Program Collaboration and Service Integration

1. Program Collaboration and Service Integration NASTAD Annual Meeting May 5, 2008 Susan DeLisle, ARNP, MPH Associate Director for Program Integration National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

2. Program Collaboration and Service Integration (PCSI) Goal: Provide prevention services that are holistic, science based, comprehensive, and high quality to appropriate populations at every interaction with the health care system. Vision: Remove barriers to and facilitate adoption of service delivery integration at the client level by aligning NCHHSTP activities, systems, and policies with this goal.

3. Program Collaboration and Service Integration (PCSI) Operating Definition: A mechanism of organizing and blending inter-related health issues, separate activities, and services in order to maximize public health impact through new and established linkages between programs to facilitate the delivery of services

4. Principles of Effective PCSI Appropriateness Integration of services must make epidemiological and programmatic sense, and be contextually appropriate Effectiveness Resources cannot be wasted on ineffective or unproven interventions Flexibility Organizations need ability to change and assemble new prevention services to meet changing epidemiology, population demographics, advances in technology, policy/political imperatives Accountability Monitoring of key aspects of services to maximize operations Acceptability PCSI must lead to improved acceptability to clients, programs, and providers through improved quantity and quality of integrated services

5. Consultation on PCSI • Held August 21-22, 2007 in Atlanta • Attended by more than 70 partners and 50 NCHHSTP staff members • Purpose: • To advise NCHHSTP on the development PCSI activities over the next 5 years

6. External Consultation Charge Obtain top three priorities in….. • Opportunities for PCSI implementation • Policy improvements related to opportunities • Performance measures for levels of service integration • Workforce developmentand training needs

7. Priority Recommendations • Integrated surveillance and data efforts • Integrated training efforts • Integrated funding

8. 1. Integrated Surveillance Efforts • Achieve leadership consensus for surveillance integration • agreement across geographic areas and programs, legal issues, partner engagement • Develop common definitions of surveillance, harmonize data elements, variables, and formats • Develop common security and confidentiality standard for surveillance and data sharing across NCHHSTP programs • Build epidemiologic and surveillance capacity at the state and local level

9. 2. Integrated Training Efforts • Increase workforce development and cross-training on NCHHSTP disease areas and prevention techniques for federal, state, and local public health staff • Increase opportunities for shared training and education programs within NCHHSTP disease areas • Develop PCSI training and education to promote shared understanding and vision for state and local public health officials.

10. 3. Integrated Funding Efforts • Develop and promote integrated NCHHSTP program announcements (PA’s) • Promote and reward collaboration on program announcements and post award management • Identify mechanisms and incentives for state and federal funding to support integration • Allow flexibility of funds to accomplish state and local objectives • Support operational research and evaluation on PCSI for NCHHSTP programs

11. Fiscal Year 2008 Action Plan Prepared by NCHHSTP The action items included in this plan have been developed by NCHHSTP in support of the Programmatic Imperative of Program Collaboration and Service Integration. The activities and interventions should not be considered final, but as a tool for supporting current and future integration activities.

13. Table 5: Addressing barriers to PCSI implementation

15. PCSI White Paper I. Background • Definition, goals • Update with consultation findings II. Purpose • Articulate strategic plan for 3 years • Frameworks • How we will work with partners III. Frameworks • Clinical ( new sections on lab, venues) • Other Prevention services • Behavioral • Health education/communication • Collaborations/partnerships • community IV. Strategic Plan • Top 3 priorities (internal and external) • Operational research (BSC • Business Plan (reference PCSI Action Plan) • Cross federal agency coordination IV. Assessment/Evaluation Plan • Baseline assessment (internal, external) • Measures of Progress (internal, external) V. Communication Plan • Grantee • Internal • Public • Federal • National partners VI. Summary and Conclusion

17. Funding Opportunity Announcements (FOA) • Standard Operating Procedures modified • Non-research FOA’s coordinated through PCSI • Cross-division engagement in development of FOA • Relevant CDC Goals and NCHHSTP Priorities in FOA architecture • Relevant PCSI activities included in program plans, FOA review criteria, reporting requirements

18. All Funding Announcements • This program addresses the CDC Health Protection Goals of: healthy people in every stage of life, and healthy people in healthy places. • Likely to become more specific • This program supports the NCHHSTP programmatic imperatives of program collaboration and service integration, and reduction of health disparities. • Measurable outcomes of the program will be in alignment with one (or more) of the following performance goals for the Coordinating Center for Infectious Diseases (CCID), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP

19. PCSI and Program Announcement PS07-768 • Eligible states, cities, and counties represent 95% of 2005 US AIDS cases among blacks • African Americans are also disproportionately affected by other infections, including HCV, HBV, STDs, and TB • Integrated service delivery has been shown to enhance HIV testing programs • For these reasons, funds can also be used for integration of these associated services

20. Required PCSI related activities in Clinical Settings • Promote opt-out testing in high-morbidity clinical settings (including STD clinics) Highly Recommended • HCV testing should be conducted concurrently with HIV testing in settings with high numbers of current or past injection drug users • Pre-vaccination testing for HAV and HBV should also be done as indicated for MSM and injection drug users. HIV funds may be used for viral hepatitis testing but not immunization against hepatitis A or B • Strongly encouraged to provide additional standard testing as indicated by current treatment guidelines for HIV infected patients

21. Required PCSI related activities - all settings • Offer linkage to HIV prevention and services for persons receiving a negative test result but are at high risk for acquiring HIV • Ensure PCRS for identification, notification, counseling, and testing of spouses and other sex partners, drug injection partners, respiratory contacts of TB/HIV co-infection, and household contacts of persons with HBV infection • Actively integrate HIV activities with STD, viral hepatitis (including HCV testing and referral for HAV and HBV vaccination), TB screening and prevention activities Strongly Recommended

22. PCSI and PA-00504 (CSPS) • Describe plans to maximize or improve program collaboration and service level integration, e.g., collaboration with HIV/AIDS programs for clinical, prevention, and partner services; and hepatitis programs for HCV screening and hepatitis B vaccinations • Integrate STD prevention messages into HIV testing and treatment services, and HIV prevention and other evidence-based behavioral interventions. • Refer individuals at-risk for HIV infection to appropriate HIV risk-reduction programs

26. Developing a research agenda for PCSIBoard of Scientific Counselors Meeting May 6, 2008 • Technological advances in rapid testing to further PCSI • Data collection, sharing, and analysis to best target integrated prevention services • Evaluating the effectiveness of integrating prevention services into HIV care • Integrating health communication and social marketing – what’s the most effective mix? • Best measures or indicators of level of cooperation and coordination between programs • Improving sustainability of interventions resulting from research

28. Program Collaboration and Service Integration • Long Beach, CA --- Training Meeting – June 24, 2008 • Draft Meeting Goal, Objectives and Agenda • Goal • Develop a shared vision for integrated training opportunities for workforce development in program collaboration and service integration (PCSI) • Objectives • Provide orientation on PCSI • Identify opportunities and approaches in developing and implementing training and education programs • Identify approaches for implementation and dissemination • Provide recommendations for future integrated training: • Cost neutral suggestions and funding priorities • Needed policies and communication channels

29. Next Steps Publication of NCHHSTP Action Plan for PCSI Vetting of NCHHSTP White Paper on PCSI Baseline assessment of PCSI Continued engagement with partners Integration “tracks” at national meetings