Integrated HIV Prevention and Care Planning Groups and Activities July 30, 2013 Andrea Jackson, MPH U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) Division of Metropolitan HIV/AIDS Programs (DMHAP)

What Is Integrated Planning? Integrated planning is the sharing, merging or integration of a State’s HIV/AIDS Prevention (CDC-sponsored) and Care (Ryan White–sponsored) planning groups This may be accomplished through collaboration on joint projects, sharing planning products, sharing members, or totally integrating into one planning body

Why Integrated Planning? To develop a coordinated Statewide response to HIV/AIDS To avoid duplication of processes Many points of intersection and shared knowledge, data and processes (ex. epidemiological profile, by-laws, nominations, community involvement) More economical (sharing resources) May have some of the same people on both groups already Increased collaboration and communication

Why Integrated Planning? HIV testing and referral to care is often funded by both prevention and care dollars Fosters integration of prevention into care services Community viral load as a recognized form of prevention, requires good care coordination Partner services is also important to both prevention and care

Why Integrated Planning? Key National Policy Shifts: The White House’s National HIV/AIDS Strategy (2010) CDC’s High-Impact HIV Prevention (HIHP) (2011) CDC’s Advancing HIV Prevention (AHP) Initiative (2003) CDC/HRSA Advisory Committee on HIV, Viral Hepatitis and STD Prevention and Treatment (2002) OMB’s increasing emphasis on streamlining CDC and HRSA requests for information from programs Improve efficiency and effectiveness of federal programs

Why Should Care And Treatment Planners Pay Attention To Prevention? New strategies for HIV prevention impact care settings PrEP Treatment = Prevention Strategies to encourage knowledge of sero-status To facilitate linkages Maximize service provider capacity

Why Should Prevention Planners Pay Attention To Care And Treatment? CDC’s AHP and HIHP expand counseling, testing and referral (CTR) and partner counseling and referral services (PCRS) Strategies to provide prevention for HIV positive individuals Provide behavioral interventions in clinical care To facilitate linkages Maximize service provider capacity

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 HIV negative individuals are linked to prevention and other services

Common Goals of Prevention and Care Plans are comprehensive and promote coordination and linkages of services Ensure planning reflects the diversity local epidemic Assure meaningful involvement of PLWH in planning processes Assess effectiveness of plans and processes

Partnerships and Collaboration HRSA expects collaboration, partnering, and coordination in planning and implementation of services between multiple sources of treatment, care and prevention service providers HIV testing sites Non-Ryan White Program providers All Ryan White Program Parts (A, B, C, D, and F) Medicaid and Medicare VA

Possible Barriers To Integration 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

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

Operationalizing Collaboration Develop operating principles (vision, mission) and by- laws Specify member recruitment and orientation Examine required products of planning Consider multiple opportunities/strategies for community/consumer input into planning Obtain training, skills-building and TA (ex: cross-training prevention/care staff)

Operationalizing Collaboration (cont.) Address fears and provide information Set clear goals and objectives for collaborative planning Develop an implementation plan Give the process time Leadership selection that is representative and neutral

Models for Collaborative Planning Information Sharing Cross Representation on Prevention and Care Planning Bodies Coordinated/ Combined Projects or Meetings Merged Bodies Needs Assessment Activities

HIV/AIDS Planning Models As known to NASTAD as of December 2012

HRSA’s HIV/AIDS Bureau (HAB)- Ryan White Part A “Crosswalk” of CDC & HRSA Planning Requirements & Expectations (snapshot) CDC- HIV Prevention HRSA’s HIV/AIDS Bureau (HAB)- Ryan White Part A Planning Body   HIV Planning Group (HGP) - state, regional, or local Planning Council Planning Body - Primary Function To inform the development or update of the health department’s Jurisdictional HIV Prevention Plan that will contribute to the reduction of HIV infection in the jurisdiction To carry out planning and determine the allocation of Ryan White Part A funds within the EMA or TGA to provide a continuum of care that meets the most critical service needs of eligible people living with HIV/AIDS, including traditionally underserved populations, to get people linked to and retained in care and achieve positive health outcomes Planning Body Membership - Nomination and Selection Process Nomination through an open process All members required to go through a clearly defined open nominations process Planning Body - Membership Composition Jointly, HPG and Health Department develop and apply criteria for selecting HPG members, placing special emphasis on identifying representatives of at-risk, affected, HIV-positive, and socioeconomically marginalized populations Legislation specifies membership categories and requirements; CEO further determines membership size and composition when establishing the Planning Council and may review proposed changes in Bylaws Created by EGMC for the TAC

Los Angeles, CA Integrated Planning Commission (serves as the RWPA Planning Council) and Prevention Planning Committee (PPC) had several shared members and a joint committee Commission had far more funding, a larger staff, and responsibility for determining the use of millions of federal, state, and county funds PPC members were concerned that if the two groups merged, the Prevention planning function could receive less focus than the HIV care-focused work of the Commission

Los Angeles Integrated Planning Integration Task Force was established in 2012. It included representatives of both planning bodies and had two Co-Chairs from each group. TF jointly developed RWPA Comprehensive Plan The joint body voted unanimously (in March) to create a new, unified planning body and approved its functions, structure, and membership composition First, there had to be agreement on the roles and functions of the new planning body, then a determination of membership and structure

Los Angeles - Lessons Learned Preparing a joint comprehensive plan provides a good foundation for eventual integration into a single body Taking time to develop shared knowledge and trust is extremely important Establishing and maintaining a sense of parity enables both bodies to accept compromises Merging the two bodies seems highly desirable once everyone recognizes the increasing overlap in the roles of prevention and care

References CDC/HRSA Letter Supporting Integrated Planning Models, In progress Dear Colleague Letter, Mermin and Cheever, May 22, 2013 NASTAD HIV/AIDS Planning Models (as of 12/2012), B. Pund, April 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, June 5, 2006 “Crosswalk of CDC & HRSA Planning Requirements and Expectations” EGMC for the TAC “Developing a Unified HIV Prevention and Care Planning Body: Lessons from the Los Angeles EMA” Prepared for: Division of Metropolitan HIV/AIDS Programs HIV/AIDS Bureau Prepared by: Emily Gantz McKay EGM Consulting, LLC

Questions? Andrea Jackson, MPH Public Health Analyst (301) 443-8364 AJackson@HRSA.gov hab.hrsa.gov