Implementing the National HIV/AIDS Strategy (NHAS) via the CDC Funding Announcement for SPG Meeting - August 17, 2011 Portland State Office Building Veda Latin Section 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 Disparities Increase 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 √ HIV Prevention Programs for Health Departments – (Core funding) Category B Expanded HIV Testing for Disproportionately Affected Populations (Oregon not eligible) Category C √ Demonstration Projects

Category A Capacity Building & Technical Assistance HIV Prevention Planning Program Planning, M & E, & QA Required ActivitiesCore Components Required Prevention with Positives HIV Testing Condom Distribution (Targeted) Policy Initiatives Recommended Components Social Marketing Evidence-Based Interventions Marketing, Media & Mobilization PrEP & nPEP

HIV Testing Category 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 A Core 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 A Core 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 A Core 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 A Core Component

Condom Distribution Condom distribution targeting HIV-positive persons and persons at highest risk of acquiring HIV infection Category A Core 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 A Core Component

Jurisdictional HIV Prevention Plan Description of Existing Resources Prevention Care and Treatment Need 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 A Required 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 A Required 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 B Oregon 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: – – CDC’s Comprehensive HIV Prevention Programs for Health Departments – Funding : – Prevention/Pages/CDCFOA.aspxhttp://public.health.oregon.gov/PreventionWellness/SafeLiving/HIV Prevention/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?