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Kansas Department of Health and Environment
Bureau of Disease Control and Prevention
HIV/AIDS Section
HIV Prevention Program
PS12-1201:
Comprehensive Human Immunodeficiency Virus (HIV)
Prevention Programs for Health Departments
Comprehensive Program Plan
Reporting Period:
January 1, 2012 – December 31, 2016
Year One, 2012
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 2
HEALTH DEPARTMENT CONTACT INFORMATION
Award Number: 1U62PS003694-01
Health Department: Kansas Department of Health and Environment
Mailing Address: 1000 SW Jackson Street, Ste. 210
City: Topeka State: KS Zip Code: 66612
Phone Number: 785-296-1037 Fax: 785-296-4197
Contact
Information for
this program plan
Title/Position Name Phone E-mail Address
Fax
Primary Contact HIV Prevention
Program Manager
Travis Barnhart Ph: 785-296-1037 tbarnhart@kdheks.g
ovF: 785-296-4197
Secondary
Contact
HIV/AIDS Program
Director
Ralph Wilmoth Ph: 785-296-8596 rwilmoth@kdheks.go
vF: 785-296-4197
HEALTH DEPARTMENT FUNDED CATEGORIES
Please select the required core components and recommended program components implemented
within the jurisdiction:
Category A: HIV Prevention Programs for Health Departments
Required core components (required for all funded grantees):
HIV Testing
Comprehensive Prevention with Positives
Condom Distribution
Policy Initiatives
Recommended program components:
Evidence-based HIV Prevention Interventions for HIV-Negative Persons at Highest Risk
Social Marketing, Media and Mobilization
Pre-Exposure Prophylaxis and Non Occupational Post-Exposure Prophylaxis Services
Category B: Expanded HIV Testing for Disproportionately Affected Populations
Not Applicable/Not Funded
Program components:
HIV Testing in Healthcare Settings (required)
HIV Testing in Non-Healthcare Settings (optional)
Service Integration (optional)
Category C: Demonstration Projects for Innovative, High-Impact Prevention
Not Applicable/Not Funded
Program focus areas:
Structural, Behavioral, and/or Biomedical Interventions
Innovative HIV Testing Activities
Enhanced Linkage to and Retention in Care
Advanced Use of Technology
Programmatic use of CD4, viral load and other surveillance data
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 3
PS12-1201 Resource Allocation
One of the goals of this FOA is to reduce HIV transmission by building capacity of health departments to
focus HIV prevention efforts in communities and local areas, where HIV is most heavily concentrated, to
achieve the greatest impact in decreasing the risks of acquiring HIV. Grantees should monitor the
HIV/AIDS epidemic within the jurisdiction for program planning, resource allocation and monitoring and
evaluation purposes. Grantees should utilize the most current epidemiological and surveillance data
and other available data sources to assist in program planning and evaluation.
To ensure that resources are reaching the areas of greatest need, grantees will be required to report
annually to CDC on the amount of funding allocated to the areas with 30% or greater of the HIV
epidemic and how the funds were used.
Please identify each city/MSA with at least 30% of the HIV epidemic within the jurisdiction.
For directly-funded cities, please report areas or zip codes within the MSA with at least 30% of
the HIV epidemic within the jurisdiction. If no area represents at least 30% of the HIV
epidemic, then identify the top three MSA/MDs, cities, or areas within the jurisdiction that
have the greatest burden of disease.
MSA/CITY Percentage of
HIV Epidemic
Percentage of
PS12-1201 Funds
Allocated
Components and
Activities Funded
Kansas City (Leavenworth,
Johnson, Miami, and
Wyandotte counties)
42% (Prevalence) 2012 – 29.34%
2013 – 28.93%
HIV Testing: Lab Support,
Opt-Out Testing in
Healthcare Settings,
Prioritized Testing in Non-
Healthcare Settings; PWP: 1
staff member salary/fringe
and support for 2 local
health department PS
grants; Condom Distribution
Wichita (Butler, Harvey,
Sedgwick and Sumner
counties)
28% (Prevalence) 2012 – 22.43%
2013 – 16.94%
HIV Testing: Lab Support,
Opt-Out Testing in
Healthcare Settings,
Prioritized Testing in Non-
Healthcare Settings; PWP:
support for 1 local health
department PS grant;
Condom Distribution
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 4
PS12-1201 Category A
HIV Prevention Programs for Health Departments (core funding)
Required Component: HIV Testing
The following are the National-Level Objectives and Performance Standards that will be used for
HIV testing and linkage to care activities funded under Category A. Category A goals and objectives
should be developed in relation to the National-Level Objectives and Performance Standards while
also addressing elements of each program component as listed in the FOA.
National Goal: CDC expects approximately two million HIV tests will be provided annually, among all
funded jurisdictions, when the program is fully implemented.
Performance Standards: CDC expects each funded jurisdiction to achieve the following performance
standards, when the program is fully implemented:
 For targeted HIV testing in non-healthcare settings or venues, achieve at least a 1.0% rate of
newly-identified HIV-positive tests annually.
 At least 85% of persons who test positive for HIV receive their test results.
 At least 80% of persons who receive their HIV-positive test results are linked to medical care
and attend their first appointment (within 90 days of the positive HIV test).
 At least 75% of persons who receive their HIV-positive test results are referred to and
interviewed for Partner Services (within 30 days of having received a positive test result).
Required Elements for HIV Testing:
A. Implement and/or coordinate opt-out HIV testing of patients ages 13-64 in healthcare settings.
B. Implement and/or coordinate HIV testing in non-healthcare settings to identify undiagnosed HIV
infection using multiple strategies and the most current recommendations for HIV counseling,
testing and referral.
C. Support HIV testing activities in venues that reach persons with undiagnosed HIV infections.
D. Ensure the provision of test results, particularly to clients testing positive.
E. Promote routine, early HIV screening for all pregnant women, according to current CDC
recommendations.
F. Encourage and support health department and non-health department providers to increase the
number of persons diagnosed with HIV through strengthening current HIV testing efforts or creating
new services.
G. Facilitate voluntary testing for other STDs (e.g., syphilis, gonorrhea, chlamydial infection), HBV, HCV,
and TB, in conjunction with HIV testing, including referral and linkage to appropriate services, where
feasible and appropriate and in accordance with current CDC guidelines and recommendations. (This
activity may be implemented in collaboration with STD, hepatitis, and/or TB programs).
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 5
H. Ensure that testing laboratories provide tests of adequate quality, report findings promptly, and
participate in a laboratory performance evaluation program for testing. (This activity may be done in
conjunction with surveillance and/or laboratory services).
I. Incorporate new testing technologies, where feasible and appropriate.
HIV Testing Goals:
Reduce new HIV infections by implementing and coordinating opt-out and prioritized (targeted)
testing while ensuring the provision of HIV test results, particularly to clients testing positive.
HIV Testing Objectives and Annual Targets
In an effort to monitor progress toward meeting the PS12-1201 Category A national objectives, please submit your
jurisdictional proposed objectives for number of HIV test events, number of newly-identified HIV-positive test
results, and new HIV-positive test rate for years 1-5 of the project period. For each year, enter the projected
number of HIV test events that will be conducted and the anticipated new HIV-positive test rate.
Objectives
Targets Per Year
Year 1 Year 2 Year 3 Year 4 Year 5 Total
# of HIV testing events - Overall 27,840 24,084 20,914 18,242 15,993 107,073
# of HIV testing events – Healthcare
Settings 26,040 22,134 18,814 15,992 13,593 96,573
# of HIV testing events – Non-
Healthcare Settings 1,800 1,950 2,100 2,250 2,400 10,500
# of HIV positive test results -
Overall 35 37 39 44 45 200
# of HIV positive test results -
Healthcare Settings 26 22 18 16 14 96
# of HIV positive test results - Non-
Healthcare Settings 9 15 21 28 31 104
# of newly-identified HIV-positive
test results - Overall 27 28 30 33 35 153
# of newly-identified HIV-positive
test results - Healthcare Settings 20 17 14 12 11 74
# of newly-identified HIV-positive
test results - Non-Healthcare
Settings 7 11 16 21 24 79
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 6
# of newly identified HIV-positive
test results returned to clients -
Overall 27 28 30 33 35 153
# of newly identified HIV-positive
test results returned to clients -
Healthcare Settings 20 17 14 12 11 74
# of newly identified HIV-positive
test results returned to clients –
Non-Healthcare Settings 7 11 16 21 24 79
New HIV-positive test rate (%)* -
Healthcare Settings 0.1% 0.1% 0.1% 0.1% 0.1% 0.1%
New HIV-positive test rate (%)* -
Non-Healthcare Settings .5% .75% 1% 1% 1%
.5% to
1%
# of high-risk HIV negative clients
who will enroll in the individual-
level evidence-based intervention
RESPECT in conjunction with HIV
testing 1,500 1,650 1,800 1,950 2,100 9,000
*# of newly-identified HIV-positive test results (numerator)/ # of HIV testing events (denominator) =
Target rate for new HIV positivity.
Outcome Objective(s) – HIV Testing in Healthcare Settings
To make people aware of their HIV status through HIV testing in
healthcare settings.
Responsible for
implementation
Process Objective 1: In Year 1 (2012) and continuing forward, achieve
at least a 0.1% positivity rate for HIV testing in all healthcare settings
and venues funded and supported by KDHE each year.
Process Objective 2: In Year 1 (2012) and continuing forward, provide
HIV test results to 100% of all clients who test positive for HIV and
provide results to at least 75% of all clients who test negative each
year.
Process Objective 3: In Year 1 (2012) and continuing forward, at least
80% of persons who receive their HIV-positive test results are referred
to Linkage to Care Services within one week of receiving their test
results per year.
Process Objective 4: In Year 1 (2012) and continuing forward, refer and
link at least 95% of all clients who receive a positive HIV test result to
Partner Services within one week of receiving their test result.
KDHE HIV
Counseling, Testing
and Linkage Program
HIV Testing Sites –
Healthcare Settings
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 7
Process Objective 5: By the end of Year 2 (2013), provide orientation
and trainings for program and clinical staff at KDHE funded and
supported HIV testing sites to outline roles and responsibilities
regarding restructuring and prioritization of testing individuals at
highest risk for HIV.
Process Objective 6: By the end of Year 2 (2013), provide training and
technical assistance for KDHE funded and supported HIV testing sites on
how to implement 3rd party billing practices.
Process Objective 7: By the end of Year 2 (2013), upgrade testing
technologies used by the state lab to fourth generation Bio-Rad HIV 1/2
Combo Ag/Ab for serum for HIV testing sites with a 0.1% positivity rate.
Outcome Objective(s) – HIV Testing in Non-Healthcare Settings
To make people aware of their HIV status through prioritized/targeted
HIV testing in non-healthcare settings.
Responsible for
implementation
Process Objective 1: By the end of Year 1 (2012), achieve at least a
0.5% positivity rate for HIV testing in all non-healthcare settings and
venues funded and supported by KDHE.
Process Objective 2: By the end of Year 2 (2013), achieve at least a
0.75% positivity rate for HIV testing in all non-healthcare settings and
venues funded and supported by KDHE.
Process Objective 3: By the end of Year 3 (2014) and continuing
forward, achieve at least a 1.0% positivity rate for HIV testing in all non-
healthcare settings and venues funded and supported by KDHE per
year.
Process Objective 4: In Year 1 (2012) and continuing forward, provide
HIV test results to 100% of all clients who test positive for HIV and
provide results to at least 85% of all clients who test negative per year.
Process Objective 5: In Year 1 (2012) and continuing forward, at least
80% of persons who receive their HIV-positive test results are referred
to Linkage to Care Services within one week of receiving their test
results per year.
Process Objective 6: In Year 1 (2012) and continuing forward, refer and
link at least 95% of all clients who receive a positive HIV test result to
Partner Services within one week of receiving their test result per year.
KDHE HIV
Counseling, Testing
and Linkage Program
HIV Testing Agencies
KDHE HIV Prevention
Program
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 8
Process Objective 7: Each site funded by KDHE to conduct prioritized
HIV testing will provide the individual-level intervention RESPECT in
conjunction with HIV testing (rapid or conventional), conducting at least
250 RESPECT cycles in 2012, 275 in 2013, 300 in 2014, 325 in 2015, and
350 in 2016 per site.
Capacity Building Activities Planned for HIV Testing:
There are two areas for CBA/TA related to HIV Testing: anticipated CBA for KDHE program staff,
and anticipated CBA provided by KDHE to contracted providers/agencies. In the area of CBA for
KDHE program staff, there is a need for the development of a targeted screening tool using
patient data that could be used to effectively estimate a patient’s risk of having undiagnosed
HIV infection. Additionally, KDHE program staff intends to seek CBA for motivational
interviewing skills in order to provide providers/agencies enhanced strategies for behavior
change counseling.
In the area of CBA provided to contracted providers/agencies, KDHE will address these areas:
1. EvaluationWeb user efficiency.
2. Understanding the roles and responsibilities of testing program and clinical staff in relation
to the restructuring of testing priorities for individuals at risk for HIV.
3. Third party billing practices for contracted agencies.
4. Efforts will be made to work with CDC to access a training of trainers for the RESPECT
intervention. Additionally, collaborations with the KDHE STD program will occur in order to
access a training of facilitators for the RESPECT intervention in the Kansas City area
(scheduled tentatively for November 2012).
5. Identification and assessment of testing venues to ensure testing is being done to meet the
1.0% positivity rate for non-healthcare sites.
6. Motivating and incentivizing testing among target populations for contracted
providers/agencies.
Monitoring and
Evaluation question
Indicator(s)/Measure(s) Data Source Timeline
What is the HIV-
positive test yield at
KDHE supported HIV
test sites, both
healthcare and non-
healthcare?
Percent of newly
identified, confirmed
HIV-positive test results
among all testing events
reported by KDHE
supported test sites.
Numerator: newly
identified, confirmed
HIV-positive test results.
Denominator: all testing
events reported.
EvaluationWeb Ongoing
How successful are Percent of newly EvaluationWeb, Ongoing
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 9
CDC-funded programs
at returning HIV-
positive test results to
clients?
identified, confirmed
HIV-positive test results
returned to clients.
Numerator: newly
identified, confirmed
HIV-positive test results.
Denominator: all testing
events reported.
Positives Database
How successful are
CDC-funded programs
at ensuring that newly
identified HIV-positive
clients are linked to
medical care?
Percent of newly
identified, confirmed
HIV-positive clients
referred to medical care
who attend their first
appointment
EvaluationWeb,
Positives Database,
SCOUT, Linkage to
Care providers
Ongoing
To what extent do
KDHE programs enroll
the projected number
of clients stated in the
program plan for the
RESPECT EBI?
Proportion of the
projected number of
clients in the program
plan that enroll in
RESPECT
CPEMS,
EvaluationWeb
Ongoing
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 10
Required Component: Comprehensive Prevention with Positives
Required Elements for Comprehensive Prevention with Positives:
A. Provide linkage to HIV care, treatment, and prevention services for those persons testing HIV-
positive or currently living with HIV/AIDS.
B. Promote retention or re-engagement in care for HIV-positive persons.
C. Offer referral and linkage to other medical and social services such as mental health, substance
abuse, housing, safety/domestic violence, corrections, legal protections, income generation, and
other services as needed for HIV-positive persons.
D. Provide ongoing Partner Services (Recommendations for Partner Services Programs for HIV
Infection, Syphilis, Gonorrhea, and Chlamydial Infection, 2008.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5709a1.htm ) for HIV-positive persons and their
partners: Collaborate and coordinate with STD programs, and HIV and/or STD surveillance programs
to utilize data to maximize the number of persons identified as candidates for Partner Services. (2)
Partner with non-health department providers, including CBOs and private medical treatment
providers, to identify more opportunities to provide Partner Services.
E. Assure that HIV-positive pregnant women receive the necessary interventions and treatment for the
prevention of perinatal transmission.
F. Conduct sentinel event case review and community action to address local systems issues that lead
to missed perinatal HIV prevention opportunities by utilizing the Fetal and Infant Mortality Review
(FIMR)-HIV Prevention Methodology, including CDC’s web-based data system (see
www.fimrhiv.org), where appropriate and based on local need and the availability of resources.
G. Support behavioral and clinical risk screening followed by risk reduction interventions for HIV-
positive persons and HIV-discordant couples at risk of transmitting HIV.
H. Support implementation of behavioral, structural, and/or biomedical interventions (including
interventions focused on treatment adherence) for HIV-infected persons.
I. Support and/or coordinate integrated hepatitis, TB, and STD screening (STD Treatment Guidelines,
2010), and Partner Services for HIV-infected persons, according to existing guidelines.
J. Support reporting of CD4 and viral load results to health departments and use of these data for
estimating linkage and retention in care, community viral load, quality of care, and providing
feedback of results to providers and patients, as deemed appropriate.
K. Promote the provision of antiretroviral therapy (ART) in accordance with current treatment
guidelines. (CDC funds may not be used to purchase antiretroviral therapy).
Comprehensive Prevention with Positives Goals:
1. Increase access to care and improve health outcomes of people living with HIV through
Linkage to Care and Medical Case Management services.
2. Through Linkage to Care and Medical Case Management services, decrease the
community viral load through medication and treatment adherence activities, thereby
decreasing infectivity rates.
3. Reduce new HIV infections through comprehensive prevention with positives activities
including Partner Services and Comprehensive Risk Counseling and Services.
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 11
Comprehensive Prevention with Positive Objectives and Annual Targets
Objectives
Targets
Year 1 Year 2 Year 3 Year 4 Year 5 Total
Newly-identified HIV-positives
# HIV-diagnosed clients (new and
previous positives) linked to HIV
medical care 45 45 46 47 48 231
# of clients with a newly-identified
HIV-positive test result linked to
medical care and attended their
first medical appointment 36 36 37 38 38 185
# of clients with a newly-identified
HIV-positive test result referred to
and interviewed for Partner Services 53 54 55 56 57 275
# of HIV-positive clients who were
referred and linked to prevention
services (CRCS) 45 45 45 45 45 225
# of newly-identified HIV-positive
clients who were referred and
linked to prevention services (CRCS) 15 15 15 15 15 75
Outcome Objective(s) – Linkage to Care (LTC)
To link newly diagnosed HIV-positive people to medical care and other
services through short-term, intensive Linkage to Care (LTC) services.
Responsible for
implementation
Process Objective 1: In Year 1 (2012) and continuing forward, at least
80% of persons who receive their HIV-positive test results are linked to
medical care and attend their first medical appointment per year.
Process Objective 2: In Year 1 (2012) and continuing forward, at least
95% of appropriately referred clients are enrolled into LTC services per
year.
Process Objective 3: In Year 1 (2012) and continuing forward, at least
95% of new LTC clients will have an orientation, intake and assessment
appointment completed within ten days of initial contact with the
Linkage to Care Coordinator (LCC) per year.
Process Objective 4: In Year 1 (2012) and continuing forward, the LCCs
will attend at least one medical visit with 95% of enrolled clients within
the first 90 to 120 days of enrollment in LTC per year.
Process Objective 5: In Year 1 (2012) and continuing forward, at least
Linkage to Care
Coordinators
KDHE Ryan White
Part B Program
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 12
70% of enrolled clients will transfer to medical case management
(MCM) from the LTC Program within 90-120 days of enrollment per
year.
Process Objective 6: In Year 1 (2012) and continuing forward, at least
80% of clients who complete the LTC Program will still be engaged in
care after one year of being enrolled in the LTC Program per year.
Outcome Objective(s) – Retention and Reengagement in Care
To ensure retention and engagement in care and treatment services for
people living with HIV/AIDS through the provision of medical case
management.
Responsible for
implementation
Process Objective 1: In Year 1 (2012) and continuing forward, at least
75% of active Ryan White Part B enrolled clients will receive a
medication and adherence screening at semiannual and annual
renewals with their medical case manager per year.
Process Objective 2: In Year 1 (2102) and continuing forward, Ryan
White Part B funded medical case managers will facilitate biannual case
consults for 75% of active Ryan White Part B enrolled clients per year.
Ryan White Medical
Case Management
Agencies
KDHE Ryan White
Part B Program
Outcome Objective(s) – Comprehensive Risk Counseling and Services
To provide individual-level HIV prevention services to people living with
HIV who are at high-risk for transmitting HIV to other people.
Responsible for
implementation
Process Objective 1: In Year 1 (2012) and continuing forward, 100% of
clients referred to CRCS will be contacted by the CRCS provider within
one week of referral per year.
Process Objective 2: In Year 1 (2012) and continuing forward, at least
60% of enrolled clients will complete at least four risk reduction
sessions per year.
Process Objective 3: In Year 1 (2012) and continuing forward, at least
90% of enrolled clients will have a written, client-centered prevention
plan by the third risk reduction session per year.
Process Objective 4: In Year 1 (2012) and continuing forward, at least
90% of enrolled clients will have a psychosocial assessment completed
by the second risk reduction session per year.
Process Objective 5: In Year 1 (2012) and continuing forward, at least
90% of enrolled clients will have a follow up risk screening at 90 days
per year.
KDHE CRCS Provider
KDHE HIV Prevention
Program Manager
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 13
Outcome Objective(s) – Partner Services
To locate sexual and injection drug-sharing partners of newly diagnosed
HIV-positive people and provide those partners with HIV and STD
testing, referral, and linkage services.
Responsible for
implementation
Process Objective 1: In Year 1 (2012) and continuing forward,
Behavioral Intervention Specialists (BIS) will obtain a final disposition on
80% of all new HIV reactors within 7 days of initiation to the field per
year.
Process Objective 2: In Year 1 (2012) and continuing forward, BIS will
conduct an intensive disease intervention interview on 80% of all newly
diagnosed HIV reactors within 7 days of initiation to the field per year.
Process Objective 3: In Year 1 (2012) and continuing forward, BIS will
initiate at least 2.0 sexual partners per case of HIV interviewed per
year.
Process Objective 4: In Year 1 (2012) and continuing forward, BIS will
initiate at least 1.0 cluster suspects /associates per case of HIV
interviewed per year.
KDHE STD Program
Behavioral
Intervention
Specialists (BIS)
Capacity Building Activities Planned for Prevention with Positives:
Each program listed in this section – LTC, MCM, CRCS, and PS – requires its staff members to
complete training requirements, some of which are the same for all four programs and some of
which are specific to the particular program. All staff members are required to complete the
training requirements set by the KDHE HIV Testing Program including an online HIV basics
course, an in-person behavior change course, and testing technology training.
KDHE is working with the Denver PTC to bring a training of facilitators training for the RESPECT
intervention to Kansas in 2012. All BIS staff will be required to attend this training, as well as
one newly hired Linkage to Care Coordinator.
Monitoring and
Evaluation question
Indicator(s)/Measure(s) Data Source Timeline
To what extent do KDHE
programs enroll the
projected number of
HIV-positive clients
stated in the program
plan for CRCS?
Proportion of the
projected number of
clients in the program
plan that enroll in CRCS
CPEMS,
EvaluationWeb
Ongoing
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 14
How successful are KDHE
programs at ensuring
that enrolled clients
complete all intended
sessions (and receive the
maximum benefit) of
CRCS?
Proportion of enrolled
CRCS clients that
complete four or more
risk reduction sessions
CPEMS,
EvaluationWeb
Ongoing
To what extent do KDHE
programs enroll the
projected number of
HIV-positive clients
stated in the program
plan for Linkage to Care?
Number of HIV
diagnosed clients who
participated in a program
or activity designed to
link them to HIV medical
care
KDHE Positives
Database,
EvaluationWeb,
Linkage to Care
Coordinators
Ongoing
To what extent do KDHE
programs enroll the
projected number of
HIV-positive clients
stated in the program
plan for adherence to
ART?
Number of HIV
diagnosed clients who
participated in a program
designed to increase
adherence to ART
KDHE Positives
Database,
EvaluationWeb,
Linkage to Care
Coordinators,
SCOUT, eHARS
Ongoing
To what extent do KDHE
programs enroll the
projected number of
HIV-positive clients
stated in the program
plan for re-engagement
to HIV medical care?
Number of HIV
diagnosed clients who
participated in a program
or activity designed to
retain or re-engage them
in HIV medical care
KDHE Positives
Database,
EvaluationWeb,
Linkage to Care
Coordinators,
SCOUT, eHARS
Ongoing
To what extent do KDHE
programs enroll the
projected number of
HIV-positive clients
stated in the program
plan for Partner
Services?
Number of HIV
diagnosed clients who
participated in Partner
Services
KDHE Positives
Database, TriSano,
Behavioral
Intervention
Specialists, SCOUT,
eHARS
Ongoing
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 15
Required Component: Condom Distribution
Required Elements for Condom Distribution:
A. Conduct condom distribution to target HIV-positive persons and persons at highest risk
of acquiring HIV infection.
Condom Distribution Goals:
Reduce new HIV infections by implementing a high-impact condom distribution program to
decrease the number of unprotected anal and vaginal sexual contacts among high-risk HIV-
positive and HIV-negative people.
Condom Distribution Objectives and Annual Targets
Objectives
Targets
Year 1 Year 2 Year 3 Year 4 Year 5 Total
# of condoms to be distributed
(overall) 50,000 55,000 60,000 65,000 70,000 300,000
# of condoms to be distributed
targeted to HIV-positive individuals 15,000 16,500 18,000 19,500 21,000 90,000
# of condoms to be distributed
targeted to high-risk negatives/HIV
unknown status 35,000 38,500 42,000 45,500 49,000 210,000
Outcome Objective(s)
To encourage people at high-risk for HIV transmission to use condoms
consistently and correctly for anal and vaginal sex, especially in sero-
discordant relationships.
Responsible for
implementation
Process Objective 1: In Year 1 (2012) and continuing forward, KDHE will
purchase and make condoms and other safer sex materials available to
community HIV service providers each year. Condoms will be targeted
toward priority populations at high-risk for HIV transmission,
specifically HIV-positive people and their sexual partners; men who
have sex with men; heterosexual African American women; injection
drug users; youth ages 15 to 24; people with a recent STD/hepatitis/TB
diagnosis; and incarcerated people upon release from incarceration.
Process Objective 2: In Year 1 (2012) and continuing forward, sites
receiving condoms and other safer sex materials from KDHE will report
distribution data including numbers distributed, populations reached,
and distribution venues/settings to KDHE on a quarterly basis.
KDHE HIV/AIDS
Program
HIV Testing Sites
HIV Prevention Sites
Behavioral
Intervention
Specialists
CRCS Provider
LTC Coordinators
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 16
Medical Case
Management
Agencies
Capacity Building Activities Planned for Condom Distribution:
KDHE will offer assistance to providers on how to best distribute condoms to populations at
highest risk for acquiring HIV.
Monitoring and
Evaluation question
Indicator(s)/Measure(s) Data Source Timeline
To what extent do KDHE
programs provide the
projected number of
condoms as stated in the
program plan for
Condom Distribution?
Total number of
condoms distributed
(overall)
Condom
Distribution
reporting
database
Ongoing
To what extent do KDHE
programs provide the
projected number of
condoms to HIV-negative
targeted, specific
populations as stated in
the program plan for
Condom Distribution?
Number of condoms
targeted to HIV-negative
specific populations
Condom
Distribution
reporting
database
Ongoing
What percentage of all
distributed condoms
reach HIV-positive
people as stated in the
program plan for
Condom Distribution?
Percentage of all
distributed condoms
reaching HIV-positive
people
Condom
Distribution
reporting
database
Ongoing
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 17
Required Component: Policy Initiatives
Required Elements for Policy Initiative Strategies:
A. Support efforts to align structures, policies, and regulations in the jurisdiction with
optimal HIV prevention, care, and treatment and to create an enabling environment
for HIV prevention efforts. Policy efforts should aim to improve efficiency of HIV
prevention efforts where applicable, and are subject to lobbying restrictions under
federal law.
Policy Initiative Goals:
Policy initiatives aim to align structures, policies, and regulations within Kansas to meet the
goals of the National HIV/AIDS Strategy:
1. Reducing new HIV infections.
2. Increasing access to care and improving health outcomes for people living with HIV.
3. Reducing HIV-related health disparities.
Note: When providing the Policy Initiatives objectives, please indicate at what stage the
jurisdiction expects to be for each of their policy initiatives for each year, using the following
categories: Identification (i.e., Identification/recognition of need, review of existing policies);
Planning (i.e., policy formulation/preparation/development); Implementation; or Evaluation.
Outcome Objective(s)
Increase knowledge of and capability to address health disparities
within the HIV services field in Kansas.
Responsible for
implementation
Process Objective 1: Beginning in Year 1 (2012), KDHE Prevention
Program staff will provide at least one website link to an online
training resource focused on addressing health disparities per quarter
during a monthly prevention provider call. Stage: Planning
Process Objective 2: By the middle of Year 2 (2013), KDHE Prevention
Program staff will develop and implement an online course on health
disparities, available through KS Train for free.
Process Objective 3: By the end of Year 2 (2013), all contracted HIV
prevention service providers will be required to take the KDHE health
disparities course online. Stage: Planning
KDHE HIV Prevention
Program Staff
HIV Prevention
Contractors
Outcome Objective(s)
Provide linkages to organizational development resources to increase
the capacity and infrastructure of HIV services in Kansas.
Responsible for
implementation
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 18
Process Objective 1: Beginning in Year 1 (2012), KDHE Prevention
Program staff will provide at least one website link to an online
training resource focused on infrastructure development on each
monthly prevention provider call. Stage: Implementation
Process Objective 2: Beginning in Year 2 (2013), KDHE Prevention
Program staff will provide at least one training on prevention program
development and maintenance per quarter during a monthly
prevention provider call. Stage: Planning
Process Objective 3: Beginning in Year 1 (2012), KDHE Prevention
Program staff will provide onsite technical assistance and capacity
building assistance to assist prevention providers in developing and
maintaining prevention program activities as needed, but no less than
once per year per site. Stage: Implementation
KDHE HIV Prevention
Program Staff
Outcome Objective(s)
Require the reporting of all HIV/AIDS CD4 test results and viral load
laboratory counts to the state health department to better direct HIV
care, prevention and treatment services in Kansas.
Responsible for
implementation
Process Objective 1: In Year 1 (2012), identify the changes in Kansas
law that will make reporting of laboratory information feasible.
Process Objective 2: In Year 2 (2013), propose changes to Kansas law
within KDHE as suggested legislative priorities for 2014.
Process Objective 3: In Year 3 (2014), work with Kansas legislature to
introduce law change.
Process Objective 4: No later than Year 5 (2016), Kansas law will be
changed to allow for reporting of all HIV/AIDS CD4 test results and
viral load laboratory counts to KDHE.
KDHE HIV/AIDS
Program Staff
KDHE HIV/AIDS
Program Director
KDHE Legislative
Liaison(s)
Kansas Legislature
Capacity Building Activities Planned for Policy Initiative:
Health Disparities:
• Provide at least quarterly online training resource about health disparities to
prevention providers through monthly prevention contractor calls.
• Develop online health disparities training course.
Infrastructure Building:
• Provide monthly online training resource about infrastructure development and
maintenance on monthly prevention contractor calls.
• Provide at least quarterly training on infrastructure development through monthly
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 19
prevention provider calls.
• Provide onsite technical assistance and capacity building assistance to contracted
prevention providers at least once per year.
Community Viral Load:
• Work within KDHE to educate staff on the importance of changing law to require
reporting of all CD4s and viral loads.
• As needed, educate Kansas legislators on the importance of changing law to require
reporting of all CD4s and viral loads.
Monitoring and
Evaluation question
Indicator(s)/Measure(s) Data Source Timeline
How many online
training resources for
addressing health
disparities were shared
per year?
Number of training
resources shared
HIV prevention
provider call
agendas
At least one
provided quarterly
How many contracted
prevention provider
staff members
successfully completed
the online health
disparities training in
the timeframe allotted?
Number of people
completing the online
training with a score of
80% or higher
KS Train Course uploaded
by KDHE by mid-
year 2013;
completed by
contract agency
staff by end of
2013
How many online
training resources for
infrastructure building
were shared per year?
Number of training
resources shared
HIV prevention
provider call
agendas
At least one
provided monthly
How many KDHE
trainings on
infrastructure building
were offered per year?
Number of KDHE
trainings offered
HIV prevention
provider call
agendas
At least one
provided quarterly
How many onsite
technical assistance/
capacity building
assistance visits were
offered per year?
Number of onsite
trainings offered to each
site per year
Site visit reports At least one per
site per year
Did Kansas law change
to allow reporting of all
CD4 and viral loads to
KDHE?
Kansas statute change Kansas statutes By 2016
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 20
Recommended Component: Evidence-based HIV Prevention Interventions for HIV-
Negative Persons at Highest Risk of Acquiring HIV
Not applicable
Recommended Component: Social Marketing, Media, and Mobilization
Not applicable
Recommended Component: Pre-Exposure Prophylaxis and Non-Occupational Post-
Exposure Prophylaxis Services
Not applicable
PS12-1201 Category B
Expanded HIV Testing for Disproportionately Affected Populations
Not applicable
Recommended Component: HIV Testing in Non-Healthcare Settings (Optional)
Not applicable
Recommended Component: Service Integration (Optional)
Not applicable
PS12-1201 Category C
Demonstration Projects
Not applicable
Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 21
Quality Assurance (QA) Plan for All Applicable Categories
Quality Assurance is the systematic monitoring and evaluation of the various aspects of a
project, service, or facility to ensure that standards of quality are being met. The QA plan is
applicable to all the aforementioned components and activities. QA plans can be outlined for
each category, component and/or activity or grouped together (e.g. list of QA activities that
apply to all activities and categories). Each grantee is required to submit their QA plan taking in
consideration at least the following domains:
Technical performance: The degree to which the tasks carried out by health workers
and facilities meet expectations of technical quality (i.e. adhere to standards).
Access to services: The degree to which healthcare services are unrestricted by
geographic, economic social, organizational or linguistic barriers.
Effectiveness of care: The degree to which desired results (outcomes) are achieved.
Continuity of services: Appropriate and timely referral/linkage and communication
between providers.
The plan should document quality assurance measures and mechanisms to ensure that services
are provided in a technically competent manner and are consistent with current CDC guidelines
and recommendations. QA activities may be included within this document or may be
submitted as a separate document.
Program activities related to quality assurance are incorporated into this document in each section, as
well as documented in the Interim Progress Report to be submitted to CDC in September 2012.

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KDHE 2012 HIV Prevention Comprehensive Plan

  • 1. Kansas Department of Health and Environment Bureau of Disease Control and Prevention HIV/AIDS Section HIV Prevention Program PS12-1201: Comprehensive Human Immunodeficiency Virus (HIV) Prevention Programs for Health Departments Comprehensive Program Plan Reporting Period: January 1, 2012 – December 31, 2016 Year One, 2012
  • 2. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 2 HEALTH DEPARTMENT CONTACT INFORMATION Award Number: 1U62PS003694-01 Health Department: Kansas Department of Health and Environment Mailing Address: 1000 SW Jackson Street, Ste. 210 City: Topeka State: KS Zip Code: 66612 Phone Number: 785-296-1037 Fax: 785-296-4197 Contact Information for this program plan Title/Position Name Phone E-mail Address Fax Primary Contact HIV Prevention Program Manager Travis Barnhart Ph: 785-296-1037 tbarnhart@kdheks.g ovF: 785-296-4197 Secondary Contact HIV/AIDS Program Director Ralph Wilmoth Ph: 785-296-8596 rwilmoth@kdheks.go vF: 785-296-4197 HEALTH DEPARTMENT FUNDED CATEGORIES Please select the required core components and recommended program components implemented within the jurisdiction: Category A: HIV Prevention Programs for Health Departments Required core components (required for all funded grantees): HIV Testing Comprehensive Prevention with Positives Condom Distribution Policy Initiatives Recommended program components: Evidence-based HIV Prevention Interventions for HIV-Negative Persons at Highest Risk Social Marketing, Media and Mobilization Pre-Exposure Prophylaxis and Non Occupational Post-Exposure Prophylaxis Services Category B: Expanded HIV Testing for Disproportionately Affected Populations Not Applicable/Not Funded Program components: HIV Testing in Healthcare Settings (required) HIV Testing in Non-Healthcare Settings (optional) Service Integration (optional) Category C: Demonstration Projects for Innovative, High-Impact Prevention Not Applicable/Not Funded Program focus areas: Structural, Behavioral, and/or Biomedical Interventions Innovative HIV Testing Activities Enhanced Linkage to and Retention in Care Advanced Use of Technology Programmatic use of CD4, viral load and other surveillance data
  • 3. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 3 PS12-1201 Resource Allocation One of the goals of this FOA is to reduce HIV transmission by building capacity of health departments to focus HIV prevention efforts in communities and local areas, where HIV is most heavily concentrated, to achieve the greatest impact in decreasing the risks of acquiring HIV. Grantees should monitor the HIV/AIDS epidemic within the jurisdiction for program planning, resource allocation and monitoring and evaluation purposes. Grantees should utilize the most current epidemiological and surveillance data and other available data sources to assist in program planning and evaluation. To ensure that resources are reaching the areas of greatest need, grantees will be required to report annually to CDC on the amount of funding allocated to the areas with 30% or greater of the HIV epidemic and how the funds were used. Please identify each city/MSA with at least 30% of the HIV epidemic within the jurisdiction. For directly-funded cities, please report areas or zip codes within the MSA with at least 30% of the HIV epidemic within the jurisdiction. If no area represents at least 30% of the HIV epidemic, then identify the top three MSA/MDs, cities, or areas within the jurisdiction that have the greatest burden of disease. MSA/CITY Percentage of HIV Epidemic Percentage of PS12-1201 Funds Allocated Components and Activities Funded Kansas City (Leavenworth, Johnson, Miami, and Wyandotte counties) 42% (Prevalence) 2012 – 29.34% 2013 – 28.93% HIV Testing: Lab Support, Opt-Out Testing in Healthcare Settings, Prioritized Testing in Non- Healthcare Settings; PWP: 1 staff member salary/fringe and support for 2 local health department PS grants; Condom Distribution Wichita (Butler, Harvey, Sedgwick and Sumner counties) 28% (Prevalence) 2012 – 22.43% 2013 – 16.94% HIV Testing: Lab Support, Opt-Out Testing in Healthcare Settings, Prioritized Testing in Non- Healthcare Settings; PWP: support for 1 local health department PS grant; Condom Distribution
  • 4. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 4 PS12-1201 Category A HIV Prevention Programs for Health Departments (core funding) Required Component: HIV Testing The following are the National-Level Objectives and Performance Standards that will be used for HIV testing and linkage to care activities funded under Category A. Category A goals and objectives should be developed in relation to the National-Level Objectives and Performance Standards while also addressing elements of each program component as listed in the FOA. National Goal: CDC expects approximately two million HIV tests will be provided annually, among all funded jurisdictions, when the program is fully implemented. Performance Standards: CDC expects each funded jurisdiction to achieve the following performance standards, when the program is fully implemented:  For targeted HIV testing in non-healthcare settings or venues, achieve at least a 1.0% rate of newly-identified HIV-positive tests annually.  At least 85% of persons who test positive for HIV receive their test results.  At least 80% of persons who receive their HIV-positive test results are linked to medical care and attend their first appointment (within 90 days of the positive HIV test).  At least 75% of persons who receive their HIV-positive test results are referred to and interviewed for Partner Services (within 30 days of having received a positive test result). Required Elements for HIV Testing: A. Implement and/or coordinate opt-out HIV testing of patients ages 13-64 in healthcare settings. B. Implement and/or coordinate HIV testing in non-healthcare settings to identify undiagnosed HIV infection using multiple strategies and the most current recommendations for HIV counseling, testing and referral. C. Support HIV testing activities in venues that reach persons with undiagnosed HIV infections. D. Ensure the provision of test results, particularly to clients testing positive. E. Promote routine, early HIV screening for all pregnant women, according to current CDC recommendations. F. Encourage and support health department and non-health department providers to increase the number of persons diagnosed with HIV through strengthening current HIV testing efforts or creating new services. G. Facilitate voluntary testing for other STDs (e.g., syphilis, gonorrhea, chlamydial infection), HBV, HCV, and TB, in conjunction with HIV testing, including referral and linkage to appropriate services, where feasible and appropriate and in accordance with current CDC guidelines and recommendations. (This activity may be implemented in collaboration with STD, hepatitis, and/or TB programs).
  • 5. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 5 H. Ensure that testing laboratories provide tests of adequate quality, report findings promptly, and participate in a laboratory performance evaluation program for testing. (This activity may be done in conjunction with surveillance and/or laboratory services). I. Incorporate new testing technologies, where feasible and appropriate. HIV Testing Goals: Reduce new HIV infections by implementing and coordinating opt-out and prioritized (targeted) testing while ensuring the provision of HIV test results, particularly to clients testing positive. HIV Testing Objectives and Annual Targets In an effort to monitor progress toward meeting the PS12-1201 Category A national objectives, please submit your jurisdictional proposed objectives for number of HIV test events, number of newly-identified HIV-positive test results, and new HIV-positive test rate for years 1-5 of the project period. For each year, enter the projected number of HIV test events that will be conducted and the anticipated new HIV-positive test rate. Objectives Targets Per Year Year 1 Year 2 Year 3 Year 4 Year 5 Total # of HIV testing events - Overall 27,840 24,084 20,914 18,242 15,993 107,073 # of HIV testing events – Healthcare Settings 26,040 22,134 18,814 15,992 13,593 96,573 # of HIV testing events – Non- Healthcare Settings 1,800 1,950 2,100 2,250 2,400 10,500 # of HIV positive test results - Overall 35 37 39 44 45 200 # of HIV positive test results - Healthcare Settings 26 22 18 16 14 96 # of HIV positive test results - Non- Healthcare Settings 9 15 21 28 31 104 # of newly-identified HIV-positive test results - Overall 27 28 30 33 35 153 # of newly-identified HIV-positive test results - Healthcare Settings 20 17 14 12 11 74 # of newly-identified HIV-positive test results - Non-Healthcare Settings 7 11 16 21 24 79
  • 6. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 6 # of newly identified HIV-positive test results returned to clients - Overall 27 28 30 33 35 153 # of newly identified HIV-positive test results returned to clients - Healthcare Settings 20 17 14 12 11 74 # of newly identified HIV-positive test results returned to clients – Non-Healthcare Settings 7 11 16 21 24 79 New HIV-positive test rate (%)* - Healthcare Settings 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% New HIV-positive test rate (%)* - Non-Healthcare Settings .5% .75% 1% 1% 1% .5% to 1% # of high-risk HIV negative clients who will enroll in the individual- level evidence-based intervention RESPECT in conjunction with HIV testing 1,500 1,650 1,800 1,950 2,100 9,000 *# of newly-identified HIV-positive test results (numerator)/ # of HIV testing events (denominator) = Target rate for new HIV positivity. Outcome Objective(s) – HIV Testing in Healthcare Settings To make people aware of their HIV status through HIV testing in healthcare settings. Responsible for implementation Process Objective 1: In Year 1 (2012) and continuing forward, achieve at least a 0.1% positivity rate for HIV testing in all healthcare settings and venues funded and supported by KDHE each year. Process Objective 2: In Year 1 (2012) and continuing forward, provide HIV test results to 100% of all clients who test positive for HIV and provide results to at least 75% of all clients who test negative each year. Process Objective 3: In Year 1 (2012) and continuing forward, at least 80% of persons who receive their HIV-positive test results are referred to Linkage to Care Services within one week of receiving their test results per year. Process Objective 4: In Year 1 (2012) and continuing forward, refer and link at least 95% of all clients who receive a positive HIV test result to Partner Services within one week of receiving their test result. KDHE HIV Counseling, Testing and Linkage Program HIV Testing Sites – Healthcare Settings
  • 7. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 7 Process Objective 5: By the end of Year 2 (2013), provide orientation and trainings for program and clinical staff at KDHE funded and supported HIV testing sites to outline roles and responsibilities regarding restructuring and prioritization of testing individuals at highest risk for HIV. Process Objective 6: By the end of Year 2 (2013), provide training and technical assistance for KDHE funded and supported HIV testing sites on how to implement 3rd party billing practices. Process Objective 7: By the end of Year 2 (2013), upgrade testing technologies used by the state lab to fourth generation Bio-Rad HIV 1/2 Combo Ag/Ab for serum for HIV testing sites with a 0.1% positivity rate. Outcome Objective(s) – HIV Testing in Non-Healthcare Settings To make people aware of their HIV status through prioritized/targeted HIV testing in non-healthcare settings. Responsible for implementation Process Objective 1: By the end of Year 1 (2012), achieve at least a 0.5% positivity rate for HIV testing in all non-healthcare settings and venues funded and supported by KDHE. Process Objective 2: By the end of Year 2 (2013), achieve at least a 0.75% positivity rate for HIV testing in all non-healthcare settings and venues funded and supported by KDHE. Process Objective 3: By the end of Year 3 (2014) and continuing forward, achieve at least a 1.0% positivity rate for HIV testing in all non- healthcare settings and venues funded and supported by KDHE per year. Process Objective 4: In Year 1 (2012) and continuing forward, provide HIV test results to 100% of all clients who test positive for HIV and provide results to at least 85% of all clients who test negative per year. Process Objective 5: In Year 1 (2012) and continuing forward, at least 80% of persons who receive their HIV-positive test results are referred to Linkage to Care Services within one week of receiving their test results per year. Process Objective 6: In Year 1 (2012) and continuing forward, refer and link at least 95% of all clients who receive a positive HIV test result to Partner Services within one week of receiving their test result per year. KDHE HIV Counseling, Testing and Linkage Program HIV Testing Agencies KDHE HIV Prevention Program
  • 8. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 8 Process Objective 7: Each site funded by KDHE to conduct prioritized HIV testing will provide the individual-level intervention RESPECT in conjunction with HIV testing (rapid or conventional), conducting at least 250 RESPECT cycles in 2012, 275 in 2013, 300 in 2014, 325 in 2015, and 350 in 2016 per site. Capacity Building Activities Planned for HIV Testing: There are two areas for CBA/TA related to HIV Testing: anticipated CBA for KDHE program staff, and anticipated CBA provided by KDHE to contracted providers/agencies. In the area of CBA for KDHE program staff, there is a need for the development of a targeted screening tool using patient data that could be used to effectively estimate a patient’s risk of having undiagnosed HIV infection. Additionally, KDHE program staff intends to seek CBA for motivational interviewing skills in order to provide providers/agencies enhanced strategies for behavior change counseling. In the area of CBA provided to contracted providers/agencies, KDHE will address these areas: 1. EvaluationWeb user efficiency. 2. Understanding the roles and responsibilities of testing program and clinical staff in relation to the restructuring of testing priorities for individuals at risk for HIV. 3. Third party billing practices for contracted agencies. 4. Efforts will be made to work with CDC to access a training of trainers for the RESPECT intervention. Additionally, collaborations with the KDHE STD program will occur in order to access a training of facilitators for the RESPECT intervention in the Kansas City area (scheduled tentatively for November 2012). 5. Identification and assessment of testing venues to ensure testing is being done to meet the 1.0% positivity rate for non-healthcare sites. 6. Motivating and incentivizing testing among target populations for contracted providers/agencies. Monitoring and Evaluation question Indicator(s)/Measure(s) Data Source Timeline What is the HIV- positive test yield at KDHE supported HIV test sites, both healthcare and non- healthcare? Percent of newly identified, confirmed HIV-positive test results among all testing events reported by KDHE supported test sites. Numerator: newly identified, confirmed HIV-positive test results. Denominator: all testing events reported. EvaluationWeb Ongoing How successful are Percent of newly EvaluationWeb, Ongoing
  • 9. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 9 CDC-funded programs at returning HIV- positive test results to clients? identified, confirmed HIV-positive test results returned to clients. Numerator: newly identified, confirmed HIV-positive test results. Denominator: all testing events reported. Positives Database How successful are CDC-funded programs at ensuring that newly identified HIV-positive clients are linked to medical care? Percent of newly identified, confirmed HIV-positive clients referred to medical care who attend their first appointment EvaluationWeb, Positives Database, SCOUT, Linkage to Care providers Ongoing To what extent do KDHE programs enroll the projected number of clients stated in the program plan for the RESPECT EBI? Proportion of the projected number of clients in the program plan that enroll in RESPECT CPEMS, EvaluationWeb Ongoing
  • 10. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 10 Required Component: Comprehensive Prevention with Positives Required Elements for Comprehensive Prevention with Positives: A. Provide linkage to HIV care, treatment, and prevention services for those persons testing HIV- positive or currently living with HIV/AIDS. B. Promote retention or re-engagement in care for HIV-positive persons. C. Offer referral and linkage to other medical and social services such as mental health, substance abuse, housing, safety/domestic violence, corrections, legal protections, income generation, and other services as needed for HIV-positive persons. D. Provide ongoing Partner Services (Recommendations for Partner Services Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection, 2008. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5709a1.htm ) for HIV-positive persons and their partners: Collaborate and coordinate with STD programs, and HIV and/or STD surveillance programs to utilize data to maximize the number of persons identified as candidates for Partner Services. (2) Partner with non-health department providers, including CBOs and private medical treatment providers, to identify more opportunities to provide Partner Services. E. Assure that HIV-positive pregnant women receive the necessary interventions and treatment for the prevention of perinatal transmission. F. Conduct sentinel event case review and community action to address local systems issues that lead to missed perinatal HIV prevention opportunities by utilizing the Fetal and Infant Mortality Review (FIMR)-HIV Prevention Methodology, including CDC’s web-based data system (see www.fimrhiv.org), where appropriate and based on local need and the availability of resources. G. Support behavioral and clinical risk screening followed by risk reduction interventions for HIV- positive persons and HIV-discordant couples at risk of transmitting HIV. H. Support implementation of behavioral, structural, and/or biomedical interventions (including interventions focused on treatment adherence) for HIV-infected persons. I. Support and/or coordinate integrated hepatitis, TB, and STD screening (STD Treatment Guidelines, 2010), and Partner Services for HIV-infected persons, according to existing guidelines. J. Support reporting of CD4 and viral load results to health departments and use of these data for estimating linkage and retention in care, community viral load, quality of care, and providing feedback of results to providers and patients, as deemed appropriate. K. Promote the provision of antiretroviral therapy (ART) in accordance with current treatment guidelines. (CDC funds may not be used to purchase antiretroviral therapy). Comprehensive Prevention with Positives Goals: 1. Increase access to care and improve health outcomes of people living with HIV through Linkage to Care and Medical Case Management services. 2. Through Linkage to Care and Medical Case Management services, decrease the community viral load through medication and treatment adherence activities, thereby decreasing infectivity rates. 3. Reduce new HIV infections through comprehensive prevention with positives activities including Partner Services and Comprehensive Risk Counseling and Services.
  • 11. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 11 Comprehensive Prevention with Positive Objectives and Annual Targets Objectives Targets Year 1 Year 2 Year 3 Year 4 Year 5 Total Newly-identified HIV-positives # HIV-diagnosed clients (new and previous positives) linked to HIV medical care 45 45 46 47 48 231 # of clients with a newly-identified HIV-positive test result linked to medical care and attended their first medical appointment 36 36 37 38 38 185 # of clients with a newly-identified HIV-positive test result referred to and interviewed for Partner Services 53 54 55 56 57 275 # of HIV-positive clients who were referred and linked to prevention services (CRCS) 45 45 45 45 45 225 # of newly-identified HIV-positive clients who were referred and linked to prevention services (CRCS) 15 15 15 15 15 75 Outcome Objective(s) – Linkage to Care (LTC) To link newly diagnosed HIV-positive people to medical care and other services through short-term, intensive Linkage to Care (LTC) services. Responsible for implementation Process Objective 1: In Year 1 (2012) and continuing forward, at least 80% of persons who receive their HIV-positive test results are linked to medical care and attend their first medical appointment per year. Process Objective 2: In Year 1 (2012) and continuing forward, at least 95% of appropriately referred clients are enrolled into LTC services per year. Process Objective 3: In Year 1 (2012) and continuing forward, at least 95% of new LTC clients will have an orientation, intake and assessment appointment completed within ten days of initial contact with the Linkage to Care Coordinator (LCC) per year. Process Objective 4: In Year 1 (2012) and continuing forward, the LCCs will attend at least one medical visit with 95% of enrolled clients within the first 90 to 120 days of enrollment in LTC per year. Process Objective 5: In Year 1 (2012) and continuing forward, at least Linkage to Care Coordinators KDHE Ryan White Part B Program
  • 12. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 12 70% of enrolled clients will transfer to medical case management (MCM) from the LTC Program within 90-120 days of enrollment per year. Process Objective 6: In Year 1 (2012) and continuing forward, at least 80% of clients who complete the LTC Program will still be engaged in care after one year of being enrolled in the LTC Program per year. Outcome Objective(s) – Retention and Reengagement in Care To ensure retention and engagement in care and treatment services for people living with HIV/AIDS through the provision of medical case management. Responsible for implementation Process Objective 1: In Year 1 (2012) and continuing forward, at least 75% of active Ryan White Part B enrolled clients will receive a medication and adherence screening at semiannual and annual renewals with their medical case manager per year. Process Objective 2: In Year 1 (2102) and continuing forward, Ryan White Part B funded medical case managers will facilitate biannual case consults for 75% of active Ryan White Part B enrolled clients per year. Ryan White Medical Case Management Agencies KDHE Ryan White Part B Program Outcome Objective(s) – Comprehensive Risk Counseling and Services To provide individual-level HIV prevention services to people living with HIV who are at high-risk for transmitting HIV to other people. Responsible for implementation Process Objective 1: In Year 1 (2012) and continuing forward, 100% of clients referred to CRCS will be contacted by the CRCS provider within one week of referral per year. Process Objective 2: In Year 1 (2012) and continuing forward, at least 60% of enrolled clients will complete at least four risk reduction sessions per year. Process Objective 3: In Year 1 (2012) and continuing forward, at least 90% of enrolled clients will have a written, client-centered prevention plan by the third risk reduction session per year. Process Objective 4: In Year 1 (2012) and continuing forward, at least 90% of enrolled clients will have a psychosocial assessment completed by the second risk reduction session per year. Process Objective 5: In Year 1 (2012) and continuing forward, at least 90% of enrolled clients will have a follow up risk screening at 90 days per year. KDHE CRCS Provider KDHE HIV Prevention Program Manager
  • 13. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 13 Outcome Objective(s) – Partner Services To locate sexual and injection drug-sharing partners of newly diagnosed HIV-positive people and provide those partners with HIV and STD testing, referral, and linkage services. Responsible for implementation Process Objective 1: In Year 1 (2012) and continuing forward, Behavioral Intervention Specialists (BIS) will obtain a final disposition on 80% of all new HIV reactors within 7 days of initiation to the field per year. Process Objective 2: In Year 1 (2012) and continuing forward, BIS will conduct an intensive disease intervention interview on 80% of all newly diagnosed HIV reactors within 7 days of initiation to the field per year. Process Objective 3: In Year 1 (2012) and continuing forward, BIS will initiate at least 2.0 sexual partners per case of HIV interviewed per year. Process Objective 4: In Year 1 (2012) and continuing forward, BIS will initiate at least 1.0 cluster suspects /associates per case of HIV interviewed per year. KDHE STD Program Behavioral Intervention Specialists (BIS) Capacity Building Activities Planned for Prevention with Positives: Each program listed in this section – LTC, MCM, CRCS, and PS – requires its staff members to complete training requirements, some of which are the same for all four programs and some of which are specific to the particular program. All staff members are required to complete the training requirements set by the KDHE HIV Testing Program including an online HIV basics course, an in-person behavior change course, and testing technology training. KDHE is working with the Denver PTC to bring a training of facilitators training for the RESPECT intervention to Kansas in 2012. All BIS staff will be required to attend this training, as well as one newly hired Linkage to Care Coordinator. Monitoring and Evaluation question Indicator(s)/Measure(s) Data Source Timeline To what extent do KDHE programs enroll the projected number of HIV-positive clients stated in the program plan for CRCS? Proportion of the projected number of clients in the program plan that enroll in CRCS CPEMS, EvaluationWeb Ongoing
  • 14. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 14 How successful are KDHE programs at ensuring that enrolled clients complete all intended sessions (and receive the maximum benefit) of CRCS? Proportion of enrolled CRCS clients that complete four or more risk reduction sessions CPEMS, EvaluationWeb Ongoing To what extent do KDHE programs enroll the projected number of HIV-positive clients stated in the program plan for Linkage to Care? Number of HIV diagnosed clients who participated in a program or activity designed to link them to HIV medical care KDHE Positives Database, EvaluationWeb, Linkage to Care Coordinators Ongoing To what extent do KDHE programs enroll the projected number of HIV-positive clients stated in the program plan for adherence to ART? Number of HIV diagnosed clients who participated in a program designed to increase adherence to ART KDHE Positives Database, EvaluationWeb, Linkage to Care Coordinators, SCOUT, eHARS Ongoing To what extent do KDHE programs enroll the projected number of HIV-positive clients stated in the program plan for re-engagement to HIV medical care? Number of HIV diagnosed clients who participated in a program or activity designed to retain or re-engage them in HIV medical care KDHE Positives Database, EvaluationWeb, Linkage to Care Coordinators, SCOUT, eHARS Ongoing To what extent do KDHE programs enroll the projected number of HIV-positive clients stated in the program plan for Partner Services? Number of HIV diagnosed clients who participated in Partner Services KDHE Positives Database, TriSano, Behavioral Intervention Specialists, SCOUT, eHARS Ongoing
  • 15. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 15 Required Component: Condom Distribution Required Elements for Condom Distribution: A. Conduct condom distribution to target HIV-positive persons and persons at highest risk of acquiring HIV infection. Condom Distribution Goals: Reduce new HIV infections by implementing a high-impact condom distribution program to decrease the number of unprotected anal and vaginal sexual contacts among high-risk HIV- positive and HIV-negative people. Condom Distribution Objectives and Annual Targets Objectives Targets Year 1 Year 2 Year 3 Year 4 Year 5 Total # of condoms to be distributed (overall) 50,000 55,000 60,000 65,000 70,000 300,000 # of condoms to be distributed targeted to HIV-positive individuals 15,000 16,500 18,000 19,500 21,000 90,000 # of condoms to be distributed targeted to high-risk negatives/HIV unknown status 35,000 38,500 42,000 45,500 49,000 210,000 Outcome Objective(s) To encourage people at high-risk for HIV transmission to use condoms consistently and correctly for anal and vaginal sex, especially in sero- discordant relationships. Responsible for implementation Process Objective 1: In Year 1 (2012) and continuing forward, KDHE will purchase and make condoms and other safer sex materials available to community HIV service providers each year. Condoms will be targeted toward priority populations at high-risk for HIV transmission, specifically HIV-positive people and their sexual partners; men who have sex with men; heterosexual African American women; injection drug users; youth ages 15 to 24; people with a recent STD/hepatitis/TB diagnosis; and incarcerated people upon release from incarceration. Process Objective 2: In Year 1 (2012) and continuing forward, sites receiving condoms and other safer sex materials from KDHE will report distribution data including numbers distributed, populations reached, and distribution venues/settings to KDHE on a quarterly basis. KDHE HIV/AIDS Program HIV Testing Sites HIV Prevention Sites Behavioral Intervention Specialists CRCS Provider LTC Coordinators
  • 16. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 16 Medical Case Management Agencies Capacity Building Activities Planned for Condom Distribution: KDHE will offer assistance to providers on how to best distribute condoms to populations at highest risk for acquiring HIV. Monitoring and Evaluation question Indicator(s)/Measure(s) Data Source Timeline To what extent do KDHE programs provide the projected number of condoms as stated in the program plan for Condom Distribution? Total number of condoms distributed (overall) Condom Distribution reporting database Ongoing To what extent do KDHE programs provide the projected number of condoms to HIV-negative targeted, specific populations as stated in the program plan for Condom Distribution? Number of condoms targeted to HIV-negative specific populations Condom Distribution reporting database Ongoing What percentage of all distributed condoms reach HIV-positive people as stated in the program plan for Condom Distribution? Percentage of all distributed condoms reaching HIV-positive people Condom Distribution reporting database Ongoing
  • 17. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 17 Required Component: Policy Initiatives Required Elements for Policy Initiative Strategies: A. Support efforts to align structures, policies, and regulations in the jurisdiction with optimal HIV prevention, care, and treatment and to create an enabling environment for HIV prevention efforts. Policy efforts should aim to improve efficiency of HIV prevention efforts where applicable, and are subject to lobbying restrictions under federal law. Policy Initiative Goals: Policy initiatives aim to align structures, policies, and regulations within Kansas to meet the goals of the National HIV/AIDS Strategy: 1. Reducing new HIV infections. 2. Increasing access to care and improving health outcomes for people living with HIV. 3. Reducing HIV-related health disparities. Note: When providing the Policy Initiatives objectives, please indicate at what stage the jurisdiction expects to be for each of their policy initiatives for each year, using the following categories: Identification (i.e., Identification/recognition of need, review of existing policies); Planning (i.e., policy formulation/preparation/development); Implementation; or Evaluation. Outcome Objective(s) Increase knowledge of and capability to address health disparities within the HIV services field in Kansas. Responsible for implementation Process Objective 1: Beginning in Year 1 (2012), KDHE Prevention Program staff will provide at least one website link to an online training resource focused on addressing health disparities per quarter during a monthly prevention provider call. Stage: Planning Process Objective 2: By the middle of Year 2 (2013), KDHE Prevention Program staff will develop and implement an online course on health disparities, available through KS Train for free. Process Objective 3: By the end of Year 2 (2013), all contracted HIV prevention service providers will be required to take the KDHE health disparities course online. Stage: Planning KDHE HIV Prevention Program Staff HIV Prevention Contractors Outcome Objective(s) Provide linkages to organizational development resources to increase the capacity and infrastructure of HIV services in Kansas. Responsible for implementation
  • 18. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 18 Process Objective 1: Beginning in Year 1 (2012), KDHE Prevention Program staff will provide at least one website link to an online training resource focused on infrastructure development on each monthly prevention provider call. Stage: Implementation Process Objective 2: Beginning in Year 2 (2013), KDHE Prevention Program staff will provide at least one training on prevention program development and maintenance per quarter during a monthly prevention provider call. Stage: Planning Process Objective 3: Beginning in Year 1 (2012), KDHE Prevention Program staff will provide onsite technical assistance and capacity building assistance to assist prevention providers in developing and maintaining prevention program activities as needed, but no less than once per year per site. Stage: Implementation KDHE HIV Prevention Program Staff Outcome Objective(s) Require the reporting of all HIV/AIDS CD4 test results and viral load laboratory counts to the state health department to better direct HIV care, prevention and treatment services in Kansas. Responsible for implementation Process Objective 1: In Year 1 (2012), identify the changes in Kansas law that will make reporting of laboratory information feasible. Process Objective 2: In Year 2 (2013), propose changes to Kansas law within KDHE as suggested legislative priorities for 2014. Process Objective 3: In Year 3 (2014), work with Kansas legislature to introduce law change. Process Objective 4: No later than Year 5 (2016), Kansas law will be changed to allow for reporting of all HIV/AIDS CD4 test results and viral load laboratory counts to KDHE. KDHE HIV/AIDS Program Staff KDHE HIV/AIDS Program Director KDHE Legislative Liaison(s) Kansas Legislature Capacity Building Activities Planned for Policy Initiative: Health Disparities: • Provide at least quarterly online training resource about health disparities to prevention providers through monthly prevention contractor calls. • Develop online health disparities training course. Infrastructure Building: • Provide monthly online training resource about infrastructure development and maintenance on monthly prevention contractor calls. • Provide at least quarterly training on infrastructure development through monthly
  • 19. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 19 prevention provider calls. • Provide onsite technical assistance and capacity building assistance to contracted prevention providers at least once per year. Community Viral Load: • Work within KDHE to educate staff on the importance of changing law to require reporting of all CD4s and viral loads. • As needed, educate Kansas legislators on the importance of changing law to require reporting of all CD4s and viral loads. Monitoring and Evaluation question Indicator(s)/Measure(s) Data Source Timeline How many online training resources for addressing health disparities were shared per year? Number of training resources shared HIV prevention provider call agendas At least one provided quarterly How many contracted prevention provider staff members successfully completed the online health disparities training in the timeframe allotted? Number of people completing the online training with a score of 80% or higher KS Train Course uploaded by KDHE by mid- year 2013; completed by contract agency staff by end of 2013 How many online training resources for infrastructure building were shared per year? Number of training resources shared HIV prevention provider call agendas At least one provided monthly How many KDHE trainings on infrastructure building were offered per year? Number of KDHE trainings offered HIV prevention provider call agendas At least one provided quarterly How many onsite technical assistance/ capacity building assistance visits were offered per year? Number of onsite trainings offered to each site per year Site visit reports At least one per site per year Did Kansas law change to allow reporting of all CD4 and viral loads to KDHE? Kansas statute change Kansas statutes By 2016
  • 20. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 20 Recommended Component: Evidence-based HIV Prevention Interventions for HIV- Negative Persons at Highest Risk of Acquiring HIV Not applicable Recommended Component: Social Marketing, Media, and Mobilization Not applicable Recommended Component: Pre-Exposure Prophylaxis and Non-Occupational Post- Exposure Prophylaxis Services Not applicable PS12-1201 Category B Expanded HIV Testing for Disproportionately Affected Populations Not applicable Recommended Component: HIV Testing in Non-Healthcare Settings (Optional) Not applicable Recommended Component: Service Integration (Optional) Not applicable PS12-1201 Category C Demonstration Projects Not applicable
  • 21. Kansas PS12-1201 Comprehensive Program Plan, 2012 Page 21 Quality Assurance (QA) Plan for All Applicable Categories Quality Assurance is the systematic monitoring and evaluation of the various aspects of a project, service, or facility to ensure that standards of quality are being met. The QA plan is applicable to all the aforementioned components and activities. QA plans can be outlined for each category, component and/or activity or grouped together (e.g. list of QA activities that apply to all activities and categories). Each grantee is required to submit their QA plan taking in consideration at least the following domains: Technical performance: The degree to which the tasks carried out by health workers and facilities meet expectations of technical quality (i.e. adhere to standards). Access to services: The degree to which healthcare services are unrestricted by geographic, economic social, organizational or linguistic barriers. Effectiveness of care: The degree to which desired results (outcomes) are achieved. Continuity of services: Appropriate and timely referral/linkage and communication between providers. The plan should document quality assurance measures and mechanisms to ensure that services are provided in a technically competent manner and are consistent with current CDC guidelines and recommendations. QA activities may be included within this document or may be submitted as a separate document. Program activities related to quality assurance are incorporated into this document in each section, as well as documented in the Interim Progress Report to be submitted to CDC in September 2012.