1. Integrated Epidemiologic Profiles for HIV Prevention and Care Planning Anna Satcher Johnson Stacy Cohen HIV Incidence and Case Surveillance Branch Division of Policy and Data Division of HIV/AIDS Prevention HIV/AIDS Bureau CDC HRSA Webinar Training for CDC DHAP and HRSA HAB Grant Recipients March 10, 2016

2. Overview  Review of Integrated Guidance for Developing Epidemiologic Profiles: HIV Prevention and Ryan White HIV/AIDS Programs Planning, July 2014  Integrated Epi Profile and the SCSN/Needs Assessment Epidemiologic Overview  HIV care continuum  Reviewing and interpreting epidemiologic data to best target resources  Ensuring goals, strategies, activities are responsive to the data  Identifying technical assistance needs  Resources

3. Integrated HIV Prevention and Care Plan Guidance  Collaboration between CDC & HRSA  Purpose – Support the submission of one integrated HIV Prevention and Care Plan to both CDC and HRSA – Build upon efforts to reduce reporting burden and duplicated efforts – Streamline work of health department staff and HIV planning groups – Promote collaboration and coordination in use of data

4. Integrated Guidance for Developing Epidemiologic Profiles - HIV Prevention and Ryan White HIV/AIDS Program Planning  Collaboration between CDC & HRSA  Purpose – Assist with development of epidemiologic profile – Assist in interpreting the data in ways that are consistent and useful – Ensure the needs for planning and evaluation are met for both prevention and care programs

5. HIV Epidemiologic Profile

6.  Describes burden of disease in service area for – Persons with diagnosed HIV – Persons living with diagnosed HIV (PLWH) – Persons at high risk for infection  Descriptions – Sociodemographic – Geographic – Behavioral – Clinical  Primary users – Prevention and care planning groups – Community-based organizations – Grant recipients

7. HIV Epidemiologic Profile cont.  Frequency – Comprehensive updates at least once during 5-year funding cycle – Annual updates to executive summary and core epidemiologic tables and figures

8. Uses of HIV Epidemiologic Profile  Provides basis for – Developing a comprehensive HIV prevention & care plan – Setting priorities among populations needing prevention and care services – Identifying appropriate interventions and services – Allocating HIV prevention and care resources – Planning programs – Evaluating programs and policies – Helping to determine the composition of planning or advisory group membership

9. Integrated Epi Profile and Statewide Coordinated Statement of Need (SCSN) Needs Assessment and Epidemiologic Overview

10. Integrated Epi Profile and SCSN/Needs Assessment Epidemiologic Overview  Data – Most recent year for which data are available – 5 years trend data (minimum)  Describe – Geographical region (map/narrative) – Sociodemographic characteristics Demographic data (e.g., race, sex, transmission category, current gender identity) Socioeconomic data (e.g., percentage of federal poverty level, income, education, health insurance status) – Burden of HIV in service area using HIV surveillance data Numbers, rates, trends, populations most affected, geographic concentrations, deaths

11. Integrated Epi Profile and SCSN/Needs Assessment Epidemiologic Overview cont.  Describe (cont.) – Indicators of risk for infection in the population covered by service area – Behavioral surveillance data (e.g., National HIV Behavioral Surveillance System, Youth Risk Behavioral Surveillance System) – Ryan White HIV/AIDS Program data (e.g., Ryan White Services Report, ADAP Data Report, Dental Services Report) – Qualitative data (e.g., observations, interviews, focus groups) – Vital statistics data – Other relevant program data (e.g., Hepatitis B or C, STD, Community Health Center program data)

12. Describing the Burden of HIV in a Jurisdiction – Ryan White HIV/AIDS Program Grant Recipients  Impact of care and treatment services received by Ryan White HIV/AIDS Program clients in the service area – Public health outcomes for the program Provision of HIV core medical & support services to improve health outcomes of clients Adherence to established clinical practice standards or HHS guidelines – Assessment of need for HIV services Demand for care: Number of PLWH without health care coverage or other resources to pay for care Unmet need: Population aware of their HIV infection but not receiving HIV primary medical care

13. Describing the Burden of HIV in a Jurisdiction - Ryan White HIV/AIDS Program Grant Recipients cont.  Other required information – Parts A & B Size & demographics of population with HIV Service needs of population Populations with severe needs & comorbidities – Parts C & D HIV prevalence & surrogate markers (e.g., STD prevalence) Social context of HIV Target populations Local HIV service delivery

14. HIV Care Continuum

15.  Model used to identify issues and opportunities related to improving delivery of services to PLWH Example: Prevalence-Based HIV Care Continuum, United States, 2011

16. HIV Care Continuum cont.  Allows grant recipients and planning groups to measure progress and direct resources effectively  Involves collaboration across HIV care and treatment, prevention, and surveillance partners  Created based on guidance provided by CDC  Epi profile/summary should be used to identify key populations in jurisdiction – Create HIV care continuum for each key population – Provide a narrative and graphic description of disparities in care engagement among key populations

17. Reviewing and Interpreting Epidemiologic Data

18. Reviewing and Interpreting Epidemiologic Data to Best Target Resources  Epi Profile and HIV care continuum may be used for – Planning, prioritizing, targeting, and monitoring available resources in response to needs – Improving engagement and outcomes at each stage of the care continuum – Identifying issues and opportunities related to improving the delivery of services to high-risk, uninfected individuals HIV testing Linkage to prevention services, behavioral health, social services

19. Reviewing and Interpreting Epidemiologic Data to Best Target Resources cont.  Most affected communities – Geographic areas or populations with Highest numbers or rates of diagnoses Highest prevalence numbers or rates Increasing numbers or rates of diagnoses over time Lowest percentages of people at various steps along the care continuum (e.g., linkage, retention, ART, viral suppression) High levels of comorbidity – Geographic “hot spots” for recent diagnoses and/or unusual trends – Populations with the highest levels of risk behaviors

20. Ensuring Goals, Strategies, Activities are Responsive to the Data  Assess trends – More data may be needed to explain unexpected trends  Focus on most affected communities  Ensure strategies and activities culturally appropriate  Engage most affected communities to inform decisions and assist with implementation  Engage care providers

21. Example: Jurisdiction A Analyzing Epi Profile and Care Continuum Data Finding: Unusually high rates of new diagnoses among Asians  Further analysis reveals majority of new diagnoses in this population are among males aged 13-24  Care continuum  Additional data show youth are centralized in a specific suburban area and the majority received testing and linkage services by the same entity How can these data be used to target resources?

22. Example: Jurisdiction A Reviewing and Interpreting Data to Target Resources 1.Homogenous group 2.Specific cultural considerations 3.Specific geographic area 4.Same entity conducted testing and linkage 5.Same provider conducting care?

23. Example: Jurisdiction A Ensure Data-Responsive Goals, Strategies, Activities  HIV-positive youth -Culturally appropriate interventions -Care re-engagement activities/Peer navigation -Linkage to core medical and supportive services (e.g., case management, mental health services, substance use treatment, transportation) -Partner services to identify transmission networks -Additional testing for comorbidities (e.g., HCV, STDs) -Education about care and treatment -HIV “prevention with positives” activities -Activities to identify and address barriers to care -Gather qualitative data directly from youth regarding falling out of care, ART non-adherence, etc. -Access to care: density of care providers within a reasonable distance; expertise of care providers; types of services available; etc.

24. Example: Jurisdiction A Ensure Data-Responsive Goals, Strategies, Activities cont.  Community -Culturally appropriate interventions -HIV prevention and education activities -PrEP -Using peers for outreach and testing activities -Partner services -Routine HIV/HCV/STD testing, as indicated -Linkage to essential services, if needed (e.g., mental health, substance use treatment) -Activities to identify and address barriers -Community-level indicators, including the social and political landscapes, poverty, stigma, and other factors that might be pertinent

25. Example: Jurisdiction A Identify Technical Assistance Needs: Testing/Linkage Entity  Assess and address – Gaps in knowledge, skills, abilities of testing and linkage specialists – “Care landscape” Reaching people where they are (linkage specialists, peer navigators) Ability to link clients to culturally appropriate care Density of care providers within a reasonable distance Expertise of community care providers Types of medical and support services available

26. Example: Jurisdiction A Identify Technical Assistance Needs: Care Providers  Assess and address – Gaps in knowledge, skills, abilities – Ability to provide culturally appropriate care – Attitudes toward clients

27. Resources

28.  Integrated Guidance for Developing Epidemiologic Profiles: HIV Prevention and Ryan White HIV/AIDS Programs Planning, July 2014 http://www.cdc.gov/hiv/pdf/guidelines_developing_epidemiologic_profiles.pdf http://www.cdc.gov/hiv/pdf/guidelines_developing_epidemiologic_profiles.pdf – SAS programs for developing the Epi Profiles (contact CDC’s HIV Incidence and Case Surveillance Branch)  Epidemiologic Overview and HIV Care Continuum components of Section One of the Integrated HIV Prevention and Care Plan, including the SCSN Guidance, June 2015 http://hab.hrsa.gov/manageyourgrant/hivpreventionplan062015.pdf http://hab.hrsa.gov/manageyourgrant/hivpreventionplan062015.pdf  Guidance for developing an HIV care continuum (contact CDC’s HIV Incidence and Case Surveillance Branch)  Capacity building assistance (CDC)/Technical assistance (HRSA)

29. Additional Resources  CDC reports http://www.cdc.gov/hiv/library/reports/surveillance/ http://www.cdc.gov/hiv/library/reports/surveillance/ – HIV Surveillance Report: National HIV surveillance data on diagnoses, diagnosed prevalence, deaths, survival – HIV Surveillance Supplemental Report – Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data: National- and state-level data measuring NHAS indicators, including the care continuum – CDC National HIV Prevention Progress Report: Describes progress toward achieving the goals and objectives of NHAS and the DHAP Strategic Plan – State HIV Prevention Progress Report: Provides state- level data that show how states are doing in relation to key national HIV prevention and care goals

30. Additional Resources cont.  HRSA report http://hab.hrsa.gov/data/servicesdelivered.html – Ryan White HIV/AIDS Program Annual Client-Level Data Report: National- and state-level data on all clients served by the Ryan White HIV/AIDS Program, including select indicators of the care continuum  Ryan White HIV/AIDS Program resources for delivery of HIV care http://hab.hrsa.gov/deliverhivaidscare/index.html http://hab.hrsa.gov/deliverhivaidscare/index.html  AIDS Education and Training Centers (AETC): Multidisciplinary education and training programs for health care providers treating PLWH http://hab.hrsa.gov/abouthab/partfeducation.html http://hab.hrsa.gov/abouthab/partfeducation.html – AETC National Resource Center http://aidsetc.org/ http://aidsetc.org/

31. Additional Resources cont.  TARGET Center: Technical Assistance resources for programs to better serve people living with HIV https://careacttarget.org/ https://careacttarget.org/

32. Questions! Anna Satcher Johnson ats5@cdc.gov 404-639-2050 Stacy Cohen sgagne@hrsa.gov 301-443-5400 For more information, contact HRSA 5600 Fishers Lane, Rockville, MD 20857 Telephone: 301-443-1993 Web: http://hab.hrsa.gov The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official positions of the Centers for Disease Control and Prevention or the Health Resources and Services Administration. For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 Web: www.cdc.gov/hiv