|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:
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.
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:
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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