ENHANCED COMPREHENSIVE HIV PREVENTION PLAN for MARYLAND International AIDS Conference Satellite Session July 22, 2012 Heather L. Hauck, Director Prevention and Health Promotion Administration Maryland Department of Health and Mental Hygiene
Objectives • Describe the Baltimore-Towson Metropolitan Statistical Area (MSA) Enhanced Comprehensive HIV Prevention Plan (ECHPP) Process • Describe the resource optimization model for the Baltimore-Towson Metropolitan Statistical Area (MSA) Enhanced Comprehensive HIV Prevention Plan (ECHPP) • Identify utilization opportunities for the resource optimization model in the Baltimore – DC corridor
ECHPP Objectives • Develop an enhanced plan that aligns the jurisdiction’s prevention activities with the National HIVAIDS Strategy • Using resources so that they have the biggest impact on HIV incidence • Identifying and addressing gaps in scope and reach of prevention activities among priority populations • Enhancing coordination between prevention, care, and treatment • Identifying/implementing the optimal combination of prevention, care, and treatment activities to maximally reduce new infections • Assuring that the most effective biomedical, behavioral and community/structural interventions are prioritized • Assuring that interventions are going to populations/communities in such a way that the level of investment matches the level of risk
Maryland ECHPP Scope • Viewed ECHPP as an opportunity to: • Step back from “business as usual” and look at HIV prevention strategies with “fresh eyes” • Begin to develop our state NHAS implementation plans • Enhance collaboration, coordination and integration • Assessed and planned for the entire Baltimore-Towson MSA (7 jurisdictions) • Decided to implement strategies statewide
Maryland ECHPP Process • Assessment of existing programming • Current level of implementation, including data on program funding, activities, reach and outcomes • Collaborative planning with key public health and community stakeholders • Presentations/meetings with seven local heath departments and five HIV/AIDS community planning bodies • Workgroup composed of HIV and STI prevention, care/treatment, and surveillance staff from IDEHA and the Baltimore City Health Department
Maryland Modeling Process • Health Department/Academic Partnership • Worked with Dr. David Holtgrave from the Johns Hopkins University Bloomberg School of Public Health • Modeling Activities • Estimated key HIV transmission rates for the MSA • Analyzed the cost effectiveness of various HIV testing approaches • Developed a resource optimization model to inform the allocation of current resources • Quantified additional resources needed to reach the prevention goals of the NHAS
Maryland Modeling Process • Modeling scope based on rapid ECHPP timeline, local resource allocation questions, and data availability • Limited scope to HIV prevention funds and a subset of HIV prevention interventions • Built upon previous modeling work • Modified model components to reflect “ideal” local implementation of interventions • Customized parameter values to reflect local costs and outcomes (when data available)
SECTION 3: ATTEMPTING TO MEET NATIONAL HIV/AIDS STRATEGY GOALS IN THE BALTIMORE-TOWSON MSA WITH CURRENT RESOURCES ECHPP Mathematical Modeling for the Baltimore-Towson MSA
Interventions Included in the Baltimore-Towson MSA Modeling • HIV Counseling and Testing • hybrid reflective of Baltimore-Towson experiences and best practices in the field (assuming rapid testing model; 1.5% seropositivity rate; and 0.9% new diagnosis rate); • includes post-test counseling for at-risk HIV- persons • Prevention Services with Persons Living with HIV • intensive behavioral risk-reduction intervention services (and reinforcement of linkage to other needed services) • Partner Services and Intensive Linkage to Care • calculated as a core service for all new diagnoses and previously diagnosed PLWH who are retested • Prevention Services for HIV- Persons at High Risk of Infection • intensive behavioral interventions above and beyond post-test counseling • Total Size of Funding Pool: $6 million
Modeled “Best Performance”: Results Note: HIV incidence is reduced 22.09% (vs the 25% goal in the NHAS) and HIV transmission rate is reduced 27.65% (vs the 30% goal in the NHAS). Unawareness of seropositivity does not quite reach the NHAS goal of 10%.
ECHPP Mathematical Modeling for the Baltimore-Towson MSA Section : what resources are needed to meet national hiv/aids strategy goals in the baltimore-towsonmsa? Prevention and Health Promotion Administration Johns Hopkins Bloomberg School of Public Health July 2012 14
Some Key Findings • Transmission rates differ greatly by population noted above and suggest strategies for intervention • There is not enough money currently in the system to meet NHAS goals, therefore…. • It is critical to (a) attempt to garner necessary resources and (b) to use current resources in the very best way possible
Some Key Findings (continued) • At current resource levels: • Targeting of counseling and testing strategies is key (and rapid testing must be ramped up in the MSA) • Prevention with persons living with HIV must be expanded (and especially emphasize small minority of persons living with HIV engaged in risk behavior) • DHMH has indicated a desire to provide partner services for all persons testing HIV seropositive in a given year (even if previously aware of HIV seropositivity) • A timely evaluation question is to examine the exact impact of such services on the transmission rate
Some Key Findings (further continued) • Evidence-based prevention services for persons who are HIV- but at risk of infection are useful and needed, but current resource levels prohibit the inclusion in the model results, however…. • Such services for at-risk HIV- persons could be provided if there were additional resources and maybe the final “piece of the puzzle” to fully meet all NHAS goals
Maryland ECHPP Activities • Significant increases in: • Routine HIV screening in clinical settings • Targeted HIV testing in non-clinical settings • Initial and ongoing HIV/STI partner services • Activities to support linkage to care, retention in care, and adherence to antiretroviral treatment • Risk reduction interventions for PLWH • Decrease and redirect resources for: • Intensive behavioral risk reduction interventions for HIV-negative persons
Maryland ECHPP Activities • Increase utilization of local HIV and STI surveillance data to target persons at highest risk for HIV transmission or acquisition • Enhance collaboration with local health departments to develop jurisdictional implementation plans • Increase partnerships across funding sources and with private providers to ensure effective coordination of services and leverage additional resources
Maryland ECHPP Benefits • Assessment of current programming: • Highlighted the importance of program targeting and the effectiveness of HIV/STI partner services • Mathematical modeling: • Quantified the additional resources needed to meet the NHAS HIV prevention goals in the Baltimore-Towson MSA • Recommended strategic redirections of current resources • Highlighted the prevention aspects of HIV care • Expanded the local evidence base for increasing focus on HIV testing, linkage to care and other interventions with persons living with HIV/AIDS
Maryland ECHPP Benefits • Collaborative, Coordination and Integration • Enhanced collaboration between HIV prevention and care • Identified priority areas to increase coordination and integration across the HIV and STI prevention, care and treatment continuum • Enhanced partnerships with local health departments to develop and implement HIV prevention activities based on local epidemiology, experience and capacity • Increased national and local partnerships across funding sources • Developed plans to enhance public/private partnerships
Maryland ECHPP Challenges • Local Realities • Insufficient staffing, staff turnover, and hiring time/delays • Barriers in procurement process delayed implementation of expanded HIV prevention activities • Major change takes time • Federal Barriers • Lack of data sharing and collaboration from and between federal agencies and related grantees at the local level. • New and ongoing federally-funded activities not coordinated across funding streams and not based on or informed by locally identified needs. • Separate CDC and HRSA planning requirements
ECHPP as a Foundation • The directions and strategies described in the Maryland ECHPP are the foundation for our state's response to NHAS and guided the development of Maryland and Baltimore’s PS12-1201 applications. • The ECHPP process is a model for collaborative, evidence-based decision making across funding sources that is grounded in NHAS, our local goals, and the Maryland epidemic.
ECHPP As a model for the baltimore – dc corridor Prevention and Health Promotion Administration July 2012 25
2010 Estimated HIV Diagnoses, Ranked by Rates STATE/TERRITORYCasesRate per 100,000 1. District of Columbia* 939 156.7 2. Virgin Islands 47 42.8 3. Florida 5,782 31.2 4. Maryland* 1,708 30.0 5. Louisiana 1,279 28.5 6. Puerto Rico 1,118 28.2 7. New York 5,321 27.2 8. Georgia 2,581 26.3 9. New Jersey 2,207 25.3 10. South Carolina 914 20.0 United States** 48,298 16.3 CDC. HIV Surveillance Report, 2010. Vol. 22. Table 19. * Maryland DHMH estimates from CDC data. ** Based on 46 states and 5 territories.
2010 Estimated HIV Diagnoses, Ranked by Rates METROPOLITAN AREACasesRate per 100,000 1. Miami, FL 2,757 49.7 2. Baton Rouge, LA 339 43.0 3. New Orleans-Metairie-Kenner, LA 439 36.9 4. Washington, DC-VA-MD-WV* 1,995 36.4 5. Baltimore-Towson, MD* 951 35.4 6. Jackson, MS 184 34.0 7. Memphis, TN-MS-AR 440 33.7 8. Orlando, FL 686 32.9 9. New York, NY-NJ-PA 6,160 32.3 10. Columbia, SC 230 30.9 United States** 47,692 16.3 CDC. HIV Surveillance Report, 2010. Vol. 22. Table 24. * Maryland DHMH estimates from CDC data. ** Based on 46 states and 5 territories.
Maryland Living Adult/Adolescent HIV Cases by Region, 12/31/10 Using data as reported through 12/31/2011
Maryland HIV Diagnosis Rate, 12/31/10 Maryland Reported Adult/Adolescent (age 13+ at HIV Diagnosis) HIV Diagnoses during 2010 with or without an AIDS diagnosis, per 100,000 population, by Jurisdiction of Residence at Diagnosis 50+ 25 – 49.9 15 – 24.9 10 – 14.9 0 – 9.9 State Rate = 29.7 per 100,000 Using data as reported through 12/31/2011
Maryland – DC Corridor “ECHPP” Potential Benefits • Assessment of current programming: • Would focus attention on where targeting needs to occur • Mathematical modeling: • Would quantify the additional resources needed to meet the NHAS HIV prevention goals in the Baltimore-DC corridor • Would recommend strategic redirections of current resources • Would expand the local evidence base for increasing focus on HIV testing, linkage to care and other interventions with persons living with HIV/AIDS
Maryland – DC Corridor “ECHPP” Potential Benefits • Collaborative, Coordination and Integration • Would provide opportunities for regional planning and collaboration including enhanced collaboration between HIV prevention and care • Would identify priority areas to increase coordination and integration across the HIV and STI prevention, care and treatment continuum • Would maximize the regional resources
Contact Information: Heather Hauck, Director Prevention and Health Promotion Administration (PHPA) Maryland Department of Health and Mental Hygiene Heather.firstname.lastname@example.org (410) 767-5013 Claudia Gray, Acting Center Chief Center for HIV Prevention and Health Services, PHPA email@example.com (410) 767-5280 Hope Cassidy-Stewart, Acting Evaluation Division Chief Center for HIV Prevention and Health Services, PHPA Hope.firstname.lastname@example.org (410)767-5250
Maryland Prevention and Health Promotion Administration http://ideha.dhmh.maryland.gov http://fha.dhmh.maryland.gov