How Health Departments Are Accelerating Improvements in HIV Prevention and Care in the United States

By Dawn Fukuda January 26, 2014

As HIV/AIDS directors in state and territorial health departments, we are no strangers to the concept of strategic planning. Community engagement, consumer advisory, and evidence-based decision making are hallmarks of our approaches—as is the capacity for our systems to evolve and adapt in response to emerging trends and population needs. Our planning and program development methods have been soundly implemented and tested over years, in some cases over decades.

The infrastructure to deliver HIV/AIDS and viral hepatitis prevention and care services, while it may look and function differently across our individual jurisdictions, has been collaboratively designed to be maximally accessible, responsive, and effective in reaching local and national health promotion objectives. We have built a system that blends social welfare, medical care, and public health in an integrated services framework, and by all accounts we have been a success.

Maximizing Outcomes Along the Continuum

Now, we are being called to draw on our collective skills and experiences to think and plan strategically in an environment unlike any we have faced before in the history of the HIV/ AIDS response. We are encountering a confluence of remarkable opportunities and unprecedented pressures—to advance prevention, care, and treatment approaches that can begin to end the HIV/AIDS epidemic, in the context of the most far-reaching transformation in our nation’s health care system in the last 50 years, and during an uncertain funding environment. This is no small task, and it demands we elevate the level of urgency we bring to the planning work before us.

So today, the National Alliance of State and Territorial AIDS Directors (NASTAD) released Raising the Bars: Accelerating HIV Prevention and Care in the United States and accompanying Raising the Bars: Policy Recommendations to Enhance Health Departments’ Efforts to End the HIV Epidemic to enhance the ability of health departments to reach the goals of the National HIV/AIDS Strategy (NHAS).

Raising the Bars illustrates how health departments are leading the domestic HIV epidemic to its end within a rapidly changing system of HIV prevention and care services by maximizing outcomes along the HIV care continuum. These resources also provide concrete examples of how health department leaders have already revised their approach to delivering HIV prevention and care programs, while recommitting to core principles: sound public health policy, fiscal efficiency, partnership and collaboration, and meaningful consumer involvement and engagement with communities impacted by HIV. NASTAD urges all health departments to use this call to action to further strengthen their programs’ ability to reach the NHAS goals. To maximize limited resources, NASTAD also encourages community partners to identify new ways to collaborate with health departments to end the epidemic.

The Future of HIV Prevention, Care, and Treatment

We have a window of opportunity to define the essential roles of public health, communicable disease response, and HIV/AIDS services in the context of the evolving health care system. Our obligation is to ensure that we do not lose ground in our efforts to combat the HIV and viral hepatitis epidemics, and that we sustain what are today proven effective prevention, care, and treatment interventions for our most vulnerable residents. This is the essential mission of public health practice, and a moral obligation of responsible government.

At the same time, we must adapt existing systems to leverage the opportunities of national health care reform, modernize our disease surveillance approaches, coordinate communicable disease intervention efforts, and integrate HIV and viral hepatitis prevention and care responses. In collaboration with our community partners, we are responsible to redesign an HIV/AIDS service system that does not exist in protected siloes, but connects across all sectors of the medical care and public health environment. Only then can we assure a responsive service system that has a chance to survive, and that will assure persons living with and at risk for HIV and viral hepatitis will not be left behind.