HIV Prevention and Care 101 Patricia Young and Holly Hanson Bureau of HIV, STD, and Hepatitis Iowa Department of Public Health Monday, March 5, 2012
U.S. Dept. of Health and Human Services CDC HRSA Prevention Care CPG HIV Comprehensive Plan
Background of HIV/AIDS Funding in Iowa CDC HRSAPrevention Ryan White Counseling, Testing, and Part B Referral (CTR) ADAP Partner Services (PS) Case Management Health Education/Risk Support Services Reduction (HE/RR) Planning Planning Part C Primary Health CareSurveillance MATEC
Prevention-Care-Prevention Continuum Enter Utilize Full High Risk Learn HIV Quality Array of Adhere to Individual Status Care and Care and Prescribed s Treatment Therapies Prevention Services Unknown Services Status Negative PositiveUtilize Full Array ofExisting PreventionPrograms and Services Utilize Quality Prevention ServicesAdopt and MaintainHIV Risk Reduction
HIV Prevention Funding for Health DepartmentsCDC provided HIV prevention funding to 65 health departments in the form of cooperative agreements: All 50 states The District of Columbia Six directly funded cities and counties Puerto Rico, the U.S. Virgin Islands, and six U.S.- affiliated Pacific Islands
Comprehensive HIV Prevention Program ComponentsHIV Community Planning Target populations will be prioritized and interventions selected based on data; The CPG will review the health department application to CDC; and The allocation of CDC-awarded funds will be consistent with the plan.
High Risk and Disproportionately Impacted Populations HIV-positive persons who engage in unprotected sex and needle sharing behaviors and partners of HIV-positive persons Men who have unprotected sex with men Racial and Ethnic Minorities –African American/Black and Hispanic/ Latino/a Heterosexuals who: have been diagnosed with an STD within the last year; or exchange sex for money, drugs, or things they need; or have unprotected sex with bisexual males, injecting drug users, or someone who exchanges sex for money, drugs, or things they need Injection Drug Users - Individuals who have ever shared injection equipment
Comprehensive HIV Prevention Program ComponentsCounseling Testing and Referral (CTR) Services Targeted testing consistent with the comprehensive plan. Confidential testing at 13 CTR sites. Demonstrate 80% HR and/or from disproportionately impacted populations. Integration of hepatitis and STD services. Referral and linkage into medical carePartner Services (PS) Provide PS for HIV-infected persons Referral Services with strong linkages to prevention and care services Referral for STD screening, HCV screening, and Hepatitis A and B vaccinations Health Education and Risk Reduction (HE/RR) Evidence-based interventions DEBIs CDC Compendium of Effective Interventions Contracted with local health departments and community based organizations
Comprehensive HIV Prevention Program Components Prevention for HIV- Infected Persons Integration of HIV Prevention Services into Care and Treatment Services Quality Assurance/Evaluation of Major Program Activities XPEMS- Luther Consulting LLC - EvaluationWeb Standardization Data Quality AssurancePublic Information Clearinghouse MSM Modernization Project Capacity Building Activities Fundamentals of HIV Prevention Counseling Training on Evidence-Based Interventions Data Collection and Reporting Bi-annual IDPH, IDE, CPG - Sponsored Conference
HIV Prevention ActivitiesSexually Transmitted Disease (STD) Prevention ActivitiesCollaboration and Coordination with Other Related ProgramsLaboratory SupportMSM Supplemental – development of an MSM Strategic Plan
Perinatal Transmission PreventionAll pregnant women must be tested for HIV infection as part of the routine panel of prenatal tests.If she declines the test, the decision must be documented in her medical record.Iowa’s Requirements and Guidelines for HIV Testing during Pregnancy can be found at http:// www.idph.state.ia.us/HivStdHep/HIV-AIDS.aspx?prog=H
Obtaining ConsentAdults General consent: All persons who are able must give consent for an HIV test, but written consent is not required for adult HIV testingMinors Before undergoing an HIV test, a minor must be informed that the legal guardian will be notified by the testing facility if the test is confirmed as positive. Minors must give written consent for HIV testing and treatment services.
National HIV/AIDS Strategy Launch of National HIV/AIDS Strategy (2010) An opportunity to: Realign CDC funded prevention activities. Address misalignment of HIV prevention resource allocation. Focus on high impact HIV prevention Requires strengthening of targeted prevention with positives and high risk negatives. Move beyond combination prevention by focusing on improved implementation, coverage, scale and impact. Increase monitoring and accountability. New cooperative agreement started: January 1, 2012
Category A: Eligible Jurisdictions Applicants eligible for Category A of this FOA are limited to state, local and territorial health departments. This includes: 50 states 10 cities: Atlanta, Baltimore, Chicago, Fort Lauderdale, Houston, Los Angeles, Miami, New York, Philadelphia, and San Francisco District of Columbia Puerto Rico Virgin Islands 6 Pacific Island jurisdictions: American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Republic of the Marshall Islands, and Republic of Palau
CATEGORY A: HIV PREVENTION PROGRAMS FOR HEALTH DEPARTMENTS• Purpose is to support and enhance the ability of health departments to design, implement, and evaluate comprehensive HIV prevention programs that are effective, scalable, and intended to yield maximum impact on reducing new HIV infections.• Applicants are expected to allocate programmatic and financial resources to local areas based on the burden of disease.• Category A is required for all applicants applying for funding.
Category A –Required Core Components Category A includes required core program components and activities. Applicants must implement all four of the core components; however, the distribution of resources and implementation of the elements under each core component should be based on scalability and balance of resources, epidemiologic data, local need, and at-risk and priority populations, including racial and ethnic groups. Applicants must also implement the three required activities to support the core components. Approximately 75% of funding must be allocated to the required components and activities.
Category A –Required Core ComponentsProgram Monitoring and QA also includes epi/surveillance,objectives/targets, program monitoring , data collection and submission,QA plan, etc.
HIV Testing 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. At least 75% of persons who receive their HIV positive test results are referred and linked to Partner Services.
Comprehensive Prevention with Positives Linkage to HIV care, treatment, and prevention services for those persons testing HIV positive or currently living with HIV/AIDS. Retention or re-engagement in care for HIV-positive persons. Referral and linkage to other medical and social services as needed for HIV-positive persons. Ongoing Partner Services for HIV-positive persons and their partners. Behavioral, structural, and/or biomedical interventions (including interventions focused on treatment adherence) for HIV infected persons. Integrated hepatitis, TB, and STD screening, and Partner Services for HIV infected persons, according to existing guidelines. Provision of antiretroviral therapy (ART) in accordance with current treatment guidelines. CDC funds may not be used to purchase antiretroviral therapy.
Condom DistributionConduct condom distribution targeting HIV-positive persons and persons at highest risk of acquiring HIV infection.
Policy InitiativesSupport 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.
Jurisdictional HIV PlanningAll funded jurisdictions are required to have in place aplanning process to include:
Capacity Building and Technical Assistance Capacity-building needs assessment of the health department, HIV prevention service providers, and other prevention agencies/partners, including CBOs capacity to provide HIV prevention services. Provide or coordinate training and technical assistance (e.g., interventions, organizational infrastructure, HIV testing efforts, policies for data security and confidentiality, data sharing across programs and data reporting to surveillance) for providers and staff of participating healthcare facilities and CBOs or other service organizations.
Program Planning, Monitoring &Evaluation (M&E), and Quality Assurance
Comprehensive HIV Program Plan• Develop and submit to CDC a detailed comprehensive program, monitoring and evaluation (M&E), and quality assurance (QA) plan, referred to as the Comprehensive Program Plan.• The jurisdictional HIV prevention plan should be used as a reference for the development of the Comprehensive Program Plan.• The final version of this comprehensive program plan must be submitted to CDC within six months after start of the project period.
Category A –Recommended Program Components In addition to the core program components, the following program components are recommended for health department jurisdictions (based on resources, capacity, and local need) applying for funding under Category A:
Ryan White HIV/AIDS TreatmentExtension Act of 2009 Part B in the State of Iowa
So…Who was Ryan White? Ryan White was a 13-year-old hemophiliac who contracted AIDS from factor VIII, which was used to control this disorder. This courageous teen found it in his heart to struggle and proved to the world that people live with AIDS, and are not dying from it. He died in 1990 and the CARE Act was named after him.
So, What is the Ryan White HIV/AIDS Treatment Extension Act?Until December 2006, it was known as the Comprehensive AIDS Resources Emergency (CARE) Act of 1990. It provides funding to States, cities, and nonprofit entities to deliver essential health care and support services to medically under-served individuals and families affected by HIV disease.
Ryan White HIV/AIDS Treatment Extension act of 2009 Enacted August 18, 1990 Reauthorized: May, 1996 October, 2000 December, 2006 October, 2009 Purpose: To improve the quality and availability of care for individuals and families with HIV disease.
Revised Purpose of the Ryan White Legislation No longer “emergency relief” for overburdened health care systems Now “Revise and extend the program for providing life-saving care for those with HIV/AIDS” “Address the unmet care and treatment needs of persons living with HIV/AIDS by funding primary health care and support services that enhance access to and retention in care”
Ryan White has four “Parts”Part A: Provides emergency relief to metropolitan areas that are disproportionately affected by HIV/AIDS
Part B Assists States and territories in improving thequality, availability, and organization of healthcare and support services for individuals andfamilies with HIV disease, and provides accessto needed pharmaceuticals through the AIDSDrug Assistance Program (ADAP)
Ryan White Part B Total of 59 Part B Grantees Part B funds are awarded to all 50 states plus The District of Columbia Puerto Rico Virgin Islands Pacific Islands: American Samoa, Federated States of Micronesia, Guam, Marshall Islands, Northern Marianas, Republic Of Palau
Part CProvides support for early intervention andprimary care services for people with HIV/AIDS
Part DEnhances access to comprehensive care forchildren, youth, women and their familieswith/at risk for HIV, and access to researchof potential clinical benefit
HIV/AIDS Bureau Expectations: Four Critical priorities
Priority Issue #1: Access to Care and TreatmentEarly Identification of Individuals with HIVAddressing Unmet NeedAccess and retention in care for special populationsRevising and Revamping Systems of Care
Priority Issue #2: Access to Medication TherapyUnderstanding the structure, function, and enrollment issues of ADAPCollaborating with HRSA, Pharmacy, NASTAD, and contractors to enhance cost containment and cost saving strategies
Priority Issue #3: Changes in the economics of health care Learn the Affordable Care Act and begin to explore the role of the Ryan White Programs Medicaid Continued opportunities Challenges Strategic and necessary changes Strengthening of partnerships
Priority Issue #4: Accountability Administrative Accountability National Monitoring Standards (program and fiscal accountability) Subgrantee monitoring systems OIG/GAO Audits How do we act as good stewards of federal funds? Data Collection and Reporting Client level data Reporting to Congress Who our programs serve and what we do? Clinical Quality Management Programs Quantitative information on impact and our continued efforts to improve What difference do our programs make? Reauthorization
Part B in IowaThe State of Iowa, Department of Public Health is the state grantee for Part B.The program is run by the HIV/AIDS Program, located within the Bureau of HIV, STD & Hepatitis within the Division of Behavioral Health.
Bureau of Division of HIV, STD Behavioral Health & Hepatitis S U Randy Mayer P Valerie Kathy Stone P Emberton O HIV/AIDS Program R TSURVEILLANCE P CARE R E V Danie Coulter, E Interim ADAP Coordinator N Pat Young Holly HansonJerry Harms T I O Karen Quinn N Amy Wadlington Al Jatta Patresa Hartman
Flow of Part B Funds and Decision Making Federal Government Governor/CEO of State/Territory State Advisory Administrative Agent or “Grantee” Body (Usually the State/Territory’s Health Department) State Managed Services One or more HIV Care Consortia (Optional)ADAP Health Home-/ Service Service Service Direct Insurance Community Providers Providers Providers Services Continuation Based Care Multiple Service Providers Services are provided to low-income & uninsured people living with HIV/AIDS Note: Funds do NOT go directly to service providers. .
2011 Part B Funding $4,173,109Base Award ADAP $2,902,350 (Total)$1,258,207 $1,555,860 $119,807 $17,986 $709,751 $498,946
Core Medical Services by Part BCase Management - MedicalMedical/Oral HealthSubstance AbuseMental HealthMedical Nutrition Therapy