Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan Statistical Areas Most Affected by HIV/AIDS

Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan Statistical Areas Most Affected by HIV/AIDS

Grantee Profiles

Enhanced Comprehensive HIV Prevention Planning (ECHPP) Project

Overview

The Enhanced Comprehensive HIV Prevention Planning (ECHPP) Project is a 3-year demonstration project funded by CDC's Division of HIV/AIDS Prevention (DHAP) for the 12 municipalities with the highest number of people living with AIDS in the United States. As part of the response to the National HIV/AIDS Strategy (NHAS), the ECHPP project supports the 12 Cities Project which is directed by the Department of Health and Human Services (HHS). These two projects directly support NHAS goals by improving program planning and implementation to:

• Reduce new HIV infections
• Link people with HIV to care and treatment and improve health outcomes,
• Reduce HIV-related health disparities, and
• Achieve a more coordinated national response to the HIV epidemic in the United States.

Lessons learned from ECHPP will inform how CDC can best work with health departments, other US government agencies and communities to reach the NHAS goals across the country.

Grantees

The project aims to maximize the impact of HIV prevention in the 12 Metropolitan Statistical Areas (MSAs) with the highest AIDS prevalence in the United States. These 12 ECHPP MSAs represent 44% of the estimated AIDS cases in the United States (data through December 2007).

Phase 1 provided $11.6 million for enhanced planning and coordination followed by implementation (September 30, 2010-September 29, 2011). Phase 2 supports ongoing planning, coordination and data reporting as well as implementation for 2 years (September 30, 2011- September 29, 2013). In year 1 of Phase 2, CDC awarded the grantees $19.6 million.

The 12 ECHPP grantees include state and territorial health departments (Georgia, Florida, Maryland, Texas, Puerto Rico, District of Columbia) and directly-funded local health departments (Los Angeles County, San Francisco, Chicago, Houston, New York City, Philadelphia).

ECHPP Planning Process and Evaluation

The planning process for ECHPP required each grantee to conduct a situational analysis and consider the following: local resources; epidemiologic profiles; available efficacy, cost, and cost-effectiveness data for specific interventions and strategies; and priority areas from existing local plans. The grantees used these data to develop a set of goals, strategies, and specific objectives to achieve an optimal combination of prevention activities to reach NHAS goals.

Each MSA developed and is implementing an ECHPP plan with the following principles:

• Conduct a comprehensive assessment considering all local HIV prevention, care, and treatment resources
• Direct resources to achieve maximum impact on HIV incidence
• Require the use of a core set of behavioral, biomedical, and structural interventions, targeted and scaled to maximize impact
• Increase data driven decision making – including incorporating local epidemiologic, cost-effectiveness and efficacy data

Grantees varied in their specific approach and included community and partner input in different ways. They were encouraged to engage community members and other stakeholders to the extent possible given the accelerated timeline for the enhanced planning during the first 6 months of year 1. It is anticipated that grantees will have ongoing conversations with partners moving forward. Several sites have also incorporated mathematical modeling techniques to further inform decisions about optimal combinations of prevention activities.

Additionally, key evaluation questions were developed that addressed the process, outcome, and impact of ECHPP. CDC's ECHPP evaluation goals are to:

1. Assess optimal combinations of approaches to HIV prevention, care and treatment activities within the ECHPP jurisdictions.
2. Use surveillance data to assess the impact of local prevention, care and treatment programs.
3. Track jurisdictions' progress towards achieving NHAS goals utilizing a variety of data types and sources.
4. Conduct additional data collection activities to monitor and evaluate ECHPP implementation in select cities

Interventions/Strategies

ECHPP plans include up to three categories of interventions and public health strategies: (1) required, (2) recommended, and (3) innovative. These interventions and strategies span the continuum from HIV prevention to care and treatment. All interventions and/or public health strategies have an evidence base and are expected to be scaled and targeted within each jurisdiction based on the local epidemic, need, and resources while considering available cost-effectiveness and efficacy data.

• The 14 required interventions or public health strategies include the following:
  • Routine opt-out HIV testing in clinical settings
  • Targeted HIV testing in non-clinical settings
  • Nine strategies for prevention with persons living with HIV
    • Linkage to care
    • Promotion of retention or re-engagement in care
    • Provision of antiretroviral therapy consistent with current guidelines
    • Promotion of adherence to antiretroviral medications
    • STD screening
    • Prevention of perinatal transmission
    • Ongoing partner services
    • Behavioral risk screening and interventions to reduce HIV transmission risk
    • Linkage to other medical and social services
  • Condom distribution targeted to HIV-positive persons and persons at greatest risk of acquiring HIV infection
  • Provision of Post-Exposure Prophylaxis
  • Efforts to change existing structures, policies and regulations that pose barriers to optimal HIV prevention, care and treatment
  • The 10 "recommended to consider" interventions or public health strategies include the following:
    • Condom distribution for the general population
    • Targeted health communications or social marketing campaigns
    • Provider-delivered, evidence-based HIV prevention interventions
    • Community-level interventions
    • Behavioral risk screening and interventions for high-risk HIV-negative persons
    • Integrated hepatitis, TB, and STD testing, partner services, vaccination, and treatment
    • Targeted use of HIV and STD surveillance data to prioritize risk reduction counseling and partner services for persons with previously diagnosed HIV infection with a new STD diagnosis, and persons with a previous STD diagnosis who receive a new STD diagnosis
    • For HIV-negative persons at highest risk of acquiring HIV, broadened linkages to and provision of services for social factors impacting HIV incidence such as mental health, substance abuse, housing, safety/domestic violence, corrections, legal protections, income generation, and others
    • Brief alcohol screening and interventions for HIV-positive persons and HIV-negative persons at highest risk of acquiring HIV
    • Community mobilization to create environments that support HIV prevention
  • The "innovative" local interventions are new ideas that jurisdictions believe could have significant impact on NHAS goals locally.

ECHPP Team

The CDC ECHPP Project Team is a multi-disciplinary one of scientists and program consultants that include division leaders and representatives from most branches within DHAP. Representatives from other federal agencies support ECHPP as members of the ECHPP Cross-Agency Implementation Working Group. These federal agencies include:

• Health Resources and Services Administration (HRSA) (both the HIV/AIDS Bureau [HAB] and Bureau of Primary Health Care [BPHC]),
• Substance Abuse and Mental Health Services Administration (SAMHSA),
• Indian Health Service (IHS),
• National Institutes of Health (NIH),
• Health and Human Services (HHS)

The Working Group fosters coordination and collaboration across agencies and evaluates agency policies that may act as barriers to coordinated planning, implementation, delivery, and evaluation of HIV/AIDS services within the ECHPP jurisdictions.

ECHPP and 12-Cities Project

The 12-Cities Project

, under the direction of the HHS, Office of the Assistant Secretary for Health (OASH), expands upon the foundation established by ECHPP and establishes a cross-agency approach to advance the goals of NHAS. The 12-Cities Project

aims to find ways that the federal government can improve coordination across the broad range of HIV prevention, care and treatment activities to support reaching NHAS goals. HHS agencies engaged in the 12-Cities Project

include CDC, Centers for Medicare and Medicaid Services (CMS), Department of Housing and Urban Development (HUD), HRSA, IHS, NIH, and SAMHSA

2011 AIDS.GOV ANNOUNCEMENT

On February 11, 2011, AIDS.gov spoke with Dr. Ron Valdiserri, Deputy Assistant Secretary for Health for Infectious Diseases in the Department of Health and Human Services about the 12 Cities Project. The National HIV/AIDS Strategy asks all of government including the Department of Health and Human Services to do a better job coordinating our program activities. So, in the 12 cities, we’re working very hard to bring together prevention, treatment, and care, which are all programs that are housed in different Federal agencies, but they all serve the same populations. So, the 12 Cities is working to bring those programs together in terms of planning for unmet need, as well as responding to unmet need with enhanced prevention services, improved diagnostic services, and efforts to maintain people in care.

It grew out of a program that CDC funded to enhance prevention activities in the 12 cities in the United States that represented the largest share of people living with AIDS—approximately 44% of all AIDS cases in these 12 cities: Atlanta, Baltimore, Chicago, Dallas, Houston, Los Angeles, Miami, New York City, Philadelphia, San Francisco, San Juan, and Washington, D.C. So you can see these are very diverse, very different communities, but what we’re attempting do in those communities is build on top of the CDC effort and bring other components of the Federal government into that process—bring in the programs that provide HIV treatment and care for people living with HIV, bring in those programs that provide mental health and substance abuse services, bring in programs from the Indian Health Service, for instance. Also bring in some of the Federally-funded research activities that can help us better understand how we can evaluate outcomes in these 12 cities.

So what we’re doing, the 12 Cities Project is an expansion of an existing effort underway by the Centers for Disease Control and Prevention, to expand that to include other important components of the Federal Government. We are emphasizing that although prevention and treatment and care and programs that address substance use and mental health and even programs that fund Federal research, they’re all developed and delivered out of different, separate Federal agencies, but what we’re attempting to do is combine them in a virtual way that will result in improved services, more highly coordinated services for communities at risk in these 12 jurisdictions. Certainly the Centers for Disease Control and Prevention has a very important role to play, but they’re not the only player in this effort.

Health Resources and Services Administration or HRSA is intimately involved in this undertaking. The Substance Abuse and Mental Health Services Administration (SAMSHA) is a key player. The Indian Health Service, as well as the National Institutes for Health. Now there are a number of other important Staff Offices who will be involved as well, and we don’t won’t to forget the important partners at the local level: state and local health departments as well as community-based and non-governmental organizations who are involved in this effort. So there’s a broad variety of partners both at the Federal level, as well as at the local level, and that’s the way it needs to be.

The Strategy tells us that achieving the goals, achieving the vision of the National HIV/AIDS Strategy, will not only require improved effort from the Federal government, but improved support and effort from all sectors of society including local government as well at the private sector. It’s really important to remember that the National HIV/AIDS Strategy applies to the entire nation and not just the 12 cities we’re talking about. We’re using these 12 cities as a way to better understand what changes we can make both at the Federal level as well as the local level to improve our services for people living with HIV/AIDS or populations at high risk for HIV/AIDS across the country.

So, we intend to apply the lessons learned in the 12 cities across the United States so that all people in America can benefit from this improved and enhanced approach to combining HIV prevention, treatment, and care services. You can learn more information about the National HIV/AIDS Strategy by visiting AIDS.gov. And AIDS.gov will continue to provide you with updates of the work surrounding the 12 Cities Project in the weeks and months to come.