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CDC, Division of HIV/AIDS Prevention (DHAP)
Update to the Federal AIDS Policy Partnership
Eugene McCray, MDDirector, DHAP
NCHHSTP, Office for Infectious Diseases, CDC
March 4, 2015
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention
DHAP – Mission and Key Areas
Supporting Prevention Programs
Tracking the HIV Epidemic
Supporting Prevention Research
Raising Awareness
Mission: To promote health and quality of life by preventing HIV infection and reducing HIV-related
illness and death in the U.S.
DHAP Budget (2014)
89%
11%
Extramural Intramural
Funding for Maximum Impact
72%
15%
8%
3% 2%
Prevention Programs
Surveillance
Technical Assistance
Operational Research
Program Evaluation
DHAP projects by mission category, total $665.99 Million (2014)*
Priorities Reducing New Infections
Expanded HIV testing in clinical and non-clinical settings “Prevention for Negatives” “Treatment as Prevention”
Improving Surveillance and use of data Strengthen surveillance systems by improving data quality and
data use to target and evaluate prevention efforts
Expanding HIP Activities Transition CBOs to HIP prevention approach
Prioritizing interventions that are…
Scientifically proven
Cost-effective
Scalable
… targeted to the right populations in the right geographic areas
... to achieve the greatest potential impact on the epidemic
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Advancing High-
Impact Prevention
(HIP)
FY16 President’s Budget Request
President’s FY 2016 funding request for NCHHSTP was $44.14M higher than 2014 enacted
The request was $12.65M higher than 2014 enacted funding levels for HIV prevention activities, including $6.4M to improve program effectiveness and $6.3M for HIV-prevention education in schools
HIV and AIDS prevention investments will continue to align activities with the NHAS and promote high-impact prevention that focuses resources on effective, scalable, and sustainable prevention strategies
High-Impact Prevention Progress Update for Health Department Program (12-1201)
Expanded prevention and care services and coordination
HD efforts in MSAs w highest burden of disease
Jurisdictions meeting FOA routine HIV testing objectives and increasing potential for retention in care
Increased routine testing in healthcare settings
Meet current FOA requirements
New biomedical strategies
Information and resources for MSM & providers
Increase utilization of surveillance data
New approaches to planning
More diverse engagement of non-traditional partners
Healthcare system transformation*
Social issues – stigma
Social determinants of health
Healthcare system transformation*
Human capital/capacity
Successes OpportunitiesChallenges
Supporting LGBT Work & Mitigating Poor Health Outcomes for MSM
Funding targeted towards communities experiencing heaviest disparities.
Organization Leadership & Inclusion• DHAP as coordinating office for domestic HIV, MSM
activities through CDC
Surveillance• Monitor trends in HIV incidence, prevalence, risk behaviors
Research• Increase understanding of drivers of HIV transmission
• Develop interventions and messaging in MSM in close partnership with communities
In addition to funding…
Programs• MSM testing initiative
• YMSM of color & transgender youth
• Training and capacity building; support for organizations serving MSM
Prevention Efforts in Transgender Community
Surveillance reporting 80% of jurisdictions reported that they collect transgender-specific data Although, issues exist with collecting and reporting transgender surveillance
data Technical assistance guidance Funding (YMSM, Transgender FOA -- PS11-1113)
$55M over five years to provide effective HIV prevention services Commitment to renew for FY 2017
New research Life Skills (for young transgender women aged 16-24) Girlfriends (for adult transgender women)
Public HIV campaigns Let’s Stop HIV Together Testing Makes Us Stronger
ACA: Essential Health Benefits
Covers a range of drugs across a broad distribution of therapeutic categories and classes and recommended drug treatment regimens treating all disease states without discouraging enrollment by any group of enrollees
Requires issuers’ formularies to provide appropriate access to drugs included in broadly accepted treatment guidelines/best practices
Changes should improve access to optimal preventative and treatment regimens for HIV and related comorbidities
“If an issuer places most or all drugs that treat a specific condition on the highest cost tiers, we believe that such plan
designs effectively discriminate against, or discourage enrollment by, individuals who have those chronic conditions.” - Notice of Benefit and Payment Parameters for 2016 Rule, CMS
Testing Reimbursement DHAP is supporting grantee efforts to address
these challenges by: Redirecting funds to support billing related activities Supporting a network of capacity building assistance providers
who can offer billing related technical assistance grantees; and Redesigning the NACCHO billing toolkit
DHAP recognizes payment models are rapidly evolving, and we need to prepare for both the present and future by: Positioning key public health partners, as recognized providers of
valued health services Actively partnering with key payers and policy innovators to
develop and test new models for delivering and paying for care
Infrastructure & System Implications Variation exists within and across states making it
difficult to provide universal guidance DHAP initiated program changes and demonstration
projects: will integrate HIV into larger healthcare delivery system when complete Example: Partnerships for Care (P4C) aims to identify and develop
effective models for partnership between Federally Qualified Health Centers (FQHCs) and health departments (HDs) to support HIV prevention and care.
Also, actively supporting transformation efforts through many of our core FOAs (CBOs, CBAs, etc.)
HIV Criminalization DOJ – leads government’s response
to laws that criminalize HIV exposure
CDC – provides information that policy makers use in drafting/revising criminalization laws
Current HIV exposure laws
Evidence about the risks of transmission
Source: Lehman JS, Carr, MH, Nichol AJ, et al. Prevalence and public health implications of state laws that criminalize potential HIV exposure in the United States. AIDS Behav 2014.
“Given that HIV-specific criminal laws may have wide-ranging social implications, states are
encouraged to utilize the findings of this paper as a basis to re-examine those laws, assess the
laws’ alignment with current evidence regarding HIV transmission risk, and consider whether current laws are the best vehicle to
achieve their intended purposes.”
DHAP
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of HIV/AIDS Prevention
Publications and Resources
Available by visiting the DHAP website:
www.cdc.gov/hiv/dhap/about.html
Or by calling:1-800-CDC-INFO
Division of HIV Prevention Centers for Disease Control and
Prevention Corporate Square, Atlanta GA
MS D-21
Q&A / DISCUSSION
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