From The Field: Enhanced Planning in Texas - the Dallas Metropolitan Division
In September 2010, the Texas Department of State Health Services (DSHS) HIV/STD Program received funding from the Centers for Disease Control and Prevention (CDC) Division of HIV/AIDS Prevention to develop, in partnership with the Dallas County Health and Human Services (DCHHS), an Enhanced Comprehensive HIV Prevention Plan (ECHPP) for the Dallas Metropolitan Division. The development of the Dallas ECHPP has included collaboration with public health and community stakeholders and community consultations with the Ryan White Planning Council, participants of the Black Women's Summit, the Texas HIV/STD Community Planning Group, participants of the HIV/STD Prevention Contractors Summit, and attendees of the Dallas Gay Men's Summit. Several internal planning meetings were also held to identify DSHS staff with insight into the Dallas HIV surveillance, treatment, care and prevention systems. Collectively, these external and internal partnerships are essential for expanding leadership and coordination by DCHHS, as well as continued investments by DSHS in implementing the Dallas ECHPP.
Reducing the proportion of undiagnosed and late diagnosed HIV infections is a critical component of the Dallas ECHPP. Recently published National HIV Behavioral Surveillance System (NHBS) data indicate a high level of undiagnosed infection among men who have sex with men (MSM) in Dallas: one in four MSM tested HIV positive and over half (54 percent) of those infected were unaware of their infection. Increasing knowledge of positive status is crucial to reducing the number of new infections and reducing the transmission rate of HIV in Dallas.
The Dallas ECHPP includes increasing investments in routine testing efforts to reduce the annual number of new infections and reduce the HIV transmission rate. Additional routine testing sites will be established within federal qualified health centers, emergency departments and private providers, in addition to expanding the capacity of existing routine testing sites. Marketing efforts will also be used to target private medical providers, primary care settings and medical associations to increase the number of sites offering routine testing. DSHS will also partner with DCHHS to coordinate and increase targeted testing in areas with high morbidity and focus on priority populations including Black gay men and other MSM.
Increasing access to care and improving health outcomes for people living with HIV (PLWH) will be strengthened by multiple activities of the ECHPP plan, including expanding linkage access points and increasing the number of Federally Qualified Health Centers (FQHCs) participating in HIV care in order to reduce the time between HIV diagnosis and entry into care. DSHS intends to work with the AIDS Education and Training Center, the Texas Association of Community Health Centers and the HRSA Bureau of Primary Care to identify opportunities and promote HIV/STD integration in primary care settings. In addition, DSHS will explore the possibility of adding a peer support component to early intervention services (EIS) to assist in navigating the care system for newly diagnosed positives. Because PLWH who are out of care are likely to have higher viral loads and be more infectious than those in care, DSHS is also exploring the possibility of including a lost‐to‐care component to the EIS program and will investigate enhancing the role of disease intervention specialists and community based organizations (CBO) staff in following up with clients on missed appointments.
Other components of the Dallas ECHPP include targeted condom distribution, social marketing efforts and structural changes to the Dallas HIV prevention, care and treatment landscape, along with strengthening case management services and increasing access to care and prevention services for people living with HIV and high risk individuals. DSHS will realign resources to increase condom distribution in Dallas and will partner with local organizations to identify additional venues to distribute condoms for PLWH. The "Greater than AIDS" events will also be funded to increase awareness and urgency of HIV in Dallas, to include printing collateral and additional billboards, transit ads and mall kiosk placements specifically in the top three zip codes for new diagnoses.
Provider‐delivered interventions are another important prevention opportunity for PLWH. DSHS plans to explore piloting programs in identified clinics in highly impacted areas and increase behavioral risk screenings and referrals for appropriate risk reduction interventions for PLWH (e.g., CRCS, Healthy Relationships and Willow). In addition, DSHS will explore expansion of partner services based on viral load reporting, expand community mobilization, integrate services at methadone clinics and supporting asset mapping to identify competent providers for MSM services.
The Dallas ECHPP also recognizes the imperative to develop sustainable programming for Black gay men in Dallas. DSHS seeks to develop skills and competencies in individuals and groups within the community through leadership development and multi-level HIV prevention programming with multiple partners. The overarching goal of DSHS is establishing a sustainable program serving this community by 2014. To support this goal, DSHS will foster relationships among stakeholders to build commitment to programming for Black gay men. The continuation of the United Black Ellument (UBE) project is another critical component of this strategy. UBE is a community‐level evidence-based HIV prevention program for young Black MSM aged 18‐29 in Dallas. DSHS plans to explore the possibility of placing this project under the administrative direction of a DSHS funded HIV prevention service provider.
In Texas, the ECHPP opportunity has allowed DSHS and DCHSS to focus attention on the critical needs in its Dallas MSA and to marshal the collective wisdom of important stakeholders on an enhanced plan to meet the goals of the National HIV/AIDS Strategy articulated via ECHPP. For more information on the Texas/Dallas ECHPP, please contact Jeff Hitt. A version of this profile can also be found with additional information on the ECHPP projects on the CDC website.
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Program Updates: NASTAD Prevention Program Updates
NASTAD's prevention team maintains a robust set of activities to support effective policy and technical assistance (TA) on prevention priorities and initiatives. Most recently, staff members have been working with NASTAD members and prevention directors to assess and respond to the recently released health department funding opportunity announcement (FOA) from CDC for HIV prevention programs. This month's digest details NASTAD's response and activities related to the FOA. NASTAD continues to support networking, communication and peer-exchange via the Prevention Networking Group (PNG) listserv and webinar series and has additional issue briefs and reports available at www.NASTAD.org. Updates on several recent initiatives are provided below.
Focusing on Stigma
NASTAD's Transgender Portfolio
As part of its focus on addressing the impact of stigma on HIV and viral hepatitis, the NASTAD has formed a cross-team effort to comprehensively assess state and local health department efforts targeting transgender populations. Transgender and gender non-conforming people endure stigma and discrimination at various levels and across different settings. Such pervasive behaviors severely impact their access to education, employment, housing, and health care. NASTAD staff will engage stakeholders, including federal agencies, state and local health departments and service providers, to further identify the distinct needs of transgender populations and strategies for meeting these needs. Future plans may include webinars and dissemination of profiles of state efforts and initiatives to address the transgender community. For more information contact Tyler TerMeer.
NASTAD and NCSD MAC AIDS Fund Stigma Grant
NASTAD and the National Coalition of STD Directors (NCSD) were recently awarded funding for a MAC AIDS Fund stigma-focused grant. Through the grant, NASTAD and NCSD will examine and address stigma in state and local HIV and STD programs. Activities will assist health departments in increasing access to prevention, care and supportive services for HIV positive and negative Black and Latino gay men, target social and sexual networks to promote positive sexual health messages and establish and promote evidence-based practices and tools to educate NASTAD and NCSD members, key community stakeholders and public health providers about the impact of stigma on HIV/AIDS, viral hepatitis and STDs. For more information contact Tyler TerMeer.
Prevention Directors/Managers Outreach
In NASTAD's continued effort to better understand the issues facing state health department HIV/AIDS prevention programs and to enhance TA available to state health department prevention programs, the NASTAD prevention staff members recently conducted phone interviews with prevention directors/managers across the country. The interviews sought information on current prevention challenges and successes, state responses to the National HIV/AIDS Strategy (NHAS) and whether any programs are targeting transgender populations. The information from these interviews will help enhance NASTAD's TA response and help states work through their identified challenges. Over the next several months NASTAD will:
For more information or to request peer-based TA on any prevention issue contact Joy Mbajah.
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Member and Staff Updates
In member news, Tina Long is the new Section Chief of the HIV/STD Section in the Arkansas Department of Health.
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