2. Planning Together: Creating Synergy between Your Jurisdiction's GTZ/ETE Plan and the CDC HRSA Integrated HIV Prevention and Care Plan
Molly Tassoa, Mike Torresb, and Annette Rockwellc
aIntegrated HIV/AIDS Planning TAC Technical Assistance Coordinator, JSI Research & Training Institute, Inc.
bHealth Program Planning Specialist III, STD/HIV Prevention & Control, County of Santa Clara, Public Health Department
cInfectious Disease Drug Assistance Program Director, Office of HIV/AIDS, Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health

3. IHAP TAC
Stewart
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U69HA30144, Ryan White HIV/AIDS Program Integrated HIV Planning Implementation. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

4. About the IHAP TAC Supports Conducts 3-year project
national & targeted
Ryan White HIV/AIDS Program Parts A & B recipients and their respective planning bodies with integrated planning including implementation of their Integrated HIV Prevention and Care Plans
began
July 1, 2016
training and technical assistance activities
Stewart: As a reminder, the IHAP TAC is a three year cooperative agreement to support jurisdictions and their planning bodies with implementation of the Integrated HIV Prevention and Care Plans, including both national and targeted TA activities.

5. Support available through the IHAP TAC
Integrating HIV prevention and care at all levels
Strategies for implementing Integrated Plan activities
Publicizing and disseminating progress of Integrated Plan activities to stakeholders
Identifying roles and responsibilities for Integrated Plan activity implementation
Monitoring and improving Integrated Plan activities
Collaborating across jurisdictions
Stewart
-       Integrating HIV prevention and care at all levels
-       Strategies for implementing Integrated Plan activities
-       Publicizing and disseminating progress of Integrated Plan activities to stakeholders
-       Identifying roles and responsibilities for Integrated Plan activity implementation
-       Monitoring and improving Integrated Plan activities
-       Collaborating across jurisdictions

6. Workshop Learning Objectives
Following the workshop, participants will be able to:
Describe three ways that ETE/GTZ plans and CDC HRSA Integrated HIV Prevention and Care plans are similar and dissimilar.
Identify whether the two types of plans might engage different population segments of a jurisdiction and the pros and cons of doing so.
Describe two strategies for helping coordinate activities across the two plans to avoid duplication and leverage resources in an effective manner.
Stewart
Describe three ways that ETE/GTZ plans and CDC/HRSA Integrated HIV/AIDS Prevention and Care plans are similar and dissimilar.
Identify whether the two types of plans might engage different population segments of a jurisdiction and the pros and cons of doing so.
Describe two strategies for helping coordinate activities across the two plans to avoid duplication and leverage resources in an effective manner.

7. Panel Participants Molly Tasso, JSI, IHAP TAC
Mike Torres, Health Planning Specialist III, Department of STD & HIV Prevention and Control, County of Santa Clara, Public Health Department
Annette Rockwell, Infectious Disease Drug Assistance Program Director, Office of HIV/AIDS, Massachusetts Department of Public Health
Stewart
Describe the rationale and benefit of aligning Integrated HIV Prevention and Care Plans and local Getting to Zero/Ending the Epidemic initiatives.
Identify at least one way jurisdictions can operationalize integration efforts.
Describe at least one practical strategy to engage and involve new stakeholders in Integrated Planning Efforts.

8. Audience Poll (#1)
Do you have an “End the Epidemic/Getting to Zero plan in your jurisdiction?
Yes No
Unsure
Stewart

9. Audience Poll (#2)
Does your jurisdiction have an integrated or joint prevention and care planning body?
Yes
Integration currently in progress
Thinking about it No
Other
Not applicable
Stewart

10. Background: Integrated HIV Prevention and Care Plans and Getting to Zero/Ending the Epidemic Initiatives
Molly Tasso
IHAP TAC
Molly
Thanks, Stewart!
Before we dive into discussing the ways jurisdictions are aligning their Integrated Plans and their Getting to Zero or Ending the Epidemic Initiatives, it’s important to first understand the similarities and differences between these types of plans, and how each came to be valuable tools used to advance and promote care and prevention efforts in their communities.

11. National HIV/AIDS Strategy: 2020 Goals
Four primary goals
Reduce new HIV infections
Increase access to care and optimize health outcomes for people living with HIV (PLWH)
Reduce HIV-related health disparities and health inequities
Achieve a more coordinated national response to the HIV epidemic
Increase the coordination of HIV programs across the Federal government and between Federal agencies and State, territorial, Tribal, and local governments.
Molly
I’m sure we are all aware of the National HIV/AIDS strategy, although the focus is usually placed on the first three goals. The development of integrated HIV prevention and care plans is a step to support progress towards and eventually achieve the fourth goals – a more coordinated national response to the HIV epidemic, specifically by way of increasing coordination of HIV programs across the Federal government and between federal agencies and state, territorial, tribal and local governments.

12. CDC and HRSA’s Alignment of Goals and Expectations Facilitates Integration
Integrated HIV Prevention and Care Plan Guidance, including Statewide Coordinated Statement of Need (SCSN) released in for Integrated HIV Prevention and Care Plans.
Integrated Plan is a living document serving as a roadmap to guide each jurisdiction’s HIV prevention and care service planning throughout the year.
An underlying goal of integrated planning is to better leverage resources and improve efficiency and coordination of HIV prevention and care service delivery.
Molly
To this end, in 2015, the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) released joint guidance to support the submission of an Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need (SCSN).
The guidance built upon efforts to:
Further reduce reporting burden and duplicated efforts
Streamline the work of health department staff and HIV planning groups
Promote collaboration and coordination in the use of data
Integrated Plans are considered ‘living documents’ which serve as a roadmap to guide jurisdiction’s HIV prevention and care service planning throughout the year, and also support jurisdictions to better leverage resources and improve efficiency and coordination of HIV prevention and care service delivery.

13. Development of Integrated Plans
Each HRSA RWHAP Parts A and B and CDC prevention - funded jurisdiction to participate in the completion and submission of an Integrated HIV Prevention and Care Plan
Health departments and HIV Planning Groups responsible for development.
Guidance provided by HRSA and CDC detailed what content was required to be included in the Plan
SMART objectives, activities, strategies, responsible parties, plans for monitoring and improvement.
Jurisdictions had the option to submit various types of plans
Molly
As required by HRSA and CDC, each HRSA Ryan White Part A and B and CDC prevention funded jurisdictions were required to participate in the completion and submission of an Integrated HIV prevention and care Plan. Ultimately, health departments and HIV Planning Groups were responsible for the plan development.
To help aid in the development of plans, HRSA and CDC released guidance that detailed what content was required to be in the plan. Specifically, plans were required to contain SMART objectives, activities, strategies, description of responsible parties for completing the activities, and also plans for ongoing monitoring and improvement of the plan.
Recognizing that a ‘one-size fits all’ approach would not work for all jurisdictions, HRSA and CDC provided jurisdictions with the option to submit various types of plans.

14. Types of Integrated Plans Submitted
Type of Integrated HIV Prevention and Care Plan
(All plans include both prevention and care) # %
Total, Integrated Part B-only Plans 37
46%
Part B only (no Part A recipients in state) 29
Part B only (Part A recipients submitted separately) 8
Total, Integrated Part A-only Plans 21
26%
Part A only - EMAs 12
Part A only - TGAs 9
Total, Integrated Part A/Part B Plans 22
28%
Total Plans Submitted 80
Molly
As you can see, jurisdictions took advantage of the opportunity to develop and submit different types of integrated plans.
As outlined in the chart, 37 plans, representing almost half of the 80 plans submitted, were submitted on behalf of the Part-B program, only. However, 29 of these plans were submitted in states without a Part A program. On the other hand, 21 plans were submitted on behalf of Part A jurisdictions, only.
In total, 22 integrated plans were submitted on behalf of a jurisdiction’s part A program and part B program.

15. Getting to Zero/Ending the Epidemic Plans
Plans or initiatives developed in cities, counties, and states outlining strategies to address HIV in their area
Collaboratively developed with elected officials, local government entities, service providers, community based organizations and advocates.
Supported by various funding streams including private foundations, national organizations, local government or community based organizations (CBOs)
Not mandated by HRSA and/or CDC.
Molly
Now, with a firm understanding of the Integrated Plans, let’s review the basics of Getting to Zero or Ending the Epidemic Plans, which in most cases takes a much different form than integrated plans. And, as a quick side note, Getting to Zero and Ending the Epidemic is often used to describe similar plans, so moving forward in this presentation, I am going to just use the phrase getting to zero to describe these plans.
So, getting to zero plans are plans or initiatives that are developed in cities, counties and states which outline strategies to address HIV in their specific area.
Most often, these are developed collaboratively with elected officials, local government entities, service providers, CBOs and community activists.
These plans are supported by multiple funding streams, including private foundations and national advocacy organizations, as well as local government and community based organizations.
Perhaps the biggest difference between Integrated Plans and Getting to Zero plans, is that getting to zero plans are not mandated, reviewed, or monitored by HRSA and/or CDC. They are entirely initiated, implemented and monitored by the state, county, or local level.
To get a better sense of what these types of plans look like and how they’re advancing the goal of ‘getting to zero’ within their jurisdictions, I’m going to introduce and describe to you a handful of GTZ plans being implementing across the country.

16. Arizona, Victory Over HIV
‘Wrap-around’ promotional initiative that provides summary of Integrated Plan activities.
Goals include:
Reduce new infections
Increase access to care and improve outcomes
Reduce gaps and inequities in HIV care
Achieve a more coordinated response
Developed by Arizona HIV Statewide Advisory Group and the Phoenix EMA Ryan White Planning Council.
Financially supported by AIDS Healthcare Foundation and Phoenix Pride.
Molly
In the state of Arizona, the Arizona HIV statewide Advisory Group and the Phoenix EMA Ryan White Planning Council developed a complimentary ‘wrap around’ promotional initiative that summarizes the goals and activities of the Integrated Plan submitted by the state. The Victory Over HIV website contains links to the full Integrated Plan, a summary document of the integrated plans, the National HIV/AIDS strategy, and other useful resources.

17. Fulton County, GA, Strategy to End AIDS in Fulton County
Developed by the Task Force on HIV/AIDS for Fulton County.
Included County Commissioner appointees, content experts, key stakeholders, and health department officials.
Has transitioned to a permanent Policy Advisory Committee.
Strategy includes various recommendations for policy changes, including adoption of a resolution to make "syringe service exchange a legitimate medical use in Fulton County”.
Strategy is rooted in social justice and civil rights framework and supports activism and advocacy.
Molly
In 2014, the Task Force on HIV/AIDS for Fulton County was established by the Board of Commissioners and tasked with providing input and recommendations in areas of public education, advocacy, treatment, prevention, housing and related issues pertaining to HIV/AIDS in Fulton County.” To this end, the Task Force set forth to develop a comprehensive, evidence-based “Strategy to End AIDS in Fulton County” that would be implemented and monitored to track progress towards success.
The Task force included various key stakeholders, including government officials, content experts, community members and health department officials and has, since it’s inception, been transitioned to a permanent Policy advisory committee.
The Strategy itself is rooted in a social justice and civil rights framework that acknowledges and works to address and reduce the racial and economic disparities of the epidemic within the County. As such, the strategies they recommend, including adopting syringe service exchange for legitimate medical use in Fulton County, support but don’t precisely mirror the goals of the state’s Integrated Plan.

18. Houston, Roadmap to Ending the HIV Epidemic in Houston
Plan developed by Legacy Community Health, in collaboration with Housing Works, Harvard Center for Health Law & Policy Innovation, and community leaders.
Funded by Ford Foundation and AIDS United
Roadmap articulates a set of recommendations that can be adopted/implemented by service providers, community organizations, policy makers.
Recommendations developed using an intersectional approach and by viewing the issues with social and racial justice lenses.
Plan specifically calls for increased financial support from local government.
Molly
In Houston, the Roadmap to Ending the HIV Epidemic in Houston was developed by Legacy Community Health, in collaboration with Housing Works, Harvard Center for Health Law & Policy Innovation, and community leaders.
The document puts forth a set of recommendations that can be adopted and/or implemented by service providers, community organizations, and policy makers, and are centered around five broad areas, including: 1) access to care, (2) prevention, (3) social determinants of health, (4) criminal justice, and (5) policy/research.
The recommendations found in the document include common goals and recommendations often found in Integrated Plans, such as increased HIV testing, increased access to mental health and substance use treatment, and improved health outcomes for people living with HIV with co-morbidities, but also several recommendations unique to Houston’s Ending the Epidemic plan, such as the recommendation to collect more comprehensive data on the trans community and those recently released from incarceration and expanded access to condoms in the correctional system.
Of note, one recommendation in the document explicitly calls for integrating their strategy into the Houston Area’s Comprehensive HIV Prevention and Care Services Plan, as a way to avoid duplication of efforts and ensure a coordinated

19. Pittsburgh, AIDS Free Pittsburgh
Defined as a public health movement collaboratively developed by CBOs, government agencies, and healthcare institution
Product is a website with information and resources for providers and consumers
Strategies include:
Normalize HIV Testing
Increase Access to PrEP
Improve linkage to care
Goal:
Reduce new HIV infections by 75% by the year 2020
Molly
Lastly, in the city of Pittsburgh, community based organizations, government agencies and healthcare institutions collaborated to created a public health movement, called AIDS Free Pittsburgh, which supports a website that contains information and resources for providers and consumers on HIV testing, PrEP, Health Insurance, and case management services.
By employing strategies such as normalizing HIV testing, increasing access to PrEP, and improving linkage to care, AIDS Free Pittburgh aims to achieve their goal of reducing new HIV infections by 75% by the year 2020.

20. Difference and Similarities between Integrated HIV Prevention and Care Plans and Getting to Zero/Ending the Epidemic Initiatives
Molly
Having reviewed Integrated Plans and several specific getting to zero initiatives, the similarities and differences between them are clear, as is opportunities for alignment and collaboration.

21. Differences between Integrated Plans and GTZ/ETE Initiatives
Structural differences, including content and final product
Funding sources for plan development and implementation
Varying levels of political advocacy involved
Understanding of what ‘ending the epidemic’ means is unique to each jurisdiction and often defined independent of funder or state/federal requirements.
Development of GTZ/ETE initiatives not required by HRSA/CDC
Molly
First, it’s clear there do exist major differences between a jurisdiction’s HRSA/CDC mandated Integrated Plan and a local getting to zero initiative.
First, the plans often differ in terms of their structure. For example, all Integrated Plans are lengthy, written documents including epidemiological data and a resource inventory. In contrast, the ‘product’, if you will, of a getting to zero plan could be anything from a website, a brief memo, informational or promotional graphics, or a combination of all of those things.
Second, getting to zero initiatives receive funding from entities that do not fund the development or implementation of Integrated Plans, such as private foundations or national advocacy groups.
Third, there is varying levels of political advocacy included in the plans, as Getting to Zero initiatives are not operating with federal monies and as such, able to advocate for programs or policies that HRSA or CDC-funded jurisdictions cannot, such as syringe exchange or condom distribution programs. ?
Lastly, of course, the most obvious difference between the two is getting to zero and ending the epidemic plans are not required, reviewed, or monitored by HRSA or CDC.

22. Similarities between Integrated Plans and the GTZ/ETE Initiatives
Integrated Plans and GTZ/ETE Initiatives share common goals and objectives
Reduce new infections
Increase linkage and retention to care
Promote PrEP
Increase viral suppression
Molly
Integrated Plans and Getting to Zero initiatives also share many similarities, most notably their overarching goals and objectives of reducing new infections, increasing linkage and retention to care, promoting PrEP, and increasing viral suppression.

23. Similarities between Integrated Plans and the GTZ/ETE Initiatives (cont.)
Plan development and implementation involves varied stakeholders
Health departments
Service Providers
CBOs
PLWH
Both place particular focus on disproportionately impacted populations
Molly
Further, the development and implementation of these plans involve similar parties, such as health departments, service providers, community based organizations, and most importantly, PLWH.
Additionally, both types of plans focus on the ways the epidemic disproportionately impacts particular populations in their jurisdiction and puts forth strategies to eliminate those disparities.

24. Opportunities for alignment and coordination
Align evaluation metrics and adopt data sharing agreements.
Combine planning groups, or appoint individuals to serve on both and act as liaison.
Develop communication processes between the implementation bodies of GTZ/ETE and the Integrated Plan.
Molly
So, given their shared goals and

25. Challenges and barriers to alignment
Overlapping development of GTZ/ETE and Integrated Plan
GTZ/ETE initiatives were often adopted before Integrated Plan was developed; now simultaneously being implemented
Misalignment of activities/goals between GTZ/ETE and Integrated Plan
GTZ/ETE includes activities centered on political and social justice changes
Molly

26. Two Initiatives, One Plan: Silicon Valley-Santa Clara County Getting to Zero and Laying a Foundation for Getting to Zero
Mike Torres
Health Program Planning Specialist III
STD/HIV Prevention & Control
County of Santa Clara, Public Health Department
Mike

27. Overview Demographics & HIV in Santa Clara County
Public Health program structure
Integrated and GTZ plan development
Challenges & Successes
Lessons learned
Tangible tips
Mike
GOAL:
Examine the Santa Clara County Getting to Zero initiative and Santa Clara County HIV Integrated Plan development as a use-case for synergistic strategic planning.

28. Demographics and HIV in Santa Clara County
Mike

29. San Jose, TGA: Who We Are Population: 1.9 million
33.7% White
32.8% Asian/Pacific Islander
27.5% Latino
2.4% African American
3.6% other race/ethnicities
HIV in Santa Clara County
3,360* PLWH of that 51% receive at least one RW funded service
86% male
13% female
1% transgender
156 new cases (2017)
Mike
Source: Santa Clara County Public Health Department, eHARS data as of May 11, 2018 and are provisional
* Based on residency at diagnosis

30. People Living with HIV/AIDS in Santa Clara County by Census Tracts, 2017
Mike

31. Santa Clara County Public Health Funding for HIV/AIDS Prevention and Care
Care Funding: $3.6 million
RWHAP Part A & MAI
RWHAP Part B & MAI
Santa Clara County General Fund
Prevention Funding: $979,411
CA Department of Public Health State Office of AIDS
Santa Clara County General Fund
STD Local Assistance Grant
Mike

32. Getting to Zero (GTZ) Santa Clara County-Silicon Valley
Collaboration between County of Santa Clara Public Health Department (SCCPHD), HIV/AIDS service providers, healthcare organizations, advocacy groups, and other community-based organizations.
Funded by Santa Clara County Board of Supervisors
Employs Collective Impact Model of implementation
Focuses on:
PrEP and PEP access
Stigma reduction
Guideline-based STI screening & HIV testing
HIV linkage and retention in care
Mike

33. California’s Integrated HIV Surveillance, Prevention, and Care Plan
California’s Integrated HIV Prevention and Care Plan, including Statewide Coordinated Statement of Need
Submitted by the California Department of Public Health (Office of AIDS)
Mike

34. Goals of Aligning Integrated Plan and GTZ Initiative
Ensure consistency across goals, strategies, and performance measures
Decrease duplicative work across two initiatives working towards same goal
Increase collaboration between public health department officials, community members, and stakeholders
Mike

35. Operationalization of Alignment Activities
Mike

36. Timeline for GTZ and Integrated Plan
Mike

37. Timeline for GTZ and Integrated Plan (cont.)
Mike

38. Putting It All Together
Mike

39. Successes
Mike

40. Alignment of California Statewide Strategy and GTZ Activities
Related GTZ Activities
Well-established
In progress
Discussions initiated/ Early work
A. Improve PrEP Utilization
Focus of Action Team; PrEP/PEP referral protocol; county PrEP navigator; media campaigns; provider trainings
Expanded PrEP screening in Re-entry program; increasing PrEP providers and access points; increasing access for uninsured patients; peer education projects
B. Increase and Improve HIV Testing
Focus of Action Team; funding for on-campus HIV testing
Data tracking for HIV tests at community health centers and other care access points; increasing access points for HIV testing
Provider trainings on HIV/STI screening; inclusion of opt-out testing in public health detailing
D. Improve Linkage to Care
Focus of Action Team
Provider outreach and education
Community survey and barriers assessment among community providers (to be initiated in Year 3)
Mike

41. Alignment of California Statewide Strategy and GTZ Activities (cont.)
Related GTZ Activities
Well-established
In progress
Discussions initiated/ Early work
E. Improve Retention in Care
Focus of Action Team; pharmacy assessment and identification of tickler program
Provider outreach and education
Community survey and barriers assessment among community providers (to be initiated in Year 3)
L. Increase General HIV Education & Awareness and Reduce Stigma around HIV, Sexual Orientation, and Gender Identity
Focus of Action Team (stigma reduction); telenovela training of trainers; extensive community outreach and distribution of materials
Condom promotion and distribution; comprehensive sexual education in high schools; distribution of stigma reduction training toolkit; peer education projects
N. Enhance Collaborations and Community Involvement
Employed a Collective Impact approach; community outreach events; mini grant program
Recruiting more community members and CBOs to take part in GTZ
Mike

42. Alignment of California Statewide Strategy and GTZ Activities (cont.)
Related GTZ Activities
Well-established
In progress
Discussions initiated/ Early work
O. Further Leverage Existing Resources to Better Meet the Needs of People at Risk for and Living with HIV in California
Mini grant program; funding for on-campus HIV/STI testing; increasing access to PrEP for uninsured individuals
Grant applications for new funding
Funding for health center practice transformation
Mike
*Please note: JSI is currently contracted to conduct the evaluation activities of Santa Clara County’s Getting to Zero Initiative. Information provided on this slide is from the Year 2 Action Research and Evaluation Report, published in July, 2018.

43. Challenges/Barriers Timeline Communication GTZ Model
Plans developed simultaneously but by different planning groups
Communication
Plans developed simultaneously making it difficult to communicate similarities to respective Planning Groups in real-time
Some stakeholders involved in both planning meetings were unaware of the intersection of initiatives
GTZ Model
Sustainability of Collective Impact Model unknown
County bureaucracy
Contract delays
Mike

44. Future Direction Continued alignment after GTZ funding ends in 2020
Sustainability Planning
Continued communication and collaboration between GTZ and Integrated Plan partners
Continue efforts to use data to inform adaptations to programs and strategies
Consider adoption of Rapid ART Action Team in GTZ initiative
Mike

45. Tangible Tips Communicate! Utilize available resources
Understand various funding streams
Strategic planning
Acquire Champions!
Mike

46. Annette Rockwell
Infectious Disease Drug Assistance Program Director, Office of HIV/AIDS
Bureau of Infectious Disease and Laboratory Sciences
Massachusetts Department of Public Health

47. Questions
Julie

48. IHAP TAC Website
Stewart

49. Integrated HIV Prevention and Care Plan Online Resource Guide
Resources, tools, and tips to support process of integrating HIV planning and implementation efforts across prevention, care, and treatment delivery systems.
Stewart One of the things we developed and launched in Spring of this year is the Integrated HIV prevention and care plan online resource guide. This online resource guide is intended to support Ryan White HIV/AIDS Program Parts A and B recipients and their respective planning bodies with the implementation and monitoring of their Integrated HIV Prevention and Care Plans. Included in the online resource guide are Resources, tools, and tips to support process of integrating HIV planning and implementation efforts across prevention, care, and treatment delivery systems.

50. Thank you! Contact us at ihaptac@jsi.com!
Sign up for our mailing list (sign-up sheet in back of session room)
Obtain more information, join our mailing list, request TA or to share your experiences or resources.
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U69HA30144, Ryan White HIV/AIDS Program Integrated HIV Planning Implementation. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.