1. Clinical Alliances and Partnerships Raul A. Romaguera, DMD, MPH Division of HIV/AIDS Prevention Centers for Disease Control and Prevention March 11, 2004

2. Strategies of AHP Make voluntary HIV testing a routine part of medical care* Implement new models for diagnosing HIV infections outside medical settings Prevent new infections by working with persons diagnosed with HIV and their partners* Further decrease perinatal HIV transmission*

3. Federal Partners Health Resources & Services Administration Center for Medicare and Medicaid Services Substance Abuse & Mental Health Services Administration Indian Health Service Veterans Administration Other Divisions and Centers at CDC

4. Collaboration with HRSA Officials from CDC/NCHSTP and HRSA/HAB met last year and agreed to: Develop a joint work plan Identify a liaison for each Agency Review relevant documents and program announcements Participate in other agencies’ meetings Collaborate in project implementation

5. Make HIV testing a routine part of medical care HRSA: –IAA with the Bureau of Primary Health Care to assess current policies and practices related to HIV testing in primary care settings; –Define use of rapid testing in a clinical environment; prioritize uses and identify target programs for training. –Develop training in collaboration with AIDS Education and Training Centers.

6. Make HIV testing a routine part of medical care - 2 SAMHSA –Conduct baseline assessment of current HIV testing policies and practices; –Develop training for staff and protocols to incorporate rapid testing into substance abuse treatment centers and methadone programs. CMS –Provide guidance to encourage reimbursement for routine HIV testing of sexually active Medicaid- and Medicare-eligible patients.

7. Prevent new infections by working with person diagnosed with HIV and their partners HRSA, NIH and HIVMA collaborated with CDC to develop the Recommendations for Incorporating HIV Prevention into the Medical Care of Persons with HIV Infection. HRSA and NIH are collaborating with CDC on two satellite broadcasts on prevention in clinical care settings. HRSA and CDC are developing training to incorporate prevention into the care of HIV- infected patients.

9. Role of clinical providers Screening for behavioral and clinical risk factors, and pregnancy; Providing brief behavioral risk- reduction interventions, and referral to prevention services; Facilitating notification and counseling of sex and needle- sharing partners.

10. Prevent new infections by working with person diagnosed with HIV and their partners - 2 Established a CDC-HRSA-CMS-SAMHSA- HUD Inter-Agency working group to share information about case management activities First meeting held Nov 3, 2003 To discuss program requirements Develop strategies to strengthen coordination at the service level Develop inter-agency guidelines A CDC-HRSA joint consultation on stigma and HIV.

11. Further decrease perinatal HIV transmission HRSA, SAMHSA, DoD, VA, IHS, and STD and FP programs - to implement rapid, opt-out HIV testing of pregnant women; including linkage to prenatal care. CMS - to revise 1995 letter to state Medicaid directors regarding prenatal HIV testing to encourage reimbursement for prenatal testing. ACOG, ACNM and AHA – to disseminate training materials and conduct provider training.

12. Other Collaborative Projects Agency for Health Research and Quality and the US Preventive Task Force to review the evidence of routine HIV screening for asymptomatic adults and for pregnant women. Assess legal and financial basis for reimbursement of prevention services, including HIV screening in EDs. –Developing a procedures manual for billing Medicaid for HIV testing and prevention

13. Other Collaborative Projects (continuation) American Hospital Association to assess current policies and practices related to HIV prevention services, and develop operation guide. Purchasers of care to develop a business case that recommends reimbursement for HIV prevention services.

14. CDC is also working with: Academy of HIV Medicine HIV Medicine Association of the IDSA Association of Nurses in AIDS Care AIDS Education and Training Centers Other medical and nursing societies in the implementation of the AHP strategies: –Conduct focus groups with providers –Develop educational materials for providers –Share information at national and regional meetings

15. Contact Information: Raul A. Romaguera, DMD, MPH Associate Director for Prevention in Care Division of HIV/AIDS Prevention, CDC 1600 Clifton Road, NE - MS D-21 Atlanta, GA 30333 Telephone: (404) 639-2004 Fax (404) 639-0897 E-mail: RRomaguera@cdc.gov RRomaguera@cdc.gov