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Engaging Communities: Achieving Maximum Impact to Reduce New HIV Infections in the US

Engaging Communities: Achieving Maximum Impact to Reduce New HIV Infections in the US. Janet C. Cleveland, MS Deputy Director, Prevention Programs Division of HIV/AIDS Prevention South Carolina HIV/STD Conference Columbia, SC October 24, 2012.

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Engaging Communities: Achieving Maximum Impact to Reduce New HIV Infections in the US

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  1. Engaging Communities: Achieving Maximum Impact to Reduce New HIV Infections in the US Janet C. Cleveland, MS Deputy Director, Prevention Programs Division of HIV/AIDS Prevention South Carolina HIV/STD Conference Columbia, SC October 24, 2012 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of HAIDS Prevention

  2. Overview State of the U.S. HIV Epidemic Strategic Frameworks for HIV Prevention High Impact Prevention in Theory High Impact Prevention in Practice Conclusions

  3. State of the U.S. HIV Epidemic: Where We Stand

  4. The U.S. HIV Epidemic: Where We Stand HIV Prevalence and Incidence Hall JAMA 2008; PreJean PlosOne 2011; MMWR 2011

  5. The U.S. HIV Epidemic: Where We Stand Health Inequity • Men who have sex with men (MSM) are >40 times more likely to have HIV than other men or women • HIV prevalence is associated with population density, region of residence, poverty, education, employment, and homelessness Purcell National STD Prevention Conference 2010; Denning IAS 2010

  6. The U.S. HIV Epidemic: Where We Stand Lifetime Risk of HIV Infection among MSM If current trends continue, half of today’s young black MSM will have HIV by age 35 Black MSM Expected HIV Prevalence All MSM And, for MSM overall, half will have HIV by age 50 Age Stall, AIDS and Behavior 2009 .

  7. The U.S. HIV Epidemic: Where We Stand Health Inequity Lifetime risk of HIV diagnosis among women per 100,000 population HIV Diagnosis Rate, 2010 per 100,000 population African American 1 in 30 Latina 1 in 100 Native Hawaiian/ 1 in 180 Pacific Islander American Indian/ 1 in 220 Alaska Native White or Asian 1 in 500 CDC HIV Surveillance Report 2010; MMWR October 2010

  8. What The Epidemiology Reveals HIV epidemic concentrated in specific geographic areas, with marked racial, ethnic, social, economic disparities African American and Hispanic/Latino men and women continue to face the most severe rates of HIV infection in the country Increasing incidence among MSM, specifically 13-29 year old black/African American MSM We MUST focus on aligning and targeting resources toward the epidemic

  9. Overarching strategicframeworks

  10. NHAS: Achieving the Prevention Goals Key Prevention-Related NHAS Goals • Decrease annual new HIV infections by 25% • Increase percentage of people with HIV who know their status to 90% • Increase the proportion of newly diagnosed patients linked to care to 85% • Increase the proportion of HIV-infected MSM, African Americans, and Latinos with an undetectable HIV viral load by 20%

  11. Faster action saves lives and resources later • Reducing incidence by 25% • In 10 years would save 62,000 infections and save $23 billion • In 5 years would prevent 109,000 infections and save $42 billion Adapted using methods from Hall , et al. JAIDS 2010 12

  12. High-Impact Prevention in Theory Advances in HIV Prevention • Preexposure prophylaxis (73% reduction) • Antiretroviral therapy (96% reduction) • Vaginal microbicide (39% reduction) • Circumcision (50-60% reduction) • Behavioral interventions • Condom distribution programs and HIV testing

  13. HIV prevention Individual & Small Group Interventions Structural Interventions HIV Testing & Linkage to Care Community Interventions Biomedical Interventions Combination PreventionMultiple disciplines and approaches Adapted from Coates Lancet; 2008

  14. Why we need more • Combining interventions is not enough • All interventions are not effective and all effective interventions are not equal • Limited resources demand difficult decisions • Must apply the scienceof implementation to ensure maximum impact

  15. High impact prevention in theory

  16. High-Impact Prevention • Available for download at: www.cdc.gov/hiv Key components • Effectiveness and cost • Feasibility of full-scale implementation • Coverage of targeted population • Interaction and targeting • Prioritizing Preventing the most HIV and reducing disparities

  17. High Impact PreventionKey Components • Effectiveness and cost • How well do interventions work in real-world practice? • Feasibility of full-scale implementation • Can an effective intervention reach its intended population at a scale that will impact the epidemic? • Coverage of targeted population • If brought to scale, will an intervention make a substantial impact on the epidemic?

  18. HIGH IMPACT PREVENTION IN PRACTICE CDC HIV Activities and programs

  19. High Impact Prevention in Practice Aligning Resources with the Epidemic Health Department Funding Proportion of Americans Diagnosed with HIV Who Live in Each State (2008) Proportion of CDC Core HIV Prevention Funding—FY20162 • $339 million annually, allocated based on HIV prevalence • Allows flexibility based on local epidemic modeling and needs • Focuses on interventions that will have greatest impact on epidemic—75% of budget devoted to 4 key strategies

  20. High Impact Prevention in Practice Four Required Program Components • HIV Testing • Testing in health care and non-health care settings • Testing of pregnant women • Ensure linkage to care and prevention services • ART and adherence interventions • STD screening and treatment • Partner services • Behavioral interventions for HIV-positive persons • Retention and re-engagement in care • HIV Prevention with Positives Condom Distribution • Focus on people with HIV and at high risk • Structural and Policy Initiatives • Create enabling environment for optimal HIV prevention and care through policies, regulations, and practice

  21. Recommended Program Components • Applicants with the resources, capacity, and need may consider implementing the recommended program components. • Up to 25% of the budget may be allocated to support the recommended activities. • Applicant may implement all or a variety of the elements listed under each recommended component.

  22. Recommended Program Components (continued)

  23. High Impact Prevention in Practice High Impact Prevention Fights Inequities Expanded Testing Initiative • In first 3 years, 2.8 million tests with 18,000 people newly diagnosed with HIV • 70% African American; 12% Latino • Averted estimated 3,381 HIV infections with return of $2 for every dollar invested MSM Testing Initiative: focus on venue and event-based testing to diagnose 2,500 people with HIV • >50% diagnoses in African American or Latino men

  24. High Impact Prevention in Practice High Impact Prevention Fights Inequities Program for young MSM and transgender youth of color • $55 million over five years to 34 community organizations • Anticipate 90,000 tests over 5 years with 3,500 newly diagnosed individuals • Behavioral interventions and support services for all clients

  25. High Impact Prevention in Practice Strengthening the Public Health Approach to HIV Public health responsibility to close gaps in HIV care and prevention services • Currently only 25% of all people with HIV are virally suppressed • Individual level, lower viral load reduces morbidity and mortality for people with HIV, and less likely to spread HIV • Population level, viral load leads to fewer new infections

  26. NCHHSTP ATLAS • An interactive platform for accessing HIV, viral hepatitis, • STD & TB data • Users can create detailed reports, maps, and other graphics www.cdc.gov/nchhstp/atlas

  27. Achieving maximum impact through Engaging communities: HIV Planning

  28. Jurisdictional HIV Prevention Planning All funded jurisdictions are required to have in place a prevention planning process to include:

  29. What is HIV Planning? HIV planning is a critical process by which health departments work in partnership with the community and key stakeholders to enhance access to HIV prevention, care, and treatment services for the populations at highest risk for acquiring or transmitting HIV infection.

  30. CDC’s Expectations for HIV Planning • To improve HIV prevention programs by strengthening the: 1) scientific basis 2) community relevance 3) key stakeholder involvement 4) population or risk-based focus of HIV prevention interventions in each jurisdiction 5) communication and coordination of services across the continuum of HIV prevention, care, and treatment, including social determinants of health associated with HIV, STDs, substance abuse, and mental health

  31. Fundamentals of HIV Planning A basic fundamental tenet is: Parity, Inclusion, and Representation (PIR) • Parity: The ability of HPG members to equally participate and carry out tasks or duties in the planning process • Inclusion: Meaningful involvement of members in the process with an active role in making decisions • Representation: The act of serving as an official member reflecting the perspective of a specific community

  32. Other Fundamentals of HIV Planning • HIV planning is a participatory and collaborative process that ensures engagement in an ongoing dialogue with the HD in the planning process • HIV planning must actively encourage and seek key stakeholders and community participation • Nomination for HPG membership should be solicited through an open process • Comprehensive participation is critical to the success of the jurisdictional plan and HIV planning process • HPGs must adopt a High Impact Prevention approach to HIV prevention activities in their communities and use the most current data to guide the planning process

  33. Relevance of HIV Planning HIV planning is a critical component in implementing NHAS and HIP Informs the development of the Jurisdictional HIV Prevention Plan Provides the opportunity to communicate and coordinate funded CDC, HRSA, and SAMHSA activities at the local level

  34. Achieving maximum impact through HEALTH COMMUNICATIONS

  35. Act Against AIDS • Target Audiences: • The general public • Populations most affected by HIV--gay, bisexual and other men who have sex with men (MSM), black men and women, Hispanics/Latinos • Health care providers Goal: • Support reduction of HIV incidence in the U.S. through effective, evidence-based communication, marketing and education campaigns

  36. Campaigns targeted to healthcare providers • Prevention is Care • HIV Screening. Standard Care. • One Test. Two Lives.

  37. Visit us at: www.cdc.gov/ActAgainstAIDS

  38. Conclusions • Growing number of people with HIV and restricted budgets require higher impact strategies • Must act swiftly as window for success may be closing • Further success will require thoughtful prioritization and new and improved programs and interventions • Reducing HIV incidence and ending disease transmission will require community mobilization and prevention partners

  39. Conclusions, cont. Large disparities require conscious application of health equity approaches Powerful tools and enhanced understanding are required Integrate public health prevention, care, and surveillance programs

  40. Acknowledgements • Jonathan Mermin • Michelle Bonds • Nick DeLuca • Jackie Rosenthal • Amy Stone • Amy Lansky • Wendy Lyon • Irene Hall • Stephanie Sansom • June Mayfield

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