeted testing in non-healthcare settings (only a few sites in Oregon), at least a 1.0% rate of newly identified HIV-positive tests annually.

• At least 85% of persons testing positive receive test results.

• At least 80% who receive test results are linked to medical care and attend their first appointment

• At least 75% who receive test results are referred and linked to Partner Services

Category ACore

Component

Comprehensive Prevention with Positives

• Linkage to care, treatment and services• Retention/re-engagement in care• Referral & linkage to other medical &

social services• Ongoing Partner Services• Ensure that HIV+ pregnant women receive

interventions & treatment• Case review & community action

secondary to missed perinatal HIV prevention opportunities

Category ACore

Component

Comprehensive Prevention with Positives (cont.)

• Risk screening followed by risk reduction interventions for HIV+ persons and HIV-discordant couples

• Behavioral, structural, and/or biomedical interventions for HIV+ persons

• Integrated hepatitis, TB, & STD screening, and Partner Services

• Reporting of CD4 & viral load results

Category ACore

Component

Condom Distribution

Condom distribution targeting HIV-positive personsand persons at highest risk of acquiring HIV

infection

Category ACore

Component

Policy Initiatives• Support efforts to align structures, policies

and regulations in the state with optimal HIV prevention, care and treatment

• Create an enabling environment for HIV prevention efforts

• Aim to improve efficiency of HIV prevention efforts where applicable

Category ACore Component

Jurisdictional HIV Prevention Plan

Jurisdictional HIV Prevention

Plan

Description of Existing Resources• Prevention

• Care and TreatmentNeed

• Resources• Infrastructure

• Service Delivery

Activities and Strategies• Timeline

• Responsible Party

Scalability• Population Level

Impact• Cost Efficient

NHAS

Jurisdictional Prevention Plan Process

Stakeholder Input/

Participation

Jurisdictional Plan

Letter of Concurrence

Capacity Building & Technical Assistance

• Conduct /update capacity building needs assessment of OHA, service providers and other partners, including CBO’s

• Provide or collaborate with partners to offer capacity building assistance to HIV prevention service providers, agencies and partners

• Ensure all key state health department staff are appropriately trained for job responsibilities under this program

Category ARequired Activity

Capacity Building & Technical Assistance (cont.)

• Provide/coordinate training and TA for providers and staff of participating healthcare facilities, CBOs and other service organizations

• Document and track provision of training and TA

• Facilitate exchange of information, peer-to-peer consultation and TA among sites

Category ARequired Activity

Funding Requirements

• Oregon must implement:

– All 4 core components, with resources distributed based on data and need

– All 3 required activities to support the core components

Category A

• Expanded HIV Testing in Disproportionately Affected Populations

• Applicants eligible for Category B have at least 3,000 Black/African American and Hispanic/Latino adults and adolescents living with a diagnosis of HIV infection as of year- end 2008

Category

BOregon is not eligible

Focus areas• Structural, behavioral, and biomedical

interventions• Innovative HIV testing initiatives• Improved linkage to & retention in care for

HIV+ persons• Advanced use of technology for

outreach, prevention messages, and linkage to services

Category

C

Demonstration Projects

Monitoring and Accountability

• Hold states accountable for local funding decisions

• Distribute state resources in alignment with the epidemic

• Provide information about programmatic/financial investment in any city representing 30% or more of the state’s overall disease burden

Resources

• National HIV/AIDS Strategy Information:–

http://aids.gov/federal-resources/policies/national-hiv-aids-strategy/

– http://www.whitehouse.gov/administration/eop/onap/nhas

• CDC’s Comprehensive HIV Prevention Programs for Health Departments – Funding :– http://public.health.oregon.gov/PreventionWellness/SafeLivi

ng/HIVPrevention/Pages/CDCFOA.aspx

Thanks to NASTAD & CDC for some of the slides

• The National Association of State and Territorial AIDS Directors

• The Centers for Disease Control and Prevention

Thoughts? Discussion?