1. Integrated HIV Prevention and Care Planning Groups and Activities July 30, 2013
Andrea Jackson, MPH
U.S. Department of Health and Human Services (HHS)
Health Resources and Services Administration (HRSA)
HIV/AIDS Bureau (HAB)
Division of Metropolitan HIV/AIDS Programs (DMHAP)

2. What Is Integrated Planning?
Integrated planning is the sharing, merging or integration of a State’s HIV/AIDS Prevention (CDC-sponsored) and Care (Ryan White–sponsored) planning groups
This may be accomplished through collaboration on joint projects, sharing planning products, sharing members, or totally integrating into one planning body

3. Why Integrated Planning?
To develop a coordinated Statewide response to HIV/AIDS
To avoid duplication of processes
Many points of intersection and shared knowledge, data and processes (ex. epidemiological profile, by-laws, nominations, community involvement)
More economical (sharing resources)
May have some of the same people on both groups already
Increased collaboration and communication

4. Why Integrated Planning?
HIV testing and referral to care is often funded by both prevention and care dollars
Fosters integration of prevention into care services
Community viral load as a recognized form of prevention, requires good care coordination
Partner services is also important to both prevention and care

5. Why Integrated Planning?
Key National Policy Shifts:
The White House’s National HIV/AIDS Strategy (2010)
CDC’s High-Impact HIV Prevention (HIHP) (2011)
CDC’s Advancing HIV Prevention (AHP) Initiative (2003)
CDC/HRSA Advisory Committee on HIV, Viral Hepatitis and STD Prevention and Treatment (2002)
OMB’s increasing emphasis on streamlining CDC and HRSA requests for information from programs
Improve efficiency and effectiveness of federal programs

6. Why Should Care And Treatment Planners Pay Attention To Prevention?
New strategies for HIV prevention impact care settings
PrEP
Treatment = Prevention
Strategies to encourage knowledge of sero-status
To facilitate linkages
Maximize service provider capacity

7. Why Should Prevention Planners Pay Attention To Care And Treatment?
CDC’s AHP and HIHP expand counseling, testing and referral (CTR) and partner counseling and referral services (PCRS)
Strategies to provide prevention for HIV positive individuals
Provide behavioral interventions in clinical care
To facilitate linkages
Maximize service provider capacity

8. Common Goals of Prevention and Care
To ensure that individuals learn their HIV status
To ensure that HIV positive individuals are linked to medical care, supportive services, and prevention services that meet their unique needs
To ensure that HIV negative individuals are linked to prevention and other services

9. Common Goals of Prevention and Care
Plans are comprehensive and promote coordination and linkages of services
Ensure planning reflects the diversity local epidemic
Assure meaningful involvement of PLWH in planning processes
Assess effectiveness of plans and processes

10. Partnerships and Collaboration
HRSA expects collaboration, partnering, and coordination in planning and implementation of services between multiple sources of treatment, care and prevention service providers
HIV testing sites
Non-Ryan White Program providers
All Ryan White Program Parts (A, B, C, D, and F)
Medicaid and Medicare VA

11. Possible Barriers To Integration
Competing agendas (turf issues, mistrust)
Over-dominance by either care or prevention
More meetings for members who had only been on one group prior
Categorical funding/requirements from CDC and HRSA
Transition phase requires initial influx of resources to increase knowledge about care and prevention

12. Benefits of Integrated Planning
Allows development of common mission/vision
Encourages sharing of knowledge and data
Combines/maximizes limited resources
Reduces planning costs in the long term
Creates comprehensive services/encourages linkage of services
Fosters integration of prevention into care services and vice versa

13. Operationalizing Collaboration
Develop operating principles (vision, mission) and by- laws
Specify member recruitment and orientation
Examine required products of planning
Consider multiple opportunities/strategies for community/consumer input into planning
Obtain training, skills-building and TA (ex: cross-training prevention/care staff)

14. Operationalizing Collaboration (cont.)
Address fears and provide information
Set clear goals and objectives for collaborative planning
Develop an implementation plan
Give the process time
Leadership selection that is representative and neutral

15. Models for Collaborative Planning
Information Sharing
Cross Representation on Prevention and Care Planning Bodies
Coordinated/ Combined Projects or Meetings
Merged Bodies
Needs Assessment Activities

16. HIV/AIDS Planning Models
As known to NASTAD as of December 2012

17. HRSA’s HIV/AIDS Bureau (HAB)- Ryan White Part A
“Crosswalk” of CDC & HRSA Planning Requirements & Expectations (snapshot)
CDC- HIV Prevention
HRSA’s HIV/AIDS Bureau (HAB)- Ryan White Part A
Planning Body
HIV Planning Group (HGP) - state, regional, or local
Planning Council
Planning Body - Primary Function
To inform the development or update of the health department’s Jurisdictional HIV Prevention Plan that will contribute to the reduction of HIV infection in the jurisdiction
To carry out planning and determine the allocation of Ryan White Part A funds within the EMA or TGA to provide a continuum of care that meets the most critical service needs of eligible people living with HIV/AIDS, including traditionally underserved populations, to get people linked to and retained in care and achieve positive health outcomes
Planning Body Membership - Nomination and Selection Process
Nomination through an open process
All members required to go through a clearly defined open nominations process
Planning Body - Membership Composition
Jointly, HPG and Health Department develop and apply criteria for selecting HPG members, placing special emphasis on identifying representatives of at-risk, affected, HIV-positive, and socioeconomically marginalized populations
Legislation specifies membership categories and requirements; CEO further determines membership size and composition when establishing the Planning Council and may review proposed changes in Bylaws
Created by EGMC for the TAC

18. Los Angeles, CA Integrated Planning
Commission (serves as the RWPA Planning Council) and Prevention Planning Committee (PPC) had several shared members and a joint committee
Commission had far more funding, a larger staff, and responsibility for determining the use of millions of federal, state, and county funds
PPC members were concerned that if the two groups merged, the Prevention planning function could receive less focus than the HIV care-focused work of the Commission

19. Los Angeles Integrated Planning
Integration Task Force was established in It included representatives of both planning bodies and had two Co-Chairs from each group. TF jointly developed RWPA Comprehensive Plan
The joint body voted unanimously (in March) to create a new, unified planning body and approved its functions, structure, and membership composition
First, there had to be agreement on the roles and functions of the new planning body, then a determination of membership and structure

20. Los Angeles - Lessons Learned
Preparing a joint comprehensive plan provides a good foundation for eventual integration into a single body
Taking time to develop shared knowledge and trust is extremely important
Establishing and maintaining a sense of parity enables both bodies to accept compromises
Merging the two bodies seems highly desirable once everyone recognizes the increasing overlap in the roles of prevention and care

21. References
CDC/HRSA Letter Supporting Integrated Planning Models, In progress
Dear Colleague Letter, Mermin and Cheever, May 22, 2013
NASTAD HIV/AIDS Planning Models (as of 12/2012), B. Pund, April 19, 2013
Toolkit: Integrated, Collaborative or Merged Prevention and Care Planning Processes, NASTAD, May 2007
Trends in Collaborative Care and Prevention Planning PowerPoint Presentation, NASTAD, C. Jorstad, June 5, 2006
“Crosswalk of CDC & HRSA Planning Requirements and Expectations” EGMC for the TAC
“Developing a Unified HIV Prevention and Care Planning Body: Lessons from the Los Angeles EMA” Prepared for: Division of Metropolitan HIV/AIDS Programs HIV/AIDS Bureau Prepared by: Emily Gantz McKay EGM Consulting, LLC

22. Questions?
Andrea Jackson, MPH Public Health Analyst (301) hab.hrsa.gov