HIV/AIDS Policy Shifts: Is Your Health Department Program Ready?

Since 2010, significant shifts in national policy have influenced the practice of HIV prevention in the US including: NHAS, Treatment as Prevention, CDC’s HIP and Cascade/Continuum of Care initiatives. Simultaneously, the Affordable Care Act (ACA) is changing reimbursement for HIV prevention services. Studies have shown the effectiveness of biomedical interventions in addition to behavioral and structural interventions. Thus, HDs are challenged to restructure programs, and have sought CBA to improve performance of the HIV Prevention workforce.

CBA services are provided to HDs nationally, including strategic responses to changing HIV prevention policy. Two CBA project examples will be presented to illustrate changing HD needs.

Structurally, many state level HIV/STD/VH/TB programs are not integrated thus hampering implementation of new policies. Prevention programs need access to HIV and STD surveillance data. Cost-effective, data-based, integrated HIV/STD/VH/TB prevention, care and treatment programs and services are needed to provide appropriate services targeted to persons most in need. HDs are focusing on using data to identify gaps in services and inform prevention planning and subsequent HD intervention and strategies.

HDs must consider several steps to align with funding requirements: 1) integrate surveillance systems to track data across HIV/STD/VH/TB programs and divisions, to maintain eligibility to receive funding; 2) identify opportunities to implement billing for HIV prevention services to offset funding changes; 3) implement strategic monitoring and evaluation to demonstrate program efficacy; 4) implement cost analysis practices to demonstrate the impact of HIV prevention dollars spent; and 5) develop their prevention workforce to build and enhance needed skills.