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  July 2011
Digest: The Month In Review
From the Field: Responding to the NHAS - Maryland's ECHPP Response
Program Update: NASTAD's Response to the NHAS
Member and Staff Updates
Inventory of NASTAD E-mail last month
Statement of Urgency – Crisis Among Gay Men – One Year Anniversary
AIDSVu Post Launch Update
FYI: Act Now to Protect the Medicaid Program
HRSA AIDS Care and Treatment in Health Centers Announcement
NASTAD HIV and Viral Hepatitis Policy Watch for June 17, 2011
National HIV Prevention Strategy
CMS Guidance on HIV-specific 115 Waivers and NASTAD Webinar Information
Update: CDC FY2011 Cooperative Agreement Balances
On 30th Year of HIV/AIDS, Obama Administration Recommits to Fighting Pandemic
NASTAD Reaffirms Its Commitment to the Fight Against HIV/AIDS
Introducing the AIDSVu Interactive Online Tool to Visually Explore Epidemic
Rev. Al Sharpton and NAN Chapters to Mobilize on HIV Testing Day
NASTAD's 2011-2012 Leadership
HHS News To Make It Easier for Americans With Pre-Existing Conditions to Get Health Insurance
ADAP Waiting List Update Compilation
  From The Field: Responding to the NHAS - Maryland's ECHPP Response

The National HIV/AIDS Strategy (NHAS) released in 2010 calls upon the country to scale up efforts to reduce HIV incidence, particularly where HIV is most heavily concentrated. As part of its implementation of this mandate, CDC released the Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan Statistical Areas Most Affected by HIV/AIDS (ECHPP) Funding Opportunity Announcement (FOA) in August 2010. Twelve Metropolitan Statistical Areas (MSAs) with the highest estimated AIDS prevalence in 2007 (New York City, Los Angeles County, the District of Columbia, Chicago, Atlanta, Miami, Philadelphia, Houston, San Francisco, Baltimore-Towson, Dallas and San Juan) were targeted for the project, with funding awarded to the state or directly-funded MSA in which that city is situated. In the first year of the two-phased project, the 12 grantees were required to develop focused comprehensive prevention plans that include a mixture of required, recommended and innovative local interventions and public health strategies.

These projects not only serve as a cornerstone of the CDC and Administration's implementation of the NHAS, but are also seen a precursor of CDC's expectations for health department management of their federal HIV prevention funding. While states await the release of the new FOA for their base HIV prevention cooperative agreement funding, they have been carefully following the ECHPP projects for tips on how to move forward. As one of the ECHPP project states, Maryland has been a leader in sharing information about their process and the lessons they have learned from the planning and initial implementation of ECHPP in their state.

Maryland's ECHPP Scope

The Maryland Infectious Diseases and Environmental Health Administration (IDEHA) viewed the ECHPP project as an opportunity to step back from "business as usual" and look at HIV prevention strategies with "fresh eyes." They decided to begin their project by examining NHAS implementation for the entire Baltimore-Towson MSA (7 jurisdictions), and then made the decision to implement strategies statewide.

To inform the development of the Baltimore-Towson ECHPP, IDEHA collaborated with key public health and community stakeholders throughout the MSA, including seven local health departments and five HIV/AIDS community planning bodies. IDEHA also convened a workgroup composed of HIV and STD prevention, care/treatment, and surveillance staff from IDEHA and the Baltimore City Health Department, the grantee for the Baltimore CDC STD cooperative agreement and Ryan White Part A. IDEHA partnered with these stakeholders to assess and describe the current level of implementation for each of the 24 required and recommended interventions, including data on program funding, activities, reach and outcomes. IDEHA also collaborated with Dr. David Holtgrave, Chair of the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, to estimate key HIV transmission rates for the MSA, analyze the cost effectiveness of various HIV testing approaches, develop a resource optimization model to inform the allocation of current resources, and quantify the additional resources necessary to reach the prevention goals of the NHAS.

Maryland ECHPP Findings

As a result of the planning process and mathematical modeling work, Maryland found that their current resources were insufficient to meet the NHAS HIV prevention goals and that strategic redirections of current resources could significantly increase the number of infections averted and lower transmission rates. Specifically, the resource optimization modeling showed that interventions which increase knowledge of serostatus, increase linkage and adherence to HIV medical care, and decrease risk behaviors among PLWH would have the greatest impact on reducing new HIV infections in the MSA. The ECHPP process also indicated that current prevention services are not being sufficiently targeted to high-risk persons and identified priority areas to increase coordination and integration across the prevention, care and treatment continuum.

Maryland ECHPP Activities

Based on these findings, Maryland will increase implementation of the following interventions/public health strategies:
Routine HIV screening in clinical settings;
Targeted HIV testing in non-clinical settings;
Initial and ongoing HIV/STD partner services;
Activities to support linkage to care, retention in care, and adherence to antiretroviral treatment; and
Risk reduction interventions for PLWH.

In order to increase these interventions, IDEHA will decrease and redirect resources that have been used for intensive behavioral risk reduction interventions for HIV-negative persons. Across all interventions, IDEHA will increase utilization of local HIV and STD surveillance data to target persons at highest risk for HIV transmission or acquisition, enhance collaboration with local health departments to develop jurisdictional implementation plans, and increase partnerships across funding sources and with private providers to ensure effective coordination of services and leverage additional resources.

Lessons Learned

The ECHPP process has provided opportunities for the Maryland IDEHA to scale up collaboration between its CDC and Ryan White programs and highlighted the prevention aspects of HIV care. Local modeling expanded the evidence base for increasing the focus on HIV testing, linkage to care and other prevention interventions with PLWH. The process also reinforced the importance of program targeting and the effectiveness of HIV/STD partner services.

For more information on Maryland's ECHPP project, please contact Claudia Gray or Hope Cassidy-Stewart.

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Program Updates: NASTAD's Response to the NHAS

Even before the National HIV/AIDS Strategy (NHAS) was released last July, NASTAD weighed-in heavily, communicating with the Obama Administration around key recommendations that underscore the central role of state health departments in the nation's response to HIV/AIDS. NASTAD continues its leadership role, advocating on behalf of the diversity of states in implementation. Additionally, NASTAD is in regular communication with the Office of National AIDS Policy, the Department of Health and Human Services and members around critical NHAS issues for consideration during the implementation phase. The following is a timeline of priority NASTAD activities during year-one of NHAS implementation:

2009/Present: NASTAD provides regular communications to members via email updating them on NHAS.

February 2010: NASTAD sends NHAS input letter to Jeff Crowley, Director of the Office of National HIV/AIDS Policy.

2010: The Institute of Medicine (IOM) holds a series of three workshops on HIV screening and access to care as part of the data gathering to feed into the development of the Strategy. Beth Scalco (LA) and Liisa Randall (MI) represent states as members of the IOM panel. NASTAD Executive Director Julie Scofield presents NASTAD recommendations during the fall 2010 IOM workshop.

July 2010: NASTAD sends a letter to ONAP Director, Jeff Crowley upon publication of the NHAS.

August 2010: NASTAD publishes the Role of States document outlining states' role in implementing the NHAS.

2010–present: NASTAD is in regular phone and email communications with HHS Deputy Assistant Secretary for Health, Infectious Diseases, Ron Valdiserri, who has been tasked with leading the development of NHAS implementation plans by all relevant federal agencies.

October 2010: NASTAD weighs in on state plans in its National HIV/AIDS Strategy & Federal Implementation Plan Issues for Consideration document, sent to all federal implementing partners.

October 2010: Julie Scofield presents on state budget cuts and the role of states in implementing the NHAS at a Funders Concerned About AIDS meeting.

November 2010: Julie Scofield presents Non-Federal Perspective on Funding Formulas and Policies at an HHS consultation on HIV/AIDS funding formulas and resource allocation.

November 2010: NASTAD attends the ECHPP Grantee Orientation held for the 12 grantees funded through PS10-10181 for the Enhanced Comprehensive HIV Prevention Planning and Implementation for Metropolitan Statistical Areas Most Affected by HIV/AIDS (ECHPP) project, a key activity outlined in the NHAS.

January 2011: Julie Scofield represents NASTAD at a meeting on the NHAS convened by the Coalition for a National AIDS Strategy in Los Angeles, CA.

February 2011: NASTAD publishes its United in HIV/AIDS: A Guide to Understanding How Faith Communities Can Make A Difference, another key aspect of building partnerships as part of NHAS implementation.

February 2011: NASTAD releases its policy statement on HIV criminalization in response to the NHAS imperative to examine and report on HIV-sentencing laws, policies and implications for people living with HIV.

March 2011: NASTAD's Executive Committee meets with Ron Valdiserri on NHAS implementation and efforts to increase federal coordination.

March 2011: Terrance Moore represents NASTAD at a meeting on the NHAS implications for LGBT communities convened by HHS.

April 2011: NASTAD surveys members on the level of involvement and collaboration that state HIV/AIDS and viral hepatitis programs have with their state correctional facility counterparts in providing HIV/STD and viral hepatitis related services to inmates in prison or in transition. This assessment will help gain an understanding of states' readiness to implement a key NHAS goal of achieving a more coordinated national response to the HIV epidemic in the U.S., particularly with state and local law enforcement.

2010 - Present: NASTAD begins to meet with HRSA's Bureau of Primary Health Care (BPHC) and the National Association of Community Health Centers (NACHC) on the NHAS and health care reform. In March 2011, the NASTAD Executive Committee meets with BPHC staff to discuss the NHAS. In April, NASTAD shares with its members communications from BPHC to Primary Care Associations (PCAs) regarding the NHAS.

May 2011: ONAP announces they have commissioned the IOM to examine data gaps in monitoring access and quality of HIV care that will result in a report at the end of 2011. ONAP asks the IOM to examine and provide suggestions on "how to obtain meaningful national level estimates of access to care and services utilization by people living with HIV." NASTAD Executive Committee member Carmine Grasso (NJ) is on the IOM panel.

May/June 2011: Natalie Cramer identified to represent NASTAD as liaison to Ron Valdiserri's office on state plans.

June 2011: Murray Penner represents NASTAD at an HHS consultation on Priority Approaches to Use of Potential New NHAS Funding. See Ron Valdiserri's blog for more information on the proposed NHAS Implementation Fund.

June 2011: Julie Scofield, Terrance Moore, and Chris Taylor represent NASTAD at a CDC consultation on Prevention Through Health Reform along with NASTAD members Heather Hauck (MD), Kathy Hafford (VA), Jacqueline Clymore (NC), Daniel Daltry (VT), Maria Courogen (WA), and Michelle Roland (CA).

June 2011: Julie Scofield, Natalie Cramer, Randy Mayer (IA), Kathy Hafford (VA) and Heather Hauck (MD) discuss perspectives on state plans at an OMB/White House meeting on the development of state plans.

June 2011: NASTAD sends a letter to ONAP Director, Jeff Crowley, around the on-going state plans discussions and reiterating the thinking about this issue based on conversations with many state AIDS directors.

Looking ahead, NASTAD intends to continue its strong participation in NHAS implementation discussions and activities and to support ongoing and frequent communication with and from members on the NHAS. For more information on NASTAD's NHAS response, please contact Julie Scofield, Murray Penner or program directors.

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Member and Staff Updates

In Member News, Amna Osman (MI) took over as Chair of NASTAD and NASTAD members elected the 2011-2012 Executive Committee and officers during the 2011 NASTAD Annual Meeting, held May 22-25 in Washington, D.C. In other member news, Susan Hall is the Acting Director of the West Virginia HIV/AIDS and STD Program.

In staff news, NASTAD recently renamed two of its major program areas to better reflect our current program and staff alignment. The NASTAD Care and Treatment team will now be known as the Health Care Access team and the Racial & Ethnic Health Disparities team as the Health Equity team.

In June, NASTAD welcomed Daniella Yaloz as a new Manager for Policy and Legislative Affairs. Daniella comes to NASTAD with a strong background in policy, advocating on behalf of several nonprofit organizations and representing victims of domestic violence, older adults and people with disabilities. Robin Flanagan will be joining NASTAD a Manager in the Global Program working with NASTAD's Caribbean project activities. In addition, University of Maryland student Naila Alam is interning with NASTAD's domestic programs this summer.

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