NCHHSTP Strategic Priorities Susan DeLisle, ARNP, MPH National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention ASTHO-NACCHO Joint Conference September 11, 2008
Content NCHHSTP Update: Mission, Organization, Budget, Key Priorities Program Collaboration and Service Integration (PCSI): An update Moving towards national implementation
NCHHSTP Strategic Imperatives
NCHHSTP Mission Maximize public health and safety nationally and internationally through the elimination, prevention, and control of disease, disability, and death caused by HIV/AIDS Non-HIV Retroviruses Viral Hepatitis Other Sexually Transmitted Diseases Tuberculosis Non-Tuberculosis Mycobacteria
NCHHSTP Structure:
NCHHSTP Workgroups Surveillance/ Strategic information MSM Program Integration Drug Users Health Measurement Global Perinatal Health Disparities Corrections
FY 2008 Enacted Funds Domestic HIV 69% STD 15% TB 14% Hepatitis 2% Total: $1 billion
NCHHSTP Imperatives* Maximizing Global Synergies Program Collaboration and Service integration (PCSI) Reducing Health Disparities *Cross-cutting priorities for NCHHSTP
NCHHSTP FY08 Priorities Publish PCSI white paper and research priorities Publish integrated surveillance report Publish guidelines on integrated surveillance Develop national mobilization on PCSI Continue directors site visits to rural US and territories Publish green paper for research on tracking the social determinants Strengthen external communications to partners (e.g. blog, connections) Heighten metaleadership for prevention across federal agencies Complete NCHHSTP 2020 strategic plan Identify opportunities for strategic partnerships for prevention
Maximizing Global Synergies Key priorities: Continued implementation of PEPFAR Global mobilization on XDR/MDR TB Development of a Global Perinatal Work Group New NCHHSTP AD Global Health position in the Office of the Director
NCHHSTP Priority Reducing Health Disparities This imperative aims to improve the health of populations disproportionately affected by HIV/AIDS, viral hepatitis, STDs, TB and other related diseases and conditions and ultimately to help eliminate health disparities. Populations include racial and ethnic minorities, women, incarcerated persons, sexual minorities and other persons disproportionately affected by these diseases and conditions.
NCHHSTP Accomplishments in Reducing Health Disparities  Health Disparities Report  Web resources  New initiatives  Community engagement  CDC conferences  Targeted funding
Program Collaboration and Service Integration (PCSI) Goal: Provide prevention services that are holistic, science-based, comprehensive, and high quality to appropriate populations at every interaction with the health care system. Vision: Remove barriers to and facilitate adoption of service delivery integration at the client level by aligning NCHHSTP activities, systems, and policies with this goal.
Program Collaboration and Service Integration (PCSI) Operating Definition: A mechanism of organizing and blending inter-related health issues, separate activities, and services in order to maximize public health impact through new and established linkages between programs to facilitate the delivery of services
Why Now? Syndemics (overlapping epidemics) Multiple epidemics in same populations Multiple diagnoses in the same patient Interactions between diseases and epidemics Missed opportunities for intervention Individual and population levels Inefficiencies as systems and infrastructures are duplicated
Why Now? Maximize health impact Accelerates coverage and scale-up with marginal cost increase Increase access to target populations May increase efficiency and costeffectiveness of service delivery Stakeholder demand Already being done in the field, but inconsistent Need for guidance, support and funding
Key principles for PCSI Know local epidemics and drivers Understand your settings Develop locally relevant strategies Implement, evaluate and review Ensure acceptability and sustainability
Towards Implementation
NCHHSTP PCSI Accomplishments Organizational realignment New PCSI Director PCSI web & resources PCSI green paper New funding Meta-leadership Domestic site visits
PCSI Priority Activities Integrated surveillance and data efforts Integrated training efforts Integrated funding http://www.cdc.gov/nchhstp/programintegration/default.htm
1. Integrated Surveillance Achieve leadership consensus for surveillance integration Develop common definitions of surveillance, harmonize data elements, variables, and formats Develop common security and confidentiality standards for surveillance and data sharing Build epidemiologic and surveillance capacity at the state and local level
2. Integrated Training Increase workforce development and cross-training on NCHHSTP disease areas and prevention techniques for public health staff Increase opportunities for shared training and education programs within NCHHSTP disease areas Develop PCSI training and education to promote shared understanding and vision.
3. Integrated Funding Develop and promote integrated NCHHSTP program announcements (PA) Promote and reward collaboration on PAs and post award management Identify mechanisms and incentives for PCSI funding support Allow flexibility of funds to accomplish state and local objectives Support operational research and evaluation on PCSI for NCHHSTP programs
Next Steps Publication of FY08 PCSI Action Plan NCHHSTP PCSI White Paper Baseline assessment of PCSI Continued partner engagement Promote PCSI at all NCHHSTP sponsored prevention conferences Review and align all new NCHHSTP program announcements
Thank You National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention www.cdc.gov/nchhstp
Extra Slides
Program PCSI Priorities
PCSI Priorities for HIV/TB Prevention Increase HIV testing and reporting in TB suspects, patients, and contacts Train staff in HIV testing Use opt-out, rapid HIV tests and fund testing Implement testing and reporting protocols Link HIV/TB patients to care Increase TB and LTBI screening and treatment Make TB a priority for HIV providers Use systems approaches Collaborate across and within agencies and sectors
Importance of HIV/TB HIV the greatest risk factor for progression to TB disease HIV(+) progress to TB at 10 times the rate as HIV(-) TB disease is an AIDS-defining opportunistic condition HIV/TB can be deadly 5 times odds of dying during anti-tb treatment TB accelerates progression of HIV disease
Viral Hepatitis Integration Priorities to decrease the incidence of new infections of hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV) to decrease risks for chronic liver disease, including cirrhosis and liver cancer, in persons with chronic HBV infection or chronic HCV infection (secondary prevention).
Hepatitis and HIV Testing Initiative Identify resources to counsel and test persons at risk for HCV and HBV 2004 HIV Program Announcement HIV funds may be used for HCV testing only (based on CPG recommendation) 2007 HIV Program Announcement-African Americans HIV funds may be used for HCV & HBV testing
CCID Adult Hepatitis B Vaccination Initiative (20 Mil) Vaccine purchase only Nationwide, 1,157 settings have already joined the initiative 1st Quarter data indicate 53,288 doses of hepatitis B vaccine ordered 25,000 doses administered in 498 (43%) of settings administering vaccine $16M available to sustain initiative for another year
PCSI Opportunities: HIV/AIDS Integrated partner services STD, TB and Hepatitis C screening Hepatitis B vaccination Contraceptive services Substance abuse treatment or referral Integrated health communication Integrated surveillance activities
PCSI and HIV Testing Initiative Program Announcement Example of integration language: Eligible states, cities, and counties represent 95% of 2005 US AIDS cases among blacks African Americans are also disproportionately affected by other infections, including HCV, HBV, STDs, and TB Integrated service delivery has been shown to enhance HIV testing programs For these reasons, funds can also be used for integration of these associated services
Program Collaboration & Service Integration: Opportunities for STD Prevention Programs Core public health activities Partner services Surveillance & data systems Guidance and training Monitoring and evaluation HIV prevention Expanded testing Viral hepatitis prevention Expanded venue-based HBV immunization Cervical cancer prevention Initiation and monitoring of immunization programs Reproductive health STD testing in FP clinics, EC and other OC in STD clinics
PCSI: Recommendations for HIV/STD Partners Services STD partner notification and HIV PCRS similar principles, different evolution Integration efforts underway Harmonized interview record Standardized behavioral variables (e.g., partner gender, drug use) Integrated program guidance Expected release August 2008 Implementation plan under development HIV testing FOA encourages partner services as a required activity
PCSI and Funding Opportunity Announcements (FOA) Standard Operating Procedures modified Non-research FOA s coordinated through PCSI Cross-division engagement in development of FOA Relevant CDC Goals and NCHHSTP Priorities in FOA architecture Relevant PCSI activities included in program plans, FOA review criteria, reporting requirements