1 1 INTEGRATED HIV PREVENTION AND CARE PLAN, INCLUDING THE STATEWIDE COORDINATED STATEMENT OF NEED, CY GUIDANCE OVERVIEW Health Resources and Services Administration, HIV/AIDS Bureau Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention
2 2 Opening Remarks Heather Hauck HRSA HAB Division of State HIV/AIDS Programs, Director Angle Ortiz Ricard CDC NCHHSTP, Senior Public Health Advisor Steven Young HRSA HAB Division of Metropolitan HIV/AIDS Programs, Director
3 3 Acknowledgments Gary Cook, HRSA Shaun Chapman, HRSA Janet Cleveland, CDC Stacy Cohen, HRSA Erica Dunbar, CDC Anita Edwards, HRSA Kimberly Fambro, CDC Sonya Hunt-Gray, HRSA Heather Hauck, HRSA Karen Ingvoldstad, HRSA Andrea Jackson, HRSA Anna Satcher-Johnson, CDC Amelia Khalil, HRSA June Mayfield, CDC Angel Luis Ortiz-Ricard, CDC Harold Phillips, HRSA Melissa Thomas-Proctor, CDC Susan Robilotto, HRSA Vanessa Shaw-Dore, HRSA Jesse Ungard, HRSA Candace Webb, HRSA Steven Young, HRSA
4 4 ORGANIZATIONAL STRUCTURES CDC Prevention Program Branch Project Officers HRSA HAB Project Officers
5 5 CDC Division of HIV/AIDS Prevention Mission Statement The Division of HIV/AIDS Prevention/Office of the Director s mission is to provide national leadership and support for HIV epidemiologic research and surveillance of the behaviors and determinants of HIV transmission and disease progression, and for prevention research and the development, implementation, and evaluation of evidencebased HIV prevention programs serving persons affected by or at risk for HIV infection.
7 7 DHAP HIV Prevention Program Branch Mission Statement The mission of the Prevention Program Branch (PPB) is to work with public and private partners to strengthen science-based HIV prevention efforts in states (Health Departments) and local communities (Community-Based Organizations). Goals/Objectives Decrease the number of persons at high risk for HIV. Increase the proportion of HIV-Positive people who: (1) know they are infected and (2) those who are linked to appropriate services.
8 8 HIV/AIDS Bureau Vision Optimal HIV/AIDS care and treatment for all. Mission Provide leadership and resources to assure access to and retention in high quality, integrated care and treatment services for vulnerable people living with HIV/AIDS and their families.
10 10 HRSA Ryan White Programs The Ryan White legislation created a number of programs, called Parts, to meet needs for different communities and populations affected by HIV/AIDS. Each is described below. Part A provides emergency assistance to Eligible Metropolitan Areas and Transitional Grant Areas that are most severely affected by the HIV/AIDS epidemic Part B provides grants to all 50 States, the District of Columbia, Puerto Rico, Guam, the U.S. Virgin Islands, and 5 U.S. Pacific Territories or Associated Jurisdictions Part C provides comprehensive primary health care in an outpatient setting for people living with HIV disease (i.e., EIS) Part D provides family-centered care involving outpatient or ambulatory care for women, infants, children, and youth with HIV/AIDS Part F provides funds for a variety of programs (i.e., SPNS)
11 11 CDC and HRSA PO Collaboration In order to facilitate the partnership and coordination between Project Officers at CDC and HRSA, we request that all grantees contact both their CDC and HRSA PO to request technical assistance around integrated planning or plan development. Your project officer should be your first point of contact for any questions, available resources, and/or technical assistance.
12 12 BACKGROUND
13 13 Background In February 2014, the Centers for Disease Control and Prevention (CDC)/Division of HIV/AIDS Prevention (DHAP) and the Health Resources and Services Administration (HRSA)/HIV/AIDS Bureau (HAB) issued a joint letter indicating that guidance will be provided to allow grantees to submit an Integrated Statewide Coordinated Statement of Need (SCSN)/Comprehensive Plan that would fulfill the legislative and programmatic requirements for the Ryan White HIV/AIDS Program (RWHAP) and the HIV Prevention Programs
14 14 Integrated HIV Prevention and Care Plan Engagement June August 2013 HIV Planning Group (HPG) Leadership Regional Trainings March July 2014 HRSA/HAB Workgroup and CDC/DHAP Workgroup Integrated SCSN/Comprehensive Plan Discussions July 8-9, 2014 NASTAD/CDC/HRSA Integrated Data & Integrated SCSN/Comprehensive Plan Consultation Meeting August 2014 HRSA/HAB Workgroup and CDC/DHAP Workgroup Reconvene Early Spring 2015 Draft guidance outline to key national and federal partners for review and comment June 2015 Release New HRSA/HAB CDC/DHAP Guidance on Integrated HIV Prevention and Care Plan September 2016 Integrated HIV Prevention and Care Plan Due
15 15 Why an Integrated HIV Prevention and Care Plan? Streamline communication, coordination, and implementation of needed HIV prevention and care services to improve health outcomes along each stage of the HIV Care Continuum Engage a broader group of stakeholders in jurisdictional HIV prevention and care planning Maximize federal and state/local HIV prevention and care investments
16 16 Why an Integrated HIV Prevention and Care Plan? Key National Policy Initiatives support it: o President s Executive Order on the HIV Continuum of Care (2013) o CDC s High-Impact HIV Prevention (HIP) (2011) o The White House s National HIV/AIDS Strategy (NHAS) (2010) Accelerate progress toward reaching the goals of the NHAS o HHS focus on reducing reporting burden for grantees Improve efficiency and effectiveness of federal programs Reduce reporting burden and duplicated efforts, align submission dates, leverage resources for HIV prevention and care, and utilize integrated epidemiologic profiles Allow jurisdictions to submit one Integrated HIV Prevention and Care Plan to CDC and HRSA
17 17 What is Integrated Planning? Integrated planning is the process by which HIV care and prevention planning groups work together to: Review information about the HIV epidemic in the jurisdiction Assess needs and service utilization data to inform decisions Provide recommendations and allocate resources for HIV prevention and care services to address the HIV epidemic May be accomplished through collaborating on joint projects, sharing planning products, cross representation on planning bodies, or unified prevention & care planning bodies
18 18 Planning vs. Plan PLANNING = PROCESS PLAN = PRODUCT The guidance addresses the content and structure of the Integrated HIV Prevention and Care Plan; it does not address the planning process that grantees use to develop the Plan.
19 19 THE GUIDANCE Integrated HIV Prevention and Care Plan including the Statewide Coordinated Statement of Need (SCSN)
20 20 Structure of the Guidance Executive Summary Introduction Background Moving Forward Section I Section II Section III Section IV
21 21 Executive Summary Integrated HIV Prevention and Care guidance is written in four (4) sections: Section I: Prevention and care needs assessment process and results Section II: Integrated HIV prevention and care plan Section III: Monitoring and improvement Section IV: Submission and review Plan must cover calendar years and may serve as a jurisdictional HIV/AIDS strategy or roadmap
22 22 Introduction National HIV/AIDS Strategy and White House HIV/AIDS Care Continuum Initiative have bolstered further integration of HIV prevention and care efforts and fostered new approaches to addressing barriers to HIV testing and care and treatment CDC and HRSA developed guidance with a new format to support the submission of an Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need (SCSN)
23 23 Moving Forward: Expectations for an Integrated HIV Prevention and Care Plan ALL CDC (DHAP) and HRSA (HAB) funded jurisdictions are required to: Establish a planning process Develop a plan that is comprehensive and achievable Establish a planning body (i.e., Planning Council, Advisory Group or HIV Planning Group) Integrated HIV Prevention and Care Plan must include all of the components outlined in the guidance
24 24 Moving Forward: Expectations for an Integrated HIV Prevention and Care Plan One plan may be submitted on behalf of several jurisdictions e.g., the State, the Part A jurisdictions in that State, CDC directly funded cities in that State However, each HRSA and CDC-funded jurisdiction needs to participate in the completion of an Integrated HIV Prevention and Care Plan Include who is responsible for developing the plan e.g., RWHAP Part A planning councils, RWHAP Part B advisory groups, and CDC HIV planning bodies Address prevention, care and treatment needs, accomplish the goals of the National HIV/AIDS Strategy and reflect the activities of the HIV Care Continuum Initiative
25 25 State and/or local jurisdictions options: Integrated state/city prevention and care plan to CDC and HRSA Integrated state-only prevention and care plan to CDC and HRSA Integrated city-only prevention and care plan to CDC and HRSA City-only prevention plan to CDC City-only care plan to HRSA It is ideal and preferable that an integrated HIV prevention and care plan be submitted to both CDC and HRSA.
26 26 SECTION I Statewide Coordinated Statement of Need Needs Assessment
27 27 Section I: SCSN/Needs Assessment A. Epidemiologic Overview B. HIV Care Continuum C. Financial and Human Resources Inventory D. Assessing Needs, Gaps, and Barriers E. Data: Access, Sources, and Systems
28 28 Statewide Coordinated Statement of Need (SCSN) Collaborative mechanism to identify and address HIV needs of PLWH and maximize coordination, integration, and effective linkages across all Ryan White HIV/AIDS Program (RWHAP) Parts, including AETCs RWHAP Part B grantees are required to convene an advisory group and submit an SCSN RWHAP Part A grantees are legislatively required to participate in the development of the SCSN CDC funded grantees are required to conduct a needs assessment
29 29 Epidemiologic Overview Based on the Integrated Guidance for Developing Epidemiologic Profiles: HIV Prevention and RWHAP Planning Section should describe: Geographical region of the jurisdiction Socio-demographic characteristics of persons at higher risk for HIV infection and PLWH Burden of HIV Indicators of risk for infection The epidemiologic overview should focus on the most recent year for which data are available.
30 30 Epidemiologic Overview In general, an epidemiologic profile is designed to: Provide a thorough description of HIV among the various populations (overall and subpopulations) in a service area in terms of sociodemographic, geographic, behavioral, and clinical characteristics Describe the current status of persons with HIV infection in the service area and provide some understanding of how the HIV distribution may look in the future Identify characteristics of the general population and of populations who are living with, or at high risk for, HIV in defined geographic areas and who need primary and secondary prevention or care services Provide information required to conduct needs assessments and gap analysis
31 31 HIV Care Continuum Framework which shows the proportion of individuals living with HIV who are engaged at each stage Diagnosed-based vs. Prevalence-based continuum The diagnosis-based HIV care continuum shows each step of the continuum as a percentage of the number of people living with HIV who have been diagnosed ( living with diagnosed HIV ) The prevalence-based HIV care continuum shows each step of the continuum as a percentage of the total number of people living with HIV ( HIV prevalence ). Prevalence includes estimates of people whose infection has been diagnosed and people who are infected but don t know it ( undiagnosed )
32 32 HIV Care Continuum Source: The U.S. Department of Health and Human Services. AIDS.gov. HIV/AIDS Care Continuum.
33 33 HIV Care Continuum The HIV care continuum consists of five main stages: Diagnosed with HIV infection Linked to care, meaning they visited a heath care provider within three months after learning they were HIV positive Engaged or retained in care, meaning they received medical care for HIV infection Prescribed antiretroviral therapy to control their HIV infection Virally suppressed, meaning that their HIV viral load the amount of HIV in the blood is at a very low level Section should include: Disparities along the HIV Care Continuum Planning, prioritizing, targeting, and monitoring available resources Improving engagement and outcomes at each stage
34 34 Financial and Human Resources Inventory Resource Inventory should include: Public and private funding sources for HIV prevention, care, and treatment services in the jurisdiction (Appendix A) Dollar amount and the percentage of the total available funds in fiscal year (FY) 2016 for each funding source Provider agencies Services delivered Components of HIV prevention programming and/or the HIV Care Continuum stage(s) that is (are) impacted
35 35 Financial and Human Resources Inventory This section should: Describe the HIV Workforce Capacity (e.g. licensed providers, community health workers, paraprofessionals) and how it impacts service delivery in the jurisdiction (AETCs) Ensure continuity of HIV prevention, care, and treatment services Identify needed services in the jurisdiction and any steps taken to secure them
36 36 Assessing Needs, Gaps, and Barriers CDC funded grantees are required to conduct a needs assessment (e.g., resources, infrastructure, and service delivery) If a needs assessment does not exist or is outdated, the applicant will have to conduct or update the 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 (e.g., testing, navigation, and linkage to care)
37 37 Assessing Needs, Gaps, and Barriers This section should: Describe the process used to identify HIV prevention and care service needs of people at higher risk for HIV and PLWH (diagnosed and undiagnosed) Describe the HIV prevention and care service needs and service gaps Describe barriers to HIV prevention and care services: Social and structural Policy Programmatic Service provider Client-specific
38 38 Data: Access, Sources, and Systems This section should: Describe the sources of data and data systems used to conduct the SCSN/ needs assessment, including the development of the HIV Care Continuum Describe any data policies that facilitated the SCSN/needs assessment and/or served as barriers Describe any desired data that was not available
39 39 SECTION II Integrated HIV Prevention and Care Plan
40 40 Integrated HIV Prevention and Care Plan A. Integrated HIV Prevention and Care Plan B. Collaborations, Partnerships, and Stakeholder Involvement C. Persons Living With HIV (PLWH) and Community Engagement
41 41 Integrated HIV Prevention and Care Plan Blueprint for achieving HIV prevention, care, and treatment goals using NHAS as the organizing framework The plan should include: Goals (consistent with the National HIV/AIDS Strategy) Objectives (measurable) Strategies (approach for achieving the objectives) Activities (how objectives will be achieved) Resources (investments)
42 42 Integrated HIV Prevention and Care Plan Be responsive to the needs identified in Section I of the Integrated HIV Prevention and Care Plan guidance Align with the three primary NHAS goals: (1) Reducing new HIV infections (2) Increasing access to care and improving health outcomes for PLWH (3) Reducing HIV-related disparities and health inequities
43 Integrated HIV Prevention and Care Plan 43 This section should: Identify at least two objectives that correspond to each NHAS goal For each objective, describe at least three strategies that correspond to each objective For each strategy, describe the activities/interventions, targeted populations, responsible parties, and time-phased, resources needed to implement the activity
44 Integrated HIV Prevention and Care Plan 44 This section should: Describe the metrics that will be used to monitor progress in achieving each goal outlined in the plan Describe any anticipated challenges or barriers in implementing the plan
45 45 Example NHAS Goal: Reducing New HIV infections SMART Objective (National): By 2015, lower the annual number of new infections by 25% (from 56,300 to 42,225) SMART Objective (Local): By 2021, lower the annual number of new infections by 10 percent (from 100 to 90) Strategy: Intensify HIV prevention efforts in communities where HIV is most heavily concentrated
46 46 Example Timeframe Responsible Parties Activity Target Population Data Indicators By the end of 2021: Ryan White Part A Early Intervention Service Providers Deliver intensified HIV testing, referral services to eliminate barriers to care, health literacy and linkage to core medical services Young Men who have Sex with Men (MSM) Number of HIV tests performed HIV Positivity Rate Number linked to medical care By the end of 2018: CDC-funded Health Department Deliver expanded partner services and HIV testing for partners of those infected MSM Number of HIV tests performed Number of newly diagnosed HIV positive persons
47 47 Collaborations, Partnerships and Stakeholder Involvement This section should: Describe the specific contributions of stakeholders and key partners to the development of the plan Describe stakeholders and partners not involved in the planning process, but who are needed to more effectively improve outcomes along the HIV Care Continuum Provide a letter of concurrence to the goals and objectives of the Integrated HIV Prevention and Care Plan from the co-chairs of the planning body and the health department representatives (Appendix B)
48 48 Sample Letter of Concurrence
49 49 People Living With HIV (PLWH) and Community Engagement - Key Principles Recognition of the essential role of PLWH, especially those who are consumers of RWHAP services Inclusion of representatives of varying races and ethnicities, genders, sexual orientations, ages, and other characteristics reflecting the experiences and expertise of those impacted by HIV in the jurisdiction Involvement of the at-risk, affected, and infected community working together to develop specific strategies
50 50 Persons Living With HIV (PLWH) and Community Engagement This section must: Include community stakeholders, not limited to, HIV service providers, PLWH, and at-risk groups Describe how the people involved in developing the Integrated HIV Prevention and Care Plan are reflective of the epidemic in the jurisdiction Describe how the inclusion of PLWH contributed to the plan development
51 51 Persons Living With HIV (PLWH) and Community Engagement This section should: Describe the methods used to engage communities, PLWH, those at substantial risk of acquiring HIV infection and other impacted population groups to ensure that HIV prevention and care activities are responsive to their needs in the service area Describe how impacted communities are engaged in the planning process to provide critical insight into developing solutions to health problems to assure the availability of necessary resources
52 52 SECTION III Monitoring and Improvement
53 53 Monitoring and Improvement Monitoring the Integrated HIV Prevention and Care Plan will assist grantees and planning bodies with: Identifying ways to measure progress toward goals and objectives Selecting strategies for data collection Analyzing information to inform decision-making and improve HIV prevention, care, and treatment efforts within the jurisdiction
54 54 Monitoring and Improvement This section should: Describe the process for regularly updating planning bodies and stakeholders on the progress of plan implementation, soliciting feedback, and using the feedback from stakeholders for plan improvements Describe the plan to monitor and evaluate implementation of the goals and SMART objectives from Section II: Integrated HIV Prevention and Care Plan
55 55 Monitoring and Improvement Describe the strategy to utilize surveillance and program data to assess and improve health outcomes along the HIV Care Continuum which will be used to impact the quality of the HIV service delivery system, including strategic long-range planning For Project Officer Monitoring: Ensure that plans reflects the diversity of local epidemic Plans are comprehensive and promote coordination and linkages of services Allows for monitoring of outcomes across the Continuum of Care
56 56 SECTION IV Submission and Review Process
57 57 Submission Process Funded entities are expected to submit the Integrated HIV Prevention and Care Plan to HRSA and CDC by September 30, 2016 to meet the legislative and programmatic requirements For CDC, submit the Plan to: and send a courtesy copy to their HIV prevention project officer For HRSA, submit the Plan through the appropriate portal in the Electronic Handbook
58 58 Review Process HRSA and CDC will: Conduct a joint review of the jurisdiction s Integrated HIV Prevention and Care Plan Provide joint feedback to the funded entities, as appropriate to the type of plan submitted Updates to the Integrated HIV Prevention and Care Plan may be submitted on an annual basis through the progress report, if applicable. CDC and HRSA will provide further instructions to jurisdictions, as needed
59 59 NEXT STEPS
60 60 Engagement and Training Process for the Guidance Trainings CDC/HRSA Project Officers CDC Capacity Building Assistance (CBA) Providers and HRSA Technical Assistance (TA) Providers and HAB Consultants CDC/HRSA Grantees and Planning Bodies Discussions/Presentations USCA (September 2015) NHPC (December 2015)
61 61 Resources Technical Assistance/CBA CDC Capacity Building Assistance (CBA) Providers HAB Technical Assistance (TA) Consultants CDC/HRSA Grantees and Planning Bodies Webinar Integrated HIV Prevention and Care Plan Guidance, including SCSN Integrated HIV Prevention-Care Planning Activities
62 62 Additional Resources HIV Planning Guidance (HPG) PS : Comprehensive HIV Prevention Programs for Health Departments Funding Opportunity Announcement Understanding the HIV Care Continuum Integrated Guidance for Developing Epidemiologic Profiles: HIV Prevention and Ryan White HIV/AIDS Programs Planning
63 63 Questions For general questions, please send to and copy your CDC and HRSA project officers For specific jurisdictional questions, please send to your CDC and HRSA project officers and copy the mailbox
64 64 QUESTIONS & ANSWERS Thank You